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Javidi H, Mariam A, Alkhaled L, Pantalone KM, Rotroff DM. An interpretable predictive deep learning platform for pediatric metabolic diseases. J Am Med Inform Assoc 2024; 31:1227-1238. [PMID: 38497983 PMCID: PMC11105121 DOI: 10.1093/jamia/ocae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVES Metabolic disease in children is increasing worldwide and predisposes a wide array of chronic comorbid conditions with severe impacts on quality of life. Tools for early detection are needed to promptly intervene to prevent or slow the development of these long-term complications. MATERIALS AND METHODS No clinically available tools are currently in widespread use that can predict the onset of metabolic diseases in pediatric patients. Here, we use interpretable deep learning, leveraging longitudinal clinical measurements, demographical data, and diagnosis codes from electronic health record data from a large integrated health system to predict the onset of prediabetes, type 2 diabetes (T2D), and metabolic syndrome in pediatric cohorts. RESULTS The cohort included 49 517 children with overweight or obesity aged 2-18 (54.9% male, 73% Caucasian), with a median follow-up time of 7.5 years and mean body mass index (BMI) percentile of 88.6%. Our model demonstrated area under receiver operating characteristic curve (AUC) accuracies up to 0.87, 0.79, and 0.79 for predicting T2D, metabolic syndrome, and prediabetes, respectively. Whereas most risk calculators use only recently available data, incorporating longitudinal data improved AUCs by 13.04%, 11.48%, and 11.67% for T2D, syndrome, and prediabetes, respectively, versus models using the most recent BMI (P < 2.2 × 10-16). DISCUSSION Despite most risk calculators using only the most recent data, incorporating longitudinal data improved the model accuracies because utilizing trajectories provides a more comprehensive characterization of the patient's health history. Our interpretable model indicated that BMI trajectories were consistently identified as one of the most influential features for prediction, highlighting the advantages of incorporating longitudinal data when available.
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Affiliation(s)
- Hamed Javidi
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, United States
- Department of Electrical Engineering and Computer Science, Cleveland State University, Cleveland, OH 44115, United States
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Arshiya Mariam
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, United States
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Lina Alkhaled
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, United States
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Kevin M Pantalone
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, United States
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Daniel M Rotroff
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, United States
- Department of Electrical Engineering and Computer Science, Cleveland State University, Cleveland, OH 44115, United States
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, United States
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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Di Bonito P, Di Sessa A, Licenziati MR, Corica D, Wasniewska M, Miraglia del Giudice E, Morandi A, Maffeis C, Faienza MF, Mozzillo E, Calcaterra V, Franco F, Maltoni G, Moio N, Iannuzzi A, Valerio G. Sex-Related Differences in Cardiovascular Risk in Adolescents with Overweight or Obesity. Rev Cardiovasc Med 2024; 25:141. [PMID: 39076567 PMCID: PMC11264036 DOI: 10.31083/j.rcm2504141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 07/31/2024] Open
Abstract
Background Pediatric obesity is closely associated with cardiometabolic comorbidities, but the role of sex in this relationship is less investigated. We aimed to evaluate sex-related differences on cardiometabolic risk factors and preclinical signs of target organ damage in adolescents with overweight/obesity (OW/OB). Methods The main cross-sectional study included 988 adolescents (510 boys and 478 girls) with OW/OB aged 10-18 years. In all youths clinical and biochemical variables were evaluated and an abdominal echography was performed. Echocardiographic data for the assessment of left ventricular mass (LVM) and relative wall thickness (RWT) were available in an independent sample of 142 youths (67 boys and 75 girls), while echographic data of carotid intima media thickness (cIMT) were available in 107 youths (59 boys and 48 girls). Results The three samples did not differ for age, body mass index, and sex distribution. In the main sample, boys showed higher waist-to-height ratio (WHtR) values (p < 0.0001) and fasting glucose levels (p = 0.002) than girls. Lower levels of estimates glomerular filtration rate (eGFR) were found in girls vs boys (p < 0.0001). No sex-related differences for prediabetes and hyperlipidemia were observed. A higher prevalence of WHtR ≥ 0.60 (57.3% vs 49.6%, p = 0.016) and fatty liver disease (FLD) (54.5% vs 38.3%, p < 0.0001) as well as a trend for high prevalence of hypertension (40.4 vs 34.7%, p = 0.06) were observed in boys vs girls. More, a higher prevalence of mild reduced eGFR (MReGFR) ( < 90 mL/min/1.73 m 2 ) was observed in girls vs boys (14.6% vs 9.6 %, p < 0.0001). In the sample with echocardiographic evaluation, boys showed higher levels of LVM (p = 0.046), and RWT (p = 0.003) than girls. Again, in the sample with carotid echography, boys showed higher levels of cIMT as compared to girls (p = 0.011). Conclusions Adolescent boys with OW/OB showed higher risk of abdominal adiposity, FLD, and increased cardiac and vascular impairment than girls, whereas the latter had a higher risk of MReGFR. Risk stratification by sex for cardiometabolic risk factors or preclinical signs of target organ damage should be considered in youths with OW/OB.
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Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie” Hospital, 80078 Pozzuoli, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli", 80138 Napoli, Italy
| | - Maria Rosaria Licenziati
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80129 Naples, Italy
| | - Domenico Corica
- Department of Human Pathology in Adulthood and Childhood, University of Messina, 98122 Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, 98122 Messina, Italy
| | - Emanuele Miraglia del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli", 80138 Napoli, Italy
| | - Anita Morandi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Maria Felicia Faienza
- Pediatric Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, University of Naples “Federico II”, 80131 Napoli, Italy
| | - Valeria Calcaterra
- Pediatric Department, “V. Buzzi" Children's Hospital, 20154 Milano, Italy
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Francesca Franco
- Pediatric Department, Azienda Sanitaria Universitaria del Friuli Centrale, Hospital of Udine, 33100 Udine, Italy
| | - Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-universitaria di Bologna, 40138 Bologna, Italy
| | - Nicola Moio
- Department of Cardiology, “S. Maria delle Grazie” Hospital, 80078 Pozzuoli, Italy
| | - Arcangelo Iannuzzi
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy
| | - Giuliana Valerio
- Department of Medical, Movement and Wellbeing Sciences, University of Napoli “Parthenope”, 80133 Napoli, Italy
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Araújo D, Morgado C, Correia-Pinto J, Antunes H. Predicting Insulin Resistance in a Pediatric Population With Obesity. J Pediatr Gastroenterol Nutr 2023; 77:779-787. [PMID: 37608437 DOI: 10.1097/mpg.0000000000003910] [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: 08/24/2023]
Abstract
OBJECTIVES Insulin resistance (IR) affects children and adolescents with obesity and early diagnosis is crucial to prevent long-term consequences. Our aim was to identify predictors of IR and develop a multivariate model to accurately predict IR. METHODS We conducted a cross-sectional analysis of demographical, clinical, and biochemical data from a cohort of patients attending a specialized Paediatric Nutrition Unit in Portugal over a 20-year period. We developed multivariate regression models to predict IR. The participants were randomly divided into 2 groups: a model group for developing the predictive models and a validation group for cross-validation of the study. RESULTS Our study included 1423 participants, aged 3-17 years old, randomly divided in the model (n = 879) and validation groups (n = 544). The predictive models, including uniquely demographic and clinical variables, demonstrated good discriminative ability [area under the curve (AUC): 0.834-0.868; sensitivity: 77.0%-83.7%; specificity: 77.0%-78.7%] and high negative predictive values (88.9%-91.6%). While the diagnostic ability of adding fasting glucose or triglycerides/high density lipoprotein cholesterol index to the models based on clinical parameters did not show significant improvement, fasting insulin appeared to enhance the discriminative power of the model (AUC: 0.996). During the validation, the model considering demographic and clinical variables along with insulin showed excellent IR discrimination (AUC: 0.978) and maintained high negative predictive values (90%-96.3%) for all models. CONCLUSION Models based on demographic and clinical variables can be advantageously used to identify children and adolescents at moderate/high risk of IR, who would benefit from fasting insulin evaluation.
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Affiliation(s)
- Daniela Araújo
- From the Pediatrics Department, Hospital de Braga, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- School of Medicine, University of Minho, Braga, Portugal
| | - Carla Morgado
- the Department of Neurology, Hospital of Braga, Braga, Portugal
- CEREBRO - Brain Health Center, Braga, Portugal
- ISAVE, Higher Institute of Health, Braga, Portugal
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- School of Medicine, University of Minho, Braga, Portugal
- the Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
- ICVS/3B's Associate Laboratory, University of Minho, Braga/Guimarães, Portugal
| | - Henedina Antunes
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- School of Medicine, University of Minho, Braga, Portugal
- the Gastroenterology, Hepatology and Nutrition Unit, Pediatric Department and Academic Clinical Center (2CA Braga), Hospital de Braga, Braga, Portugal
- ICVS/3B's Associate Laboratory, University of Minho, Braga/Guimarães, Portugal
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Mihuta MS, Paul C, Borlea A, Roi CM, Pescari D, Velea-Barta OA, Mozos I, Stoian D. Connections between serum Trimethylamine N-Oxide (TMAO), a gut-derived metabolite, and vascular biomarkers evaluating arterial stiffness and subclinical atherosclerosis in children with obesity. Front Endocrinol (Lausanne) 2023; 14:1253584. [PMID: 37850094 PMCID: PMC10577381 DOI: 10.3389/fendo.2023.1253584] [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: 07/05/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Childhood obesity leads to early subclinical atherosclerosis and arterial stiffness. Studying biomarkers like trimethylamine N-oxide (TMAO), linked to cardio-metabolic disorders in adults, is crucial to prevent long-term cardiovascular issues. Methods The study involved 70 children aged 4 to 18 (50 obese, 20 normal-weight). Clinical examination included BMI, waist measurements, puberty stage, the presence of acanthosis nigricans, and irregular menstrual cycles. Subclinical atherosclerosis was assessed by measuring the carotid intima-media thickness (CIMT), and the arterial stiffness was evaluated through surrogate markers like the pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures. The blood biomarkers included determining the values of TMAO, HOMA-IR, and other usual biomarkers investigating metabolism. Results The study detected significantly elevated levels of TMAO in obese children compared to controls. TMAO presented positive correlations to BMI, waist circumference and waist-to-height ratio and was also observed as an independent predictor of all three parameters. Significant correlations were observed between TMAO and vascular markers such as CIMT, PWV, and peripheral BP levels. TMAO independently predicts CIMT, PWV, peripheral BP, and central SBP levels, even after adding BMI, waist circumference, waist-to-height ratio, puberty development and age in the regression model. Obese children with high HOMA-IR presented a greater weight excess and significantly higher vascular markers, but TMAO levels did not differ significantly from the obese with HOMA-IR Conclusion Our study provides compelling evidence supporting the link between serum TMAO, obesity, and vascular damage in children. These findings highlight the importance of further research to unravel the underlying mechanisms of this connection.
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Affiliation(s)
- Monica Simina Mihuta
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Corina Paul
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Andreea Borlea
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Cristina Mihaela Roi
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Denisa Pescari
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Oana-Alexandra Velea-Barta
- 3rd Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioana Mozos
- Department of Functional Sciences—Pathophysiology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Dana Stoian
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
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Mihuta MS, Paul C, Borlea A, Roi CM, Velea-Barta OA, Mozos I, Stoian D. Unveiling the Silent Danger of Childhood Obesity: Non-Invasive Biomarkers Such as Carotid Intima-Media Thickness, Arterial Stiffness Surrogate Markers, and Blood Pressure Are Useful in Detecting Early Vascular Alterations in Obese Children. Biomedicines 2023; 11:1841. [PMID: 37509481 PMCID: PMC10376407 DOI: 10.3390/biomedicines11071841] [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: 06/01/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Obese children present a higher cardio-metabolic risk. Measuring vascular biomarkers that assess the evolution of arterial stiffness, subclinical atherosclerosis, and hypertension in such patients could be helpful in the long term. We studied 84 children, aged from 6 to 18 years: 50 obese subjects, versus 34 of normal weight. Clinical examination involved: BMI, waist circumference, waist-to-height ratio, and detection of the presence of acanthosis nigricans and irregular menstrual cycles (the latter in adolescent girls). The carotid intima-media thickness (CIMT) was measured with the Aixplorer MACH 30 echography device. The pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures (i.e., SBP, DBP, cSBP, cDBP, and cPP) were acquired through a Mobil-O-Graph device. Obese subjects underwent body composition analysis with a Tanita BC-418. Blood tests were: HOMA-IR, lipid panel, uric acid, and 25-OH vitamin D. All vascular biomarkers presented increased values in obese subjects versus controls. The following cut-off values were significant in detecting obesity: for PWV > 4.6 m/s, cSBP > 106 mmHg for the <12-year-olds, PWV > 4.5 m/s and cSBP > 115 mmHg for the 12-15-year-olds, and PWV > 5 m/s, cSBP > 123 mmHg for the >15-year-olds. AIx is higher in obese children, regardless of their insulin resistance status. Waist circumference and waist-to-height ratio correlate to all vascular parameters. HOMA-IR is an independent predictor for all vascular parameters except CIMT. Cut-off values for PWV of >4.8 m/s, SBP > 125 mmHg, and a cSBP > 117 mmHg predicted the presence of acanthosis nigricans. Obese girls with irregular menses displayed significantly higher PWV, SBP, and DPB. Elevated levels of uric acid, LDL-c, non-LDL-c, triglycerides, and transaminases, and low levels of HDL-c and 25-OH vitamin D correlated with higher arterial stiffness and CIMT values. We conclude that CIMT and the markers of arterial stiffness are useful in the early detection of vascular damage in obese children.
