Metabolic syndrome risk factors in overweight, obese, and extremely obese Brazilian adolescents

Inulin may prevent the high-fat diet induced-obesity via suppressing endocannabinoid system in the prefrontal cortex in Wistar rats

High-fat diets contribute to various metabolic disorders. Inulin supplementation has been shown to reduce appetite, lower food intake, and promote weight loss. Although there is evidence that the endocannabinoid system has metabolic effects in the prefrontal cortex, studies investigating the effects of inulin on the endocannabinoid system are limited. This study investigated the impact of inulin on obesity through the endocannabinoid system in the prefrontal cortex. Twenty-four male Wistar rats were fed one of four diets over 12 weeks. Findings indicated that a high-fat diet led to obesity, whereas inulin reduced food intake and supported weight loss. Consequently, inulin supplementation both prevented obesity and significantly decreased the expressions of Adrb3 and Adcy1, and anandamide and 2-arachidonylglycerol levels in the prefrontal cortex. Additionally, inulin lowered leptin in circulation and stimulated Trpv1. Thus, inulin may mitigate obesity development, possibly by modulating gene expressions linked to obesity in the prefrontal cortex via endocannabinoids.

Muscle Strength Indexes and Its Association With Cardiometabolic Risk Factors in Adolescents: An Allometric Approach

Background and aims: Muscle strength (MS) has been associated with better cardiometabolic health prognosis. However, the result for the beneficial relationship seems to be dependent on the influence of body size in determining MS levels. We investigate the association between allometric MS indexes and its association with cardiometabolic risk factors in adolescents. Methods: It was a cross-sectional study comprising 351 adolescents (male: 44.4%; age range 14-19 years) from Southern Brazil. MS was assessed by handgrip strength and three different allometric approaches were adopted: 1) MS index based on theoretical allometric exponent; 2) MS index including body mass and height; 3) MS index including fat-free mass and height. Obesity, high blood pressure, dyslipidemia, glucose imbalance and high-sensitivity C-reactive protein were investigated as individual factors or as combinations (either as combinations of components - presence of two adverse conditions, or number of components present in an individual - 0, 1, 2, 3+ cardiometabolic risk factors). Logistic and multinomial logistic regression analyses adjusted for confounding factors were used. The statistical significance adopted was 5%. Results: MS index based on theoretical allometric exponent was associated with lower likelihood (OR: 0.54; 95% CI: 0.28 - 0.89) for the presence of three or more cardiometabolic risk factors in the same individual. Conclusion: This study suggests that MS index based on the theoretical allometric exponent can be superior to allometric MS indexes that included body mass and height, or fat-free mass and height in representing the presence of high number of cardiometabolic risk factors in adolescents.

Inflammatory cytokines and chemokines in obese adolescents with antibody against to adenovirus 36

Obesity in adolescents has reached epidemic proportions and is associated with the inflammatory response and viral infections. The aim of this study was to understand the profile of inflammatory cytokines and chemokines associated with the inflammatory response and metabolic syndrome (MetS) in obese adolescents with positive serology for adenovirus 36 (ADV36). Thirty-six overweight, 36 obese, and 25 severe obesity adolescents aged 10 to 16 years were included in the study. The following variables were analyzed: sex, age, body mass index (BMI), blood pressure, total cholesterol and fractions, triglycerides, glucose, serum cytokine concentrations, and ADV36 antibodies. Cytokines and chemokines were quantified by cytometry and ADV36 serology was determined by enzyme-linked immunosorbent assay (ELISA). The results showed higher levels of the cytokines interleukin-1beta (IL-1β), IL-6, IL-10 and of the chemokine interferon-gamma-inducible protein 10 (IP-10) in severe obesity adolescents compared to the obese and overweight groups, as well as in the group with MetS compared to the group without this syndrome. The frequency of ADV36-positive individuals did not differ between groups. The findings revealed differences in BMI between the obese and severe obesity groups versus the overweight group in the presence of positivity for ADV36, suggesting an association with weight gain and possibly MetS installation.

