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Chen A, Mocumbi AO, Ojji DB, Waite L, Chan YK, Beilby J, Celermajer DS, Nkeh-Chungag BN, Damasceno A, Codde J, Stewart S. Projected burden and distribution of elevated blood pressure levels and its consequence among adolescents in sub-Saharan Africa. J Glob Health 2024; 14:04136. [PMID: 38940275 PMCID: PMC11212112 DOI: 10.7189/jogh.14.04136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background There is minimal data on the number of adolescents in sub-Saharan Africa (SSA) with elevated blood pressure (BP) at increased risk of future cardiovascular events. Combining country-specific population data with data derived from two previously conducted meta-analyses (one African-specific, one based on international cohorts), we sought to address this knowledge deficit. Methods We used meta-analysis data from 37 926 adolescents participating in 36 contemporary SSA studies to generate sex-specific proportions of adolescents aged 10-14 and 15-19 years with elevated BP. The estimates were applied to the 2021 World Bank population data for each country in SSA. We then applied the rate of cardiovascular events attributable to elevated BP levels, derived from a meta-analysis of 17 observational, longitudinal cohort studies comprising 4.5 million young adults (non-African), to determine the excess number of cardiovascular events linked to hypertension among those aged 15-19 years transitioning to adulthood. Results The estimated prevalence of elevated BP among male and female adolescents aged 10-14 years living in SSA was 7.2% (95% confidence interval (CI) = 4.9-9.9) and 6.9% (95% CI = 4.7-9.5), respectively, which increased to 13.0% (95% CI = 10.6-15.6) and 12.5% (95% CI = 10.4-15.3) among male and female adolescents aged 15-19 years, respectively. Consequently, we estimate that 13.6/138.0 million (95% CI = 10.4-17.3) male and 12.9/135.7 million (95% CI = 9.83-16.3) female adolescents living in SSA have elevated BP. Among the estimated 16.1 million adolescents aged 15-19 years with elevated BP approaching adulthood, the projected excess in cardiovascular events attributable to hypertension (vs normotension) is 201 000 (95% CI = 115 000-322 000) to 503 000 (95% CI = 286 000-805 000) over the next 10-25 years. Conclusions Based on the best available data, we estimate that 26.5 million adolescents living in SSA have elevated BP. If left undetected and untreated among those approaching adulthood (those aged 15-19 years), they will experience >0.5 million excess cardiovascular events associated with persistently elevated BP within the next 25 years. Registration PROSPERO: CRD42022297948.
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Affiliation(s)
- Alexander Chen
- Torrens University Australia, Adelaide, South Australia, Australia
| | - Ana O Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Dike B Ojji
- University of Abuja, Abuja, Nigeria
- University of Cape Town, Cape Town, South Africa
| | - Laura Waite
- South Eastern Melbourne Primary Health Network Australia, Victorian Department of Health, Melbourne, Victoria, Australia
| | - Yih-Kai Chan
- Australian Catholic University, Melbourne, Victoria, Australia
| | - Justin Beilby
- Torrens University Australia, Adelaide, South Australia, Australia
| | | | | | - Albertino Damasceno
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Jim Codde
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Simon Stewart
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Marracuene, Mozambique
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Burhanuddin K, Mohammed A, Badhan RKS. The Impact of Paediatric Obesity on Drug Pharmacokinetics: A Virtual Clinical Trials Case Study with Amlodipine. Pharmaceutics 2024; 16:489. [PMID: 38675150 PMCID: PMC11053426 DOI: 10.3390/pharmaceutics16040489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
The incidence of paediatric obesity continues to rise worldwide and contributes to a range of diseases including cardiovascular disease. Obesity in children has been shown to impact upon the plasma concentrations of various compounds, including amlodipine. Nonetheless, information on the influence of obesity on amlodipine pharmacokinetics and the need for dose adjustment has not been studied previously. This study applied the physiologically based pharmacokinetic modelling and established a paediatric obesity population to assess the impact of obesity on amlodipine pharmacokinetics in children and explore the possible dose adjustments required to reach the same plasma concentration as non-obese paediatrics. The difference in predicted maximum concentration (Cmax) and area under the curve (AUC) were significant between children with and without obesity across the age group 2 to 18 years old when a fixed-dose regimen was used. On the contrary, a weight-based dose regimen showed no difference in Cmax between obese and non-obese from 2 to 9 years old. Thus, when a fixed-dose regimen is to be administered, a 1.25- to 1.5-fold increase in dose is required in obese children to achieve the same Cmax concentration as non-obese children, specifically for children aged 5 years and above.
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Affiliation(s)
| | | | - Raj K. S. Badhan
- School of Pharmacy, College of Health and Life Science, Aston University, Birmingham B4 7ET, UK; (K.B.); (A.M.)
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3
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Shapiro WL, Kunani P, Sidell MA, Li X, Anderson SR, Slezak JM, Koebnick C, Schwimmer JB. Prevalence of Adolescents Meeting Criteria for Metabolic and Bariatric Surgery. Pediatrics 2024; 153:e2023063916. [PMID: 38410833 DOI: 10.1542/peds.2023-063916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The American Academy of Pediatrics endorses metabolic and bariatric surgery (MBS) as a safe and effective treatment of severe obesity in children with class 3 obesity or with class 2 obesity and qualifying comorbidities. The study objective was to determine eligibility and characteristics of adolescents who qualify for MBS based on American Academy of Pediatrics guidelines. METHODS This retrospective cohort study analyzed electronic health record data of 603 051 adolescents aged 13 to 17 years between January 1, 2018, and December 31, 2021. Centers for Disease Control and Prevention criteria were used to define obesity classes 2 and 3. Multivariable logistic regression was used to evaluate the factors associated with meeting MBS eligibility criteria. RESULTS Of the 603 041 adolescents evaluated, 22.2% had obesity (12.9% class 1, 5.4% class 2, and 3.9% class 3). The most frequently diagnosed comorbid conditions were gastroesophageal reflux disease (3.2%), hypertension (0.5%), and nonalcoholic fatty liver disease (0.5%). Among adolescents with class 2 obesity, 9.1% had 1 or more comorbidities qualifying for MBS, and 4.4% of all adolescents met the eligibility criteria for MBS. In multivariable modeling, males, Black and Hispanic adolescents, and those living in more deprived neighborhoods were more likely to meet MBS eligibility criteria. CONCLUSIONS Overall, 1 in 23 adolescents met the eligibility criteria for MBS. Demographic and social determinants were associated with a higher risk for meeting these criteria. The study suggests that the health care system may face challenges in accommodating the demand for MBS among eligible adolescents.
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Affiliation(s)
- Warren L Shapiro
- Department of Pediatrics, Southern California Permanente Medical Group, San Diego, California
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California, San Diego School of Medicine, San Diego, California
- Department of Gastroenterology, Rady Children's Hospital, San Diego, California
| | - Poornima Kunani
- Department of Pediatrics, Kaiser Permanente South Bay Medical Center, Southern California Permanente Medical Group, Manhattan Beach, California
| | - Margo A Sidell
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Xia Li
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Sabina R Anderson
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California, San Diego School of Medicine, San Diego, California
- Amherst College, Amherst, Massachusetts
| | - Jeffrey M Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Corinna Koebnick
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Jeffrey B Schwimmer
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California, San Diego School of Medicine, San Diego, California
- Department of Gastroenterology, Rady Children's Hospital, San Diego, California
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4
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Weidemann DK, Orr CJ, Norwood V, Brophy P, Leonard MB, Ashoor I. Child Health Needs and the Pediatric Nephrology Subspecialty Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678P. [PMID: 38300004 DOI: 10.1542/peds.2023-063678p] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric nephrology is dedicated to caring for children with kidney disease, a unique blend of acute care and chronic longitudinal patient relationships. Though historically a small field, trainee interest has declined over the past 2 decades. This has led to growing alarm about the health of the pediatric nephrology workforce, although concerns have been hampered by a lack of available data to enable feasible projections. This article is part of a supplement that anticipates the future pediatric subspecialty workforce supply. It draws on existing literature, data from the American Board of Pediatrics, and findings from a model that estimates the future supply of pediatric subspecialists developed by the Carolina Health Workforce Research Center at the University of North Carolina Chapel Hill's Cecil G. Sheps Center for Health Services Research and Strategic Modeling Analytics & Planning Ltd. The workforce projections from 2020 to 2040 incorporate population growth, clinical effort, and geographic trends and model alternate scenarios adjusting for changes in trainee interest, clinical efforts, and workforce attrition. The baseline model predicts growth of clinical work equivalents by 26% by 2040, but further widening geographic disparities worsen the existing mismatch between supply, clinical need, and market demand. The worst-case scenario projects 13% growth by 2040 which, at best, maintains the status quo of an already strained workforce. The models do not account for many factors expected to heighten demand over the coming decades. Urgent reforms are necessary now. Proposed solutions require multipronged changes in education and training pathways, remuneration, clinical practice models, and government policy.
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Affiliation(s)
- Darcy K Weidemann
- Division of Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
- School of Medicine, University of Missouri, Kansas City, Kansas City, Missouri
| | - Colin J Orr
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Victoria Norwood
- Division of Nephrology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Patrick Brophy
- Division of Nephrology, Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
| | - Mary B Leonard
- Division of Nephrology, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Isa Ashoor
- Boston Children's Hospital, Department of Pediatrics, Boston, Massachusetts
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5
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Leung AKC, Wong AHC, Hon KL. Childhood Obesity: An Updated Review. Curr Pediatr Rev 2024; 20:2-26. [PMID: 35927921 DOI: 10.2174/1573396318666220801093225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/05/2022] [Accepted: 05/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Childhood obesity is an important and serious public health problem worldwide. OBJECTIVE This article aims to familiarize physicians with the evaluation, management, and prevention of childhood. METHODS A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article. RESULTS Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition. CONCLUSION Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, China
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6
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Zhong Y, Zhang Z, Hu Y. The combined effects of overweight/obesity and dietary antioxidant quality score on hypertension in children and adolescents. BMC Pediatr 2023; 23:584. [PMID: 37990172 PMCID: PMC10664687 DOI: 10.1186/s12887-023-04397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/29/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND This study was to evaluate the combined effects of overweight/obesity and DAQS on the risk of hypertension in children and adolescents. METHODS In this cross-sectional study, the data of 14,316 subjects were extracted from the National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression analysis was used to explore the associations of obesity and DAQS with the risk of hypertension. The combined effect of overweight/obesity and DAQS on the risk of hypertension was evaluated. RESULTS Body mass index (BMI)-for-age < 85th percentile was associated with reduced risk of hypertension in children and adolescents [odds ratio (OR) = 0.48, 95% confidence interval (CI): 0.41-0.62]. No significant association between DAQS ≥ 3 and the risk of hypertension before and after the adjustment of confounders (P > 0.05). Subjects with BMI-for-age of < 85th percentile and DAQS < 3 was associated with decreased risk of hypertension (OR = 0.53, 95%CI: 0.35-0.79). People with BMI-for-age of < 85th percentile and DAQS ≥ 3 was correlated with decreased risk of hypertension (OR = 0.52, 95%CI: 0.36-0.74). Subgroup analysis revealed that in subjects aged ≥ 12 years, decreased risk of hypertension was observed in BMI-for-age < 85th percentile and DAQS < 3 group (OR = 0.48, 95%CI: 0.31-0.73) as well as BMI-for-age < 85th percentile and DAQS ≥ 3 group (OR = 0.47, 95%CI: 0.32-0.67). In boys, BMI-for-age < 85th percentile and DAQS < 3 group (OR = 0.45, 95%CI: 0.25-0.81) as well as BMI-for-age < 85th percentile and DAQS ≥ 3 group (OR = 0.40, 95%CI: 0.25-0.65) were correlated with decreased risk of hypertension. CONCLUSION Overweight/obesity and DAQS had combined effects on the risk of hypertension in children and adolescents, which implied that for children and adolescents with normal weight, to keep normal weight combined with high quality of diet might be recommended.