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Affiliation(s)
- Monica Simina Mihuta
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Corina Paul
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andreea Borlea
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristina Mihaela Roi
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Oana-Alexandra Velea-Barta
- 3rd Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, 300173 Timisoara, Romania
| | - Dana Stoian
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Palumbo S, Cirillo G, Sanchez G, Aiello F, Fachin A, Baldo F, Pellegrin MC, Cassio A, Salerno M, Maghnie M, Faienza MF, Wasniewska M, Fintini D, Giacomozzi C, Ciccone S, Miraglia Del Giudice E, Tornese G, Grandone A. A new DLK1 defect in a family with idiopathic central precocious puberty: elucidation of the male phenotype. J Endocrinol Invest 2022; 46:1233-1240. [PMID: 36577869 DOI: 10.1007/s40618-022-01997-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE We aimed to investigate a cohort of female and male patients with idiopathic central precocious puberty (CPP), negative for Makorin Ring Finger Protein 3 (MKRN3) defect, by molecular screening for Delta-like 1 homolog (DLK1) defects. DLK1 is an imprinted gene, whose mutations have been described as a rare cause of CPP in girls and adult women with precocious menarche, obesity and metabolic derangement. METHODS We enrolled 14 girls with familial CPP and 13 boys with familial or sporadic CPP from multiple academic hospital centers. Gene sequencing of DLK1 gene was performed. Circulating levels of DLK1 were measured and clinical and biochemical characteristics were described in those with DLK1 defects. RESULTS A novel heterozygous mutation in DLK1, c.288_289insC (p.Cys97Leufs*16), was identified in a male proband, his sister and their father. Age at onset of puberty was in line with previous reports in the girl and 8 years in the boy. The father with untreated CPP showed short stature. No metabolic derangement was present in the father except hypercholesterolemia. Undetectable Dlk1 serum levels indicated the complete lack of protein production in the three affected patients. CONCLUSION A DLK1 defect has been identified for the first time in a boy, underscoring the importance of genetic testing in males with idiopathic or sporadic CPP. The short stature reported by his untreated father suggests the need for timely diagnosis and treatment of subjects with DLK1 defects.
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Affiliation(s)
- S Palumbo
- Department of Child, Women, General and Specialized Surgery, University of Campania, "L. Vanvitelli", Vico L. De Crecchio n° 2, 80138, Naples, Italy
| | - G Cirillo
- Department of Child, Women, General and Specialized Surgery, University of Campania, "L. Vanvitelli", Vico L. De Crecchio n° 2, 80138, Naples, Italy
| | - G Sanchez
- Department of Child, Women, General and Specialized Surgery, University of Campania, "L. Vanvitelli", Vico L. De Crecchio n° 2, 80138, Naples, Italy
| | - F Aiello
- Department of Child, Women, General and Specialized Surgery, University of Campania, "L. Vanvitelli", Vico L. De Crecchio n° 2, 80138, Naples, Italy
| | - A Fachin
- University of Trieste, Trieste, Italy
| | - F Baldo
- University of Trieste, Trieste, Italy
| | - M C Pellegrin
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - A Cassio
- Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - M Salerno
- Pediatric Endocrine Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - M Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - M F Faienza
- Department of Biomedical Sciences and Human Oncology, Pediatric Unit, University of Bari A. Moro, Bari, Italy
| | - M Wasniewska
- Unit of Paediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - D Fintini
- Endocrinology Unit, University-Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - C Giacomozzi
- Unit of Pediatrics, Department of Maternal and Child Health, Carlo Poma Hospital, ASST-Mantova, Mantua, Italy
| | - S Ciccone
- Pediatric Unit-"M. Bufalini" Hospital - Cesena, Cesena, Italy
| | - E Miraglia Del Giudice
- Department of Child, Women, General and Specialized Surgery, University of Campania, "L. Vanvitelli", Vico L. De Crecchio n° 2, 80138, Naples, Italy
| | - G Tornese
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - A Grandone
- Department of Child, Women, General and Specialized Surgery, University of Campania, "L. Vanvitelli", Vico L. De Crecchio n° 2, 80138, Naples, Italy.
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Hu X, Li XK, Wen S, Li X, Zeng TS, Zhang JY, Wang W, Bi Y, Zhang Q, Tian SH, Min J, Wang Y, Liu G, Huang H, Peng M, Zhang J, Wu C, Li YM, Sun H, Ning G, Chen LL. Predictive modeling the probability of suffering from metabolic syndrome using machine learning: A population-based study. Heliyon 2022; 8:e12343. [PMID: 36643319 PMCID: PMC9834713 DOI: 10.1016/j.heliyon.2022.e12343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/16/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Background There is an increasing trend of Metabolic syndrome (MetS) prevalence, which has been considered as an important contributor for cardiovascular disease (CVD), cancers and diabetes. However, there is often a long asymptomatic phase of MetS, resulting in not diagnosed and intervened so timely as needed. It would be very helpful to explore tools to predict the probability of suffering from MetS in daily life or routinely clinical practice. Objective To develop models that predict individuals' probability of suffering from MetS timely with high efficacy in general population. Methods The present study enrolled 8964 individuals aged 40-75 years without severe diseases, which was a part of the REACTION study from October 2011 to February 2012. We developed three prediction models for different scenarios in hospital (Model 1, 2) or at home (Model 3) based on LightGBM (LGBM) technique and corresponding logistic regression (LR) models were also constructed for comparison. Model 1 included variables of laboratory tests, lifestyles and anthropometric measurements while model 2 was built with components of MetS excluded based on model 1, and model 3 was constructed with blood biochemical indexes removed based on model 2. Additionally, we also investigated the strength of association between the predictive factors and MetS, as well as that between the predictors and each component of MetS. Results In this study, 2714 (30.3%) participants suffer from MetS accordingly. The performances of the LGBM models in predicting the probability of suffering from MetS produced good results and were presented as follows: model 1 had an area under the curve (AUC) value of 0.993 while model 2 indicated an AUC value of 0.885. Model 3 had an AUC value of 0.859, which is close to that of model 2. The AUC values of LR model 1 and 2 for the scenario in hospital and model 3 at home were 0.938, 0.839 and 0.820 respectively, which seemed lower than that of their corresponding machine learning models, respectively. In both LGBM and logistic models, gender, height and resting pulse rate (RPR) were predictors for MetS. Women had higher risk of MetS than men (OR 8.84, CI: 6.70-11.66), and each 1-cm increase in height indicated 3.8% higher risk of suffering from MetS in people over 58 years, whereas each 1- Beat Per Minute (bpm) increase in RPR showed 1.0% higher risk in individuals younger than 62 years. Conclusion The present study showed that the prediction models developed by machine learning demonstrated effective in evaluating the probability of suffering from MetS, and presented prominent predicting efficacies and accuracies. Additionally, we found that women showed a higher risk of MetS than men, and height in individuals over 58 years was important factor in predicting the probability of suffering from MetS while RPR was of vital importance in people aged 40-62 years.
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Affiliation(s)
- Xiang Hu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Xue-Ke Li
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Shiping Wen
- Centre for Artificial Intelligence, Faculty of Engineering Information Technology, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Xingyu Li
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Tian-Shu Zeng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Jiao-Yue Zhang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Weiqing Wang
- Department of Endocrinology and Metabolism, State Key Laboratory of Medical Genomes, National Clinical Research Center for Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yufang Bi
- Department of Endocrinology and Metabolism, State Key Laboratory of Medical Genomes, National Clinical Research Center for Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Qiao Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng-Hua Tian
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Jie Min
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Ying Wang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Geng Liu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | | | - Miaomiao Peng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | | | - Chaodong Wu
- Department of Nutrition and Food Science, Texas A&M University, College Station, TX, USA
| | - Yu-Ming Li
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Hui Sun
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Guang Ning
- Department of Endocrinology and Metabolism, State Key Laboratory of Medical Genomes, National Clinical Research Center for Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Lu-Lu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China,Corresponding author.
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8
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Pollock S, Swamy MR, Tremblay ES, Shen L. Acanthosis nigricans in the pediatric population: a narrative review of the current approach to management in primary care. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2022; 5:42. [PMID: 36420374 PMCID: PMC9678372 DOI: 10.21037/pm-21-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective This narrative review aims to provide readers with a comprehensive overview of the current literature of acanthosis nigricans (AN) in the pediatric and adolescent population, including best practices for identifying the condition, with a focus on the recommended management in the primary care setting to enable early and enhanced intervention. Background AN is frequently seen in obese and overweight children and adolescents. Current research suggests an association with insulin resistance, type 2 diabetes mellitus, and obesity, and often primary care physicians are the first point of contact for individuals with this dermatologic condition. However, identifying the condition at an early stage may be difficult. Methods We identified case and cross-sectional studies, clinical trials, and literature reviews of pediatric AN for ages 0 to 18 years in the United States and internationally. We considered publications for background from before the year 2000 and publications for approach to management from after the year 2000. Conclusions AN in the pediatric population can be a harbinger for underlying metabolic syndrome and insulin resistance. A thorough investigation and appropriate screening of children at risk, with a focus on early identification of the dermatologic condition and its associated comorbidities in the primary care setting, and early treatment is recommended to prevent long term consequences and decrease the risk of cardiovascular complications.
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Affiliation(s)
- Samara Pollock
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | | | | | - Lisa Shen
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
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9
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Diagnosis accuracy of waist-to-height ratio to predict cardiometabolic risk in children with obesity. Pediatr Res 2022; 93:1294-1301. [PMID: 35915238 DOI: 10.1038/s41390-022-02223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Waist-to-height ratio (WHtR) predicts abdominal fat and cardiometabolic risk. In children with obesity, the most adequate cut-off to predict cardiometabolic risk as well as its ability to predict risk changes over time has not been tested. Our aim was to define an appropriate WHtR cut-off to predict cardiometabolic risk in children with obesity, and to analyze its ability to predict changes in cardiometabolic risk over time. METHODS This is an observational prospective study secondary to the OBEMAT2.0 trial. We included data from 218 participants (8-15 years) who attended baseline and final visits (12 months later). The main outcome measure was a cardiometabolic risk score derived from blood pressure, lipoproteins, and HOMA index of insulin resistance. RESULTS The optimal cut-off to predict the cardiometabolic risk score was WHtR ≥0.55 with an area under the curve of 0.675 (95% CI: 0.589-0.760) at baseline and 0.682 (95% CI: 0.585-0.779) at the final visit. Multivariate models for repeated measures showed that changes in cardiometabolic risk were significantly associated with changes in WHtR. CONCLUSION This study confirms the clinical utility of WHtR to predict changes in cardiometabolic risk over time in children with obesity. The most accurate cut-off to predict cardiometabolic risk in children with obesity was WHtR ≥0.55. IMPACT In children, there is no consensus on a unique WHtR cut-off to predict cardiometabolic risk. The present work provides sufficient evidence to support the use of the 0.55 boundary. We have a large sample of children with obesity, with whom we compared the previously proposed boundaries according to cardiometabolic risk, and we found the optimal WHtR cut-off to predict it. We also analyzed if a reduction in the WHtR was associated with an improvement in their cardiometabolic profile.
