Metabolic Syndrome in Children and Adolescents

Nutrition and Health in Arab Adolescents (NaHAR): Study protocol for the determination of ethnic-specific body fat and anthropometric cut-offs to identify metabolic syndrome

The prevalence of adolescent obesity in the Middle-East is considered among the highest in the world. Obesity in adolescents is associated with several cardiometabolic abnormalities, the constellation of which is referred to as the metabolic syndrome (MetS). This multi-country cross-sectional study aims to determine the optimal cut-off values for body fat (BF); body mass index (BMI) z-score; waist circumference (WC) percentile, and mid-upper arm circumference (MUAC) for the prediction of MetS among adolescents from Kingdom of Saudi-Arabia (KSA), Kuwait, Jordan, Lebanon and Syria. A secondary objective is to examine the validity of Bioelectrical Impendence Vector Analysis (BIVA) in estimating BF against the deuterium dilution technique (DDL). In each country, a sample of 210 adolescents will be recruited. Data collection will include demographics, socioeconomic, lifestyle and dietary data using a multi-component questionnaire; anthropometric measurements will be obtained and body composition will be assessed using the DDL and BIVA; blood pressure and biochemical assessment will be performed for the identification of the MetS. Receiver operating characteristic analyses will be undertaken to determine optimal cut-off values of BMI, WC, MUAC and BF in identifying those with MetS. Odds ratios (OR) and their respective 95% confidence interval (CI) for the association of the anthropometric measurements with MetS will be computed based on multiple logistic regression analysis models. The Bland and Altman approach will be adopted to compare BIVA against the reference DDL method for the determination of body composition parameters. This study responds to the need for ethnic-specific anthropometric cut-offs for the identification of excess adiposity and associated cardiometabolic risks in the adolescent population. The adoption of the generated cut-offs may assist policy makers, public health professionals and clinical practitioners in providing ethnic-specific preventive and curative strategies tailored to adolescents in the region.

Criteria in the Diagnosis of Metabolic Syndrome in Children: A Scoping Review

Currently, there is no consensus on the criteria for identifying metabolic syndrome in children, as observed in the diversity of research developed. For this reason, a scoping review was developed in this work, in order to compare the criteria for the diagnosis of metabolic syndrome (MetS) applied in children, described in observational, descriptive cross-sectional studies. The databases PubMed, Scopus, Web of Science and the search engine Google Scholar were used. The search terms "metabolic syndrome", "cardiometabolic syndrome", "child", "children" and "childhood" were considered, as well as the names of organizations or authors proposing identification criteria for MetS to establish search relationships using the Boolean connectors "AND" and "OR". Likewise, two reviewers carried out the evaluation and selection of articles, of which 26 articles were included in which children aged 6 to 12 participated. It was found that the most commonly used criteria for identifying MetS since 2015 are those of Cook et al, IDF, NCEP ATPIII, and De Ferranti et al, in that order. Specific criteria, such as those proposed by Cook et al, are being chosen to enhance the accuracy of identifying MetS in children. The most common risk factors in children with MetS are abdominal circumference and BMI, followed by triglycerides, HDL, blood pressure, and blood glucose. The prevalence of MetS in children varies according to the criteria used, being higher with De Ferranti et al.

Precocious evaluation of cardiovascular risk and its correlation with perinatal condition

The cardiovascular disease is the main cause of worldwide death. This profile is potentialized by the increased severity of infections in people with obesity, type 2 diabetes and hypertension. Children and adolescents are target groups for the prevention of non-communicable diseases. The Developmental Origins of Health and Disease concept points that perinatal conditions are an important risk factor to development of non-communicable disease in adulthood. In this context, the present review identifies perinatal factor that induces precocious cardiovascular risk factors, related with cardiometabolic syndrome. The low or high birth weight and caesarean delivery are risk factors that induce increased occurrence of cardiovascular risk biomarkers in children and adolescents, while the breast feeding or feeding with breast milk from the birth until two years-old is a protector strategy. Evaluation of perinatal conditions associated with precocious identification of cardiovascular risk factors in children and adolescents is an efficient strategy to prevent and control cardiovascular mortality; through interventions, as lifestyle changes during vulnerable windows of development, able to set up the risk to cardiometabolic disease.

Response to school-based interventions for overweight and obesity: A systematic scoping review

Heterogeneity of response to paediatric obesity interventions is one of the greatest challenges to obesity care. While evaluating school-based interventions by mean changes compared to control is important, it does not provide an understanding of the individual variability in response to intervention. The objective of this study was to comprehensively review school-based interventions that reported study results in terms of response and identify definitions of response used. A scoping review was conducted using a systematic search of five scientific databases from 2009 to 2021. Inclusion criteria included randomized controlled trial design, school-based setting, weight-based outcomes (e.g., BMI, BMI z-score), weight-based outcomes analysed among youth with overweight/obesity, a study conducted in a developed country and publication in English. A total of 26 reports representing 25 unique studies were included. Overall, 19% (5/26) of articles reported response. Response was defined in three ways: maintenance/decrease in BMI z-score, decrease in BMI z-score ≥0.10, and decrease in BMI z-score ≥0.20. Few school-based interventions identified an a priori intervention goal or identified the proportion of participants who responded to the intervention. Without such evaluation participants who do not benefit are likely to be overlooked.

Patterns of body weight change affect weight loss during a multidisciplinary intervention in adolescents with obesity

AIM

The current pediatric obesity health challenge necessitates a better understanding of the factors affecting weight loss success during interventions. The aim of this observational study was to test the impact of the rate of initial weight loss and body weight variability on weight loss during a 9-month residential, multidisciplinary weight loss program in adolescents with obesity.