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Affiliation(s)
- Ying Zhong
- Department of Children's Health Care, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210036, China
| | - Zhiqun Zhang
- Department of Neonatology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, 310000, China
| | - Youfang Hu
- Department of Children's Health Care, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210036, China.
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Dragoumani K, Troumbis A, Bacopoulou F, Chrousos G. Childhood and Adolescent Obesity with Somatic Indicators of Stress, Inflammation, and Dysmetabolism before and after Intervention: A Meta-Analysis. J Pers Med 2023; 13:1322. [PMID: 37763090 PMCID: PMC10532912 DOI: 10.3390/jpm13091322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
There have been numerous attempts to establish a correlation between obesity and stress, inflammatory, and dysmetabolism biomarkers in children and adolescents. Here, we performed a meta-analysis of existing studies to shed light on the elusive correlations of childhood and adolescent obesity with physiological indicators of stress, inflammation, and metabolism before and after lifestyle interventions. Observational studies, meta-analyses, narrative and systematic reviews were excluded. From a total of 53 articles, 11 were selected according to specific criteria. The biomarkers examined were circulating glucose, insulin, HDL, LDL, triglycerides, adiponectin, leptin, CRP, TNF-alpha, interleukin (IL)-6, systolic and diastolic blood pressure, and HOMA-IR. All analyses were performed using IBM SPSS Statistics Version 28.0.1.0 (142). The current meta-analysis provides evidence of a beneficial effect of a lifestyle intervention and/or drugs in children and adolescents living with obesity or overweight, consistent with a significant reduction in body fat-but not in BMI or waist circumference-an increase in circulating adiponectin and/or a reduction in serum insulin levels and diastolic blood pressure, and a trend towards a reduction of circulating leptin and glucose levels, as well as of the HOMA-IR. This meta-analysis indicates that lifestyle interventions could reduce overweight-/obesity-associated systemic inflammation and dysmetabolism even without an apparent decrease in BMI.
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Affiliation(s)
- Konstantina Dragoumani
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece
| | - Andreas Troumbis
- Department of Environmental Studies, University of the Aegean, 81100 Mytilene, Greece
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, Aghia Sophia Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, Aghia Sophia Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Donald BJ, King TD, Phillips BL, Jones K, Barham A, Watson J, Batson J. Physician-Pharmacist Collaborative Drug Therapy Management in Pediatric Hypertension. J Pediatr Pharmacol Ther 2023; 28:204-211. [PMID: 37303761 PMCID: PMC10249969 DOI: 10.5863/1551-6776-28.3.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/31/2022] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Pediatric hypertension affects 2% to 5% of children and adolescents in the United States and is frequently undertreated. The increasing prevalence of pediatric hypertension and worsening physician shortage create difficulties in closing this treatment gap. Physician-pharmacist collaborations have been shown to improve patient outcomes in adult patients. Our aim was to demonstrate a similar benefit for pediatric hypertension. METHODS Pediatric patients whose hypertension was managed at a single pediatric cardiology clinic from January 2020 to December 2021 were enrolled in collaborative drug therapy management (CDTM). Patients whose hypertension was managed in the same clinic from January 2018 to December 2019 were used as a comparison group. The primary outcomes were achievement of at-goal blood pressure at 3, 6, and 12 months and time to control of hypertension. Secondary outcomes were appointment adherence and serious adverse events. RESULTS A total of 151 patients were included in the CDTM group, and 115 patients were included in the traditional care group. Of those, 100 CDTM patients and 78 traditional care patients were assessed for the primary outcome. Fifty-four (54%) CDTM patients and 28 (36%) traditional care patients achieved at-goal blood pressure at 12 months (OR, 2.09; 95% CI, 1.14-3.85). Appointment non-adherence was 9.4% for CDTM and 16% for traditional care (OR, 0.54; 95% CI, 0.35-0.82). Adverse events were similar between groups. CONCLUSIONS CDTM increased rates of at-goal blood pressure without increased adverse events. Physician-pharmacist collaboration may improve treatment of hypertension in pediatric patients.
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Affiliation(s)
- Bryan J. Donald
- School of Clinical Sciences (BJD), University of Louisiana Monroe College of Pharmacy, Monroe, LA
| | - Terry D. King
- Department of Pediatrics (TDK, BLP, KJ, AB, JW, JB), Ochsner Health, West Monroe, LA
| | - Brandon L. Phillips
- Department of Pediatrics (TDK, BLP, KJ, AB, JW, JB), Ochsner Health, West Monroe, LA
| | - Krista Jones
- Department of Pediatrics (TDK, BLP, KJ, AB, JW, JB), Ochsner Health, West Monroe, LA
| | - Anna Barham
- Department of Pediatrics (TDK, BLP, KJ, AB, JW, JB), Ochsner Health, West Monroe, LA
| | - Jennifer Watson
- Department of Pediatrics (TDK, BLP, KJ, AB, JW, JB), Ochsner Health, West Monroe, LA
| | - Jerry Batson
- Department of Pediatrics (TDK, BLP, KJ, AB, JW, JB), Ochsner Health, West Monroe, LA
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Dart A, Singer A, Chanchlani R, Ferguson T, Tangri N, Zappitelli M. Evaluation of administrative case definitions for hypertension in Canadian children. Sci Rep 2023; 13:7654. [PMID: 37169770 PMCID: PMC10175274 DOI: 10.1038/s41598-023-33401-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/12/2023] [Indexed: 05/13/2023] Open
Abstract
Hypertension is increasing in children and warrants disease surveillance. We therefore sought to evaluate the validity of case definitions to identify pediatric hypertension in administrative healthcare data. Cases of hypertension in children 3-18 years of age were identified utilizing blood pressures recorded in the Manitoba Primary Care Research Network (MaPCReN) electronic medical record from 2014 to 2016. Prevalence of hypertension and associated clinical characteristics were determined. We then evaluated the validity of 18 case definitions combining outpatient physician visits (ICD9CM codes), hospital claims (ICD9CM/ICD10 codes) and antihypertensive use within 1-3 years of data housed at the Manitoba Centre for Health Policy. The MaPCReN database identified 241 children with hypertension and 4090 without (prevalence = 5.6%). The sensitivity of algorithms ranged between 0.18 and 0.51 and the specificity between 0.98 and 1.00. Pharmaceutical use increased the sensitivity of algorithms significantly. The algorithms with the highest sensitivity and area under the ROC curve were 1 or more hospitalization OR 1 or more physician claim OR 1 or more pharmaceutical record. Evaluating 2 years of data is recommended. Administrative data alone reflects diagnosis of hypertension with high specificity, but underestimate the true prevalence of this disease. Alternative data sources are therefore required for disease surveillance.
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Affiliation(s)
- Allison Dart
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Diabetes Research Envisioned and Accomplished in Manitoba, University of Manitoba, FE-009 820 Sherbrook St., Winnipeg, MB, R3A1R9, Canada.
| | - Alexander Singer
- Division of Family Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Thomas Ferguson
- Max Rady College of Medicine, Department of Internal Medicine, Chronic Disease Innovation Centre, University of Manitoba, Winnipeg, Canada
| | - Navdeep Tangri
- Max Rady College of Medicine, Department of Internal Medicine, Chronic Disease Innovation Centre, University of Manitoba, Winnipeg, Canada
| | - Michael Zappitelli
- Division of Nephrology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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10
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Welser L, Pfeiffer KA, Silveira JFDC, Valim ARDM, Renner JDP, Reuter CP. Incidence of Arterial Hypertension is Associated with Adiposity in Children and Adolescents. Arq Bras Cardiol 2023; 120:e20220070. [PMID: 36888776 DOI: 10.36660/abc.20220070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/05/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The increase of hypertension in children and adolescents has attracted the attention of the scientific community largely due to its association with the obesity epidemic. OBJECTIVES To describe the incidence of hypertension and its relationship with the cardiometabolic and genetic profile in children and adolescents from a city in southern Brazil in a three-year period. METHODS This longitudinal study followed 469 children and adolescents, aged 7-17 years old (43.1% boys), assessed at two-time points. We evaluated systolic and diastolic blood pressures (SBP and DBP), waist circumference (WC), body mass index (BMI), body fat percentage (%BF), lipid profile, glucose, cardiorespiratory fitness (CRF), and rs9939609 Polymorphism ( FTO ). Cumulative incidence of hypertension was calculated, and multinomial logistic regression was conducted. The statistical significance was established as p < 0.05. RESULTS After three years, the incidence of hypertension was 11.5%. Overweight or obese individuals were more likely to become borderline hypertensive (overweight OR: 3.22, 95% CI: 1.08-9.55; obesity OR: 4.05, 95% CI: 1.68-9.75), and obese individuals were more likely to become hypertensive (obesity OR: 4.84, 95% CI: 1.57-14.95). High-risk WC and %BF values were associated with hypertension development (OR: 3.41, 95% CI: 1.26-9.19; OR: 2.49, 95% CI: 1.08-5.75, respectively). CONCLUSIONS We found a higher incidence of hypertension in children and adolescents as compared with previous studies. Individuals with higher values of BMI, WC and %BF at baseline were more likely to develop hypertension, suggesting the importance of adiposity in the development of hypertension even in such a young population.
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Affiliation(s)
- Letícia Welser
- Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS - Brasil
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11
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Kos M, Nađ T, Stanojević L, Lukić M, Stupin A, Drenjančević I, Pušeljić S, Davidović Cvetko E, Mihaljević Z, Dumančić D, Jukić I. Estimation of Salt Intake in Normotensive and Hypertensive Children: The Role of Body Weight. Nutrients 2023; 15:nu15030736. [PMID: 36771442 PMCID: PMC9921955 DOI: 10.3390/nu15030736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The connection between increased dietary salt intake and arterial hypertension has been recognized for a long time, even in children. This study aimed to investigate salt consumption in normotensive and hypertensive children and evaluate their dietary habits. MATERIALS AND METHODS A total of fifty participants were included in this cross-sectional study: twenty-five normotensive children and 25 children of both sexes with essential arterial hypertension from 12-17 years old. Subjects' body mass index, waist-to-hip ratio, body composition and arterial blood pressure were measured, and their daily salt intake was calculated from 24-h urine samples. Using the food frequency questionnaire (FFQ), the data on the average daily total energy and food intakes were collected and analyzed using a suitable program. RESULTS Estimated daily salt intake was significantly higher in hypertensive compared to normotensive children, and this is positively associated with blood pressure and body mass index (BMI). Hypertensive children had significantly higher BMIs, which also positively correlated with blood pressure. Consistently, resting metabolic rate (kcal) is higher in hypertensive children compared to normotensive, and this is also associated with blood pressure. Reported energy intake is also enlarged in hypertensive compared to normotensive children and for both groups, levels are significantly higher than the recommended values. CONCLUSIONS Our study results confirm the relationship between daily salt consumption, blood pressure and body weight. Sodium consumption related to blood pressure and body weight among children. Cardiovascular disease prevention should start in early childhood by reducing salt intake and preventing overweight/obesity since these are two of the most important modifiable risk factors for hypertension.