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10
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Javidi H, Mariam A, Khademi G, Zabor EC, Zhao R, Radivoyevitch T, Rotroff DM. Identification of robust deep neural network models of longitudinal clinical measurements. NPJ Digit Med 2022; 5:106. [PMID: 35896817 PMCID: PMC9329311 DOI: 10.1038/s41746-022-00651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
Deep learning (DL) from electronic health records holds promise for disease prediction, but systematic methods for learning from simulated longitudinal clinical measurements have yet to be reported. We compared nine DL frameworks using simulated body mass index (BMI), glucose, and systolic blood pressure trajectories, independently isolated shape and magnitude changes, and evaluated model performance across various parameters (e.g., irregularity, missingness). Overall, discrimination based on variation in shape was more challenging than magnitude. Time-series forest-convolutional neural networks (TSF-CNN) and Gramian angular field(GAF)-CNN outperformed other approaches (P < 0.05) with overall area-under-the-curve (AUCs) of 0.93 for both models, and 0.92 and 0.89 for variation in magnitude and shape with up to 50% missing data. Furthermore, in a real-world assessment, the TSF-CNN model predicted T2D with AUCs reaching 0.72 using only BMI trajectories. In conclusion, we performed an extensive evaluation of DL approaches and identified robust modeling frameworks for disease prediction based on longitudinal clinical measurements.
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Affiliation(s)
- Hamed Javidi
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Electrical Engineering and Computer Science, Cleveland State University, Cleveland, OH, USA
| | - Arshiya Mariam
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gholamreza Khademi
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emily C Zabor
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ran Zhao
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tomas Radivoyevitch
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel M Rotroff
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
- Department of Electrical Engineering and Computer Science, Cleveland State University, Cleveland, OH, USA.
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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11
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Stevens P, Hunter J, Molodysky E. The role of hyperinsulinaemia in screening for prediabetes in the adolescent population: A systematic literature review. Diabetes Metab Syndr 2022; 16:102445. [PMID: 35305511 DOI: 10.1016/j.dsx.2022.102445] [Citation(s) in RCA: 2] [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: 06/21/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Present screening methods for Type 2 diabetes (T2DM) fall short of detecting prediabetes. This paper summarises the literature on the utility of insulin measurements (hyperinsulinemia) in detecting prediabetes in adolescents. METHODS A systematic literature review was conducted using EMBASE and Medline. Relevant data on hyperinsulinemia in the adolescent population is narrated. RESULTS The database search identified 174 potential articles; 106 underwent a full-paper review, and 36 were included. CONCLUSION Elevated fasting insulin is a marker of impaired insulin resistance and pending beta-cell dysfunction in at-risk adolescents and can be an early indicator of prediabetes.
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12
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Pediatric obesity-related non-alcoholic fatty liver disease: waist-to-height ratio best anthropometrical predictor. Pediatr Res 2021; 90:166-170. [PMID: 33038873 DOI: 10.1038/s41390-020-01192-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in pediatric obesity. Our study aims to identify a predictive anthropometrical measure for NAFLD in obese children. METHODS We retrospectively enrolled children and adolescents with obesity. Physical, biochemical, and ultrasound assessments were available. ROC curve tests were performed to identify the best predictor of NAFLD among waist-to-height ratio (WHR), BMI z-score, and triponderal mass index (TMI, an anthropometric index recently associated with increased adiposity in children). Subsequently, a cut-off value was identified. RESULTS In total, 1900 children and adolescents (1011 with NAFLD) were included. WHR (AUC 0.62, 95% CI 0.59-0.64) was the best predictor of NAFLD compared to BMI z-score (AUC 0.58, 95% CI 0.55-0.60) and TMI (AUC 0.58, 95% CI 0.55-0.61). WHR ≥ 0.53 in boys and 0.63 in girls displayed the best sensitivity and specificity for NAFLD presence. In addition, children with high WHR showed a significantly higher risk of NAFLD (boys: OR 2.43, 95% CI 1.61-3.68, p < 0.0001; girls: OR 1.92, 95% CI 1.58-2.34, p < 0.0001) and elevated ALT (OR 5.71, 95% CI 2.09-15.56, p = 0.0007; girls: OR 2.16, 95% CI 1.70-2.74, p < 0.0001) independent of covariates. CONCLUSIONS WHR might represent a good anthropometric tool to candidate children and adolescents to NAFLD screening. WHR cut-off differs according to sex, being lower in boys than girls. IMPACT Waist-to-height ratio is a better predictor of non-alcoholic fatty liver disease risk compared to other anthropometric measures in obese children and adolescents. The predictive cut-off of waist-to-height ratio differs between boys and girls, being lower in boys than girls. The use of waist-to-height ratio measurement and its cut-off in clinical practice might help clinician in identifying obese children and adolescents at risk of non-alcoholic fatty liver disease.
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Bellarosa C, Bedogni G, Bianco A, Cicolini S, Caroli D, Tiribelli C, Sartorio A. Association of Serum Bilirubin Level with Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study of 1672 Obese Children. J Clin Med 2021; 10:jcm10132812. [PMID: 34202304 PMCID: PMC8268762 DOI: 10.3390/jcm10132812] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022] Open
Abstract
As in adults, obesity also plays a central role in the development of metabolic syndrome (MS) in children. Non-alcoholic fatty liver disease (NAFLD) is considered a manifestation of MS. Not only MS but also NAFLD seem to be inversely associated with serum bilirubin concentrations, an important endogenous tissue protector when only mild elevated. The aim of the study was to evaluate the association between serum bilirubin levels and the prevalence of MS and NAFLD in Italian obese children and adolescents. A retrospective cross-sectional study was performed in 1672 patients aged from 5 to 18 years. Clinical and laboratory parameters were assessed. NAFLD was measured by liver ultrasonography. The study was approved by the Ethical Committee of the Istituto Auxologico Italiano (research project code 1C021_2020, acronym BILOB). MS was present in 24% and fatty liver (FL) in 38% of this population. Bilirubin was not associated with FL and MS as a whole, but it was inversely associated only with selected components of MS, i.e., large WC, high blood pressure and high triglycerides. Our data suggest that bilirubin is not protective against MS and NAFLD in the presence of severe obesity.
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Affiliation(s)
- Cristina Bellarosa
- Italian Liver Foundation, 34149 Trieste, Italy; (G.B.); (A.B.); (C.T.)
- Correspondence:
| | - Giorgio Bedogni
- Italian Liver Foundation, 34149 Trieste, Italy; (G.B.); (A.B.); (C.T.)
| | - Annalisa Bianco
- Italian Liver Foundation, 34149 Trieste, Italy; (G.B.); (A.B.); (C.T.)
- Life Science Department, University of Trieste, 34127 Trieste, Italy
| | - Sabrina Cicolini
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Verbania, Italy; (S.C.); (D.C.); (A.S.)
| | - Diana Caroli
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Verbania, Italy; (S.C.); (D.C.); (A.S.)
| | - Claudio Tiribelli
- Italian Liver Foundation, 34149 Trieste, Italy; (G.B.); (A.B.); (C.T.)
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Verbania, Italy; (S.C.); (D.C.); (A.S.)
- Istituto Auxologico Italiano, IRCCS, Division of Auxology and Metabolic Diseases, 28824 Verbania, Italy
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Vangeepuram N, Liu B, Chiu PH, Wang L, Pandey G. Predicting youth diabetes risk using NHANES data and machine learning. Sci Rep 2021; 11:11212. [PMID: 34045491 PMCID: PMC8160335 DOI: 10.1038/s41598-021-90406-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/30/2021] [Indexed: 01/21/2023] Open
Abstract
Prediabetes and diabetes mellitus (preDM/DM) have become alarmingly prevalent among youth in recent years. However, simple questionnaire-based screening tools to reliably assess diabetes risk are only available for adults, not youth. As a first step in developing such a tool, we used a large-scale dataset from the National Health and Nutritional Examination Survey (NHANES) to examine the performance of a published pediatric clinical screening guideline in identifying youth with preDM/DM based on American Diabetes Association diagnostic biomarkers. We assessed the agreement between the clinical guideline and biomarker criteria using established evaluation measures (sensitivity, specificity, positive/negative predictive value, F-measure for the positive/negative preDM/DM classes, and Kappa). We also compared the performance of the guideline to those of machine learning (ML) based preDM/DM classifiers derived from the NHANES dataset. Approximately 29% of the 2858 youth in our study population had preDM/DM based on biomarker criteria. The clinical guideline had a sensitivity of 43.1% and specificity of 67.6%, positive/negative predictive values of 35.2%/74.5%, positive/negative F-measures of 38.8%/70.9%, and Kappa of 0.1 (95%CI: 0.06-0.14). The performance of the guideline varied across demographic subgroups. Some ML-based classifiers performed comparably to or better than the screening guideline, especially in identifying preDM/DM youth (p = 5.23 × 10-5).We demonstrated that a recommended pediatric clinical screening guideline did not perform well in identifying preDM/DM status among youth. Additional work is needed to develop a simple yet accurate screener for youth diabetes risk, potentially by using advanced ML methods and a wider range of clinical and behavioral health data.
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Affiliation(s)
- Nita Vangeepuram
- Division of General Pediatrics, Department of Pediatrics, Icahn School of Medicine At Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, USA.
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
- Department of Environmental Medicine and Public Health, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, New York, NY, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Po-Hsiang Chiu
- Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Linhua Wang
- Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
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Prevalence of Metabolic Syndrome among Children and Adolescents in High-Income Countries: A Systematic Review and Meta-Analysis of Observational Studies. BIOMED RESEARCH INTERNATIONAL 2021. [DOI: 10.1155/2021/6661457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction. Metabolic syndrome (MetS) is an assemblage of interconnected cardiovascular risk factors that are prevalent among children and adolescents in high-income countries (HICs). Despite the presence of several studies on the issue, the study findings are incongruent due to the absence of a gold standard diagnostic method of MetS in children. Thus, the findings of the original studies are inconclusive for policy makers and other stakeholders. This systematic review and meta-analysis is aimed at giving conclusive evidence about MetS among children and adolescents in HICs. Methods. We conducted searches using electronic databases (PubMed, Scopus, Web of Science, CINAHL (EBSCOhost), EMBASE (Elsevier), and Medline (EBSCOhost)) and other sources (Google Scholar and Google) up to September 2020. Observational studies reporting the prevalence of MetS were eligible in this study. The pooled estimates were computed in fixed and random effect models using six diagnostic methods (IDF, ATP III, de Ferranti et al., WHO, Weiss et al., and Cruz and Goran). Publication bias was verified using funnel plots and Egger’s regression tests. Subgroup and sensitivity analysis were performed in case of higher heterogeneities among the included studies. Result. In this study, 77 studies with a total population of 125,445 children and adolescents were used in the final analysis. Metabolic syndrome among the overweight and obese population was computed from 28 studies with the pooled prevalence of 25.25%, 24.47%, 39.41%, 29.52%, and 33.36% in IDF, ATP III, de Ferranti et al., WHO, and Weiss et al. criteria, respectively. Likewise, 49 studies were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, MetS was found in 3.70% (IDF), 5.40% (ATP III), 14.78% (de Ferranti et al.), 3.90% (WHO), and, 4.66% (Cruz and Goran) of study participants. Regarding the components of MetS, abdominal obesity in the overweight and obese population, and low HDL-C in the general population were the most common components. Besides, the prevalence of Mets among males was higher than females. Conclusion. This study demonstrates that MetS among children and adolescents is undoubtedly high in HICs. The prevalence of MetS is higher among males than females. Community-based social and behavioral change communications need to be designed to promote healthy eating behaviors and physical activities. Prospective cohort studies could also help to explore all possible risk factors of MetS and to design specific interventions accordingly.