METHODS

This retrospective study considered a whole sample of 510 adolescents with obesity (12-16 years, 435 girls). Body weight assessment was performed before (T0) and each week during the 9 months of a multidisciplinary weight loss program. Initial weight change (week 4-W4) and overall weight change at week 12 (T1) and the end of the intervention (T2) were considered. Participants were divided into three groups (tertiles), based on their percentage of weight loss between T0 and W4; and weight variability was expressed by the root mean square error (RMSE) around each participant's regression line at each considered period (W4, T1, T2).

RESULTS

Adolescents with lower initial weight loss at W4 (tertile 3) displayed the lesser weight loss at T1 and T2 compared with adolescents in tertile 1 and 2. The RMSE was positively associated with the percentage of weight loss of the period considered, but when the analyses were adjusted for age and initial body weight, there was no more significant association.

CONCLUSIONS

The rate of weight loss during the first few weeks is crucial for weight loss success, and weight variability is positively associated with weight loss in adolescents with obesity. Overall, results show that initial body weight is a determinant characteristic to consider during a lifestyle intervention. Further studies are thus needed to better understand the relationship between body weight change patterns and weight loss during the dynamic state that is adolescence.

Association of protein-energy partitioning with body weight and body composition changes in adolescents with severe obesity

BACKGROUND/OBJECTIVES

Body composition and protein-energy partitioning changes are important factors of body weight regulation, but have not been studied in the context of clinical obesity treatment setting. Thus, the aim of the present study was to investigate the pattern of body weight loss, body composition, and energy partitioning changes during a 9-month multidisciplinary weight loss program and 4-month follow up and to test the associations among these changes in adolescents with severe obesity.

SUBJECTS/METHODS

Twenty-five adolescents (14.1 ± 1.5 years old; 13 girls) with severe obesity joined a pediatric obesity center for a 9-month inpatient multidisciplinary weight loss program. All participants performed body composition assessment (i.e. fat mass-FM, and fat-free mass-FFM) and completed a 36-h session in indirect calorimetric chamber before the start (T0), at the end of the intervention (T1) and 4 months follow-up to the intervention (T2). The protein-energy partitioning (P ratio) was calculated as urinary nitrogen loss/total energy expenditure over 24 hours.

INTERVENTIONS

9-month individualized multidisciplinary weight loss program consisting of lifestyle education, psychological support, physical activity, and dietary intervention.

RESULTS

Initial P ratio was positively associated with changes in body weight from T0 to T1 (p = 0.038). The changes in FFM/FM were negatively associated with body weight changes in boys (p = 0.006) from T0 to T1 and in girls (p < 0.001) from T1 to T2. Urinary nitrogen excretion (p < 0.001) and total energy expenditure (p < 0.001) significantly decreased during the weight loss program while the P ratio did not significantly change.

CONCLUSION

The present results suggest that baseline and changes in energy partitioning may be associated with changes in body weight in adolescents with severe obesity. In addition, sexual dimorphism in these patterns of change suggest the need for specific dietary and physical activity strategies in boys and girls to optimize body weight loss and to prevent or slow weight regain.

Levilactobacillus brevis from carnivores can ameliorate hypercholesterolemia: in vitro and in vivo mechanistic evidence

AIMS

To explore the probiotic and hypocholesterolemic potential of two Levilactobacillus brevis strains of carnivore origin along with selected underlying mechanisms.

METHODS AND RESULTS

L. brevis MT950194 and L. brevis MW365351 were analyzed in vitro for oro-gastro-intestinal stress tolerance, cholesterol reduction, cholesterol adsorption (through scanning electron microscopy) and bile salt hydrolase (BSH) activity. Strains could survive (> 80%) in oro-gastro-intestinal conditions, reduce high amount of cholesterol (35% and 54%) from media containing bile salts (0.3%) as compared with Lactobacillus acidophilus ATCC4356 and presented least pathogenicity towards mammalian cells. Exopolysaccharide production, cell surface cholesterol adherence and BSH activity were witnessed as possible cholesterol lowering mechanisms. In in vivo experiment, the treatments of hypercholesterolemic rats with L. brevis MT950194, L. brevis MW365351 and their mixture led to significant (p < 0.05) reduction in serum and hepatic cholesterol, low density lipids, cholesterol ratio, liver steatosis, and size of adipocytes. It further ameliorated diet induced changes in hepatic enzymes.

CONCLUSIONS

L. brevis MT950194 and L. brevis MW365351 from carnivores have probiotic pharmacological potential and can reduce serum cholesterol through surface adherence and BSH production.

SIGNIFICANCE AND IMPACT OF STUDY

These strains may be utilized in treating hypercholesterolemia and production of low fat functional foods.

The Role of Nutraceutical Containing Polyphenols in Diabetes Prevention

Research in pharmacological therapy has led to the availability of many antidiabetic agents. New recommendations for precision medicine and particularly precision nutrition may greatly contribute to the control and especially to the prevention of diabetes. This scenario greatly encourages the search for novel non-pharmaceutical molecules. In line with this, the daily and long-term consumption of diets rich in phenolic compounds, together with a healthy lifestyle, may have a protective role against the development of type 2 diabetes. In the framework of the described studies, there is clear evidence that the bio accessibility, bioavailability, and the gut microbiota are indeed affected by: the way phenolic compounds are consumed (acutely or chronically; as pure compounds, extracts, or in-side a whole meal) and the amount and the type of phenolic compounds (ex-tractable or non-extractable/macromolecular antioxidants, including non-bioavailable polyphenols and plant matrix complexed structures). In this review, we report possible effects of important, commonly consumed, phenolic-based nutraceuticals in pre-clinical and clinical diabetes studies. We highlight their mechanisms of action and their potential effects in health promotion. Translation of this nutraceutical-based approach still requires more and larger clinical trials for better elucidation of the mechanism of action toward clinical applications.