COVID-19 and screen-based sedentary behaviour: Systematic review of digital screen time and metabolic syndrome in adolescents

AIM

The COVID-19 pandemic has prompted governments around the globe to implement various restriction policies, including lockdown, social distancing, and school closures. Subsequently, there has been a surge in sedentary behaviour particularly screen time (ST) together with a significant decline in physical activity that was more marked amongst children and adolescents. Excessive screen exposure in adolescents has been correlated with cardio-metabolic risk factors including obesity, hypertension, high cholesterol, and glucose intolerance that may have adverse morbidity and mortality implications in adulthood. Thus, the current study aimed to synthesize the literature on the relationship between ST of various types and the risk of metabolic syndrome (MetS) in adolescents in the context of the COVID-19 pandemic.

METHODS

In August 2021, a systematic search of the literature was undertaken using electronic databases: PubMed, PsycINFO, and the Cochran library. Studies were considered if they met the following key eligibility criteria: (i) Measure of ST as an exposure (TV, computer, videogames, internet, smartphone, tablet), using quantified duration/frequency either self-reported or observed; (ii) Measure of MetS as an outcome with standard definition and/or criteria required to establish MetS diagnosis. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias.

RESULTS

A total of ten studies met the inclusion criteria, and the majority were cross sectional studies. Most studies met fair bias scoring. Overall, the review revealed considerable evidence that suggests a significant negative association between ST and components of MetS among adolescents with dose-response association.

CONCLUSION

During the pandemic, screen usage may become more prevalent through periods of school closures, lockdowns, social isolation, and online learning classes. Public health policies and health promotion strategies targeting parents are needed to raise awareness of the adverse health effects associated with screen-based sedentary behaviour as a precursor of NCDs. Parent or home focused interventions might be effective in limiting adolescents' screen exposure, alternatively substituted with an appropriate level of physical activity.

PROSPERO REGISTRATION NUMBER

PROSPERO 2021 CRD42021272436.

Changes in prevalence of overweight in adolescents living in areas highly vulnerable to food insecurity

This study ascertained changes, over 5 years, in the prevalence of overweight in adolescents and associations with socio-demographic variables and food insecurity. Two cross-sectional population-based studies were conducted with 511 (2005) and 314 (2010) adolescents resident in Campos Elíseos (Duque de Caxias-RJ). Overweight was evaluated by sex and age specific cut-off points of BMI (weight/height²). The prevalence of food insecurity was investigated using the Brazilian Food Insecurity Scale. Logistic regression was used to determine the association between changes in overweight over time and sex, age, skin colour, and food insecurity. Overweight was found to increase significantly, between 2005 and 2010, in boys who were younger (from 20.1% to 49.5%), black or brown (22.2% to 37.3%), those with per capita income of up to half a minimum wage (13.6% to 32.5%) and those experiencing moderate or severe food insecurity (9.2% to 36.3%). It was concluded that overweight increased significantly in adolescents living in an area of food insecurity, and that younger, black or brown, lower-income adolescents, and those living with moderate and severe food insecurity, were more exposed to that increase.

Does Recreational Soccer Change Metabolic Syndrome Status in Obese Adolescents? A Pilot Study

Purpose: To evaluate whether a soccer program (RSP) might lower risk factors related to metabolic syndrome (MetS) in obese adolescents. Methods: A 12-week randomized controlled trial [RSP: n = 6 (2 girls), age = 13.9 ± 1.6 yr, body mass index = 30.5 ± 2.1 kg/m²; Control: n = 7 (2 girls); age = 14.7 ± 2.3 yr, body mass index: 30.8 ± 3.1 kg/m²] was conducted. Participants underwent anthropometric, body fractioning, blood pressure, lipid profile, and glucose tolerance assessments at baseline and post-intervention. MetS status was determined based on waist circumference and at least two additional criteria: high blood pressure, hypertriglyceridemia, dyslipidemia, and hyperglycemia. RSP included eutrophic and overweight adolescents and consisted of small-sided games (85 ± 4% maximal heart rate) performed three times/week. Results: High-density lipoprotein increased [(HDL) ∆15.5 ± 5.2 mg·dL^-1; p = .01] and triglycerides lowered [(TG) ∆-34.7 ± 7.1 mg·dL^-1; p = .02] after RSP intervention. Between-group differences were also detected for changes in HDL (∆13.0 ± 6.1 mg·dL^-1; p = .04) and TG (∆-47.1 ± 7.7 mg·dL^-1; p = .05). The presence of MetS lowered in RSP (5 in 6 participants; p = .02), but not Control (1 in 7 participants; p = .32). Conclusion: A 12-week RSP was effective to reduce MetS risk factors and status in obese adolescents.