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Affiliation(s)
- Martina Kos
- Clinic of Pediatrics, University Hospital Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Department of Pediatrics, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Tihana Nađ
- Clinic of Pediatrics, University Hospital Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Department of Pediatrics, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Lorena Stanojević
- Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Matea Lukić
- Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Ana Stupin
- Institute and Department of Physiology and Immunology, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Scientific Centre of Excellence for Personalized Health Care, University of Osijek, Trg Sv. Trojstva 3, HR-31000 Osijek, Croatia
| | - Ines Drenjančević
- Institute and Department of Physiology and Immunology, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Scientific Centre of Excellence for Personalized Health Care, University of Osijek, Trg Sv. Trojstva 3, HR-31000 Osijek, Croatia
| | - Silvija Pušeljić
- Clinic of Pediatrics, University Hospital Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Department of Pediatrics, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Erna Davidović Cvetko
- Lavoslav Ružička College of Applied Sciences of Vukovar, Županijska 50, HR-32000 Vukovar, Croatia
| | - Zrinka Mihaljević
- Institute and Department of Physiology and Immunology, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Scientific Centre of Excellence for Personalized Health Care, University of Osijek, Trg Sv. Trojstva 3, HR-31000 Osijek, Croatia
| | - Dijana Dumančić
- Department of Diagnostic and Interventional Radiology, University Hospital Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Department of Radiology, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Ivana Jukić
- Institute and Department of Physiology and Immunology, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Scientific Centre of Excellence for Personalized Health Care, University of Osijek, Trg Sv. Trojstva 3, HR-31000 Osijek, Croatia
- Correspondence: ; Tel.: +385-31512869
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12
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Gunaratne N, Deplewski D. Metabolic Consequences of Pediatric Obesity: A Review of Pathophysiology, Screening, and Treatment. Pediatr Ann 2023; 52:e62-e67. [PMID: 36779885 DOI: 10.3928/19382359-20230102-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The prevalence of pediatric obesity has been increasing during the last 30 years, and the subsequent metabolic consequences of obesity, which were mainly seen in adults, are now presenting in childhood. Type 2 diabetes, prediabetes, metabolic syndrome, and nonalcoholic fatty liver disease are serious metabolic ramifications of pediatric obesity; pediatricians need to be familiar in screening and treatment of these metabolic issues. This review will discuss the inflammation and insulin resistance involved in obesity that can lead to these conditions. We will explore the pathophysiology of type 2 diabetes and prediabetes, metabolic syndrome, and nonalcoholic fatty liver disease and review screening and treatment modalities. Finally, we will highlight other important endocrine related comorbidities in pediatric obesity, including polycystic ovary syndrome, precocious puberty, and early accelerated growth. [Pediatr Ann. 2023;52(2):e62-e67.].
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13
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Association of Overweight and Obesity With Bell Palsy in Children. Pediatr Neurol 2023; 139:43-48. [PMID: 36508882 DOI: 10.1016/j.pediatrneurol.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/14/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the Division of Pediatric Neurology at the University Medical Center Göttingen we observed that many patients with Bell palsy are overweight or obese. To evaluate whether overweight and obesity are associated with increased risk of Bell palsy in children we conducted this single-centered retrospective study by performing a database search for International Classification of Diseases (ICD)-10 primary and secondary diagnosis of G51.0 (facial nerve palsy) between January 1, 2010, and December 31, 2020. METHODS For risk assessment, patients' body mass indices (BMIs) were compared with BMI data of controls from a nationwide child health survey. RESULTS In total, 202 patients with peripheral facial nerve palsies (pFPs) were included, of which nearly half were classified as Bell palsies; 38% and 24% of the patients with Bell palsy and pFP had a BMI above the 90th percentile, respectively. High BMI was associated with statistically increased odds of Bell palsy in the group of overweight and obese patients (BMI >90th percentile; odds ratio [OR], 2.42; 95% confidence interval [CI], 1.6 to 3.8; P < 0.001) and solely obese patients (BMI >97th percentile; OR, 2.43; 95% CI, 1.4 to 4.3; P = 0.003). CONCLUSIONS We could confirm our observation that overweight and obesity are associated with increased risk of Bell palsy in children.
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14
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Park SJ, Shin JI. Diagnosis and Treatment of Monogenic Hypertension in Children. Yonsei Med J 2023; 64:77-86. [PMID: 36719014 PMCID: PMC9892546 DOI: 10.3349/ymj.2022.0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/08/2022] [Accepted: 12/26/2022] [Indexed: 01/17/2023] Open
Abstract
Although the majority of individuals with hypertension (HTN) have primary and polygenic HTN, monogenic HTN is a secondary type that is widely thought to play a key role in pediatric HTN, which has the characteristics of early onset, refractory HTN with a positive family history, and electrolyte disorders. Monogenic HTN results from single genetic mutations that contribute to the dysregulation of blood pressure (BP) in the kidneys and adrenal glands. It is pathophysiologically associated with increased sodium reabsorption in the distal tubule, intravascular volume expansion, and HTN, as well as low renin and varying aldosterone levels. Simultaneously increased or decreased potassium levels also provide clues for the diagnosis of monogenic HTN. Discovering the genetic factors that cause an increase in BP has been shown to be related to the choice of and responses to antihypertensive medications. Therefore, early and precise diagnosis with genetic sequencing and effective treatment with accurate antihypertensive agents are critical in the management of monogenic HTN. In addition, understanding the genetic architecture of BP, causative molecular pathways perturbing BP regulation, and pharmacogenomics can help with the selection of precision and personalized medicine, as well as improve morbidity and mortality in adulthood.
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Affiliation(s)
- Se Jin Park
- Department of Pediatrics, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Jae Il Shin
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
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15
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Hsieh HS, Chuang HH, Hsin LJ, Lin WN, Kang CJ, Zhuo MY, Chuang LP, Huang YS, Li HY, Fang TJ, Lee LA. Effect of Preoperative Weight Status and Disease Presentation on Postoperative Elevated Blood Pressure After Childhood Adenotonsillectomy. Otolaryngol Head Neck Surg 2023; 168:1197-1208. [PMID: 36939432 DOI: 10.1002/ohn.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/24/2022] [Accepted: 10/22/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To investigate the risk factors of postoperative elevated blood pressure (BP) in children with childhood obstructive sleep apnea syndrome (OSAS) after adenotonsillectomy (AT). STUDY DESIGN Case series with planned data collection. SETTING Tertiary referral center. METHODS Two hundred forty-five consecutive children (180 boys and 65 girls, median age 6.6 years) with polysomnography-diagnosed OSAS who underwent AT between January 2010 and August 2019. Clinical, polysomnographic, and evening BP data were assessed preoperatively and postoperatively (≥3 months after AT). Changes in the variables before and after AT and between individuals with and without hypertension were compared. RESULTS Postoperatively, the median (interquartile range) apnea-hypopnea index significantly decreased from 10.4 (5.3-22.6) to 2.2 (1.0-3.8) events/h. In addition, the mean (standard deviation) evening diastolic BP z-score significantly decreased from 0.7 (0.94) to 0.5 (0.81) in the overall cohort, and both systolic (2.1 [0.94]-1.0 [1.31]) and diastolic BP z-scores (1.6 [0.98]-0.7 [0.85]) significantly decreased in the preoperative elevated BP subgroup. Multivariate logistic regression analysis showed that preoperative obesity (adjusted odds ratio = 4.36, 95% confidence interval = 2.24-8.49) and mean peripheral oxygen saturation <95% during sleep (adjusted odds ratio = 2.73, 95% confidence interval = 1.29-5.79) were independently associated with postoperative elevated BP. CONCLUSION Preoperative obesity and mean peripheral oxygen saturation <95% during sleep were significantly associated with postoperative elevated BP in the children with OSAS, further indicating the importance of careful BP monitoring in this subgroup despite AT treatment.
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Affiliation(s)
- Hui-Shan Hsieh
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Hai-Hua Chuang
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.,School of Medicine, College of Life Science, National Tsing Hua University, Hsinchu, Taiwan.,Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan
| | - Li-Jen Hsin
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ni Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Ming-Ying Zhuo
- Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Li-Pang Chuang
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shu Huang
- Department of Child Psychiatry, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
| | - Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.,School of Medicine, College of Life Science, National Tsing Hua University, Hsinchu, Taiwan
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16
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Hypertension and Obesity in Children: Misclassification Leads to Underdiagnosis. Indian J Pediatr 2022; 89:1167-1168. [PMID: 35925542 DOI: 10.1007/s12098-022-04346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/05/2022]
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17
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Tully L, Arthurs N, Wyse C, Browne S, Case L, McCrea L, O’Connell JM, O’Gorman CS, Smith SM, Walsh A, Ward F, O’Malley G. Guidelines for treating child and adolescent obesity: A systematic review. Front Nutr 2022; 9:902865. [PMID: 36313105 PMCID: PMC9597370 DOI: 10.3389/fnut.2022.902865] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Obesity is a chronic disease that compromises the physical and mental health of an increasing proportion of children globally. In high-income countries, prevalence of paediatric obesity is increasing faster in those from marginalised populations such as low-income households, suggesting the disease as one that is largely systemic. Appropriate treatment should be prioritised in these settings to prevent the development of complications and co-morbidities and manage those that already exist. An array of clinical practice guidelines are available for managing overweight and obesity in children and adolescents, but no systematic review has yet compared their quality or synthesised their recommendations. We aimed to narratively review clinical practice guidelines published in English for treating child and adolescent obesity, to identify the highest quality guidelines, and assess similarities, conflicts, and gaps in recommendations. We systematically searched academic databases and grey literature for guidelines published. We used the AGREE II tool to assess the quality, and identified nine high quality guidelines for inclusion in a narrative review of recommendations. Guidelines predominantly recommended the delivery of multi-component behaviour-change interventions aimed at improving nutrition and physical activity. Treatment outcomes were generally focussed on weight, with less emphasis on managing complications or improving quality-of-life. There was no evidence-based consensus on the best mode of delivery, setting, or treatment format. The guidelines rarely included recommendations for addressing the practical or social barriers to behaviour change, such as cooking skills or supervised physical activity. There is insufficient evidence to evaluate pharmaceutical and surgical interventions in children, and these were generally not recommended. It should be noted that this review addressed documents published in English only, and therefore the included guidelines were applicable predominantly to high-resource settings.
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Affiliation(s)
- Louise Tully
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Niamh Arthurs
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland,W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Cathy Wyse
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Browne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Lucinda Case
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Lois McCrea
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Jean M. O’Connell
- St. Columcille’s Hospital Weight Management Service, St.Vincent’s University Hospital, Dublin, Ireland
| | - Clodagh S. O’Gorman
- School of Medicine, University of Limerick, Limerick, Ireland,Department of Paediatrics, University Hospital Limerick, Limerick, Ireland
| | - Susan M. Smith
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Aisling Walsh
- Department of Epidemiology, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Ward
- Department of Clinical Nutrition and Dietetics, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Grace O’Malley
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland,W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland,*Correspondence: Grace O’Malley,
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18
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Abstract
In the past few decades, obesity in the pediatric population has dramatically increased and is common in many countries. Childhood obesity often causes health problems and increases the risk of cardiometabolic diseases such as type 2 diabetes, nonalcohol fatty liver, and cardiovascular diseases. Obesity in young people has been closely associated with environmental, behavioral, and genetic defects, including the availability of high-energy and sugary food and beverages, sedentary behavior, and hereditary factors. Few drugs are currently available to treat obesity in children and adolescents because it is difficult to demonstrate the safety of these drugs on the growth and development of the youth. Lifestyle modifications, such as diet control and physical exercise, are the primary approaches for preventing and treating childhood obesity. Among them, physical activity is a crucial component. This review summarizes the epidemiology, cardiometabolic risk of obesity, therapeutic strategies, and the benefits of exercise on obesity-related chronic diseases in children and adolescents.
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19
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Fragmented day-night cycle induces reduced light avoidance, excessive weight gain during early development, and binge-like eating during adulthood in mice. Physiol Behav 2022; 253:113851. [PMID: 35609722 DOI: 10.1016/j.physbeh.2022.113851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/28/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022]
Abstract
Fragmented day-night (FDN) cycles are environments in which multiple periods of light and dark alternate across a 24 h period. Exposure to FDN cycles disrupts circadian rhythms, resulting in period lengthening and alterations to mood in mice. A constant light environment, which also induces period lengthening, is linked to mood and metabolic disturbances and disruption to the development of the circadian clock. This study aims to determine how exposure to the FDN cycle impacts development in mice, with the hypothesis that there would be similar and adverse effects as observed in constant light conditions. Our study used CD-1 mice reared under the FDN cycle compared to the commonly used 12 h light: 12 h dark consolidated day-night cycle. During the first week of development, mouse pups reared under the FDN cycle gained bodyweight at a faster rate and did not avoid aberrant light exposure in comparison to 12:12 LD reared mouse pups. Developmental exposure to the FDN cycle lasted two weeks, and then mice were transferred to the 12:12 LD cycle, where after 2 weeks, bodyweight was similar between FDN reared and 12:12 LD reared mice at 1-month and 2-months old. When re-exposed to the FDN cycle during adulthood, FDN reared pups exhibited binge-like eating behaviors and reduced light avoidance. This study shows that the unnatural distribution of light and dark across the 24 h day can cause disruptions during early development that can reappear during adulthood when placed in the same stressful light-dark environment as adults.