Gender and age differences in the prevalence and associated factors of metabolic syndrome among children and adolescents in South Korea

Purpose

This study examined the prevalence of metabolic syndrome (MetS) in South Korean children and adolescents by gender and age and analyzed gender-specific factors associated with MetS.

Methods

This study used data on children aged 10-18 years from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2015. Analyses included descriptive statistics, the independent t-test, the x² test, and univariate logistic regression analysis (p<.050).

Results

The prevalence of MetS was 4.8% in boys and 3.4% in girls. The prevalence was higher in girls up to the age of 12, but higher in boys who were 13 or older. Abdominal obesity was frequent in girls, whereas low high-density lipoprotein cholesterol (HDL-C) and elevated blood pressure were more common in boys. Higher body mass index, waist-to-height ratio, waist circumference, blood pressure, triglycerides, HDL-C, perceived "fat" body shape, and weight loss efforts were associated with MetS in both genders. Increasing age, having one meal per day, and weight maintenance were associated factors unique to boys. Fasting plasma glucose, familial medical history of low HDL-C, and perceived "thin" body shape were associated factors in girls.

Conclusion

Gender and age differences should be considered in the risk assessment and prevention of MetS.

Metabolic syndrome in adolescents and antioxidant nutrient intake: a cross-sectional study

OBJECTIVE

To verify the association between metabolic syndrome and its components, and intake of antioxidant nutrients in adolescents.

METHODS

This is a cross-sectional study of the data of 327 adolescents in a high school in Teresina, Piauí, Brazil, pertaining to their socioeconomic background, anthropometric measurements, dietary intake (selenium; copper; zinc; vitamins A, C, and E), hemodynamics, and biochemical tests. The criteria for diagnosing metabolic syndrome in adolescents were applied. Binary logistic regression was used to verify the association between metabolic syndrome and its components, and intake of antioxidants. The level of significance was established at p<0.05.

RESULTS

Prevalence of metabolic syndrome was 7.0%, with a significant association between body mass index and blood pressure. Lower tertiles of copper and vitamins A and E intake were associated with high triglyceride and glycemic levels. The association with vitamins A and E remained after adjustment.

CONCLUSIONS

A significant association between lower vitamins A and E intake and metabolic syndrome components (altered triglycerides and glycemic levels) was found. Besides further studies on this issue, the need for health interventions was found, which ensures the appropriate intake of antioxidant nutrients during adolescence.

Associations between Anthropometrics, Cardiorespiratory Fitness, and Metabolic Syndrome Components in Brazilian Adolescents with Obesity

Purpose: To describe the presence of metabolic syndrome (MS) in Brazilian adolescents with obesity, and to compare anthropometric and cardiorespiratory fitness measurements in relation to the presence of MS. Methods: Sixty-seven adolescents (13-18 years, 36 girls) with obesity (body mass index z-score ≥2.0) were enrolled. The following were assessed for each participant: anthropometrics, body composition, lipid profile, glucose, serum insulin, insulin resistance, blood pressure (BP), and cardiorespiratory fitness. Results: The presence of MS was found in 47.76% of the sample. The following abnormal measurements were most frequently reported: waist circumference (WC) (100.0%), BP (85.07%), and triglycerides (TG) (50.75%). Boys with obesity were more likely to meet MS criteria when compared to girls (P = 0.040; odds ratio = 2.80 [1.04-7.56]). Conclusion: The presence of MS in Brazilian adolescents with obesity in this study was 47.76%. Among this sample, the most frequently reported MS variables above the established cutoffs were WC (100%), followed by altered BP (85%) and TG (50%). These data further support previously published studies that low levels of cardiorespiratory fitness may increase the risk of MS among adolescents with obesity.

Redox Imbalance and Methylation Disturbances in Early Childhood Obesity

Obesity is increasing worldwide in prepubertal children, reducing the age of onset of associated comorbidities, including type 2 diabetes. Sulfur-containing amino acids, methionine, cysteine, and their derivatives play important roles in the transmethylation and transsulfuration pathways. Dysregulation of these pathways leads to alterations in the cellular methylation patterns and an imbalanced redox state. Therefore, we tested the hypothesis that one-carbon metabolism is already dysregulated in prepubertal children with obesity. Peripheral blood was collected from 64 children, and the plasma metabolites from transmethylation and transsulfuration pathways were quantified by HPLC. The cohort was stratified by BMI z-scores and HOMA-IR indices into healthy lean (HL), healthy obese (HO), and unhealthy obese (UHO). Fasting insulin levels were higher in the HO group compared to the HL, while the UHO had the highest. All groups presented normal fasting glycemia. Furthermore, high-density lipoprotein (HDL) was lower while triglycerides and lactate levels were higher in the UHO compared to HO subjects. S-adenosylhomocysteine (SAH) and total homocysteine levels were increased in the HO group compared to HL. Additionally, glutathione metabolism was also altered. Free cystine and oxidized glutathione (GSSG) were increased in the HO as compared to HL subjects. Importantly, the adipocyte secretory function was already compromised at this young age. Elevated circulating leptin and decreased adiponectin levels were observed in the UHO as compared to the HO subjects. Some of these alterations were concomitant with alterations in the DNA methylation patterns in the obese group, independent of the impaired insulin levels. In conclusion, our study informs on novel and important metabolic alterations in the transmethylation and the transsulfuration pathways in the early stages of obesity. Moreover, the altered secretory function of the adipocyte very early in life may be relevant in identifying early metabolic markers of disease that may inform on the increased risk for specific future comorbidities in this population.