Effects of physical activity on quality of life in overweight and obese children

Introduction

Background: in recent years the prevalence of obesity in infants, children, and adolescents has increased alarmingly, which may affect their health, educational level, and quality of life. Objectives: the aim of this study was to determine whether a program with physical activity and nutritional recommendations may improve health-related quality of life (HRQL) in overweight and obese children. Material and methods: the design of this study was that of a randomized clinical trial (RCT). The sample consisted of 54 children with a median age of 10.65 years, all of them overweight or obese. They were divided into a study (SG) and a control (CG) group, with 27 children each. The study group received physical activity and nutritional advice, while the control group only received theoretical-practical sessions on nutrition during 9 months. Families participated in the workshops on nutritional recommendations in both groups. Results: there was a significant difference in fat percentage before and after the intervention in the study group compared to the children who did not engage in sports activity. In the SF-10 quality-of-life perception questionnaire, statistically significant differences in both the physical and mental components may be seen at the end of the study between both groups (p < 0.001). Conclusions: an educational intervention with physical activity based on play and nutritional advice improved quality of life in overweight and obese children. Family involvement is vital for children to improve their life habits, and achieve favorable results in the reduction of overweight and obesity.

Prevalence of Metabolic Syndrome and Impaired Glucose Metabolism among 10- to 17-Year-Old Overweight and Obese Lithuanian Children and Adolescents

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.

Health profile with body mass index and physical fitness in Swedish adolescents: a cross-sectional study

Objectives Physical inactivity and poor physical fitness in children and adolescents are growing public health problems globally. This study aimed to investigate the correlation between Body Mass Index (BMI) and three physical fitness components, including overall fitness, according to the Swedish Physical power, Mental harmony and Social capacity profile (FMS profile). Another aim was to investigate the test-retest reliability of the FMS questionnaire and fitness tests. Methods A total of 3,692 male and female adolescents in Sweden, between year 2004 and 2013, aged from 16 to 18 years old, were included. Height and weight data were collected to calculate the Body mass index (BMI). The participants performed physical fitness tests, which measure cardio-respiratory fitness, muscular strength and flexibility. The test-retest study included 18 adolescents, aged 16. They answered the FMS questionnaire and participated in the fitness tests with one-week interval. Results A weak inverse relationship between BMI and physical fitness was found: r=-0.06 to -0.07 (p<0.05) for flexibility, r=-0.13 to 0.10 (p<0.001) for strength, r=-0.14 to -0.33 (p<0.001) for cardiorespiratory fitness, and r=-0.15 to -0.27 (p<0.001) for overall fitness. In the test-retest study, the ICC's for strength, flexibility and balance were 0.94, 0.96 and 0.89, respectively. The ICC's for the questions regarding lifestyle ranged from 0.75 to 1.00 and for diet, physical activity and drugs were 0.56, 0.44 and 0.58, respectively. The correlation was stronger in overweight/obese individuals compared to normal weight individuals. Conclusion Overweight and obese individuals scored lower in the fitness tests compared to their normal weight counterparts. The test-retest study revealed that the FMS questionnaire and fitness tests are reliable tools.

ASSOCIATED FACTORS WITH THE ISOLATED AND SIMULTANEOUS PRESENCE OF OVERWEIGHT AND ABDOMINAL OBESITY IN ADOLESCENTS

OBJECTIVE

To analyze the sociodemographic and lifestyle factors associated with excessive weight (EW), abdominal obesity (AO) and the simultaneous presence of EW and AO in adolescents from Southern Brazil.