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20
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Pediatric Sleep Questionnaire Predicts Moderate-to-Severe Obstructive Sleep Apnea in Children and Adolescents with Obesity. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091303. [PMID: 36138612 PMCID: PMC9497855 DOI: 10.3390/children9091303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
Pediatric obesity is associated with an increased risk of morbidity during childhood. Alongside the well-known metabolic syndrome, during the last decades scientific research has deeply investigated the risk of sleep breathing disorders. Among them, obstructive sleep apnea (OSA) commonly affects children with obesity. The presence of OSA heightens the risk of metabolic impairment and weight gain. Therefore, it deserves specific treatment. However, polysomnography (PSG) is not always available in clinical settings, and alternative diagnostic tools are needed. This study aimed to investigate the predictivity of the pediatric sleep questionnaire (PSQ) for moderate-to-severe OSA diagnosis. Children and adolescents with obesity and suspected OSA with available full-night cardiorespiratory PSG were retrospectively enrolled. Receiver operating curve analysis was performed to test the ability of PSQ in predicting moderate-to-severe OSA (AHI > 5 episode/h). The final sample included 60 children and adolescents. The PSQ showed a good area under the curve (AUC) of 0.88 (95% CI 0.78−0.98, p < 0.0001). Moreover, a value above or equal to 0.65 showed an 80% sensitivity and 100% specificity for moderate and severe OSA. These findings suggest that PSQ might be used in clinical settings with limited access to PSG for stratifying disease severity and for selecting children with urgent need of sleep study.
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21
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Stępniewska A, Wójcik M, Starzyk JB. Arterial hypertension is associated with an increased risk of metabolic complications in pediatric patient with obesity. J Pediatr Endocrinol Metab 2022; 35:1028-1032. [PMID: 35771937 DOI: 10.1515/jpem-2022-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/23/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Coexistence of arterial hypertension (AH) in children with obesity increases morbidity and shortens life. Its role as an indicator of coexisting metabolic complications is however less known. The objective of the study was to compare metabolic profiles of children with obesity and with or without AH. METHODS We included patients aged 10-18 with the BMI Z-score ≥2. Diagnosis of AH was based on the European Society of Hypertension criteria (2016). Metabolic profiles were assessed by glucose and insulin levels taken before and after glucose load, fasting levels of triglycerides (TG), total (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, and HOMA-IR. RESULTS Of 534 patients, 33.5% were diagnosed with AH. The AH patients, as compared to non-AH, had higher fasting insulin levels (22 vs. 19.7 mIU/L, p=0.04), HOMA-IR (4.5 vs. 4.0, p=0.029), and post-load glucose level (6.3 vs. 5.7, p=0.000041). No differences in the post-load insulin levels (113 vs. 100 mIU/L, p=0.056), fasting glucose (4.5 vs. 4.5 mmol/L, p=0.5), or lipids were found (TC: 4.4 vs. 4.4 mmol/L, p=0.9; LDL: 2.7 vs. 2.7, p=0.2; TG: 1.4 vs. 1.4 mmol/L, p=0.5; HDL: 1.1 vs. 1.2, p=0.3. CONCLUSIONS Concomitance of AH in children with obesity may be an indicator of coexisting metabolic complications.
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Affiliation(s)
- Anna Stępniewska
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Kraków, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy B Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Kraków, Poland
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22
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Carpena Lucas PJ, Sánchez-Cubo F, Vargas Vargas M, Mondéjar Jiménez J. Influence of Lifestyle Habits in the Development of Obesity during Adolescence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4124. [PMID: 35409807 PMCID: PMC8998286 DOI: 10.3390/ijerph19074124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/18/2022]
Abstract
Background: The alarming increase in childhood obesity is a global public health problem since it has significant health consequences. This cross-sectional study aimed to identify the potentially modifiable risk factors for developing excess weight and determine the importance of developing certain habits to prevent childhood overweight and obesity. Methods: The sample included 416 students between the ages of 12 and 14 (12.8 ± 0.62) first-year high school students from Murcia in Spain. Data were collected on their lifestyle habits through the ENHASA questionnaire, and the somatometry of the participants was measured. Such data were studied through structural equation modeling and importance-performance map analyses. Results: The modifiable risk factors that presented the greatest potency directly regarding when developing excess weight in adolescents were ‘use of electronic devices’ and ‘not performing physical activity’ (p < 0.001). ‘Social and school environment’ and ‘diet’ showed relationships but no significant differences with overweight or obesity. Globally, the lifestyle habit of the greatest importance for not being overweight was ‘engagement in extracurricular physical activities’. On the other hand, the habits related to using new technologies in a sedentary way showed the best capacity for improvement. Therefore, it would be very efficient to focus on them to control excess weight. Conclusion: Responsible and limited use of screens and engaging in extracurricular physical activities may be the most remarkable and cost-effective strategies for obesity prevention programs.
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Affiliation(s)
| | - Francisco Sánchez-Cubo
- Department of Political Economy and Public Finance, Economic and Business Statistics and Economic Policy, Faculty of Social Sciences, University of Castilla-La Mancha, 16007 Cuenca, Spain;
| | - Manuel Vargas Vargas
- Faculty of Economic and Business Sciences, University of Castilla-La Mancha, 02006 Albacete, Spain;
| | - José Mondéjar Jiménez
- Department of Statistics, Faculty of Social Sciences in Cuenca, University of Castilla-La Mancha, 16007 Cuenca, Spain;
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23
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Amino Acid-Related Metabolic Signature in Obese Children and Adolescents. Nutrients 2022; 14:nu14071454. [PMID: 35406066 PMCID: PMC9003189 DOI: 10.3390/nu14071454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/06/2023] Open
Abstract
The growing interest in metabolomics has spread to the search for suitable predictive biomarkers for complications related to the emerging issue of pediatric obesity and its related cardiovascular risk and metabolic alteration. Indeed, several studies have investigated the association between metabolic disorders and amino acids, in particular branched-chain amino acids (BCAAs). We have performed a revision of the literature to assess the role of BCAAs in children and adolescents' metabolism, focusing on the molecular pathways involved. We searched on Pubmed/Medline, including articles published until February 2022. The results have shown that plasmatic levels of BCAAs are impaired already in obese children and adolescents. The relationship between BCAAs, obesity and the related metabolic disorders is explained on one side by the activation of the mTORC1 complex-that may promote insulin resistance-and on the other, by the accumulation of toxic metabolites, which may lead to mitochondrial dysfunction, stress kinase activation and damage of pancreatic cells. These compounds may help in the precocious identification of many complications of pediatric obesity. However, further studies are still needed to better assess if BCAAs may be used to screen these conditions and if any other metabolomic compound may be useful to achieve this goal.
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24
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Corken A, Thakali KM. Maternal Obesity Programming of Perivascular Adipose Tissue and Associated Immune Cells: An Understudied Area With Few Answers and Many Questions. Front Physiol 2022; 12:798987. [PMID: 35126181 PMCID: PMC8815821 DOI: 10.3389/fphys.2021.798987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/09/2021] [Indexed: 12/11/2022] Open
Abstract
At present, the worldwide prevalence of obesity has become alarmingly high with estimates foreshadowing a continued escalation in the future. Furthermore, there is growing evidence attributing an individual’s predisposition for developing obesity to maternal health during gestation. Currently, 60% of pregnancies in the US are to either overweight or obese mothers which in turn contributes to the persistent rise in obesity rates. While obesity itself is problematic, it conveys an increased risk for several diseases such as diabetes, inflammatory disorders, cancer and cardiovascular disease (CVD). Additionally, as we are learning more about the mechanisms underlying CVD, much attention has been brought to the role of perivascular adipose tissue (PVAT) in maintaining cardiovascular health. PVAT regulates vascular tone and for a significant number of individuals, obesity elicits PVAT disruption and dysregulation of vascular function. Obesity elicits changes in adipocyte and leukocyte populations within PVAT leading to an inflammatory state which promotes vasoconstriction thereby aiding the onset/progression of CVD. Our current understanding of obesity, PVAT and CVD has only been examined at the individual level without consideration for a maternal programming effect. It is unknown if maternal obesity affects the propensity for PVAT remodeling in the offspring, thereby enhancing the obesity/CVD link, and what role PVAT leukocytes play in this process. This perspective will focus on the maternal contribution of the interplay between obesity, PVAT disruption and CVD and will highlight the leukocyte/PVAT interaction as a novel target to stem the tide of the current obesity epidemic and its secondary health consequences.
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Affiliation(s)
- Adam Corken
- Arkansas Children’s Nutrition Center, Little Rock, AR, United States
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Keshari M. Thakali
- Arkansas Children’s Nutrition Center, Little Rock, AR, United States
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- *Correspondence: Keshari M. Thakali,
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Carpena Lucas PJ, Jiménez Candel MI, Sánchez-Cubo F, Ceballos-Santamaría G, Vargas Vargas M, Mondéjar Jiménez J. Gender differences in the development of childhood obesity in young teenagers in Murcia, Spain. Pediatr Int 2022; 64:e15065. [PMID: 34807492 DOI: 10.1111/ped.15065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The number of overweight children is increasing at an alarming rate. This issue requires effective action plans, as childhood obesity has become a problem in which addressing environmental factors is decisive. Significant differences have also been shown in lifestyle habits that determine overweight based on sex. This study therefore aimed to examine these risk factors according to sex. METHODS The sample included first-year high school students from Murcia, Spain. Information was collected through the "Questionnaire on Healthy Habits in Adolescents," validated for this age range, and the weight, height, and waist circumference of the participants were obtained. Data were analyzed through partial least squares structural equation modeling to determine which modifiable risk factors promoted the appearance of excess weight and in what magnitude. RESULTS A total of 421 students participated in the study, and 40.6% of overweight patients were detected according to their body mass index. No differences were found between the sexes and weights. The environment and the use of new technologies that do not involve sitting were significant only in girls (P < 0.05). Conversely, physical activity was significantly higher in boys (P < 0.05). Dietary factors and sedentary activities did not differ according to sex. CONCLUSIONS The social and school environment, the use of new technologies (for girls), and physical activity (for boys) condition nutritional status. Identifying gender disparities in behaviors that involve health should be a priority for new prevention programs. Targeting young people's health from a gender perspective has considerable potential to reduce overweight problems in adulthood.
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Affiliation(s)
| | | | - Francisco Sánchez-Cubo
- Department of Political Economy and Public Finance, Economic and Business Statistics and Economic Policy, Faculty of Social Sciences, University of Castilla-La Mancha, Cuenca, Spain
| | | | - Manuel Vargas Vargas
- Department of Statistics, Faculty of Social Sciences, Castilla-La Mancha University, Cuenca, Spain
| | - José Mondéjar Jiménez
- Department of Statistics, Faculty of Social Sciences, Castilla-La Mancha University, Cuenca, Spain
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Chuang HH, Wang CY, Chuang LP, Huang YS, Li HY, Fang TJ, Lin RH, Lee LA. The 3% Oxygen Desaturation Index is an Independent Risk Factor for Hypertension Among Children with Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:1149-1164. [PMID: 35733819 PMCID: PMC9208670 DOI: 10.2147/nss.s362557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and obesity are both directional risk factors of hypertension. Chronic intermittent hypoxemia (IH) is a commonly observed pathophysiological mechanism involved in multiple comorbidities of OSA. However, their interactions are not well understood in children. This study aimed to investigate the associations of IH indexes (oxygen desaturation index 3% [ODI3], mean peripheral oxygen saturation [SpO2], least SpO2, and time with SpO2 < 85%), apnea-hypopnea index, and weight status with hypertension in a sample of pediatric OSA patients. METHODS The medical records of 365 pediatric OSA patients were retrospectively reviewed in this cross-sectional study. Demographics, anthropometrics, standard in-laboratory polysomnography, and nocturnal blood pressure were collected. Multivariate logistic regression with forward selection was used to identify independent predictors of hypertension. RESULTS Multivariate logistic regression analysis showed that ODI3 (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 1.01-1.03) and body mass index z-score (OR = 1.34, 95% CI = 1.12-1.60) were independent continuous predictors of pediatric hypertension, whilst severe OSA (OR = 2.62, 95% CI = 1.60-4.29) and overweight/obesity (OR = 2.63, 95% CI = 1.59-4.34) were independent categorical predictors. Traditional risk factors including male sex (OR = 2.33, 95% CI = 1.02-5.33), late childhood/adolescence (OR = 1.98, 95% CI = 1.01-3.88), and overweight/obesity (OR = 2.97, 95% CI = 1.56-5.67) combined with sleep hypoxemia (least SpO2 ≤ 95%) (OR = 2.24, 95% CI = 1.16-4.04) predicted hypertension (R 2 = 0.21) in the severe IH subgroup (n = 205), while the no/mild IH subgroup (n = 160) had an entirely different predictor, severe OSA (OR = 3.81, 95% CI = 1.49-9.74) (R 2 = 0.07). CONCLUSION The close relationships among IH, overweight/obesity, and hypertension highlight the importance of reducing IH and body weight in children with OSA.