Reproductive disorders in male rats induced by high-fructose consumption from juvenile age to puberty

There is compelling evidence that a hypercaloric, high-fructose diet can cause metabolic syndrome (MetS) and a whole range of other metabolic changes. In the context of androgen deficiency, MetS in boys merits special attention, but the effects of fructose-rich diet in youth on future male reproductive function are still poorly evidenced. The aim of this study was to address this issue and analyse the effects of high-fructose intake starting from weaning to puberty (postnatal day 23 up to 83) on the reproductive function of male rats. For this purpose juvenile male Wistar rats were divided in two groups: control and the group receiving 10 % fructose solution instead of drinking water. Reproductive function was evaluated in terms of fertility, sperm count, testes/epididymis morphology, and serum sex hormones. The fructose-treated group showed a decrease in testosterone and twofold increase in luteinising and follicle-stimulating hormone levels in the serum. This was accompanied with lower testis/epididymis weights, sperm count, and changed testis/epididymis morphology. Their fertility remained unchanged, but the fertility of females mating with these males diminished. In addition, pre-implantation and post-implantation embryonic death rate rose in these females. Our results have confirmed that high fructose consumption from early age until puberty can impair the reproductive function of male rats, and call for further animal and epidemiological investigation.

Prevalence of Metabolic Syndrome among Children and Adolescents in High-Income Countries: A Systematic Review and Meta-Analysis of Observational Studies

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.

Telomere length mediates the association between polycyclic aromatic hydrocarbons exposure and abnormal glucose level among Chinese coke oven plant workers

INTRODUCTION

Diabetes is a chronic and complex disease determined by environmental and genetic factors. This study aimed to investigate the association between polycyclic aromatic hydrocarbons (PAHs) exposure and fasting blood glucose levels and telomere length among coke-oven plant workers, to explore potential role of telomere length (TL) in the association between PAHs exposure and abnormal glucose level.

METHODS

The cross-sectional survey was conducted in 2017. The high-performance liquid chromatography mass spectrometry (HPLC-MS) was used to detect 11 urine biomarkers of PAHs exposure. TL was measured using the Real-time quantitative polymerase chain reaction (RT-qPCR) method. Logistic regression model, the modified Poisson regression models, and mediation analysis were used to evaluate the associations between PAHs exposure, TL, and abnormal glucose.

RESULTS

The results showed that the urinary 1-hydroxypyrene (1-PYR) was positively related to abnormal glucose in a dose-dependent manner (P_trend = 0.007), the prevalence ratio of abnormal glucose was 8% (95% CI: 1.01-1.16) higher in 3rd tertile of urinary 1-PYR levels. Urinary 1-PYR in the 2nd tertile and 3rd tertile were associated with a 53% (OR = 0.47, 95% CI: 0.28-0.79) and 59% (OR = 0.41, 95% CI: 0.23-0.76) higher risk of shortening TL. And there was a negatively association between 1-PYR and TL in a dose-dependent manner (P_trend = 0.045). We observed that the association between 1-PYR and abnormal glucose was more significantly positive among participants with median TL level (P_trend = 0.006). In addition, mediation analysis showed the TL could explain 11.7% of the effect of abnormal glucose related to PAHs exposure.

CONCLUSIONS

Our findings suggested the effect of abnormal glucose related to PAHs exposure was mediated by telomere length in coke oven plant workers.

Cardiometabolic efficacy of multidisciplinary weight loss interventions is not altered in adolescents with obesity initially diagnosed or with a persistent metabolic syndrome

The efficacy of weight loss interventions might be affected by the metabolic profile of adolescents with obesity. In this study, we hypothesized that the initial diagnosis of the MS, or its persistence after an intervention, will not reduce the efficacy of a 16-week multidisciplinary weight loss program. Ninety two adolescents (12-15 years; 62 girls) with obesity completed baseline anthropometric and body composition evaluation (DXA). Lipid profile, insulinemia, glycaemia and blood pressure were measured and metabolic syndrome (MS) diagnosed. The adolescents then followed a 4-month inpatient multidisciplinary weight-management program. All measurements were performed before (T0) and after 4 months of intervention (T1). Body weight, body mass index (BMI) and percentage of fat mass (%FM) decreased significantly between T0 and T1 (P< .001), with no difference in fat-free mass (kg). All metabolic variables (except blood pressure) were improved. 47.6% of the whole sample presented with MS at baseline against 35.7% at T1. Body weight (P = 0.006), BMI (P = 0.0261), %FM (P = 0.0211), hip circumference (= 0.0131), BMI percentile (P = 0.0319), and diastolic blood pressure (P = 0.0365) showed a time x group interaction and their deltas (variations between T0 and T1) were significantly different between adolescents with and without MS at baseline. There was no significant difference between adolescents with persistent and nonpersistent MS except for ΔBMI percentile that deceased significantly more in the nonpersistent group (P = 0.0115). According to our results, the efficacy of weight loss interventions is not reduced in adolescents initially diagnosed with MS or different between those who present a persistent or nonpersistent MS after the intervention.