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Vizzuso S, Del Torto A, Dilillo D, Calcaterra V, Di Profio E, Leone A, Gilardini L, Bertoli S, Battezzati A, Zuccotti GV, Verduci E. Visceral Adiposity Index (VAI) in Children and Adolescents with Obesity: No Association with Daily Energy Intake but Promising Tool to Identify Metabolic Syndrome (MetS). Nutrients 2021; 13:nu13020413. [PMID: 33525454 PMCID: PMC7911630 DOI: 10.3390/nu13020413] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022] Open
Abstract
(1) Background. Visceral adiposity index (VAI) has been recently identified as a new cardiometabolic risk marker reflecting abdominal fat distribution and dyslipidaemia. The aim of the present paper was to evaluate the relationship between VAI, daily energy intake and metabolic syndrome (MetS) in a cohort of obese Caucasian children and adolescents, aged 8 to 15 years. (2) Methods. Consecutive Italian children and adolescents with obesity, according to World Health Organization were enrolled. Anthropometric parameters and blood pressure were measured. Fasting blood samples have been analyzed for lipids, insulin and glucose levels. MetS was diagnosed using identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) or International Diabetes Federation (IDF) criteria according to age. Homeostatic model assessment index (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), A body shape index (ABSI) and VAI were calculated. Multivariable logistic regression analyses with sex, age and each anthropometric parameter (body mass index (BMI) z-score, ABSI, waist-to-height ratio (WHR)) or VAI was performed to predict MetS. Receiver operation curve (ROC) analysis was used to define the optimal VAI cut-off to identify MetS. Multiple regression was performed to predict the BMI z-score and VAI from daily energy intake after adjusting for age and sex. (3) Results. Six hundred and thirty-seven (313 boys and 324 girls) children and adolescents with obesity with median age 11 (interquartile range 10–13) years were included in the analysis. MetS was diagnosed in 79 patients. VAI correlated with BMI, WHR, ABSI, HOMA-IR, QUICKI, systolic blood pressure, low- and high-density lipoprotein cholesterol, triglycerides and triglycerides-to-HDL ratio (p < 0.050). Optimal VAI cut-off (AUC) values to identify MetS were 1.775 (0.774), 1.685 (0.776) and 1.875 (0.797) in the whole population, boys and girls, respectively. Energy intake was positively associated with BMI z-score but no association was found with VAI. (4) Conclusion. VAI is a promising tool to identify MetS in children and adolescents with obesity and should be used in the management of abdominal obesity together with dietary assessment.
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Affiliation(s)
- Sara Vizzuso
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.D.); (V.C.); (G.V.Z.); (E.V.)
- Correspondence:
| | | | - Dario Dilillo
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.D.); (V.C.); (G.V.Z.); (E.V.)
| | - Valeria Calcaterra
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.D.); (V.C.); (G.V.Z.); (E.V.)
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | | | - Alessandro Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Sandro Botticelli 21, 20133 Milan, Italy; (A.L.); (S.B.); (A.B.)
| | - Luisa Gilardini
- Istituto Auxologico Italiano, IRCCS, Lab of Nutrition and Obesity Research, 20145 Milan, Italy;
| | - Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Sandro Botticelli 21, 20133 Milan, Italy; (A.L.); (S.B.); (A.B.)
- Istituto Auxologico Italiano, IRCCS, Lab of Nutrition and Obesity Research, 20145 Milan, Italy;
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Sandro Botticelli 21, 20133 Milan, Italy; (A.L.); (S.B.); (A.B.)
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.D.); (V.C.); (G.V.Z.); (E.V.)
| | - Elvira Verduci
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.D.); (V.C.); (G.V.Z.); (E.V.)
- Department of Health Sciences, University of Milan, 20154 Milan, Italy
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Smetanina N, Valickas R, Vitkauskiene A, Albertsson-Wikland K, Verkauskienė R. Prevalence of Metabolic Syndrome and Impaired Glucose Metabolism among 10- to 17-Year-Old Overweight and Obese Lithuanian Children and Adolescents. Obes Facts 2021; 14:271-282. [PMID: 33951670 PMCID: PMC8255643 DOI: 10.1159/000514720] [Citation(s) in RCA: 3] [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: 03/19/2019] [Accepted: 01/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Overweight (Ow) and obesity among adults and children increases the risk of metabolic consequences. Metabolic syndrome (MS) and impaired glucose metabolism are well-known risk factors for cardiovascular diseases and type 2 diabetes. The aim of this study was to evaluate the prevalence of MS and impaired glucose metabolism among Ow and obese (Ob) children and adolescents (aged 10-17 years) in Lithuania, and to evaluate the associations between insulin resistance (IR) indices and anthropometric parameters as well as metabolic disturbances. METHODS The study population consisted of 344 OwOb children and adolescents of all pubertal stages. Oral glucose tolerance tests (OGTTs), IR and β cell function indices, lipid profile, and anthropometric parameters of all subjects were analyzed. MS was defined according to the International Diabetes Federation consensus guidelines. RESULTS MS was found in 21.3% of the OwOb children and adolescents, and 12.1% had impaired glucose metabolism (6.9% with impaired fasting glucose, 4.5% with impaired glucose tolerance, and 0.6% with type 2 diabetes). IR was directly related to body mass index and waist circumference, waist-to-height and waist-to-hip ratios, and sum of skin-fold thicknesses. Children with MS were more insulin-resistant, had higher odds ratio for prediabetes and had a more disturbed lipid profile than subjects without MS. Moreover, total cholesterol and low-density lipoprotein cholesterol levels were significantly lower in the more mature OwOb adolescents. CONCLUSION MS and lipid profile disturbances are common in OwOb children and adolescents. MS is directly associated with IR. Therefore, OwOb children and adolescents should be carefully followed up for metabolic abnormalities during late childhood as these can persist into adulthood.
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Affiliation(s)
- Natalija Smetanina
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- *Natalija Smetanina,
| | - Raimondas Valickas
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Astra Vitkauskiene
- Department of Laboratory Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kerstin Albertsson-Wikland
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Rasa Verkauskienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Vizzuso S, Amatruda M, Del Torto A, D’Auria E, Ippolito G, Zuccotti GV, Verduci E. Is Macronutrients Intake a Challenge for Cardiometabolic Risk in Obese Adolescents? Nutrients 2020; 12:nu12061785. [PMID: 32560039 PMCID: PMC7353408 DOI: 10.3390/nu12061785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022] Open
Abstract
(1) Background: Pediatric obesity is an emerging public health issue, mainly related to western diet. A cross-sectional study was conducted to explore the association between macronutrients intake and cardiometabolic risk factors in obese adolescents. (2) Methods: Ninety-three Italian obese adolescents were recruited; anthropometric parameters, body composition, glucose and lipid metabolism profiles were measured. Macronutrients intake was estimated by a software-assisted analysis of a 120-item frequency questionnaire. The association between macronutrients and cardiometabolic risk factors was assessed by bivariate correlation, and multiple regression analysis was used to adjust for confounders such as age and sex. (3) Results: By multiple regression analysis, we found that higher energy and lower carbohydrate intakes predicted higher body mass index (BMI) z-score, p = 0.005, and higher saturated fats intake and higher age predicted higher HOmeostasis Model Assessment of insulin resistance (HOMA-IR) and lower QUantitative Insulin-sensitivity ChecK (QUICK) index, p = 0.001. In addition, a saturated fats intake <7% was associated with normal HOMA-IR, and a higher total fats intake predicted a higher HOMA of percent β-cell function (HOMA-β), p = 0.011. (4) Conclusions: Higher energy intake and lower carbohydrate dietary intake predicted higher BMI z-score after adjustment for age and sex. Higher total and saturated fats dietary intakes predicted insulin resistance, even after adjustment for confounding factors. A dietary pattern including appropriate high-quality carbohydrate and reduced saturated fat intakes could result in reduced cardiometabolic risk in obese adolescents.
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Affiliation(s)
- Sara Vizzuso
- Department of Health Sciences, University of Milan, 20133 Milan, Italy; (S.V.); (M.A.); (G.I.)
| | - Matilde Amatruda
- Department of Health Sciences, University of Milan, 20133 Milan, Italy; (S.V.); (M.A.); (G.I.)
| | | | - Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital University of Milan, 20154 Milan, Italy; (E.D.); (G.V.Z.)
| | - Giulio Ippolito
- Department of Health Sciences, University of Milan, 20133 Milan, Italy; (S.V.); (M.A.); (G.I.)
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital University of Milan, 20154 Milan, Italy; (E.D.); (G.V.Z.)
| | - Elvira Verduci
- Department of Health Sciences, University of Milan, 20133 Milan, Italy; (S.V.); (M.A.); (G.I.)
- Department of Pediatrics, Vittore Buzzi Children’s Hospital University of Milan, 20154 Milan, Italy; (E.D.); (G.V.Z.)
- Correspondence:
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19
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Leone A, Vizzuso S, Brambilla P, Mameli C, Ravella S, De Amicis R, Battezzati A, Zuccotti G, Bertoli S, Verduci E. Evaluation of Different Adiposity Indices and Association with Metabolic Syndrome Risk in Obese Children: Is there a Winner? Int J Mol Sci 2020; 21:E4083. [PMID: 32521608 PMCID: PMC7313019 DOI: 10.3390/ijms21114083] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022] Open
Abstract
Body shape index (ABSI) and triponderal mass index (TMI) have been recently associated with cardiovascular risk in adults. A cross-sectional study was conducted to evaluate the relationship between different anthropometric adiposity indexes and metabolic syndrome (MetS) in Caucasian obese children and adolescents. Consecutive obese children aged ≥7 years have been enrolled. Anthropometric parameters, body composition (by bioelectrical impedance), and systolic and diastolic blood pressure have been measured. Fasting blood samples have been analyzed for lipids, insulin, glucose. A multivariate logistic regression analyses, with body mass index z-score, waist to height ratio, ABSI z-score, TMI, conicity index as predictors for MetS (IDEFICS and IDF criteria according to age) has been performed. Four hundred and three (179 boys and 224 girls) obese children, aged 7-20 years, have been evaluated. When we explored the joint contribution of each anthropometric and adiposity index of interest and BMIz on the risk of MetS, we found that the inclusion of ABSIz improved the prediction of MetS compared to BMIz alone. ABSI-BMI can be a useful index for evaluating the relative contribution of central obesity to cardiometabolic risk in clinical management of obese children and adolescents.
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Affiliation(s)
- Alessandro Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Sandro Botticelli 21, 20133 Milan, Italy; (A.L.); (S.R.); (R.D.A.); (A.B.)
| | - Sara Vizzuso
- Department of Health Sciences, University of Milan, 20133 Milan, Italy; (S.V.); (E.V.)
| | - Paolo Brambilla
- Family Pediatrician, ATS Città Metropolitana Milano, 20122 Milan, Italy;
| | - Chiara Mameli
- Department of Pediatrics Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (C.M.); (G.Z.)
| | - Simone Ravella
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Sandro Botticelli 21, 20133 Milan, Italy; (A.L.); (S.R.); (R.D.A.); (A.B.)
| | - Ramona De Amicis
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Sandro Botticelli 21, 20133 Milan, Italy; (A.L.); (S.R.); (R.D.A.); (A.B.)
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Sandro Botticelli 21, 20133 Milan, Italy; (A.L.); (S.R.); (R.D.A.); (A.B.)
| | - Gianvincenzo Zuccotti
- Department of Pediatrics Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (C.M.); (G.Z.)
| | - Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Sandro Botticelli 21, 20133 Milan, Italy; (A.L.); (S.R.); (R.D.A.); (A.B.)
- Istituto Auxologico Italiano, IRCCS, Lab of Nutrition and Obesity Research, 20145 Milan, Italy
| | - Elvira Verduci
- Department of Health Sciences, University of Milan, 20133 Milan, Italy; (S.V.); (E.V.)
- Department of Pediatrics Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (C.M.); (G.Z.)
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20
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The Daily Mile Is Able to Improve Cardiorespiratory Fitness When Practiced Three Times a Week. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062095. [PMID: 32235688 PMCID: PMC7143074 DOI: 10.3390/ijerph17062095] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
The Daily Mile is a promising initiative aimed at removing some of the barriers to physical activity in the school setting. This quasi-experimental study investigated the dose–effect of The Daily Mile on cardiorespiratory fitness, waist-to-height ratio, and body mass index (BMI) after a period of 3- and 6-months. A total of 279 students (mean age = 9 ± 1 years) participated in The Daily Mile while 269 students (mean age = 9 ± 1 years) did not (control group). A posteriori, the classes performing The Daily Mile on average two times per week were included in the 2_times subgroup, while those performing the activity on average three times per week in the 3_times subgroup. A significant difference was observed in favor of the experimental compared to the control group in the 6 Minute Run Test (F = 13.932, p = 0.008). Moreover, the improvement of the 6-minute run test was more pronounced for 3_times (effect size = 0.51) rather than for the 2_times subgroup (effect size = 0.29). No differences were observed in waist-to-height ratio and BMI scores. In conclusion, teachers are strongly recommended to implement The Daily Mile at least three times a week to see appreciable effects on cardiorespiratory fitness.