METHODS

Cross-sectional study with 583 adolescents (11 to 17 years old) of Criciúma, Santa Catarina, Brazil. EW was assessed by body mass index (BMI) and AO by waist circumference (WC). The independent variables analyzed were gender, age, maternal schooling, balanced diet, physical activity, cigarette use, excessive alcohol use and screen time. Binary logistic regression was used to estimate Odds Ratios (OR) and 95% confidence intervals (95%CI).

RESULTS

Boys had 58% higher likelihood of having EW (OR 1.58; 95%CI 1.08-2.29; p<0.05). Younger age group (11 to 14 years) was directly associated with higher likelihood of EW (OR 6.07; 95%CI 4.05-9.11; p<0.05). Adolescents whose mothers had higher education had 75% more likelihood of having AO (OR 1.75; 95%CI 1.01-3.00; p<0.05). Higher likelihood for EW and AO (OR 1.84; 95%CI 1.01-3.34; p<0.05) was identified in younger adolescents (11 to 14 years).

CONCLUSIONS

Boys and younger age (11 to 14 years) were associated with a higher likelihood of EW. Adolescents whose mothers studied nine years or more were more likely to have AO. The younger age group (11 to 14 years) was associated with greater chances for the simultaneous presence of EW and AO.

OVERWEIGHT AND ASSOCIATED FACTORS IN CHILDREN AND ADOLESCENTS WITH PHENYLKETONURIA: A SYSTEMATIC REVIEW

Objective:

To verify the occurrence of overweight in children and adolescents with phenylketonuria and to identify possible causal factors.

Data sources:

A systematic review was performed in the SciELO, PubMed and VHL databases using the descriptors “Phenylketonurias”, “Overweight”, “Child” and “Adolescent”. Original articles conducted with children and adolescents, published between 2008 and 2018 in Portuguese, English or Spanish languages were included.

Data synthesis:

A total of 16 articles were identified and, after screening procedures, 6 studies were selected for the review. Overweight in children and adolescents with phenylketonuria was a frequent occurence in the studies included in this review, ranging from 7.8 to 32.6%. The female sex was the most affected by the nutritional disorder. Furthermore, a high caloric intake combined with a lack of stimuli to practice physical activities were main factors associated with the excessive weight in the population of interest.

Conclusions:

Excess weight can be considered a common outcome in children and adolescents with phenylketonuria. It is mainly caused by inadequate food consumption and sedentary lifestyle. The importance of early identification of nutritional disturbances in children and adolescents with phenylketonuria should be emphasized, in order to prevent associated chronic diseases and to promote health by encouraging continued healthy eating habits and the regular practice of physical exercises.

The relationship between cardiometabolic risks and vitamin D levels with the degree of obesity

Aim:

The aim of this study was to evaluate the cardiometabolic risk factors including vitamin D levels according to the degree of obesity in adolescents.

Material and Methods:

This is a retrospective cross-sectional study. A total of 363 overweight/obese adolescents aged between 11 and 18 years who were evaluated in our clinic from January 2012 to December 2015 were included in the study. The degree of obesity was calculated as the body mass index standard deviation. Hypertension, dyslipidemia, hyperinsulinemia, hyperglycemia, insulin resistance, and vitamin D deficiency were defined as cardiometabolic risk factors. Mann-Whitney U, Chi-square, Spearman and Pearson’s correlation tests, and linear regressions analyses were used for statistical analyses.

Results:

Of the 319 (n=319/363) adolescents, all of whose cardiometabolic risk factors were known, 267 (85.7%) had at least one cardiometabolic risk factor. The body mass index standard deviation had a positive correlation with the number of cardiometabolic risk factors (p<0.001). In the linear regression models in which sex and age were considered as covariates, an increase of one unit in the body mass index standard deviation led to an increase of 6.085 mm Hg in systolic blood pressure, 4.4 mm Hg in diastolic blood pressure, 1.59 points in HOMA-IR, 13% in insulin level, and a decrease of 2.16 ng/mL in vitamin D levels.