Micronutrient status and associated factors of adiposity in primary school children with normal and high body fat in Colombo municipal area, Sri Lanka

BACKGROUND

The prevalence of obesity and associated risk of chronic diseases are increasing among the paediatric population. The effectiveness of preventive measures and interventions are likely to improve when all factors which associate with obesity in a specific target group are considered. Currently such comprehensive data is unavailable for Sri Lankan children aged 8-9 years.

METHODS

This paper pertains to the data collected from August-2015 to November-2016 for a case-control study which included cases (high body fat) (N = 160; males-81) and controls (normal body fat) (N = 164; males-80) recruited from primary schools in the Colombo Municipal area. Anthropometry and body composition (Bioelectrical impedance analysis-BIA) were measured. Diet, physical activity and socio-demographic data were collected using validated interviewer administered questionnaires. Serum concentrations of vitamins A, D [25(OH)D], E, folate (serum and red blood cell-RBC), zinc (Zn), selenium (Se), copper (Cu), iron (Fe), magnesium (Mg), calcium (Ca), chromium (Cr), manganese (Mn), cobalt (Co), ferritin, leptin and high sensitivity C-reactive protein (hs-CRP) were assessed using fasting blood samples.

RESULTS

Cases were from higher socio-economic strata and spent significantly less time on physical activities, more time on sedentary behaviours and consumed higher energy compared to the controls. Cases from both genders had significantly lower levels of vitamin D [25 (OH)D], Fe and Mg (all p < 0.05) and higher levels of Cu and Ca (all p < 0.01) compared to controls. Higher levels of ferritin and Cr were seen among male (p < 0.001) and female (p > 0.05) cases compared to the controls. However, total serum folate levels were lower in male (p < 0.01) and female (p > 0.05) cases while the RBC folate levels were higher among male (p < 0.01) and female (p > 0.05) cases compared with controls. Vitamins A, E, Se, Mn and Co (p > 0.05) were not significantly different between groups. The inflammatory markers, both hs-CRP and leptin levels were higher among cases (p < 0.001) compared to the controls.

CONCLUSIONS

This study highlights higher socio-economic status, lower physical activity, more sedentary behaviours, higher energy intake and inconsistent distribution of micronutrients among the children with high body fat when compared with the control group. Increased levels of inflammatory markers indicate the presence of the risk of chronic inflammation in children with high body fat.

Tri-Ponderal Mass Index Reference Values for Screening Metabolic Syndrome in Children and Adolescents: Results From Two National-Representative Cross-Sectional Studies in China and America

INTRODUCTION

To ascertain the possible cut point of tri-ponderal mass index (TMI) in discriminating metabolic syndrome (MetS) and related cardio-metabolic risk factors in Chinese and American children and adolescents.

METHODS

A total of 57,201 Chinese children aged 7-18 recruited in 2012 and and 10,441 American children aged 12-18 from National Health and Nutrition Examination Survey (NHANES 2001-2014) were included to fit TMI percentiles. Participants were randomly assigned to a derivation set (75%) and validation set (25%). The cut points of TMI with the lowest misclassification rate under the premise of the highest area under curves (AUC) were selected for each sex, which were additionally examined in the validation set. All of data analysis was conducted between September and December in 2019.

RESULTS

TMI showed good capacity on discriminating MetS, with AUC of 0.7658 (95% CI: 0.7544-0.7770) to 0.8445 (95% CI: 0.8349-0.8537) in Chinese and 0.8871 (95% CI: 0.8663-0.9056) to 0.9329 (95% CI: 0.9166-0.9469) in American children. The optimal cut points were 14.46 kg/m³ and 13.91 kg/m³ for Chinese boys and girls, and 17.08 kg/m³ and 18.89 kg/m³ for American boys and girls, respectively. The corresponding misclassification rates were 17.1% (95% CI: 16.4-17.8) and 11.2% (95% CI: 9.9-12.6), respectively. Performance of these cut points were also examined in the validation set (sensitivity 67.7%, specificity 82.4% in Chinese; sensitivity 84.4%, specificity 88.7% in American children).

CONCLUSIONS

A sex- and ethnicity- specific single cut point of TMI could be used to distinguish MetS and elevated risk of cardio-metabolic factors in children and adolescents.

The dynamics of metabolic syndrome development from its isolated components among iranian children and adolescents: Findings from 17 Years of the Tehran Lipid and Glucose Study (TLGS)

BACKGROUND

Careful evaluation of the progression trend of the metabolic syndrome (MetS) in children and adolescents (C&A) is one of the important methods of studying the natural history of MetS in them. This study was performed to determine the trend of changes in the progression of MetS from its components.

METHODS

This was a longitudinal study which was performed on data from 4 follow-up periods of Tehran Lipid and Glucose Study (TLGS) between 1999 and 2015. The research population consisted of 6-18-year-old children and adolescents creating 3895-person population. The criteria for the diagnosis of MetS was joint interim statement (JIS). The considered components were central adiposity, high blood pressure, insulin resistance, and dyslipidemia.

RESULTS

In this study, in the long term, the highest increase in the MetS' incidence in boys occurred in obesity and in girls in dyslipidemia and in total mode, in obesity. But in the short term (3.6 year follow-up periods) in the first to fourth periods, in total mode, the highest incidence occurred in dyslipidemia, hyperglycemia, dyslipidemia, and obesity. In terms of trend, in total mode, the highest increase in MetS incidence was related to the obesity component. Also, the incidence of MetS from all components was declining in overall mode. Also, the most common components at the beginning and end of the study in all groups were dyslipidemia with a decreasing and obesity with an increasing trend, respectively.