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Affiliation(s)
- Hai-Hua Chuang
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.,Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan.,School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chao-Yung Wang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
| | - Li-Pang Chuang
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shu Huang
- Department of Child Psychiatry, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
| | - Rong-Ho Lin
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan
| | - Li-Ang Lee
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan
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Wu Y, Geng X, Xu Z, Ni X. Overweight/Obese Status Synergistically Worsens Nocturnal Time-to-Time Blood Pressure in Children with Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:1261-1271. [PMID: 35873713 PMCID: PMC9297044 DOI: 10.2147/nss.s370334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the influence of obstructive sleep apnea (OSA) severity and weight on blood pressure (BP) during nighttime sleep in children. METHODS Habitually snoring children who were 3-14 years old and from Beijing Children's Hospital between 1 January 2018 and 31 December 2020 were recruited. All participants completed polysomnography (PSG) and BP monitoring during different sleep stages using pulse transit time analysis. Subjects were divided into three groups based on the obstructive apnea-hypopnea index (OAHI), ie, primary snoring (PS), mild-to-moderate OSA, and severe OSA group. RESULTS Totally, 284 habitually snoring children were enrolled, including 85 with PS, 152 with mild-to-moderate OSA, and 47 with severe OSA. The differences of age and sex ratio among groups were not statistically significant (all P>0.05). For the normal weight group, compared with those in the PS group, children in the severe OSA group had higher BP, mainly in N2 and R stages, and children in the mild-to-moderate OSA group had lower BP in all sleep and wake stages (all P<0.01). For the overweight/obese group, compared with the PS group, children in the severe OSA group had higher BP in all sleep and wake stages, and children in the mild-to-moderate group had higher BP mainly in sleep stages (all P<0.01). Compared with normal weight children, those who were overweight/obese and had OSA had higher BP in all sleep and wake stages (all P<0.01). There was a synergistic effect of OSA and weight status on BP (P<0.01). CONCLUSION The influence of OSA on both systolic and diastolic pediatric BP differs between children with normal weight and overweight/obese status. Overweight/obese status synergistically worsens nocturnal blood pressure in children with OSA. Early diagnosis and risk stratification are more important in overweight/obese children with OSA to achieve timely initiation of treatment.
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Affiliation(s)
- Yunxiao Wu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Xuezhi Geng
- Department of infectious diseases, Tianjin Children's Hospital, Tianjin, People's Republic of China
| | - Zhifei Xu
- Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Xin Ni
- Department of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
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Wang J, Lin H, Chiavaroli V, Jin B, Yuan J, Huang K, Wu W, Dong G, Derraik JGB, Fu J. High Prevalence of Cardiometabolic Comorbidities Among Children and Adolescents With Severe Obesity From a Large Metropolitan Centre (Hangzhou, China). Front Endocrinol (Lausanne) 2022; 13:807380. [PMID: 35663319 PMCID: PMC9160715 DOI: 10.3389/fendo.2022.807380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to describe the clinical characteristics of children and adolescents with obesity, and the prevalence of cardiometabolic comorbidities over 10 years in this population from a large metropolitan centre in China. METHODS This was a cross-sectional study (2008-2017) of patients aged <18 years with obesity [body mass index (BMI) ≥ 95th percentile for age and sex] enrolled at the Department of Endocrinology, Children's Hospital of Zhejiang University School of Medicine (Hangzhou, Zhejiang Province). Clinical assessments included anthropometry, blood pressure, liver ultrasound, lipid profile, oral glucose tolerance test, and uric acid. For examination of outcomes, our study cohort was stratified by sex and age bands (<10 vs. ≥10 years), with the study period also split into two strata (2008-2012 and 2013-2017). RESULTS A total of 2,916 patients (1,954 boys and 962 girls) were assessed at a mean age of 10.5 years. Patients almost invariably presented severe obesity (median BMI SDS = 2.98; Q1 = 2.60, Q3 = 3.39). Obesity-related comorbidities were common among boys and girls, including type 2 diabetes mellitus (2.6% and 3.6%, respectively), abnormal glycaemia (33.6% and 35.5%, respectively), hypertension (33.9% and 32.0%, respectively), dyslipidaemia (35.2% and 39.6%, respectively), hyperuricaemia (16.2% and 8.3%, respectively), acanthosis nigricans (71.9% and 64.0%, respectively), abnormal liver function (66.9% and 47.0%, respectively), and non-alcoholic fatty liver disease (NAFLD) (63.8% and 45.1%, respectively); 38.7% of boys and 44.4% of girls aged ≥10 years had metabolic syndrome. Notably, the incidence of many cardiometabolic comorbidities was in 2013-2017 compared to 2008-2012. For example, rates of hypertension among boys aged <10 years and aged ≥10 years rose from 28.4% and 26.5% to 48.0% and 35.8%, respectively, and in girls from 20.3% and 20.8% to 41.7% and 39.6%, respectively. In 2013-2017, 9.5% of girls in the older group had metabolic syndrome compared to 2.2% in 2008-2013. CONCLUSIONS We observed a high incidence of obesity-related cardiometabolic comorbidities among Chinese children and adolescents with severe obesity over 10 years. It was particularly concerning that rates of several comorbidities rose markedly over the study period, highlighting the need to address the obesity epidemic early in life (in China and elsewhere) to prevent the development of obesity-related comorbidities and, subsequently, of overt disease.
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Affiliation(s)
- Jinling Wang
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Hu Lin
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Valentina Chiavaroli
- Neonatal Intensive Care Unit, Pescara Public Hospital, Pescara, Italy
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Binghan Jin
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jinna Yuan
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ke Huang
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wei Wu
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guanping Dong
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - José G. B. Derraik
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Environmental and Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- *Correspondence: Junfen Fu, ; José G. B. Derraik,
| | - Junfen Fu
- Department of Endocrinology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- *Correspondence: Junfen Fu, ; José G. B. Derraik,
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Wieërs MLAJ, Mulder J, Rotmans JI, Hoorn EJ. Potassium and the kidney: a reciprocal relationship with clinical relevance. Pediatr Nephrol 2022; 37:2245-2254. [PMID: 35195759 PMCID: PMC9395506 DOI: 10.1007/s00467-022-05494-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 10/26/2022]
Abstract
By controlling urinary potassium excretion, the kidneys play a key role in maintaining whole-body potassium homeostasis. Conversely, low urinary potassium excretion (as a proxy for insufficient dietary intake) is increasingly recognized as a risk factor for the progression of kidney disease. Thus, there is a reciprocal relationship between potassium and the kidney: the kidney regulates potassium balance but potassium also affects kidney function. This review explores this relationship by discussing new insights into kidney potassium handling derived from recently characterized tubulopathies and studies on sexual dimorphism. These insights reveal a central but non-exclusive role for the distal convoluted tubule in sensing potassium and subsequently modifying the activity of the sodium-chloride cotransporter. This is another example of reciprocity: activation of the sodium-chloride cotransporter not only reduces distal sodium delivery and therefore potassium secretion but also increases salt sensitivity. This mechanism helps explain the well-known relationship between dietary potassium and blood pressure. Remarkably, in children, blood pressure is related to dietary potassium but not sodium intake. To explore how potassium deficiency can cause kidney injury, we review the mechanisms of hypokalemic nephropathy and discuss if these mechanisms may explain the association between low dietary potassium intake and adverse kidney outcomes. We discuss if potassium should be repleted in patients with kidney disease and what role dietary potassium plays in the risk of hyperkalemia. Supported by data and physiology, we reach the conclusion that we should view potassium not only as a potentially dangerous cation but also as a companion in the battle against kidney disease.
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Affiliation(s)
- Michiel L. A. J. Wieërs
- grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Room Ns403, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jaap Mulder
- grid.5645.2000000040459992XDepartment of Pediatrics, Division of Pediatric Nephrology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands ,grid.10419.3d0000000089452978Department of Pediatrics, Division of Pediatric Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joris I. Rotmans
- grid.10419.3d0000000089452978Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ewout J. Hoorn
- grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Room Ns403, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Chung YL, Rhie YJ. Severe Obesity in Children and Adolescents: Metabolic Effects, Assessment, and Treatment. J Obes Metab Syndr 2021; 30:326-335. [PMID: 34924365 PMCID: PMC8735819 DOI: 10.7570/jomes21063] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022] Open
Abstract
Childhood obesity has been increasing steadily in recent decades, and severe childhood obesity has emerged as a major public health problem both nationally and internationally. A current concern is that lockdown due to the coronavirus disease 2019 (COVID-19) pandemic could exacerbate the spread of childhood obesity and increase the gap in obesity risk. Recent research results indicate the aggravation of obesity after school closures. The consequences of severe childhood obesity are more devastating than those of mild to moderate obesity. Children with severe obesity are at greater risk than others for hypertension, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, atherosclerosis, and adult obesity. Accurately assessing and diagnosing a child with severe obesity is the key to implementing successful therapy. A detailed and accurate patient history and physical examination are important to discriminate monogenic obesity and metabolic syndrome diagnoses from severe obesity without an underlying cause. Psychosocial factors, including eating behaviors, should be assessed to facilitate better weight management outcomes. Treatment options for severe pediatric obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. However, lifestyle modification should be the priority. Although progress has been made, safe and effective treatment for severe pediatric obesity is still challenging. More efforts and innovations are needed to find a solution for the huge medical and emotional burden that these children and their families carry. Public health organizations also need to make efforts to encourage and normalize healthy eating habits and exercise to prevent severe obesity in childhood.