Conclusion:

In adolescents, the number of cardiometabolic risk factors increases as the degree of obesity increases. The determination of the severity of obesity can help to identify individuals at greater risk for higher blood pressure, impaired glucose metabolism, and lower serum vitamin D levels. On the other hand, the degree of obesity may not reflect the presence of abnormal lipid and glucose levels.

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.

Alterações clínicas, metabólicas e resistência à insulina entre adolescentes

Resumo Objetivo Analisar as alterações clínicas, metabólicas e sua relação com a resistência à insulina entre adolescentes. Métodos Estudo analítico, realizado com 357 adolescentes de escolas públicas estaduais de um município do Nordeste brasileiro. O formulário aplicado continha as variáveis Índice de Massa Corporal, Circunferência da Cintura, Circunferência do Pescoço, Índice de Conicidade, Pressão Arterial Média; Triglicerídeos, Glicemia, High — Density Lipoprotein Coiesteroi, Insulina e Índice Homeostasis Model Assessment, analisadas por medidas descritivas para variáveis quantitativas; e frequências para variáveis qualitativas. Foram realizados testes de associações através do Qui-quadrado e do teste Odds Ratio. Resultados A prevalência de resistência à insulina foi de 33,9%. As médias da circunferência da cintura, circunferência do pescoço, índice de conicidade, pressão arterial sistólica média e pressão arterial diastólica média estiveram elevadas respectivamente em 4,2%; 30%; 10,9%; 4,2% e 14% dos adolescentes. Os níveis de High – Density Lipoprotein colesterol estiveram diminuídos em 30,5% da amostra, ao passo que os triglicerídeos estavam elevados em 18,8%. Não foi identificada alteração na glicemia. Aqueles que apresentaram índice de massa corporal, circunferência da cintura, circunferência do pescoço, índice de conicidade e triglicerídeos com valores alterados possuíam maiores chances de apresentar resistência à insulina (OD: 3,62; 11,54; 3,50; 4,49; 3,05, respectivamente). De maneira oposta, os adolescentes com pressão arterial sistólica média, pressão arterial diastólica média e High — Density Lipoprotein colesterol alterados não apresentaram significância estatística (p<0,05). Conclusão A resistência à insulina está presente entre os adolescentes, com associações positivas e significativas com alterações clínicas e metabólicas.

COMPARISON OF DIFFERENT CRITERIA IN THE PREVALENCE OF METABOLIC SYNDROME IN STUDENTS FROM PARANAVAÍ, PARANÁ

Objective:

To investigate the difference in the proportion of students with metabolic syndrome, diagnosed according to different criteria.

Methods:

The sample consisted of 241 students (136 boys and 105 girls) aged 10 to 14 years, from public and private schools in Paranavaí, Paraná. We used three distinct diagnostic criteria for metabolic syndrome, considering the presence of at least three of the following risk factors: increased waist circumference, hypertension, fasting hyperglycemia, low HDL-C, and elevated triglycerides.

Results:

The prevalence of metabolic syndrome found was 1.7% (confidence interval of 95% - 95%CI 0-3.3) for the IDF criterion; 3.3% (95%CI 1.0-5.6) for Cook; and 17.4% (95%CI 12.6-22.3) for Ferranti. Analyzing the criteria in pairs, the agreement between IDF and Cook was 97.5% (k=0.95); between IDF and Ferranti, 83.4% (k=0.67); and between Cook and Ferranti, 85.9% (k=0.72). Onlyone student (0.4%) was diagnosed with metabolic syndrome solely by the IDF criterion, while 34 (14.1%) were diagnosed exclusively by Ferranti. The comparison of the three criteria showed that Ferranti presented the highest proportion of metabolic syndrome (p<0.001), and Cook had a greater proportion than IDF (p<0.001).

Conclusions:

We found a significant difference in the proportion of metabolic syndrome in the three criteria. The choice of which criterion to use can compromise not only the percentage of metabolic syndrome prevalence but also interfere in strategies of intervention and prevention in children and adolescents with and without metabolic syndrome, respectively.