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21
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Umano GR, Di Sessa A, Cirillo G, Ursi D, Marzuillo P, Miraglia del Giudice E. Waist-to-height ratio is more strongly associated than other weight-related anthropometric measures with metabolic variables. Acta Paediatr 2019; 108:2296-2297. [PMID: 31461785 DOI: 10.1111/apa.14992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Giuseppina Rosaria Umano
- Department of the Woman, the Child, of General and Specialized Surgery University of Campania Luigi Vanvitelli Naples Italy
| | - Anna Di Sessa
- Department of the Woman, the Child, of General and Specialized Surgery University of Campania Luigi Vanvitelli Naples Italy
| | - Grazia Cirillo
- Department of the Woman, the Child, of General and Specialized Surgery University of Campania Luigi Vanvitelli Naples Italy
| | - Davide Ursi
- Department of the Woman, the Child, of General and Specialized Surgery University of Campania Luigi Vanvitelli Naples Italy
| | - Pierluigi Marzuillo
- Department of the Woman, the Child, of General and Specialized Surgery University of Campania Luigi Vanvitelli Naples Italy
| | - Emanuele Miraglia del Giudice
- Department of the Woman, the Child, of General and Specialized Surgery University of Campania Luigi Vanvitelli Naples Italy
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22
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Tricò D, Di Sessa A, Caprio S, Chalasani N, Liu W, Liang T, Graf J, Herzog RI, Johnson CD, Umano GR, Feldstein AE, Santoro N. Oxidized Derivatives of Linoleic Acid in Pediatric Metabolic Syndrome: Is Their Pathogenic Role Modulated by the Genetic Background and the Gut Microbiota? Antioxid Redox Signal 2019; 30:241-250. [PMID: 28279074 PMCID: PMC6277079 DOI: 10.1089/ars.2017.7049] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 12/28/2022]
Abstract
We tested whether oxidized linoleic acid metabolites (OXLAM) are associated with pediatric metabolic syndrome (MetS) and a proatherogenic lipoprotein profile in 122 obese adolescents. Furthermore, we examined whether genetic and metagenomic factors can modulate plasma OXLAM concentrations by genotyping the fatty acid desaturase 1/2 (FADS) gene and by characterizing the gut microbiota. Subjects with MetS (n = 50) showed higher concentrations of 9- and 13-oxo-octadecadienoic acid (9- and 13-oxo-ODE) than subjects without MetS (n = 72). Both metabolites were associated with an adverse lipoprotein profile that was characterized by elevated very small-dense low-density lipoprotein (p < 0.005) and large very low-density lipoprotein particles (p = 0.01). Plasma 9- and 13-oxo-ODE were higher in subjects carrying the haplotype AA of the FADS gene cluster (p = 0.030 and p = 0.048, respectively). Furthermore, the reduced gut bacterial load was associated with higher 9-oxo-ODE concentrations (p = 0.035). This is the first study showing that high plasma OXLAM concentrations are associated with MetS and suggesting that the leading factors for high plasma concentrations of OXLAM might be the genetic background and the composition of the gut microbiota. In conclusion, high concentrations of 9- and 13-oxo-ODE, which may be the result of a genetic predisposition and a reduced gut bacterial load, are associated with MetS and with a proatherogenic lipoprotein profile in obese adolescents.
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Affiliation(s)
- Domenico Tricò
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Anna Di Sessa
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Sonia Caprio
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Naga Chalasani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Wanqing Liu
- Purdue School of Pharmacy, Purdue University, West Lafayette, Indiana
| | - Tiebing Liang
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Joerg Graf
- Department of Molecular and Cell Biology, University of Connecticut, Hartford, Connecticut
| | - Raimund I. Herzog
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Casey D. Johnson
- Department of Pediatrics, University of California San Diego, San Diego, California
| | | | - Ariel E. Feldstein
- Department of Pediatrics, University of California San Diego, San Diego, California
| | - Nicola Santoro
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
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23
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González-Saldivar G, Rodríguez-Gutiérrez R, Treviño-Alvarez AM, Gómez-Flores M, Montes-Villarreal J, Álvarez-Villalobos NA, Elizondo-Plazas A, Salcido-Montenegro A, Ocampo-Candiani J, González-González JG. Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance. DERMATO-ENDOCRINOLOGY 2018; 10:e1471958. [PMID: 30279953 PMCID: PMC6166604 DOI: 10.1080/19381980.2018.1471958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/18/2018] [Accepted: 04/27/2018] [Indexed: 11/02/2022]
Abstract
Any clinical/biochemical marker revealing obesity or diabetes before their appearance is valuable. Insulin resistance (IR) is present in both disorders many years before occurrence. Accordingly, we determined whether acanthosis nigricans (AN) in the knuckles is associated to higher insulin and homeostasis model assessment for estimated insulin resistance (HOMA-IR) index values, and assessed the influence of body-mass index (BMI) and the diagnostic performance of AN in the knuckles to detect IR. In this cross-sectional controlled study, we included men or women, 18 to 23 years old, with or without AN in the knuckles. In 149 cases with AN in the knuckles and 145 controls, fasting insulin was higher in cases (13.45 µU/mL ± 7.8 vs. 8.59 µU/mL ± 3.63, P < .001, respectively). Mean HOMA-IR index was also higher (2.86 ± 1.68 vs. 1.78 ± 0.77, P < .001). A significant increase in fasting insulin and HOMA-IR values between and within BMI groups from normal through obese category was identified in controls and cases. By multivariate regression analysis, cases with normal BMI were significantly associated to a HOMA-IR ≥2.5 (OR = 3.09, CI95% = 1.75-5.48, P = .001). A model of AN in the knuckles, normal BMI, and increased waist circumference allowed identifying 2 out of 3 cases with HOMA-IR index ≥2.5. AN in the knuckles could be addressed with two aims: as an easy, accessible, and costless diagnostic tool suggesting hyperinsulinemia secondary to IR, and, an early marker of IR even in the absence of overweight or obesity.
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Affiliation(s)
- Gloria González-Saldivar
- Dermatology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - René Rodríguez-Gutiérrez
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.,Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Andrés Marcelo Treviño-Alvarez
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Minerva Gómez-Flores
- Dermatology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Juan Montes-Villarreal
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Neri Alejandro Álvarez-Villalobos
- Clinical Research Unit, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Anasofía Elizondo-Plazas
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Alejandro Salcido-Montenegro
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - José Gerardo González-González
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
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24
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Body composition and insulin resistance in children. Eur J Clin Nutr 2018; 72:1239-1245. [DOI: 10.1038/s41430-018-0239-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 12/21/2022]
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25
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The Membrane-bound O-Acyltransferase7 rs641738 Variant in Pediatric Nonalcoholic Fatty Liver Disease. J Pediatr Gastroenterol Nutr 2018; 67:69-74. [PMID: 29601441 DOI: 10.1097/mpg.0000000000001979] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The rs641738 polymorphism in the membrane-bound O-acyltransferase domain containing protein 7 (MBOAT7) gene has been associated with increased risk of nonalcoholic fatty liver disease (NAFLD). OBJECTIVES To investigate the association between the MBOAT7 rs641738 polymorphism and both hepatic steatosis and biochemical markers of liver damage and to evaluate the potential additive effect of this variant and the I148M patatin-like phospholipase domain-containing 3 (PNPLA3) and the rs58542926 transmembrane 6 superfamily member 2 (TM6SF2) polymorphisms. METHODS One thousand and 2 obese children were genotyped for MBOAT7, PNPLA3, and TM6SF2 polymorphisms and underwent anthropometrical, ultrasonographic, and biochemical evaluation. Indirect measurement of liver fibrosis (Pediatric NAFLD Fibrosis Index [PNFI]) and a genetic risk score from these polymorphisms were calculated. RESULTS Carriers of the MBOAT7 T allele showed both higher alanine transaminase (ALT) (P = 0.004) and PNFI values (P = 0.04) than noncarriers. These findings were confirmed also for the carriers of the MBOAT7 T allele polymorphism with hepatic steatosis compared with noncarriers. A higher genetic risk score was associated with higher ALT (P = 0.011) and with an odds ratio (OR) to show elevated ALT of 3.4 (95% CI 1.3-5.5, P = 0.003). Patients belonging to genetic risk score 3 group had an OR to present steatosis of 2.6 (95% CI 1.43-4.83, P = 0.0018) compared with those belonging to lower genetic risk score group. CONCLUSIONS We first demonstrated in childhood obesity the role of the MBOAT7 rs641738 variant on serum ALT and the combined effect of the MBOAT7, PNPLA3, and TM6SF2 variants on NAFLD risk. We also provided the first pediatric association of the MBOAT7 polymorphism with indirect markers of liver fibrosis.
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26
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Menale C, Grandone A, Nicolucci C, Cirillo G, Crispi S, Di Sessa A, Marzuillo P, Rossi S, Mita DG, Perrone L, Diano N, Miraglia Del Giudice E. Bisphenol A is associated with insulin resistance and modulates adiponectin and resistin gene expression in obese children. Pediatr Obes 2017; 12:380-387. [PMID: 27187765 DOI: 10.1111/ijpo.12154] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/31/2016] [Accepted: 04/25/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Bisphenol A (BPA) exposure has been associated with increased incidence of diabetes and obesity in adults. OBJECTIVES To evaluate whether an association between BPA urinary levels and insulin resistance as well as adiponectin and resistin production and serum concentrations may occur in obese children. METHODS Clinical and biochemical features of 141 obese children were collected. Serum resistin and adiponectin were evaluated. Insulin resistance and urinary BPA levels were assessed. Moreover, the effect of BPA on adiponectin and resistin gene expression in adipocytes from eight normal weight prepubertal children was investigated by quantitative real-time RT-PCR (qPCR). RESULTS Direct association between BPA and homeostasis model assessment (r = 0.23; p: 0.0069) and a strong inverse association between BPA and adiponectin have been found (r = -0.48; p < 0.0001). In adipocytes, resistin expression was detected only after BPA treatment, while adiponectin expression resulted down-regulated after BPA exposure (p < 0.05 at both 10 and 100 nM BPA concentrations). CONCLUSIONS We suggest the involvement of BPA in the development of insulin resistance in childhood obesity highlighting that urinary BPA levels are directly associated with insulin resistance regardless of BMI. This association may be explained, at least partly, by the findings that BPA affects resistin and adiponectin production in adipose tissue cultures.
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Affiliation(s)
- Ciro Menale
- Department of Experimental Medicine, Second University of Naples, Naples, Italy.,National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Biophysics Laboratory, Institute of Genetics and Biophysics - CNR, Naples, Italy
| | - Anna Grandone
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Carla Nicolucci
- Department of Experimental Medicine, Second University of Naples, Naples, Italy.,National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Department of Experimental Medicine, University of Messina, Messina, Italy
| | - Grazia Cirillo
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Stefania Crispi
- Gene Expression and Molecular Genetics Laboratory, Institute of Biosciences and Bioresources - CNR Naples, Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Sergio Rossi
- Biophysics Laboratory, Institute of Genetics and Biophysics - CNR, Naples, Italy
| | - Damiano Gustavo Mita
- National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Biophysics Laboratory, Institute of Genetics and Biophysics - CNR, Naples, Italy
| | - Laura Perrone
- National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Nadia Diano
- Department of Experimental Medicine, Second University of Naples, Naples, Italy.,National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Biophysics Laboratory, Institute of Genetics and Biophysics - CNR, Naples, Italy
| | - Emanuele Miraglia Del Giudice
- National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
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27
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Marzuillo P, Di Sessa A, Umano GR, Nunziata L, Cirillo G, Perrone L, Miraglia Del Giudice E, Grandone A. Novel association between the nonsynonymous A803G polymorphism of the N-acetyltransferase 2 gene and impaired glucose homeostasis in obese children and adolescents. Pediatr Diabetes 2017; 18:478-484. [PMID: 27481583 DOI: 10.1111/pedi.12417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/24/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The N-acetyltransferase 2 ( NAT2 ) A803G polymorphism has been associated with decreased insulin sensitivity in a large adult population with the A allele associated with insulin-resistance-related traits. OBJECTIVE Evaluate the association of this polymorphism with anthropometric and metabolic parameters in obese children and adolescents. SUBJECTS A total of 748 obese children and adolescents were enrolled. METHODS Anthropometric and laboratory data were collected. During oral glucose tolerance test, the presence of a possible exaggerated plasma glucose excursion at 1 h (1HPG) or impaired glucose tolerance (IGT) was considered. Homeostasis model assessment, oral disposition index (oDI) and insulinogenic index (IDI) were calculated. Patients were genotyped for the NAT2 A803G polymorphism. RESULTS The prevalence of both IGT and elevated-1HPG was higher in children carrying the A803 allele (P = .02 and P = .03). Moreover, this allele was associated with both oDI and IGI reduction (P = .01). No differences among the NAT2 A803G genotypes for the other parameters were shown. Children homozygous for the A allele presented an odds ratio (OR), to show IGT of 4.9 (P = .01). Children both homozygous and heterozygous for the A allele had higher risk to show elevated-1HPG (OR of 2.7, P = .005; and OR = 2.3, P = .005) compared with patients homozygous for the NAT2 803G allele. CONCLUSIONS NAT2 A803 allele seems to play a role in worsening the destiny of obese children carrying it, predisposing them to elevated-1HPG and IGT and then to a possible future type 2 diabetes mellitus throughout an impairment of pancreatic β-cellular insulin secretion as suggested by oDI and IGI reduction.