CONCLUSION

It seems that in Iranian C&As, obesity and dyslipidemia components play a more important role in the further development of the MetS than other components. This matter requires careful and serious attention in preventive and control planning.

An Approach to Early Detection of Metabolic Syndrome through Non-Invasive Methods in Obese Children

Background: Metabolic Syndrome (MetS) has a high prevalence in children, and its presence increases in those with a high BMI. This fact confirms the need for early detection to avoid the development of other comorbidities. Non-invasive variables are presented as a cost-effective and easy to apply alternative in any clinical setting. Aim: To propose a non-invasive method for the early diagnosis of MetS in overweight and obese Chilean children. Methods: We conducted a cross-sectional study on 221 children aged 6 to 11 years. We carried out multivariate logistic regressions, receiver operating characteristic curves, and discriminant analysis to determine the predictive capacity of non-invasive variables. The proposed new method for early detection of MetS is based on clinical decision trees. Results: The prevalence of MetS was 26.7%. The area under the curve for the BMI and waist circumference was 0.827 and 0.808, respectively. Two decision trees were calculated: the first included blood pressure (≥104.5/69 mmHg), BMI (≥23.5 Kg/m²) and WHtR (≥0.55); the second used BMI (≥23.5 Kg/m²) and WHtR (≥0.55), with validity index of 74.7% and 80.5%, respectively. Conclusions: Early detection of MetS is possible through non-invasive methods in overweight and obese children. Two models (Clinical decision trees) based on anthropometric (non-invasive) variables with acceptable validity indexes have been presented. Clinical decision trees can be applied in different clinical and non-clinical settings, adapting to the tools available, being an economical and easy to measurement option. These methods reduce the use of blood tests to those patients who require confirmation.

Overfeeding During Lactation in Rats is Associated with Cardiovascular Insulin Resistance in the Short-Term

Childhood obesity is associated with metabolic and cardiovascular comorbidities. The development of these alterations may have its origin in early life stages such as the lactation period through metabolic programming. Insulin resistance is a common complication in obese patients and may be responsible for the cardiovascular alterations associated with this condition. This study analyzed the development of cardiovascular insulin resistance in a rat model of childhood overweight induced by overfeeding during the lactation period. On birth day, litters were divided into twelve (L12) or three pups per mother (L3). Overfed rats showed a lower increase in myocardial contractility in response to insulin perfusion and a reduced insulin-induced vasodilation, suggesting a state of cardiovascular insulin resistance. Vascular insulin resistance was due to decreased activation of phosphoinositide 3-kinase (PI3K)/Akt pathway, whereas cardiac insulin resistance was associated with mitogen-activated protein kinase (MAPK) hyperactivity. Early overfeeding was also associated with a proinflammatory and pro-oxidant state; endothelial dysfunction; decreased release of nitrites and nitrates; and decreased gene expression of insulin receptor (IR), glucose transporter-4 (GLUT-4), and endothelial nitric oxide synthase (eNOS) in response to insulin. In conclusion, overweight induced by lactational overnutrition in rat pups is associated with cardiovascular insulin resistance that could be related to the cardiovascular alterations associated with this condition.

Metabolic syndrome among children and adolescents in low and middle income countries: a systematic review and meta-analysis

BACKGROUND

Metabolic syndrome (MetS) is a clustering of cardiovascular risk factors, which is rising in the low and middle income countries (LMICs). There are various studies with inconsistent findings that are inconclusive for policy makers and program planners. Thus, this systematic review and meta-analysis aimed at estimating the pooled prevalence of MetS and its components in LMICs.

METHODS

Electronic searches were conducted in international databases including PubMed, Web of Science, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), Science direct (Elsevier), Food Science and Technology Abstracts (FSTA), Global Health and Medline, and other sources (World Cat, Google Scholar, and Google). The pooled estimates were computed in the random effect model. The pooled prevalence was computed using the three diagnostic methods (IDF, ATP III and de Ferranti). Publication bias was verified using funnel plot and Egger's regression test. Subgroup and sensitivity analysis were performed to identify the possible sources of heterogeneity among the included studies.

RESULT

In this study, 142,142 children and adolescents from 76 eligible articles were included to compute the pooled prevalence of MetS and its components in LMCIs. MeTs among overweight and obese population was computed from 20 articles with the pooled prevalence of 24.09%, 36.5%, and 56.32% in IDF, ATP III and de Ferranti criteria, respectively. Similarly, a total of 56 articles were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, Mets was found in 3.98% (IDF), 6.71% (ATP III) and 8.91% (de Ferranti) of study subjects. Regarding the components of MetS, abdominal obesity was the major component in overweight and obese population and low HDL-C was the most common component in the general population. This study also revealed that males were highly affected by MetS than females.

CONCLUSION

This study illustrates that MetS among children and adolescents is an emerging public health challenge in LMICs, where the prevalence of obesity is on the move. Preventive strategies such as community and school based intervention need to be designed. Promoting physical activities and healthy eating behaviors could avert this problem.