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Affiliation(s)
- Yoojin Lindsey Chung
- Department of Pediatrics, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
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Haddad LSP, Fernandes KA, Lopes GB, Veloso FBR, Caniçali SC, Poton WL. Determinantes antropométricos da pressão arterial elevada em escolares do ensino fundamental. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2021. [DOI: 10.5712/rbmfc16(43)2779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: A hipertensão arterial infantil vem recebendo atenção especial dos pediatras, pois o aumento da pressão arterial na infância contribui para o início precoce da hipertensão arterial essencial na idade adulta e para a mortalidade por doenças cardiovasculares. As medidas antropométricas têm sido úteis para o diagnóstico de sobrepeso e obesidade na infância, e tais condições são consideradas de risco para hipertensão arterial na idade adulta. Quanto mais precoce a identificação desses fatores de risco, seja no ambiente escolar, seja nos serviços de saúde, mais ações preventivas poderão ser desenvolvidas para minimizar tal problemática. Objetivo: Identificar a incidência de pressão arterial elevada e sua associação com medidas antropométricas em escolares do ensino fundamental. Métodos: Estudo longitudinal com 1.116 escolares; destes, 133 participaram de três avaliações no período de 2017 a 2019. As informações demográficas, as medidas antropométricas (peso, altura, circunferência abdominal, índice de massa corporal) e as pressóricas (sistólica e diastólica ajustadas de acordo com os parâmetros do Centro de Controle e Prevenção de Doenças para sexo e idade) foram registradas em formulário. A associação das variáveis com a pressão arterial elevada foi analisada por meio da regressão de Poisson, com ajuste robusto da variância. Resultados: Dos estudantes, 51,6% eram meninos com, em média, 7,9 anos, e 45,4% tinham pressão arterial elevada conforme os critérios do Centro de Controle e Prevenção de Doenças. Entre os que apresentaram circunferência abdominal elevada, 19,4% evoluíram de pressão sistólica normal para elevada e 35,5% de pressão diastólica normal para elevada ao longo dos três anos de acompanhamento. Nos escolares com sobrepeso ou obesidade, a pressão sistólica normal evoluiu para elevada em 20,7 e 21,2%, respectivamente, e a pressão diastólica normal evoluiu para elevada em 24,1 e 42,4%, respectivamente. Os escolares com circunferência abdominal (risco relativo – RR 1,51; intervalo de confiança – IC95% 1,20–1,91; RR 1,58; IC95% 1,25–2,00), peso (RR 1,37; IC95% 1,08–1,74; RR 1,34; IC95% 1,05–1,71) e índice de massa corporal elevado (RR 1,51; IC95% 1,21–1,87; RR 1,50; IC95% 1,20–1,88) apresentaram maior risco para hipertensão sistólica e diastólica, respectivamente. Conclusão: A circunferência abdominal, o peso e o índice de massa corporal estiveram associados com o aumento da pressão arterial sistólica e diastólica nos escolares, e o risco foi maior entre os que tinham circunferência abdominal aumentada.
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Association between Sleep Time and Blood Pressure in Korean Adolescents: Cross-Sectional Analysis of KNHANES VII. CHILDREN 2021; 8:children8121202. [PMID: 34943398 PMCID: PMC8700331 DOI: 10.3390/children8121202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
Abstract
Background: Hypertension is highly related to sleep, and there have been a number of studies on sleep deprivation and the occurrence of hypertension. However, there is still insufficient research on the relationship between hypertension and various factors related to sleep. Thus, this study attempted to investigate the relationship between hypertension and sleep time-related variables in Korean adolescents. Methods: A total of 1470 adolescents (709 girls and 761 boys) between 12 and 18 years of age were enrolled through the Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII). The systolic and diastolic blood pressure were measured. Sleep time-related variables such as sleep onset time, wake time, and sleep duration (weekday and weekend, each) were also investigated using a questionnaire. We performed multivariate regression analyses to determine the independent effects of the variables. Results: Systolic blood pressure was negatively correlated with the wake time (r = −0.081; p = 0.002) and sleep onset time (r = −0.088; p = 0.001) on weekends. There was a positive correlation between diastolic blood pressure and weekday sleep onset time (r = 0.158; p = 0.000) and weekend sleep onset time (r = 0.184; p = 0.000). The sleep duration on weekdays and weekends showed a negative correlation (r = −0.136; p = 0.000, r = −0.088; p = 0.001, respectively). In the multivariate linear regression analysis results, the sleep onset time on weekends was significantly correlated with elevated diastolic blood pressure. Conclusions: Delayed sleep onset time on weekends was significantly associated with increased diastolic blood pressure in Korean adolescents. Further investigation is needed to confirm the clinical significance of these findings.
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Ji Y, Zhao X, Feng Y, Qu Y, Liu Y, Wu S, Wu Y, Xue F, Liu Y. Body mass index trajectory from childhood to puberty and high blood pressure: the China Health and Nutrition Survey. BMJ Open 2021; 11:e055099. [PMID: 34824123 PMCID: PMC8627396 DOI: 10.1136/bmjopen-2021-055099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The prevalence of childhood hypertension is rising in parallel with the increasing prevalence of overweight and obesity in children. How growth trajectories from childhood to puberty relate to high blood pressure (HBP) is not well defined. We aimed to characterise potential body mass index (BMI) dynamic changing trajectories from childhood to puberty and investigate their association with HBP. DESIGN A dynamic prospective cohort. SETTING China Health and Nutrition Survey 1991-2015. PARTICIPANTS There were 1907 participants (1027 men and 880 women) in this study. OUTCOMES The primary outcome was HBP defined as systolic blood pressure (SBP)/diastolic blood pressure (DBP) exceeding the standards or diagnosis by medical records or taking antihypertensive medication. RESULTS A model of cubic parameters with three groups was chosen, labelled as normal increasing group (85.16%, n=1624), high increasing group (9.81%, n=187) and resolving group (5.03%, n=96). Compared with the normal increasing group, the unadjusted HRs (95% CIs) for the resolving and high increasing groups were 0.91 (0.45 to 1.86) and 1.88 (1.26 to 2.81), respectively. After adjusting for baseline age, region, sex, baseline BMI z-score, baseline SBP and baseline DBP in model 3, the HRs (95% CIs) for the resolving and high increasing groups were 0.66 (0.30 to 1.45) and 1.56 (1.02 to 2.38). CONCLUSIONS These results indicate that the BMI trajectories from childhood to puberty have significant impact on HBP risk. Puberty is a crucial period for the development of HBP.
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Affiliation(s)
- Yiman Ji
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Xiangjuan Zhao
- Department of gynaecology, Maternal and Child Health Care of Shandong Province, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Yiping Feng
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Yanlin Qu
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Ying Liu
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Sijia Wu
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Yutong Wu
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Yunxia Liu
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
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Obesity and Cardiometabolic Risk Factors: From Childhood to Adulthood. Nutrients 2021; 13:nu13114176. [PMID: 34836431 PMCID: PMC8624977 DOI: 10.3390/nu13114176] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity has become a major epidemic in the 21st century. It increases the risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic risk factors and components of the metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction are the domain of adulthood, it is evident that the CV continuum begins very early in life. Recognition of risk factors and early stages of CV damage, at a time when these processes are still reversible, and the development of prevention strategies are major pillars in reducing CV morbidity and mortality in the general population. In this review, we will discuss the role of well-known but also novel risk factors linking obesity and increased CV risk from prenatal age to adulthood, including the role of perinatal factors, diet, nutrigenomics, and nutri-epigenetics, hyperuricemia, dyslipidemia, hypertension, and cardiorespiratory fitness. The importance of 'tracking' of these risk factors on adult CV health is highlighted and the economic impact of childhood obesity as well as preventive strategies are discussed.
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Welser L, Lima RA, Silveira JF, Andersen LB, Pfeiffer KA, Renner JDP, Reuter CP. Cardiometabolic risk factors in children and adolescents from southern Brazil: comparison to international reference values. J Pediatr Endocrinol Metab 2021; 34:1237-1246. [PMID: 34237809 DOI: 10.1515/jpem-2021-0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/05/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To compare cardiometabolic risk factors of Brazilian children and adolescents with international reference values. Cardiometabolic risk factors constitute the Metabolic Syndrome, whose evaluation is important to assess pediatric populations' health and potential to experience metabolic disorders. METHODS Cross-sectional study that included 2,250 randomly selected children and adolescents (55.6% girls), aged 6 to 17. Cardiometabolic parameters (body mass index [BMI], waist circumference [WC], systolic and diastolic blood pressures [SBP and DBP], total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], TC:HDL-C ratio, triglycerides [TG], glucose and peak oxygen uptake [VO2peak]), and clustered risk scores were compared to international age- and sex-specific reference values. A clustered risk score was calculated by summing the WC, glucose, SBP, TG, and the TC:HDL-C ratio Z-scores divided by five. A second clustered was calculated including VO2peak (inverted) Z-score, but divided by six. RESULTS The clustered risk score, considering the all ages sample, was better in the Brazilian boys (-0.20 [-0.41;0.01] and -0.18 [-0.37;0.01], including or not VO2peak, respectively) but not significantly, and worse in girls (0.24 [0.05;0.43] and 0.28 [0.11;0.44], including or not VO2peak, respectively) than the international reference. Additionally, Brazilian youth had a statistically better profile in TC, LDL-C, HDL-C, TC:HDL-C ratio, and VO2peak (only girls) as well as a worse profile in BMI, WC, SBP, DBP, TG (only girls), and VO2peak (only boys). CONCLUSIONS The clustered cardiometabolic risk score (including or not VO2peak), considering the all ages sample, was better in the Brazilian boys, but not significantly, and worse in girls compared to the international reference.
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Affiliation(s)
- Letícia Welser
- Graduate Program in Health Promotion, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Rodrigo Antunes Lima
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - João Francisco Silveira
- Graduate Program in Health Promotion, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Lars Bo Andersen
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Sogndal, Norway
| | | | - Jane Dagmar Pollo Renner
- Graduate Program in Health Promotion, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil.,Department of Life Sciences, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Cézane Priscila Reuter
- Graduate Program in Health Promotion, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil.,Health Sciences Department, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
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Kwak BO, Lim J, Chung S. Body Shape Indices in Adolescents Based on the 2009-2012 Korea National Health and Nutrition Examination Survey. CHILDREN-BASEL 2021; 8:children8100894. [PMID: 34682159 PMCID: PMC8534381 DOI: 10.3390/children8100894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
A Body Shape Index (ABSI) is a recently proposed index for standardizing waist circumference (WC) for body mass index (BMI) and height in adults, using 2/3 and 1/2 as scaling exponents, respectively. However, ABSI has limited applicability to children and adolescents, as the relationship between height and weight changes with age and varies according to sex. This study aimed to investigate whether ABSI can be applied to adolescents and to analyze the relationships among BMI, WC, height, weight, and body shape index (BSI) in Korean adolescents. The data of 1023 adolescents aged 10-19 years from the 2009-2012 Korea National Health and Nutrition Examination Survey were collected. Body measurements (height, weight, WC, and BMI) were analyzed to estimate the BSI using log-linear regression. The scaling exponents for standardizing WC for weight and height were estimated according to age (per year) and sex. The scaling exponents for standardizing WC for weight and height were 0.698 and -1.090 for boys and 0.646 and -0.855 for girls, respectively. The exponents also differed according to age. BSI was negatively correlated with height, weight, and BMI in boys and girls, and these correlations differed in direction from those in adults. ABSI cannot be applied to adolescents. In adolescents, the BSI is dependent on age and sex and is associated with growth and puberty. Further studies are required to evaluate the association between BSI and other biomarkers, to improve its applicability as a parameter for predicting the risk of chronic diseases in adolescents.
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Affiliation(s)
- Byung Ok Kwak
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Korea;
| | - Jisun Lim
- Research Institute of Basic Science, Seoul National University, Seoul 08826, Korea;
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
- Correspondence: ; Tel.: +82-2-2030-7553
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Hypertension in Children with Obstructive Sleep Apnea Syndrome-Age, Weight Status, and Disease Severity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189602. [PMID: 34574528 PMCID: PMC8471072 DOI: 10.3390/ijerph18189602] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
Older age, obesity, and obstructive sleep apnea syndrome (OSAS) are known to increase the risk of hypertension in adults. However, data for children are scarce. This study aimed to investigate the relationships between hypertension, age, weight status, and disease severity in 396 children with OSAS. The prevalence rates of hypertension, obesity, and severe OSAS (apnea-hypopnea index ≥10) were 27.0%, 28.0%, and 42.9%, respectively. Weight z-score and apnea-hypopnea index were independently correlated with systolic blood pressure z-score, and minimal blood oxygen saturation (SpO2) was independently associated with diastolic blood pressure z-score. Overall, late childhood/adolescence (odds ratio (OR) = 1.72, 95% CI = 1.05–2.81), obesity (OR, 2.58, 95% CI = 1.58–4.22), and severe OSAS (OR = 2.38, 95% CI = 1.48–3.81) were independent predictors of pediatric hypertension. Furthermore, late childhood/adolescence (OR = 2.50, 95% CI = 1.10–5.71) and abnormal SpO2 (mean SpO2 < 95%; OR = 4.91, 95% CI = 1.81–13.27) independently predicted hypertension in obese children, and severe OSAS (OR = 2.28, 95% CI = 1.27–4.10) independently predicted hypertension in non-obese children. In conclusion, obesity, OSAS severity, and abnormal SpO2 are potentially modifiable targets to improve hypertension while treating children with OSAS.