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Affiliation(s)
- Pierluigi Marzuillo
- Department of Woman, Child and General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy
| | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy
| | - Luigia Nunziata
- Department of Woman, Child and General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy
| | - Grazia Cirillo
- Department of Woman, Child and General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy
| | - Laura Perrone
- Department of Woman, Child and General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy
| | - Anna Grandone
- Department of Woman, Child and General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy
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Tricò D, Prinsen H, Giannini C, de Graaf R, Juchem C, Li F, Caprio S, Santoro N, Herzog RI. Elevated α-Hydroxybutyrate and Branched-Chain Amino Acid Levels Predict Deterioration of Glycemic Control in Adolescents. J Clin Endocrinol Metab 2017; 102:2473-2481. [PMID: 28482070 PMCID: PMC5505187 DOI: 10.1210/jc.2017-00475] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/14/2017] [Indexed: 12/14/2022]
Abstract
CONTEXT Traditional risk factors for type 2 diabetes mellitus are weak predictors of changes in glucose tolerance and insulin sensitivity in youth. OBJECTIVE To identify early metabolic features of insulin resistance (IR) in youth and whether they predict deterioration of glycemic control. DESIGN AND SETTING A cross-sectional and longitudinal study was conducted at the Yale Pediatric Obesity Clinic. PATIENTS AND INTERVENTION Concentrations of α-hydroxybutyrate, β-hydroxybutyrate, lactate, and branched-chain amino acids (BCAAs) were measured by nuclear magnetic resonance spectroscopy in 78 nondiabetic adolescents during an oral glucose tolerance test (OGTT). Associations between baseline metabolic alterations and longitudinal changes in glucose control were tested in 16 subjects after a mean follow-up of 2.3 years. MAIN OUTCOME MEASURES The relationship between metabolite levels, parameters of IR, and glycemic control, and their progression over time. RESULTS Elevated fasting α-hydroxybutyrate levels were observed in adolescents with reduced insulin sensitivity after adjusting for age, sex, ethnicity, Tanner stage, and body mass index z-score (P = 0.014). Plasma α-hydroxybutyrate and BCAAs were increased throughout the course of the OGTT in this group (P < 0.03). Notably, borderline IR was associated with a progressive α-hydroxybutyrate decrease from elevated baseline concentrations to normal levels (P = 0.02). Increased baseline α-hydroxybutyrate concentrations were further associated with progressive worsening of glucose tolerance and disposition index. CONCLUSION α-Hydroxybutyrate and BCAA concentrations during an OGTT characterize insulin-resistant youth and predict worsening of glycemic control. These findings provide potential biomarkers for risk assessment of type 2 diabetes and new insights into IR pathogenesis.
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Affiliation(s)
- Domenico Tricò
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06519
| | - Hetty Prinsen
- Department of Diagnostic Radiology and Biomedical Imaging, Magnetic Resonance Research Center, Yale University School of Medicine, New Haven, Connecticut 06519
| | - Cosimo Giannini
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06519
| | - Robin de Graaf
- Department of Diagnostic Radiology and Biomedical Imaging, Magnetic Resonance Research Center, Yale University School of Medicine, New Haven, Connecticut 06519
| | - Christoph Juchem
- Department of Diagnostic Radiology and Biomedical Imaging, Magnetic Resonance Research Center, Yale University School of Medicine, New Haven, Connecticut 06519
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, Connecticut 06519
| | - Sonia Caprio
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06519
| | - Nicola Santoro
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06519
- Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso 86100, Italy
| | - Raimund I. Herzog
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06519
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Umano GR, Martino M, Santoro N. The Association between Pediatric NAFLD and Common Genetic Variants. CHILDREN-BASEL 2017. [PMID: 28629152 PMCID: PMC5483624 DOI: 10.3390/children4060049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the most common complications of obesity. Several studies have shown that genetic predisposition probably plays an important role in its pathogenesis. In fact, in the last few years a large number of genetic studies have provided compelling evidence that some gene variants, especially those in genes encoding proteins regulating lipid metabolism, are associated with intra-hepatic fat accumulation. Here we provide a comprehensive review of the gene variants that have affected the natural history of the disease.
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Affiliation(s)
- Giuseppina Rosaria Umano
- Department of Pediatrics, Yale University, 06520, New Haven, CT, USA.
- Dipartimento della Donna, del Bambino, di Vhirurgia Generale e Specialistica, Universita' della Campania Luigi Vanvitelli, 80138, Napoli, Italy.
| | - Mariangela Martino
- Department of Pediatrics, Yale University, 06520, New Haven, CT, USA.
- Dipartimento di Medicina V. Tiberio, Universita' del Molise, 86100, Campobasso, Italy.
| | - Nicola Santoro
- Department of Pediatrics, Yale University, 06520, New Haven, CT, USA.
- Dipartimento di Medicina V. Tiberio, Universita' del Molise, 86100, Campobasso, Italy.
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Santomauro F, Lorini C, Pieralli F, Niccolai G, Picciolli P, Vezzosi S, Bonaccorsi G. Waist-to-height ratio and its associations with body mass index in a sample of Tuscan children in primary school. Ital J Pediatr 2017; 43:53. [PMID: 28592270 PMCID: PMC5463347 DOI: 10.1186/s13052-017-0372-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/31/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Visceral obesity in children increases the risk of developing cardiovascular diseases. To evaluate overweight children, in addition to Body Mass Index (BMI), waist-to-height ratio (WHtR) can be used to predict cardiometabolic risk. The goal of this study is to describe WHtR in a sample of Tuscan children. METHODS A sample of children living in the province of Pistoia, Tuscany, was measured for the following anthropometric parameters: weight, height, and waist circumference. BMI and WHtR were calculated. For the latter indicator, a threshold of 0.5 was considered as a cardiovascular risk predictor. The subjects were classified into underweight, normal weight, overweight, and obese using Cole's cut-offs. RESULTS The number of children enrolled were 1575 (821 males; 754 females), aged 6-11 years. Of them, 64.3% were normal weight, 4.9% underweight, 22.3% overweight, and 8.5% obese. Moreover, 12.8% had a WHtR ≥0.5 (85.7% males; 88.7% females). The average WHtR value was 0.45 ± 0.045, and was significantly different as per gender (F = 0.45 vs. M = 0.46). WHtR was significantly correlated with BMI (r = 0.766). CONCLUSION The average WHtR value was in line with previous studies conducted among children of similar age groups. Large-scale perspective studies are needed to validate the Italian WHtR cut-offs for children.
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Affiliation(s)
- Francesca Santomauro
- Department of Health Science, University of Florence, Viale G.B. Morgagni, 48, 50134, Florence, Italy.
| | - Chiara Lorini
- Department of Health Science, University of Florence, Viale G.B. Morgagni, 48, 50134, Florence, Italy
| | - Francesca Pieralli
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Viale G.B. Morgagni, 48, 50134, Florence, Italy
| | - Giuditta Niccolai
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Viale G.B. Morgagni, 48, 50134, Florence, Italy
| | - Paola Picciolli
- Local Health Unit Toscana Centro, Viale Matteotti, 19, 51100, Pistoia, Italy
| | - Stefania Vezzosi
- Local Health Unit Toscana Centro, Viale Matteotti, 19, 51100, Pistoia, Italy
| | - Guglielmo Bonaccorsi
- Department of Health Science, University of Florence, Viale G.B. Morgagni, 48, 50134, Florence, Italy
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Effects of an Intensive Lifestyle Intervention to Treat Overweight/Obese Children and Adolescents. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8573725. [PMID: 28656151 PMCID: PMC5474545 DOI: 10.1155/2017/8573725] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/18/2017] [Accepted: 04/26/2017] [Indexed: 01/17/2023]
Abstract
Objective The purpose of the present study is to examine the effects of a multidisciplinary lifestyle intervention to treat overweight/obese children and adolescents. The main outcome was cardiometabolic risk based on the waist-to-height ratio (WHTR) measurement. Secondary outcomes were (1) changes in body composition; (2) adherence to a Mediterranean diet; and (3) physical performance. Method The study involved 74 overweight/obese children or adolescents. The intervention was multidisciplinary including nutrition, exercise, and psychological aspects based on a family-based approach; it was delivered for six months for children and three months for adolescents. Before and after the intervention, several anthropometric measures (height, body weight, body mass index or BMI, waist circumference, and body composition), cardiometabolic risk index (waist-to-height ratio or WHTR), and nutrition habits of the participants and their families were evaluated. In addition, a set of functional motor fitness tests was performed to evaluate physical performance measures. Results After the intervention both children and adolescents showed a significant reduction in body weight, BMI, waist circumference, fat mass, and WHTR index and an improvement of fat-free mass, adherence to the Mediterranean diet, and physical fitness performance. Conclusion A family-based multidisciplinary approach is effective in the short term in ameliorating the health status, the nutrition habits, and physical performance in children and adolescents.
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Nigro E, Scudiero O, Ludovica Monaco M, Polito R, Schettino P, Grandone A, Perrone L, Miraglia Del Giudice E, Daniele A. Adiponectin profile and Irisin expression in Italian obese children: Association with insulin-resistance. Cytokine 2017; 94:8-13. [PMID: 28385328 DOI: 10.1016/j.cyto.2016.12.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/10/2016] [Accepted: 12/21/2016] [Indexed: 02/07/2023]
Abstract
Adiponectin (Acrp30), its high molecular weight (HMW) oligomers, and Irisin are molecules involved in several metabolic processes. To investigate if these cytokines could represent new metabolic markers, we evaluated the expression of Acrp30 and Irisin in serum of obese children from South Italy affected by different degrees of insulin resistance (IR). The anthropometric and metabolic features were evaluated in 27 obese children versus 13 age-matched controls. The expression of Acrp30, its pattern and Irisin were investigated by ELISA, western blotting and fast protein liquid chromatography. The HOMA index was significantly higher in obese children versus controls, and metabolic syndrome was more prevalent in obese children with elevated IR versus those with normal HOMA (38% vs 16%). Total Acrp30 and HMW oligomers were significantly lower in obese than in control children, and the difference was more pronounced in children with HOMA >3.4. In control and obese children, total Acrp30 and HMW oligomers were inversely related to HOMA (r-0.38, p 0.02; r-0.35, p 0.03). Irisin was significantly higher in obese than in control children, and was inversely correlated with Acrp30 and HMW (r-0.32, p 0.04; r-0.39, p 0.01). The inverse correlation of Acpr30 and HMW oligomers with HOMA indicates that Acpr30 is directly involved in IR status. Moreover, the inverse correlation between Irisin and Acrp30 and, more significantly, between Irisin and HMW oligomers suggests that the two cytokines are closely connected. The use of Acrp30, HMW oligomers and Irisin as predictive factors of IR in obese children remains to be further elucidated.