Dietary supplement of Smilax china L. ethanol extract alleviates the lipid accumulation by activating AMPK pathways in high-fat diet fed mice

Background

Obesity has become a public health concern worldwide because it is linked to numerous metabolic disorders, such as hyperlipidemia, hypertension and cardiovascular disease. Therefore, there is an urgent need to develop new therapeutic strategies that are efficacious and have minimal side effects in obesity treatment. This study examined the effect of dietary supplement of Smilax china L. ethanol extract (SCLE) on high-fat diet (HFD) induced obesity.

Methods

Fifty ICR mice were fed a normal diet, high-fat diet (HFD) or HFD supplemented with 0.25, 0.5% or 1% SCLE for 8 weeks. Body weight, intraperitioneal adipose tissue (IPAT) weight, serum biochemical parameters, and liver lipids were measured. Activity, mRNA and protein expressions of lipid metabolism-related enzymes were analyzed.

Results

Over 0.5% SCLE had reduced cholesterol biosynthesis by the activation of AMP-activated protein kinase (AMPK), which subsequently suppressed the mRNA expression of both sterol regulatory element binding protein-2 and 3-hydroxy-3-methyl-glutaryl-CoA reductase. Thus, the plasma and liver cholesterol concentrations in the HFD-fed mice were decreased. AMPK activation caused by SCLE also significantly upregulated lipolysis by enhancing adipose triglyceride lipase and hormone-sensitive lipase activities. This accelerated triglyceride hydrolysis and fatty acid release. Finally, SCLE increased carnitine palmitoyltransferase 1 and acyl-CoA oxidase activities, which further promoted fatty acid β-oxidation.

Conclusion

SCLE could lead to a decrease in body weight gain and fat mass by inhibiting the lipid synthesis and promoting lipolysis and β-oxidation in HFD fed mice. The underlying mechanism is probably associated with regulating AMPK pathway.

Relations among obesity, family socioeconomic status, oral health behaviors, and dental caries in adolescents: the 2010-2012 Korea National Health and nutrition examination survey

Background

The purpose of this study was to examine the relationships among obesity, family socioeconomic status, oral health behaviors, and dental caries and to identify possible differences in factors related with dental caries according to gender among a representative sample of Korean adolescents.

Methods

Data were obtained from the Korean National Health and Nutrition Examination Survey, which was conducted between 2010 and 2012. This nationally representative cross-sectional survey included approximately 10,000 individuals, including adolescents, each year as a survey sample, and collected information on socioeconomic status, health-related behaviors, quality of life, healthcare utilization, anthropometric measures, biochemical and clinical profiles for non-communicable diseases, and dietary intake via three component surveys (health interview, health examination, and nutrition survey). The health interview and health examination were conducted by trained staff members. A total of 1646 adolescents of ages 13 to 18 years old were included in this study; there were 879 males and 767 females. Data were analyzed by t-test, X²-test, and univariate and multivariate logistic regression analyses using SAS 9.4 and ‘R’ statistical software for Windows to account for the complex sampling design.

Results

In males, significant associations between family income and dental caries on permanent teeth were noted after adjusting for confounding variables; the odds ratios and 95% confidence intervals thereof were 0.43(0.24–0.76), 0.41(0.24–0.70), and 0.28(0.16–0.49) for low-middle, middle-high, and high family income, respectively. Smoking experience showed a significant association with dental caries on permanent teeth in females. Oral health behaviors, such as tooth brushing frequency, were associated with dental caries in only male adolescents. There was no association between obesity and dental caries on permanent teeth in either male or female adolescents.

Conclusion

The present study demonstrated that factors associated with dental caries in adolescents differ according to gender. Therefore, gender-specific interventions may be warranted to improve dental health among adolescents.