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Interaction between Autonomic Regulation, Adiposity Indexes and Metabolic Profile in Children and Adolescents with Overweight and Obesity. CHILDREN-BASEL 2021; 8:children8080686. [PMID: 34438577 PMCID: PMC8394084 DOI: 10.3390/children8080686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 01/22/2023]
Abstract
Early obesity predicts initial modifications in cardiac and vascular autonomic regulation. The aim of this study was to assess the possible interaction between non-invasive measures of autonomic cardiovascular control and peripheral endothelium regulation in children with overweight and obesity. We involved 114 young subjects (77M/37F, 12.7 ± 2.2 years) with normal weight (NW, n = 46) to overweight or obesity (OB, n = 68). Multivariate statistical techniques utilizing a collection of modern indices of autonomic regulation, adiposity indexes and metabolic profile were employed. Resting values show substantial equivalence of data. Conversely, blood pressure variance is greater in NW/OB groups. The correlation matrix between major autonomic and metabolic/hemodynamic variables shows a clustered significant correlation between homogeneous indices. A significant correlation between metabolic indices and endothelial and autonomic control, mostly in its vascular end, was recorded. Particularly, the alpha index is significantly correlated with triglycerides (r = −0.261) and endothelial indices (RHI, r = 0.276). Children with obesity show a link between indices of autonomic and endothelial function, fat distribution and metabolic profile. The optimization of autonomic control, for instance by exercise/nutrition interventions, could potentially prevent/delay the occurrence of structural vascular damage leading to reduced cardiovascular health.
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Rosenbaum M, Garofano R, Liimatta K, McArthur K, Paul E, Starc T, Sopher AB, Thaker V, Baidal JW. The Families Improving Health Together (FIT) Program: Initial evaluation of retention and research in a multispecialty clinic for children with obesity. Obes Sci Pract 2021; 7:357-367. [PMID: 34401195 PMCID: PMC8346376 DOI: 10.1002/osp4.498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity affects ∼17% of US children, with parallel increases in multiple comorbidities, especially among African-, Asian-, Hispanic-, and Native-Americans. Barriers to patient retention in pediatric obesity programs include lack of centralized care, and frequent subspecialty MD visits which conflict with patient school attendance and parental work attendance as well as with support service utilization. Lack of integration of multispecialty clinical care with interdisciplinary research is a major barrier to fuller exploration of the treatment, prevention, and understanding of obesity in childhood. OBJECTIVE To test the hypothesis, a novel multispecialty/interdisciplinary clinical and research infrastructure with strong emphasis on a primary obesity care physician for children with early-onset (<9 years) obesity (Families Improving health Together [FIT]) could promote lower patient attrition (primary goal) and foster productive research in pediatric obesity (secondary goal). RESULTS Data support the hypotheses. Over 15 months, FIT reported a >90% participant retention (p < 0.001 vs. expected rate based on other studies of similar programs). Though 90% of children had at least one adiposity-related comorbidity and 70% had at least two, there was no need for additional subspecialist visits with cardiologists, endocrinologists, gastroenterologists, or molecular geneticists. Three abstracts were presented at national meetings, and two manuscripts were published all with junior faculty as primary authors. CONCLUSION This pilot study suggests that an integrated multispecialty/interdisciplinary approach to children with obesity improves patient retention and can be integrated successfully with research.
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Affiliation(s)
- Michael Rosenbaum
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Robert Garofano
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Kalle Liimatta
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Kerry McArthur
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Erin Paul
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Thomas Starc
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Aviva B. Sopher
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Vidhu Thaker
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
| | - Jennifer Woo Baidal
- Berrie Diabetes Research PavilionColumbia University Medical CollegeNew YorkUSA
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Agostinis-Sobrinho CA, Vilan K. Blood Pressure in Children. The Key Role of Physical Activity and Body Fatness. Arq Bras Cardiol 2021; 116:957-958. [PMID: 34008821 PMCID: PMC8121466 DOI: 10.36660/abc.20210117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- César A. Agostinis-Sobrinho
- Klaipeda UniversityFaculty of Health SciencesKlaipedaLituâniaKlaipeda University - Faculty of Health Sciences, Klaipeda – Lituânia
| | - Katiane Vilan
- Klaipeda UniversityFaculty of Health SciencesKlaipedaLituâniaKlaipeda University - Faculty of Health Sciences, Klaipeda – Lituânia
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Tatum KL, Valenzuela JM, Amirniroumand RA, Brochu PM. Parents' Perceptions of and Responses to School-Based Body Mass Index Screening Programs-A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2021; 91:331-344. [PMID: 33655546 DOI: 10.1111/josh.13003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/11/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Evidence for the effectiveness of state-mandated body mass index (BMI) screening programs in the United States has been inconclusive, and potential unintended consequences of the programs have been debated. The present review aims to understand parents' perceptions of and responses to school-based BMI screening, and to highlight racial/ethnic differences. METHODS We systematically identified studies published January 2003-May 2019 examining parent and/or youth perceptions of and/or responses to US school-based BMI screening. RESULTS A total of 16 studies were included in the review. Studies suggested that while parents largely found BMI screening helpful, they held concerns regarding stigma, lack of privacy, and unhealthy behaviors and attitudes resulting from school-based screening. Furthermore, parents did not frequently follow-up with health care providers, although they reported some healthy behavior changes. CONCLUSIONS Our review highlights existing parent perceptions of school-based BMI screening including the potential for healthy behavior change and important concerns regarding weight-stigma and disturbed eating attitudes/behaviors. Additionally, racial/ethnic differences in screening preferences and experiences were found. Limitations of existing literature included a need to understand youths' experiences and a lack of standardized, reliable outcomes research. Implications for future research and the role of parents, schools, and providers are discussed.
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Affiliation(s)
- Kristina L Tatum
- Doctoral Student, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
| | - Jessica M Valenzuela
- Associate Professor, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
| | - Roya A Amirniroumand
- Doctoral Student, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
| | - Paula M Brochu
- Assistant Professor, , Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, Florida, 33314., USA
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Orman G, Masand PM, Kukreja KU, Acosta AA, Guillerman RP, Jadhav SP. Diagnostic sensitivity and specificity of CT angiography for renal artery stenosis in children. Pediatr Radiol 2021; 51:419-426. [PMID: 33151345 DOI: 10.1007/s00247-020-04852-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/14/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Children with suspected renal artery stenosis (RAS) are screened with renal Doppler ultrasonography or computed tomography (CT) angiography/magnetic resonance (MR) angiography depending on institutional preference. CT angiography produces images with superior resolution, allowing higher quality multiplanar two-dimensional reformats and three-dimensional reconstructions. However, there is a paucity of data in the literature regarding the utility and diagnostic performance of renal CT angiography in pediatric RAS. OBJECTIVE The objective of this study is to retrospectively review our experience with renal CT angiography in the diagnosis of pediatric RAS relative to digital subtraction angiography (DSA) as the reference standard. MATERIALS AND METHODS All patients 0-18 years of age who underwent CT angiography for evaluation of RAS as a cause of hypertension between January 2012 and May 2019 were identified for the study. A total of 131 patients were identified, 23 of whom had DSA correlation. RESULTS Twenty-three patients (17 boys, 6 girls) with a mean age of 6 years 3 months (range: 3 months to 14 years 7 months) were included in this study. Of the 59 renal arteries studied by DSA, 22 were abnormal on CT angiography and 20 were abnormal on DSA. Of the 59 renal arteries, CT angiography was true positive in 18 and true negative in 35. The sensitivity and specificity of CT angiography for RAS diagnosis were 90.0% and 89.7%, respectively. CT angiography identified all cases of main RAS. CONCLUSION Renal CT angiography has a high sensitivity and specificity for pediatric RAS diagnosis in patients referred for DSA.
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Affiliation(s)
- Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX, 77030, USA.
| | - Prakash M Masand
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX, 77030, USA
| | - Kamlesh U Kukreja
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX, 77030, USA
| | - Alisa A Acosta
- Renal Section, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - R Paul Guillerman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX, 77030, USA
| | - Siddharth P Jadhav
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX, 77030, USA
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Chen Y, Ye P, Liu X, Gong C, Li C, Yuan Y, Zheng H, Xu X, Dong H, Kong Q, Yan Y, Mi J. Characteristics of pediatric inpatients with primary and secondary hypertension. Pediatr Investig 2021; 5:28-32. [PMID: 33778424 PMCID: PMC7983996 DOI: 10.1002/ped4.12249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/14/2021] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Extensive population-based studies have explored the prevalence of primary hypertension (HTN) in children and adolescents. However, there is little published data on the characteristics of different types of pediatric HTN and the causes of secondary HTN. OBJECTIVE To investigate the characteristics of different types of pediatric HTN and the causes of secondary HTN in a hospital setting. METHODS The study cohort comprised pediatric inpatients (<18 years of age) discharged with a diagnosis of HTN from Beijing Children's Hospital during 2015-2020. Pediatric patients with HTN were allocated to secondary and primary HTN groups on the basis of comprehensive analyses of their diagnoses, family history of HTN, and findings on physical examination, as documented in their medical records. The Mann-Whitney U test, χ 2 and Fisher's exact test were used to assess differences in characteristics of patients with different HTN types and causes of secondary HTN. RESULTS Data of 1470 inpatients with HTN from 18 clinical departments were included in the analysis. Among them, 458 (31.2%) had primary HTN, and 1012 (68.8%) had secondary HTN. Compared with patients had primary HTN, children with secondary HTN were younger and had lower body mass indexes and longer lengths of stay. Moreover, children with primary HTN had mostly been managed by the Endocrinology and Cardiology Departments, 75.8% of them having obesity-related comorbidities. In contrast, most patients with secondary HTN had been managed by the Nephrology Department, renal diseases being the leading cause of their HTN (46.3%). INTERPRETATION Secondary HTN is more common than primary HTN in pediatric clinical settings, renal diseases being the leading cause of secondary HTN.
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Affiliation(s)
- Yijun Chen
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Peiyu Ye
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xiaorong Liu
- Department of NephrologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Chunxiu Gong
- Department of Endocrinology, Genetics and MetabolismBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Caifeng Li
- Department of RheumatologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yue Yuan
- Department of CardiologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Huyong Zheng
- Hematology Oncology CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xin Xu
- Information CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Hongbo Dong
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Qin Kong
- Information CenterBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yinkun Yan
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Jie Mi
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
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Simoes E, Correia-Lima J, Calfat ELDB, Otani TZDS, Vasques DAC, Otani VHO, Bertolazzi P, Kochi C, Seelaender M, Uchida RR. Sex-Dependent Dyslipidemia and Neuro-Humoral Alterations Leading to Further Cardiovascular Risk in Juvenile Obesity. Front Nutr 2021; 7:613301. [PMID: 33644105 PMCID: PMC7906975 DOI: 10.3389/fnut.2020.613301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/21/2020] [Indexed: 01/21/2023] Open
Abstract
Objective: Childhood obesity is a growing concern as the World Health Organization (WHO) states that ~10% of adolescents worldwide are overweight or obese. This condition is the reflex of energy imbalance between the calories consumed and those expended. Sex-related responses associated with dyslipidemia, hormonal alterations, and neuro-humoral disruptions in childhood obesity are the focus of the present investigation. Methods: Ninety-two Brazilian adolescents were enrolled and divided between obese and eutrophic groups. Obesity was assessed using body mass index Z-score according to age and weight. Anthropometrical analyses, blood pressure, blood lipids, metabolism-regulating hormones, and neuropeptides were carried out. Results: Systolic blood pressure was higher in female and male patients with obesity. Obese females presented alterations in lipid profile and an augment of cardiovascular disease prediction ratios TC/HDL, TG/HDL, LDL/HDL, and VLDL/HDL. The levels of leptin, GIP, and neuropeptide showed sex-dimorphism in obesity. The obese adolescents presented increased levels of circulating insulin, c-peptide, amylin, glucagon, and GLP-1. Correlation analysis showed significant linearity between body mass index, blood pressure, lipids, lipoproteins, hormones, and neuropeptides content. Conclusions: Our data support an existing link associating hypertension, dyslipidemia, and neuro-hormonal imbalance in childhood obesity. We also described a sex-dependent pattern in childhood obesity-associated dyslipidemia and blood pressure in female patients with obesity solely.