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Affiliation(s)
- Ersilia Nigro
- CEINGE-Biotecnologie Avanzate Scarl, Via G. Salvatore 486, 80145 Napoli, Italy; Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Seconda Università degli Studi di Napoli, Via A. Vivaldi 42, 81100 Caserta, Italy
| | - Olga Scudiero
- CEINGE-Biotecnologie Avanzate Scarl, Via G. Salvatore 486, 80145 Napoli, Italy; Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Via S. Pansini 5, 80131 Napoli, Italy
| | | | - Rita Polito
- CEINGE-Biotecnologie Avanzate Scarl, Via G. Salvatore 486, 80145 Napoli, Italy; Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Seconda Università degli Studi di Napoli, Via A. Vivaldi 42, 81100 Caserta, Italy
| | - Pietro Schettino
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Via S. Pansini 5, 80131 Napoli, Italy
| | - Anna Grandone
- Dipartimento della Donna del Bambino e di Chirurgia Generale e Specialistica, Università della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138 Napoli, Italy
| | - Laura Perrone
- Dipartimento della Donna del Bambino e di Chirurgia Generale e Specialistica, Università della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138 Napoli, Italy
| | - Emanuele Miraglia Del Giudice
- Dipartimento della Donna del Bambino e di Chirurgia Generale e Specialistica, Università della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138 Napoli, Italy
| | - Aurora Daniele
- CEINGE-Biotecnologie Avanzate Scarl, Via G. Salvatore 486, 80145 Napoli, Italy; Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Seconda Università degli Studi di Napoli, Via A. Vivaldi 42, 81100 Caserta, Italy.
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Ng HY. Acanthosis nigricans in obese adolescents: prevalence, impact, and management challenges. Adolesc Health Med Ther 2016; 8:1-10. [PMID: 28031729 PMCID: PMC5179206 DOI: 10.2147/ahmt.s103396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Obesity in adolescence is a public health priority because it usually tracks into adulthood, resulting in enormous medical and social costs. This underscores the importance of early identification and intervention. Acanthosis nigricans (AN) was once considered a rare paraneoplastic dermatosis, but is now frequently observed in obese adolescents. Current understanding suggests that it is associated with insulin resistance and has a unique role in secondary prevention. The purpose of this narrative review is to provide a comprehensive overview of AN in obese adolescents, covering its history, current knowledge on the condition, its clinical significance, management challenges, and the direction of future research.
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Affiliation(s)
- Hak Yung Ng
- Department of Paediatrics and Adolescent Medicine, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong, China
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Yoo EG. Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk. KOREAN JOURNAL OF PEDIATRICS 2016; 59:425-431. [PMID: 27895689 PMCID: PMC5118501 DOI: 10.3345/kjp.2016.59.11.425] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 02/07/2023]
Abstract
The waist-to-height ratio (WHtR), calculated by dividing the waist circumference (WC) by height, has recently gained attention as an anthropometric index for central adiposity. It is an easy-to-use and less age-dependent index to identify individuals with increased cardiometabolic risk. A WHtR cutoff of 0.5 can be used in different sex and ethnic groups and is generally accepted as a universal cutoff for central obesity in children (aged ≥6 years) and adults. However, the WHtR has not been validated in preschool children, and the routine use of WHtR in children under age 6 is not recommended. Prospective studies and meta-analysis in adults revealed that the WHtR is equivalent to or slightly better than WC and superior to body mass index (BMI) in predicting higher cardiometabolic risk. In children and adolescents, studies have shown that the WHtR is similar to both BMI and WC in identifying those at an increased cardiometabolic risk. Additional use of WHtR with BMI or WC may be helpful because WHtR considers both height and central obesity. WHtR may be preferred because of its simplicity and because it does not require sex- and age-dependent cutoffs; additionally, the simple message 'keep your WC to less than half your height' may be particularly useful. This review article summarizes recent publications on the usefulness of using WHtR especially when compared to BMI and WC as a screening tool for obesity and related cardiometabolic risks, and recommends the use of WHtR in clinical practice for obesity screening in children and adolescents.
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Affiliation(s)
- Eun-Gyong Yoo
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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35
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Parrino C, Vinciguerra F, La Spina N, Romeo L, Tumminia A, Baratta R, Squatrito S, Vigneri R, Frittitta L. Influence of early-life and parental factors on childhood overweight and obesity. J Endocrinol Invest 2016; 39:1315-1321. [PMID: 27312861 DOI: 10.1007/s40618-016-0501-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE We recently reported that a high BMI and high waist circumference prevalence is present in Sicilian children and that the male gender is associated with a significant risk of obesity. Early-life and parent-related risk factors were investigated 1521 Sicilian children (752 females and 769 males, aged 9.0-14.0 years) to identify biological and environmental factors that can contribute to obesity onset. METHODS Anthropometric measurements of children, their urban vs rural area provenience, birth weight and neonatal feeding were collected. In addition, the BMI and educational level of their parents and the perception of their child weight status were investigated. RESULTS In the study cohort, the prevalence of overweight and obesity was 27.2 and 14.1 %, respectively, significantly (p < 0.05) higher in males than in females. Breastfeeding emerged as a protective factor (OR 0.64; p < 0.0005), while risk factors for developing childhood obesity were a birth weight ≥4.0 kg (OR 1.83; p < 0.05), an overweight or obese mother (OR 2.33; p < 0.0001) or father (OR 1.68; p < 0.0001) and a mother with a low/medium education level (OR 1.72; p < 0.005). CONCLUSION Understanding risk factors for pediatric obesity is a prerequisite to identify children at highly risk of being obese and to predispose early intervention strategies.
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Affiliation(s)
- C Parrino
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - F Vinciguerra
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - N La Spina
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - L Romeo
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - A Tumminia
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - R Baratta
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
- "S. Signorelli" Diabetes and Obesity Center, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - S Squatrito
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - R Vigneri
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
- Institute of Biostructures and Bioimages, National Research Council, CNR, Catania, Italy
| | - L Frittitta
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy.
- "S. Signorelli" Diabetes and Obesity Center, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
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Xue Y, Gao M, Gao Y. Childhood type 2 diabetes: Risks and complications. Exp Ther Med 2016; 12:2367-2370. [PMID: 27703500 PMCID: PMC5038872 DOI: 10.3892/etm.2016.3654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/03/2016] [Indexed: 12/19/2022] Open
Abstract
The universal endocrine pathological state affecting young individuals and adults is type 2 diabetes mellitus, which has seen a significant increase in the last 30 years, particularly in children. Genetic and evnironmental factors are the causative agents for this pathological state in children. This rapid and wide spread of the disease can be controlled by enforcing amendments in environmental factors such as diet, physical activities and obesity. In young infants breastfeeding may be a key modulator of the disease. Associated disorders co-observed in the patients of type 2 diabetes mellitus include renal failure, heart problems and circulatory dysfunctionalities, such as cardiac failure and vision disability. These associated disorders become more pronounced in young patients when they reach puberty. To overcome the lethal outcomes of the disease, early screening of the disease is crucial. The present review focused on the latest updates in the field, as well as plausible risks and complications of this pathological state.
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Affiliation(s)
- Ying Xue
- Department of Endocrinology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Min Gao
- Department of Endocrinology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Yiqing Gao
- Department of Endocrinology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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Rossi F, Bellini G, Luongo L, Manzo I, Tolone S, Tortora C, Bernardo ME, Grandone A, Conforti A, Docimo L, Nobili B, Perrone L, Locatelli F, Maione S, Del Giudice EM. Cannabinoid Receptor 2 as Antiobesity Target: Inflammation, Fat Storage, and Browning Modulation. J Clin Endocrinol Metab 2016; 101:3469-78. [PMID: 27294325 DOI: 10.1210/jc.2015-4381] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Obesity is associated with a low-grade inflammatory state and adipocyte (ADP) hyperplasia/hypertrophy. Obesity inhibits the "browning" of white adipose tissue. Cannabinoid receptor 2 (CB2) agonists reduce food intake and induce antiobesity effect in mice. A common missense CB2 variant, Q63R, causes CB2-reduced function. OBJECTIVE To evaluate the influence of CB2 receptor on the modulation of childhood obesity and of ADP activity and morphology. DESIGN CB2-Q63R variant was analyzed in obese Italian children. The effects of an inflammatory stimulus and those of drugs selectively acting on CB2 were investigated on in vitro ADPs obtained from mesenchymal stem cells of adult healthy donors or from sc adipose biopsies of adult nonobese and obese subjects. SETTING Department of Women, Child and General and Specialist Surgery of the Second University of Naples. PATIENTS OR OTHER PARTICIPANTS A total of 501 obese Italian children (age 11 ± 2.75). Twelve healthy bone marrow donors (age 36.5 ± 15); and 17 subjects, 7 lean (age 42 ± 10) and 10 obese (age 37.8 ± 12) underwent sc adipose tissue biopsies. MAIN OUTCOME MEASURES Effects of CB2 stimulation on adipokine, perilipin, and uncoupling protein-1 expression. RESULTS The less-functional CB2-R63 variant was significantly associated with a high z-score body mass index. CB2 blockade with AM630 reverse agonist increased inflammatory adipokine release and fat storage and reduced browning. CB2 stimulation with JWH-133 agonist reversed all of the obesity-related effects. CONCLUSION CB2 receptor is a novel pharmacological target that should be considered for obesity.
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Affiliation(s)
- Francesca Rossi
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Giulia Bellini
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Livio Luongo
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Iolanda Manzo
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Salvatore Tolone
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Chiara Tortora
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Maria Ester Bernardo
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Anna Grandone
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Antonella Conforti
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Ludovico Docimo
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Bruno Nobili
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Laura Perrone
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Franco Locatelli
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Sabatino Maione
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Women, Child and General and Specialist Surgery (F.R., I.M., A.G., B.N., L.P., E.M.d.G.) and Department of Experimental Medicine (G.B., L.L., I.M., C.T., S.M.), Division of Pharmacology Leonardo Donatelli, The Second University of Naples, 80138 Naples, Italy; The Endocannabinoid Research Group (L.L., S.M.), 80078 Pozzuoli, Naples, Italy; Division of General and Obesity Surgery (S.T., L.D.), The Second University of Naples, 80131 Naples, Italy; Department of Onco-Hematology (M.E.B., A.C., F.L.), Istituto di Ricovero e Cura a Caarattere Scientifico Bambino Gesù Children's Hospital, 00165 Rome, Italy; and University of Pavia (F.L.), 27100 Pavia, Italy
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Grandone A, Cozzolino D, Marzuillo P, Cirillo G, Di Sessa A, Ruggiero L, Di Palma MR, Perrone L, Miraglia Del Giudice E. TM6SF2 Glu167Lys polymorphism is associated with low levels of LDL-cholesterol and increased liver injury in obese children. Pediatr Obes 2016; 11:115-9. [PMID: 25893821 DOI: 10.1111/ijpo.12032] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 03/06/2015] [Accepted: 03/11/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Glu167Lys (E167K) transmembrane 6 superfamily member 2 (TM6SF2) variant has been associated with liver steatosis, high alanine transaminase (ALT) levels and reduced plasma levels of liver-derived triglyceride-rich lipoproteins. OBJECTIVES The objectives of this study were to investigate in a group of obese children the association among the 167K allele of TM6SF2 gene and ALT, cholesterol and triglycerides levels, and hepatic steatosis, and to evaluate the potential interaction between this variant and the I148M patatin like phospholipase 3 gene (PNPLA3) polymorphism on liver enzymes. METHODS We genotyped 1010 obese children for TM6SF2 E167K and PNPLA3 I148M polymorphisms. Anthropometrical and biochemical data were collected. Ultrasound imaging of the liver was performed. RESULTS The 167K allele showed an association with steatosis (P < 0.0001), higher ALT levels (P < 0.001) and lower total cholesterol (P < 0.00001), low-density lipoprotein cholesterol (P < 0.0001), triglycerides (P = 0.02) and non-high-density lipoprotein cholesterol levels (P < 0.000001). The subjects homozygous for the PNPLA3 148M allele carrying the rare variant of TM6SF2 showed an odds ratio of 12.2 (confidence interval 3.8-39.6, P = 0.000001) to present hypertransaminasaemia compared with the remaining patients. CONCLUSION Although the TMS6SF2 E167K variant predisposes the obese children to non-alcoholic fatty liver disease, there is an association between this variant and lower levels of cardiovascular risk factors. Overall, the data suggest differential effects of TMS6SF2 E167K variant on liver and heart health.