Sociodemographic and behavioral characteristics of obese students with sleep problems in Southern Brazil

ABSTRACT Objective This study estimated the combined prevalence of insufficient number of hours of sleep per day and excess body adiposity among young students. The sociodemographic and behavioral characteristics associated with this concurrent health conditions were investigated. Methods This is a cross-sectional school-based study of 975 participants aged 11-14 years in Florianópolis, Santa Catarina state, Brazil. Body adiposity was assessed based on tricipital and subscapular skinfold measurements and classified according to Lohman. The total number of hours of sleep per day was reported by the students’ parents/guardians, and it was classified as follows: as <8 hours per day and ≥8 hours per day. Data on sociodemographic characteristics, food consumption, and physical activity were collected using a self-administered questionnaire. The chi-square test and multinomial logistic regression with a 5% significance level were used to evaluate the association between the variables. Results The combined prevalence of insufficient number of hours of sleep per day and excess body adiposity was 25.1% (CI95%:20.7-29.9). The sociodemographic and behavioral factors predictive of these conditions were as follows: 13-14 year age group and household monthly income in the intermediate tertile. Conclusion The concurrent presence of insufficient sleep and excess body adiposity was found in a little more than a quarter of the students investigated. The population subgroups belonging to the 13-14 year age group and intermediate tertile of income were more likely to have concurrent insufficient number of hours of sleep per day and excess body adiposity.

Predictive value of body mass index to metabolic syndrome risk factors in Syrian adolescents

BACKGROUND

Obesity has become a serious epidemic health problem in both developing and developed countries. There is much evidence that obesity among adolescents contributed significantly to the development of type 2 diabetes and coronary heart disease in adulthood. Very limited information exists on the prevalence of overweight, obesity, and associated metabolic risk factors among Syrian adolescents. Therefore, the purpose of this study was to determine the relationship between obesity determined by body mass index and the major metabolic risk factors among Syrian adolescents.

METHODS

A cross-sectional study of a randomly selected sample of 2064 apparently healthy Syrian adolescents aged 18 to 19 years from Damascus city, in Syria, was performed. Body mass index and blood pressure were measured. Serum concentrations of glucose, triglycerides, total cholesterol, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol were determined. Metabolic syndrome was defined using the national criteria for each determined metabolic risk factor. Individuals with a body mass index 25 to 29.9 were classified as overweight, whereas individuals with a body mass index ≥30 were classified as obese. A receiver operating characteristics curve was drawn to determine appropriate cut-off points of the body mass index for defining overweight and obesity, and to indicate the performance of body mass index as a predictor of risk factors.

RESULTS

The obtained data showed that blood pressure and the overall mean concentrations of fasting blood sugar, triglycerides, cholesterol, low-density lipoprotein-cholesterol, and triglycerides/high-density lipoprotein-cholesterol were significantly higher in overweight and obese adolescent groups (p <0.0001) in comparison with the normal group. Based on receiver operating characteristics calculation for body mass index and some metabolic risks, the data suggest the best body mass index cut-offs ranged between 23.25 and 24.35 kg/m².

CONCLUSIONS

A strong association between overweight and obesity as determined by body mass index and high concentrations of metabolic syndrome components has been demonstrated. Although body mass index values were lower than the international cut-offs, these values were good predictors of some metabolic abnormalities in Syrian adolescents; body mass index is a good predictor of these abnormalities in this population.

Blood pressure, dyslipidemia and inflammatory factors are related to body mass index in scholar adolescents

INTRODUCTION

Obesity is associated with increased occurrence of numerous diseases, including hypertension, dyslipidemia, insulin resistance, diabetes, and atherosclerosis. Blood pressure (BP), dyslipidemia, and inflammation markers and their relationships with body mass index (BMI) were determined in scholar adolescents.

MATERIAL AND METHODS

Adolescents (n = 210) (sex ratio G/B = 106/104; 11 to 16 years) were recruited in three colleges of Oran city. Anthropometric parameters were measured to classify adolescents as thin (T), normal weight (NW), overweight (OW), or obese (O). Waist circumference (WC) and BP were measured, and serum glucose, uric acid, urea, lipid parameters, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), C-reactive protein (CRP), insulin, leptin, and adiponectin were analyzed.