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Affiliation(s)
- Estefania Simoes
- Cancer Metabolism Research Group, University of São Paulo, São Paulo, Brazil
| | - Joanna Correia-Lima
- Cancer Metabolism Research Group, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Pamela Bertolazzi
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Cristiane Kochi
- Physiology Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Marilia Seelaender
- Cancer Metabolism Research Group, University of São Paulo, São Paulo, Brazil.,Faculdade de Medicina, University of São Paulo, São Paulo, Brazil.,Laboratórios de Inventigação Médica 26, Hospital das Clínicas of the University of São Paulo, São Paulo, Brazil
| | - Ricardo Riyoiti Uchida
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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侯 淼, 孙 凌, 周 万, 丁 粤, 徐 秋, 曹 磊, 沈 洁, 杨 道, 吕 海. [Association between serum uric acid and subclinical cardiac damage in children with primary hypertension]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:174-179. [PMID: 33627214 PMCID: PMC7921541 DOI: 10.7499/j.issn.1008-8830.2009061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the condition of subclinical cardiac damage in children with primary hypertension and the association between serum uric acid and subclinical cardiac damage. METHODS A retrospective analysis was performed on the medical data of 55 children who were hospitalized and diagnosed with primary hypertension in the Department of Cardiology, Children's Hospital of Soochow University from January 2015 to June 2020. Forty-five healthy children, matched for age and sex, were enrolled as the control group. The two groups were compared in terms of clinical features, laboratory examination, and parameters for left ventricular structure, systolic function, and diastolic function. The correlation of serum uric acid with the parameters for left ventricular structure, systolic function, and diastolic function in children with primary hypertension was analyzed. RESULTS Compared with the control group, the hypertension group had significantly higher left ventricular mass (LVM), left ventricular mass index (LVMI), and relative wall thickness (RWT) (P < 0.05). Among the children with primary hypertension, 20 (36%) had left ventricular hypertrophy. The hypertension group had significantly larger left atrial diameter and aortic root diameter than the control group (P < 0.05). The hypertension group had a significantly higher ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity than the control group (P < 0.05). The correlation analysis showed that in children with primary hypertension, serum uric acid was positively correlated with LVM (r=0.534, P < 0.01), left atrial diameter (r=0.459, P < 0.01), and aortic root diameter (r=0.361, P=0.010). After adjustment for blood pressure, serum uric acid was still positively correlated with the above parameters (P < 0.05). CONCLUSIONS Children with primary hypertension may have subclinical cardiac damage such as left ventricular hypertrophy, left ventricular diastolic dysfunction, left atrial enlargement, and proximal aortic dilation. Elevated serum uric acid is significantly associated with cardiac damage in children with primary hypertension.
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Affiliation(s)
- 淼 侯
- />苏州大学附属儿童医院心血管内科, 江苏苏州 215000Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - 凌 孙
- />苏州大学附属儿童医院心血管内科, 江苏苏州 215000Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - 万平 周
- />苏州大学附属儿童医院心血管内科, 江苏苏州 215000Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - 粤粤 丁
- />苏州大学附属儿童医院心血管内科, 江苏苏州 215000Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - 秋琴 徐
- />苏州大学附属儿童医院心血管内科, 江苏苏州 215000Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - 磊 曹
- />苏州大学附属儿童医院心血管内科, 江苏苏州 215000Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - 洁 沈
- />苏州大学附属儿童医院心血管内科, 江苏苏州 215000Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - 道平 杨
- />苏州大学附属儿童医院心血管内科, 江苏苏州 215000Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - 海涛 吕
- />苏州大学附属儿童医院心血管内科, 江苏苏州 215000Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, China
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Kelley GA, Kelley KS, Pate RR. Inter-individual differences in body mass index were not observed as a result of aerobic exercise in children and adolescents with overweight and obesity. Pediatr Obes 2021; 16:e12692. [PMID: 32657544 DOI: 10.1111/ijpo.12692] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/09/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Exercise has been recommended as an important intervention for reducing adiposity in children and adolescents with overweight and obesity. OBJECTIVE Determine whether inter-individual differences exist in relation to exercise-induced changes in adiposity among children and adolescents with overweight and obesity. METHODS Meta-analysis of randomized controlled aerobic exercise trials and body mass index (BMI) in kg · m-2 . Change outcome standard deviations were pooled using the inverse-variance heterogeneity model. RESULTS Twenty-eight studies (1185 participants) were included. Inter-individual differences in BMI were -0.1 (95% compatibility interval, -0.7 to 0.7). The 95% prediction interval for inter-individual responses in a future study was -2.9 to 2.9. The probability of a clinically meaningful difference in variability was 29% (possibly clinically important) in favour of controls vs exercisers. CONCLUSIONS Inter-individual differences for BMI in kg · m-2 were not observed as a result of aerobic exercise in children and adolescents with overweight and obesity.
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Affiliation(s)
- George A Kelley
- School of Public Health, Department of Biostatistics, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Kristi S Kelley
- School of Public Health, Department of Biostatistics, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Russell R Pate
- Children's Physical Activity Research Group, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
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S Machado IB, Tofanelli MR, Saldanha da Silva AA, Simões E Silva AC. Factors Associated with Primary Hypertension in Pediatric Patients: An Up-to-Date. Curr Pediatr Rev 2021; 17:15-37. [PMID: 33430749 DOI: 10.2174/1573396317999210111200222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Arterial hypertension in children is considered a common alteration nowadays, mainly because obesity is a growing worldwide problem closely related to increased blood pressure. Childhood hypertension can be classified as primary or secondary, depending on the etiology. Primary or essential hypertension still has its pathophysiology not fully elucidated, and there is no consensus in the literature on most underlying mechanisms. In this review, genetic and environmental factors, including sodium and potassium intake, socioeconomic status, ethnicity, family structure, obesity, sedentary lifestyle, prematurity and low birth weight, prenatal and postnatal exposures are highlighted. OBJECTIVE The present study aimed to perform an update on primary hypertension in childhood, providing clinicians and researchers an overview of the current state of the literature regarding the influence of genetic and environmental factors. METHODS This integrative review searched for articles on genetic and environmental factors related to primary hypertension in pediatric patients. The databases evaluated were PubMed and Scopus. RESULTS The studies have provided insights regarding many genetic and environmental factors, in addition to their association with the pathophysiology of primary hypertension in childhood. Findings corroborated the idea that primary hypertension is a multifactorial disease. Further studies in the pediatric population are needed to elucidate the underlying mechanisms. CONCLUSION The study of primary hypertension in pediatrics has utmost importance for the adoption of preventive measures and the development of more efficient treatments, therefore reducing childhood morbidity and the incidence of cardiovascular diseases and other health consequences later in life.
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Affiliation(s)
- Isabella Barreto S Machado
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Matheus Rampinelli Tofanelli
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Ariadna A Saldanha da Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Zhao W, Su D, Mo L, Chen C, Ye B, Qin S, Liu J, Pang Y. Lifestyle Clusters and Cardiometabolic Risks in Adolescents: A Chinese School-Based Study Using a Latent Class Analysis Approach. Front Pediatr 2021; 9:728841. [PMID: 34976884 PMCID: PMC8716941 DOI: 10.3389/fped.2021.728841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Unhealthy dietary and lifestyle behaviors are associated with a higher prevalence of non-communicable chronic diseases and higher mortality in adults. However, there remains some uncertainty about the magnitude of the associations between lifestyle behaviors and cardiovascular factors in adolescents. Methods: We conducted a school-based cross-sectional study of 895 Chinese adolescents aged 15-19 years. They participated in a questionnaire survey, physical examination, and blood sample collection. Latent class analysis (LCA) was used to identify heterogeneous subgroups of lifestyle behaviors. A set of 12 latent class indicators, which reflected lifestyle behaviors including dietary habits, physical activity, sleep duration, screen time, and pressure perception, were included in the analysis. Logistic regression analysis was performed to determine whether the derived classes were related to a cardiometabolic risk. Results: In total, 13.7 and 5.6% of the participants were overweight and obese, respectively, and 8.4 and 14.1% reported having pre-hypertension and hypertension, respectively. A two-class model provided the best fit with a healthy lifestyle pattern (65.8%) and a sub-healthy lifestyle pattern (34.2%). There were more female participants with a healthy lifestyle (56.2 vs. 43.8%), whereas there were more males with a sub-healthy lifestyle (45.4 vs. 54.6%), (all P = 0.002). Increased risk of cardiometabolic abnormality (BMI categories, blood pressure and lipids) was not significant across lifestyle patterns, except for waist circumference (70.5 vs 69.1 cm, P = 0.044). There was no significant difference in physical activity and intake of fruit and vegetable between the two patterns. Conclusion: Primary prevention based on lifestyle modification should target patterns of behaviors at high risk in adolescents. Due to the complex effect of lifestyle clusters on cardiometabolic risks, well-designed and prospective studies in adolescents are needed in the future.
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Affiliation(s)
- Weiying Zhao
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Danyan Su
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Luxia Mo
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Cheng Chen
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bingbing Ye
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Suyuan Qin
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Liu
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yusheng Pang
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Angi A, Chiarelli F. Obesity and Diabetes: A Sword of Damocles for Future Generations. Biomedicines 2020; 8:E478. [PMID: 33171922 PMCID: PMC7694547 DOI: 10.3390/biomedicines8110478] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
Childhood obesity is one of the most challenging problem of the 21st century. The prevalence has increased, reaching an alarming rate. Furthermore, the problem is global and is also affecting low- and middle-income countries. This global obesity epidemic explains how the roots of cardiovascular disease, the most common cause of mortality among adults, begin in childhood. Overweight and obese children are likely to stay obese into adulthood and to develop noncommunicable diseases such as diabetes and cardiovascular diseases at a younger age. Thus, prevention should be the major goal and should start early in life. The aim of this review is to present an updated framework of the current understanding of the cardiovascular and metabolic risks in obese children and adolescents and to discuss the available therapeutic options.
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Affiliation(s)
- Alessia Angi
- Department of Pediatrics, University of Chieti, 66100 Chieti, Italy;
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Overweight and Obesity in Children of Immigrant Versus Native Parents: Exploring a Local Setting in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217897. [PMID: 33126527 PMCID: PMC7663684 DOI: 10.3390/ijerph17217897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 11/29/2022]
Abstract
In Portugal, the majority of immigrants come from Portuguese-speaking countries. Among children, overweight and obesity are serious public health concerns, but a few studies include children with immigrant background. This study aimed to estimate the prevalence of overweight and obesity and risk of abdominal obesity in school-age children and to explore potential determinants, considering the origin of the children’s parents (both mother and father are non-Portuguese, only one Portuguese, and both are Portuguese). A cross-sectional study included a random sample of 789 children (5–11 years old, 49.2% of males and 50.8% female) attending public primary schools in Barreiro, district of Setubal, Portugal. Fieldwork occurred from 20th April to 3rd July 2009. Data concerning socioeconomic, eating habits, and sports outside school were obtained through a questionnaire applied to the children’s person in charge. Anthropometric measures were collected by certified technicians. One-third of the children presented overweight and obesity (33.7%, 95% CI [30.0; 37.7]) and risk of abdominal obesity (16.4%, 95% CI [13.6; 19.7]) without differences according to parents’ origin. Children with immigrant background presented higher consumption of low-priced, high-sugar, and high-fat foods, with a worse situation for girls. Females from both non-Portuguese parents also practiced less sports outside school than those where one or two parents are Portuguese. Thus, promoting and monitoring a healthy diet and physical activity in this group should be prioritized in this local setting.
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