Increased coronary arteriolar contraction to serotonin in juvenile pigs with metabolic syndrome

Metabolic syndrome (MetS) is associated with alterations in coronary vascular smooth muscle and endothelial function. The current study examined the contractile response of the isolated coronary arterioles to serotonin in pigs with and without MetS and investigated the signaling pathways responsible for serotonin-induced vasomotor tone. The MetS pigs (8-weeks old) were fed with a hyper-caloric, fat/cholesterol diet and the control animals (lean) were fed with a regular diet for 12 weeks (n = 6/group). The coronary arterioles (90–180 μm in diameter) were dissected from the harvested pig myocardial tissues and the in vitro coronary arteriolar response to serotonin was measured in the presence of pharmacological inhibitors. The protein expressions of phospholipase A2 (PLA₂), TXA₂ synthase, and the thromboxane-prostanoid (TP) receptor in the pigs’ left ventricular tissue samples were measured using Western blotting. Serotonin (10⁻⁹–10⁻⁵ M) induced dose-dependent contractions of coronary-resistant arterioles in both non-MetS control (lean) and MetS pigs. This effect was more pronounced in the MetS vessels compared with those of non-MetS controls (lean, P < 0.05]. Serotonin-induced contraction of the MetS vessels was significantly inhibited in the presence of the selective PLA₂ inhibitor quinacrine (10⁻⁶ M), the COX inhibitor indomethacin (10⁻⁵ M), and the TP receptor antagonist SQ29548 (10⁻⁶ M), respectively (P < 0.05). MetS exhibited significant increases in tissue levels of TXA₂ synthase and TP receptors (P < 0.05 vs. lean), respectively. MetS is associated with increased contractile response of porcine coronary arterioles to serotonin, which is in part via upregulation/activation of PLA₂, COX, and subsequent TXA₂, suggesting that alteration of vasomotor function may occur at an early stage of MetS and juvenile obesity.

TG : HDL-C Ratio Is a Good Marker to Identify Children Affected by Obesity with Increased Cardiometabolic Risk and Insulin Resistance

Metabolic syndrome (MetS) is an important predictor of cardiovascular diseases in adulthood. This study aims to examine the clinical utility of triglyceride to high-density lipoprotein ratio (TG : HDL-C) in identifying cardiometabolic risk and insulin resistance (IR) among children with obesity, in comparison with MetS as defined by the International Diabetes Federation (IDF). Data of 232 children with obesity aged 10-16 years were obtained from our study, MyBFF@school study, conducted between January and December 2014. Children were divided into tertiles of TG : HDL-C ratio. The minimum value of the highest tertile was 1.11. Thus, elevated TG : HDL-C ratio was defined as TG : HDL-C ≥1.11. Children with MetS were categorized based on the definition established by the IDF. Out of 232 children, 23 (9.9%) had MetS, out of which 5.6% were boys. Almost twofold of boys and girls had elevated TG : HDL-C ratio compared to MetS: 13.8% vs. 5.6% and 13.8% vs. 4.3%, respectively. Children with elevated TG : HDL-C ratio had lower fasting glucose compared to children with MetS (boys = 5.15 ± 0.4 vs. 6.34 ± 2.85 mmol/l, p=0.02; girls = 5.17 ± 0.28 vs. 6.8 ± 4.3 mmol/l, p=0.03). Additionally, boys with elevated TG : HDL-C ratio had a higher HDL-C level compared to those with MetS (1.08 ± 0.18 vs. 0.96 ± 0.1 mmol/l, p=0.03). There was no significant difference across other MetS-associated risk factors. Overall, TG : HDL-C ratio demonstrated higher sensitivity (42.7% vs. 12.9%) but lower specificity (74.8% vs. 93.2%) than MetS in identifying IR, either in HOMA-IR ≥2.6 for prepubertal children or HOMA-IR ≥4 for pubertal children. TG : HDL-C ratio in children with obesity is thus as useful as the diagnosis of MetS. It should be considered an additional component to MetS, especially as a surrogate marker for IR.

One-Year Prospective Study of Liver Function Tests in Children and Adolescents on Second-Generation Antipsychotics: Is There a Link with Metabolic Syndrome?

OBJECTIVE

To analyze liver function tests (LFT), weight, metabolic syndrome (MetS) and at risk of meeting MetS criteria (AR-MetS) in children and adolescents on antipsychotics (AP) during a year-long follow-up.

METHODS

Two hundred sixteen patients, AP naïve or quasi-naïve (<30 days on AP), were included. Total bilirubin, the enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), weight and other parameters of MetS were measured at baseline, and at 3, 6 and 12 months, while patients remained on the same AP.

RESULTS

At baseline, patients (mean age: 14.1 ± 3.1 years; 60.2% male) were on risperidone (N = 143), olanzapine (N = 37), or quetiapine (N = 36), although the sample decreased over time to 67 patients at 12 months (risperidone N = 46, olanzapine N = 10, and quetiapine N = 11). Around 3% of patients had ALT/AST levels that were at least twice the upper limit of normal (ULN) at 3 and 6 months; whereas roughly 19% of patients had ALP levels that were at least twice the ULN in at least one assessment after baseline, but had no clinical symptoms. From baseline to 6 months, significant increases were observed in ALT levels in the whole sample (p = 0.005), whereas ALP increased only in patients on risperidone. Patients showed significant weight gain, and more individuals met criteria for MetS and AR-MetS over time (from baseline: 2.8% and 8.3%, to 1 year: 10.5% and 23.9%, respectively). There was a trend-level group effect in global ALT across time (p = 0.076). Patients with MetS showed higher ALT concentrations (28.9 [18.4-39.4] U/L) than AR-MetS (20.4 [8.5-32.2] U/L), and no-AR-MetS (19.2 [8.4-29.9] U/L).

CONCLUSIONS

Less than 3% of children and adolescents on AP during 1-year follow-up showed an increase in ALT or AST levels in one or more of the assessments, and none of these increases was of clinical significance. Patients with MetS and AR-MetS increased during this period, and the possible role of ALT levels to monitor these patients deserves further study.