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Affiliation(s)
- A Grandone
- Department of Woman, Child and General and Specialized Surgery, Seconda Univesità degli Studi di Napoli, Napoli, Italy
| | - D Cozzolino
- Division of Internal Medicine, Seconda Università di Napoli, Napoli, Italy
| | - P Marzuillo
- Department of Woman, Child and General and Specialized Surgery, Seconda Univesità degli Studi di Napoli, Napoli, Italy
| | - G Cirillo
- Department of Woman, Child and General and Specialized Surgery, Seconda Univesità degli Studi di Napoli, Napoli, Italy
| | - A Di Sessa
- Department of Woman, Child and General and Specialized Surgery, Seconda Univesità degli Studi di Napoli, Napoli, Italy
| | - L Ruggiero
- Department of Woman, Child and General and Specialized Surgery, Seconda Univesità degli Studi di Napoli, Napoli, Italy
| | - M R Di Palma
- Department of Woman, Child and General and Specialized Surgery, Seconda Univesità degli Studi di Napoli, Napoli, Italy
| | - L Perrone
- Department of Woman, Child and General and Specialized Surgery, Seconda Univesità degli Studi di Napoli, Napoli, Italy
| | - E Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, Seconda Univesità degli Studi di Napoli, Napoli, Italy
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Morandi A, Miraglia Del Giudice E, Maffeis C. Reply: To PMID 25112691. J Pediatr 2015; 166:1549-50. [PMID: 25769234 DOI: 10.1016/j.jpeds.2015.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | | | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
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Morandi A, Maffeis C. Predictors of metabolic risk in childhood obesity. Horm Res Paediatr 2015; 82:3-11. [PMID: 24923289 DOI: 10.1159/000362237] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 03/14/2014] [Indexed: 11/19/2022] Open
Abstract
Most of the complications of juvenile obesity are due to metabolic disturbances induced by an excessive accumulation of fat which leads to chronic diseases like type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Finding effective ways of identifying obese paediatric patients who are at increased risk of developing cardiovascular and metabolic complications has been recognised to be a promising strategy to improve prevention of complications of early obesity. Moreover, correctly identifying obese children who are already affected by metabolic co-morbidities should be a clinical priority. According to the state of the art summarised in this review, traditional metabolic variables included in the definitions of metabolic syndrome (MS), pre-diabetes, non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steato-hepatitis and, in obese girls, the presence of polycystic ovary syndrome are the best available longitudinal predictors of CVD and T2DM among obese children and adolescents. In clinical practice, traditional metabolic variables included in the definitions of MS should be assessed in all obese children and adolescents; fasting metabolic variables have been proposed to identify obese patients likely to be affected by impaired glucose tolerance or T2DM, and ultrasound has proved to be a valid surrogate for biopsy in the diagnosis of NAFLD. Further large longitudinal and cross-sectional studies are needed to improve our chances of identifying obese youth at the highest metabolic risk.
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Affiliation(s)
- Anita Morandi
- Regional Centre for Pediatric Diabetes, Clinical Nutrition and Obesity, ULSS 20, and University of Verona, Verona, Italy
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Platt AM. Insulin Resistance, Metabolic Syndrome, and Polycystic Ovary Syndrome in Obese Youth. NASN Sch Nurse 2015; 30:207-13. [PMID: 25816425 DOI: 10.1177/1942602x15575355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
School nurses are well aware of the childhood obesity epidemic in the United States, as one in three youth are overweight or obese. Co-morbidities found in overweight or obese adults were not commonly found in youth three decades ago but are now increasingly "normal" as the obesity epidemic continues to evolve. This article is the second of six related articles discussing the co-morbidities of childhood obesity and discusses the complex association between obesity and insulin resistance, metabolic syndrome, and polycystic ovary syndrome. Insulin resistance increases up to 50% during puberty, which may help to explain why youth are more likely to develop co-morbidities as teens. Treatment of these disorders is focused on changing lifestyle habits, as a child cannot change his or her pubertal progression, ethnicity, or family history. School nurses and other personnel can assist youth with insulin resistance, metabolic syndrome, and polycystic ovary syndrome by supporting their efforts to make changes, reinforcing that insulin resistance is not necessarily type 2 diabetes even if the child is taking medication, and intervening with negative peer pressure.
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Affiliation(s)
- Adrienne M Platt
- The Children's Mercy Hospitals and Clinics Division of Diabetes and Endocrinology, Kansas City, MO 64108
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Morandi A, Miraglia Del Giudice E, Martino F, Martino E, Bozzola M, Maffeis C. Anthropometric indices are not satisfactory predictors of metabolic comorbidities in obese children and adolescents. J Pediatr 2014; 165:1178-1183.e2. [PMID: 25112691 DOI: 10.1016/j.jpeds.2014.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/28/2014] [Accepted: 07/01/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the accuracy of body mass index (BMI), Z score of the BMI, waist circumference, and waist-to-height ratio in selecting obese children with fasting metabolic impairments or impaired glucose tolerance. STUDY DESIGN In a cohort of 883 obese children and adolescents (age 8-18 years), we assessed the associations of anthropometric indices with traditional metabolic complications of obesity (impaired fasting glucose, impaired glucose tolerance, hypertension, high triglycerides, low high-density lipoprotein-cholesterol). The accuracy of anthropometric indices as markers of metabolic impairment was assessed by receiver operating characteristic analysis and the areas under the receiver operating characteristics curves (AUROCs) of anthropometric indices were compared with each other by the DeLong test. RESULTS BMI, Z score of the BMI, waist circumference, and waist-to-height ratio were associated with metabolic impairments but showed low to moderate accuracy in discriminating both single and clustered metabolic impairments. The AUROCs ranged from 0.55-0.70. The 4 anthropometric indices did not show significantly different AUROCs as predictors of clustered metabolic risk factors (all P values of DeLong tests: >.05). CONCLUSIONS Commonly used anthropometric indices are not satisfactory markers of metabolic comorbidity among obese children and adolescents and should not be adopted as screening tools for the metabolic assessment of this category of patients.
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Affiliation(s)
- Anita Morandi
- Center for Pediatric Diabetes, Clinical Nutrition and Obesity, University of Verona, Verona, Italy.
| | | | | | - Eliana Martino
- Department of Pediatrics, "La Sapienza" University, Rome, Italy
| | - Mauro Bozzola
- Internal Medicine and Therapeutics Department, University of Pavia, Pavia, Italy
| | - Claudio Maffeis
- Center for Pediatric Diabetes, Clinical Nutrition and Obesity, University of Verona, Verona, Italy
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Abstract
The ever growing prevalence of childhood obesity is being accompanied by an increase in the pediatric population of diseases once believed to be exclusive of the adulthood such as the metabolic syndrome (MS). The MS has been defined as the link between insulin resistance, hypertension, dyslipidemia, impaired glucose tolerance, and other metabolic abnormalities associated with an increased risk of atherosclerotic cardiovascular diseases in adults. In this review, we will discuss the peculiar aspects of the pediatric MS and the role of novel molecules and biomarkers in its pathogenesis.
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Novel association between a nonsynonymous variant (R270H) of the G-protein-coupled receptor 120 and liver injury in children and adolescents with obesity. J Pediatr Gastroenterol Nutr 2014; 59:472-5. [PMID: 25250621 DOI: 10.1097/mpg.0000000000000463] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The G-protein-coupled receptor 120 (GPR120) is a receptor for polyunsaturated fatty acids with anti-inflammatory activity. The R270H variant of GPR120 enhances inflammation in adipose and hepatic tissues. We investigated whether the R270H variant could play a role in determining liver injury in children and adolescents with obesity. Five hundred eighty-one children with obesity were studied. No homozygotes and 20 heterozygotes for the 270H allele were found. Heterozygotes showed higher alanine transaminase (ALT) levels (P = 0.01) than wild-type subjects, and also showed an odds ratio to have pathologic ALT of 3.2 (95% confidence interval [CI] 1.2-8.0, P < 0.05). Moreover, we genotyped the same patients for the patatin-like phospholipase-containing domain 3 (PNPLA3) I148M polymorphism, which is implicated in the development of liver steatosis. Stratifying the patients with the GPR120 270H variant on the basis of their PNPLA3 polymorphism, we demonstrated a significant interaction effect on ALT levels (P = 0.00001), suggesting a driving effect of the PNPLA3 148M allele on liver injury in children with obesity carrying this variant.
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Cooney TE. CORR Insights®: Hospital for special surgery pediatric functional activity brief scale predicts physical fitness testing performance. Clin Orthop Relat Res 2014; 472:2287-9. [PMID: 24668074 PMCID: PMC4048408 DOI: 10.1007/s11999-014-3582-1] [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: 03/06/2014] [Accepted: 03/13/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Timothy E. Cooney
- Department of Orthopaedic Research, UPMC Hamot Medical Center, 201 State St, Erie, PA 16550 USA
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Wree A, Broderick L, Canbay A, Hoffman HM, Feldstein AE. From NAFLD to NASH to cirrhosis-new insights into disease mechanisms. Nat Rev Gastroenterol Hepatol 2013; 10:627-36. [PMID: 23958599 DOI: 10.1038/nrgastro.2013.149] [Citation(s) in RCA: 449] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
NAFLD has evolved as a serious public health problem in the USA and around the world. In fact, NASH-the most serious form of NAFLD-is predicted to become the leading cause of liver transplantation in the USA by the year 2020. The pathogenesis of NAFLD and NASH, in particular the mechanisms responsible for liver injury and fibrosis, is the result of a complex interplay between host and environmental factors, and is at the centre of intense investigation. In this Review, we focus on recently uncovered aspects of the genetic, biochemical, immunological and molecular events that are responsible for the development and progression of this highly prevalent and potentially serious disease. These studies bring new insight into this complex disorder and have led to the development of novel therapeutic and diagnostic strategies that might enable a personalized approach in the management of this disease.
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Affiliation(s)
- Alexander Wree
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92037-0715, USA
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Gong CD, Wu QL, Chen Z, Zhang D, Zhao ZY, Peng YM. Glycolipid metabolic status of overweight/obese adolescents aged 9- to 15-year-old and the BMI-SDS/BMI cut-off value of predicting dyslipidemiain boys, Shanghai, China: a cross-sectional study. Lipids Health Dis 2013; 12:129. [PMID: 23984682 PMCID: PMC3766195 DOI: 10.1186/1476-511x-12-129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/23/2013] [Indexed: 12/28/2022] Open
Abstract
Background The prevalence of adolescents’ obesity and overweight has dramatically elevated in China. Obese children were likely to insulin resistance and dyslipidemia, which are risk factors of cardiovascular diseases. However there was no cut-off point of anthropometric values to predict the risk factors in Chinese adolescents. The present study was to investigate glycolipid metabolism status of adolescents in Shanghai and to explore the correlations between body mass index standard deviation score (BMI-SDS) and metabolic indices, determine the best cut-off value of BMI-SDS to predict dyslipidemia. Methods Fifteen schools in Shanghai’s two districts were chosen by cluster sampling and primary screening was done in children aged 9-15 years old. After screening of bodyweight and height, overweight and obese adolescents and age-matched children with normal body weight were randomly recruited in the study. Anthropometric measurements, biochemical measurements of glycolipid profiles were done. SPSS19.0 was used to analyze the data. Receiver operating characteristic (ROC) curves were made and the best cut-off values of BMI-SDS to predict dyslipidemia were determined while the Youden indices were maximum. Results Five hundred and thirty-eight adolescents were enrolled in this research, among which 283 have normal bodyweight, 115 were overweight and 140 were obese. No significant differences of the ages among 3 groups were found. There were significant differences of WC-SDS (p<0.001), triacylglycerol (p<0.05), high and low density lipoprotein cholesterol (p<0.01), fasting insulin (p<0.01) and C-peptide (p<0.001) among 3 groups. Significant difference of fasting glucose was only found between normal weight and overweight group. Significant difference of total cholesterol was found between obese and normal weight group. There was no significant difference of glycated hemoglobin among 3 groups. The same tendency was found in boys but not in girls. Only HDL-C reduced and TG increased while BMI elevated in girls. The best cut-off value of BMI-SDS was 1.22 to predict dyslipidemia in boys. The BMI cut-off was 21.67 in boys. Conclusion Overweight and obese youths had reduced insulin sensitivity and high prevalence of dyslipidemia.When BMI-SDS elevated up to 1.22 and BMI was higher than 21.67 in boys, dyslipidemia may happen.
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Affiliation(s)
- Chun-dan Gong
- Department of Child Health Care, Children's Hospital of Fudan University, Shanghai 201102, China.
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