New Insights about How to Make an Intervention in Children and Adolescents with Metabolic Syndrome: Diet, Exercise vs. Changes in Body Composition. A Systematic Review of RCT

OBJECTIVE

To record which interventions produce the greatest variations in body composition in patients ≤19 years old with metabolic syndrome (MS).

METHOD

search dates between 2005 and 2017 in peer reviewed journals, following the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses). The selection criteria were: diagnostic for MS or at least a criterion for diagnosis; randomized clinical trials, ≤19 years of age; intervention programs that use diet and/or exercise as a tool (interventions showing an interest in body composition).

RESULTS

1781 clinical trials were identified under these criteria but only 0.51% were included. The most frequent characteristics of the selected clinical trials were that they used multidisciplinary interventions and were carried out in America. The most utilized parameters were BMI (body mass index) in kg/m² and BW (body weight) in kg.

CONCLUSIONS

Most of the clinical trials included had been diagnosed through at least 2 diagnostic criteria for MS. Multidisciplinary interventions obtained greater changes in body composition in patients with MS. This change was especially prevalent in the combinations of dietary interventions and physical exercise. It is proposed to follow the guidelines proposed for patients who are overweight, obese, or have diabetes type 2, and extrapolate these strategies as recommendations for future clinical trials designed for patients with MS.

Effect of cardiometabolic risk factors on the relationship between adiposity and bone mass in girls

BACKGROUND/OBJECTIVE

Childhood obesity has been separately associated with cardiometabolic risk factors (CMRs) and increased risk of fracture. However, both augmented and compromised bone mass have been reported among overweight/obese children. Metabolic dysfunction, often co-existing with obesity, may explain the discrepancy in previous studies. The aim of this study was to examine whether the relationship between adiposity and dual-energy X-ray absorptiometry (DXA) derived bone mass differed in young girls with and without CMR(s).

SUBJECTS/METHODS

Whole-body bone and body composition measures by DXA and measures of CMR (fasting glucose, high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), systolic and diastolic blood pressure, waist circumference (WC)) were obtained from 307, 9- to 12-year-old girls. Girls with 1 or ≥ 2 CMR(s) were considered to be at risk (vs. no CMR). Multiple linear regression was used to test the relationship of total fat mass with total body bone mineral content (BMC) after controlling for height, lean mass, CMR risk, and other potential confounders.

RESULTS

There was a significant interaction between CMR risk and total body fat mass. When girls were stratified by CMR group, all groups had a significant positive relationship between fat mass and BMC (p < 0.05), however, girls with ≥ 2 CMRs had a lower BMC for a given level of body fat. Total body fat was not significantly related to bone mineral density (p > 0.05).

CONCLUSION

Fat mass has a positive relationship with BMC even after controlling for lean mass. However, the positive relationship of fat mass with BMC may be attenuated if multiple CMRs are present.

Metabolic syndrome and atherogenic indices in school children: A worrying panorama in Brazil

BACKGROUND

Metabolic Syndrome (MS) is defined as the combination of a cluster of cardiovascular risk factors. The use of cardiovascular indices such as the ratios TC/HDL-c, LDL-c/HDL-c and TG/HDL-c may help in the assessment of cardiovascular risk. Investigation of cardio-metabolic risks in the pre-adolescent stage is essential to characterize possible patterns for MS in the earliest stages of the life avoiding further irreversible consequences.

AIMS

This work aimed to investigate the presence of MS and cardiovascular indices in a group of children aged 6-10 years.

METHODS

We included 150 children from a city in Brazil. Anthropometric (Body Mass Index and Waist Circumference) and biochemical parameters (glycaemia, total cholesterol, LDL-c, HDL-c, and triglycerides) were evaluated in order to identify the presence of MS. Atherogenic Indices were also calculated (TC/HDL-c, LDL-c/HDL-c and TG/HDL-c).

RESULTS

Our results showed that there are high percentages of children with altered values for biochemical and anthropometric parameters and in the atherogenic indices. MS was identified in 17.8% of the children. The main parameters related to alterations in the atherogenic indices were waist circumference, body mass index and the presence of MS.

CONCLUSION

The high prevalence of MS and alterations in the atherogenic indices in schoolchildren is a worrying panorama. We suggest the performance of more studies focusing on identification, intervention and prevention programs in order to reduce the risk factors of this syndrome in childhood and to reduce future cardiovascular deaths.

Probiotics and Disease: A Comprehensive Summary-Part 3, Cardiometabolic Disease and Fatigue Syndromes

This article series provides a literature review of the disease-specific probiotic strains, associated with cardiometabolic diseases and fatigue syndromes, studied in published clinical trials in humans and animals. This is not an exhaustive review. The table design allows for quick access to supportive data and will be helpful as a guide for both researchers and clinicians. The goal of the probiotics and disease series is to provide clinically useful tools. The first article (part 1) focused on mental health and neurological conditions and the second article (part 2) explored cultured and fermented foods that are commonly available in the United States. This third article (part 3) explores the relationship between bacterial strains and 2 of the most prevalent diseases we have in modern society: cardiometabolic disease and fatigue syndromes. Future articles will review conditions related to respiratory, ear, nose, and throat infections and infectious diseases; autoimmunity and dermatological conditions; cancer; and gastrointestinal and genitourinary, followed by an article focused on probiotic supplements. This literature review is specific to disease condition, probiotic classification, and individual strain.