RESULTS

Adolescents were classified according to their BMI as T (15%), NW (63%), OW (13%), and O (9%). Compared to NW, increased values of WC, BP (p < 0.001), and glucose (p < 0.01) were noted in OW and O groups. Total cholesterol (TC) level was elevated in O adolescents (p < 0.01). Increased low-density lipoprotein cholesterol (LDL-C) in OW (p < 0.05) and O (p < 0.01), and reduced high-density lipoprotein cholesterol (HDL-C) concentrations were noted in both OW and O groups (p < 0.05), compared to NW. Elevated triglyceride (TG) values and TG : HDL-C ratio were observed in OW (p < 0.05) and O (p < 0.01). High values of uric acid were noted in OW and O adolescents (p < 0.01). Compared to NW, there was no significant difference in IL-1β whereas IL-6 was elevated in T (p < 0.05), OW (p < 0.01) and O (p < 0.001). Leptin, TNF-α, and CRP concentrations were significantly increased (p < 0.001), whereas adiponectin values were decreased in both OW and O groups (p < 0.01), compared to NW.

CONCLUSIONS

Significant associations were noted between WC, BP, dyslipidemia, inflammation markers, and BMI, indicating that both OW and O adolescents have a tendency to present metabolic syndrome risk factors.

Do metabolic syndrome and its components have an impact on bone mineral density in adolescents?

In recent years, there has been growing concern about the occurrence of metabolic syndrome (MetS) at an early age and its effects on bone mass in adolescents. Adolescence is considered a critical period for bone mass gain. Impaired bone acquisition during this phase can lead to “suboptimal” peak bone mass and increase the risk of osteopenia/osteoporosis and fractures in old age. The objective of this review was to perform a critical analysis of articles that specifically focus on this age group, evaluating the influence of MetS and its components on bone mineral density in adolescents. A possible relationship between this syndrome and bone mass has been demonstrated, but the number of studies addressing this topic in adolescents is small. Despite the scarcity of evidence, the results of those studies show that Metabolic Syndrome is negatively correlated with bone mass and also that some components of MetS are negatively correlated with bone mineral density in adolescents. However, the associations between MetS and bone mass development need to be further explored in the age group corresponding to adolescence. Further good-quality studies are necessary to complement the understanding of this relationship.

Early changes in adipokines from overweight to obesity in children and adolescents

OBJECTIVE

Childhood obesity has been associated with metabolic syndrome and cardiovascular diseases. This study aimed to compare plasma levels of traditional metabolic markers, adipokines and soluble tumor necrosis factor receptor type 1 (sTNFR1) in overweight, obese and lean children. We also assessed the relationships of these molecules with classical metabolic risk factors.

METHODS

This study included 104 children and adolescents, which were grouped as: lean (n=24), overweight (n=30), and obese subjects (n=50). They were subjected to anthropometrical, clinical and laboratorial measurements. All measurements were compared between groups. Correlation analyses were also performed to evaluate the association between clinical data, traditional metabolic markers, adipokines and sTNFR1.

RESULTS

Fasting glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), LDL-cholesterol and triglycerides were comparable in lean, overweight and obese subjects. Plasma levels of sTNFR1 were similar in lean and overweight subjects, but significantly increased in obese group. Leptin, adiponectin and resistin levels did not differ when overweight were compared to obese subjects. However, all adipokines differed significantly when lean subjects were compared to overweight and obese individuals. Plasma levels of adiponectin were negatively correlated with body mass index (BMI), whereas leptin, resistin and sTNFR1 concentrations positively correlated with BMI.

CONCLUSION

Our results showed significant differences in circulating levels of the evaluated markers when lean, overweight and obese individuals were compared, suggesting that these biomarkers may change from lean to overweight and from overweight to obesity.

Prevalence and sociodemographic correlates of metabolic syndrome in school-aged children and their parents in nine Mesoamerican countries

OBJECTIVE

To ascertain the prevalence and sociodemographic correlates of cardiometabolic risk factors in adults and school-aged children from Mesoamerica.

DESIGN

Cross-sectional study with convenience sampling. In adults, metabolic syndrome was defined according to the National Cholesterol Education Program's Adult Treatment Panel III (ATP III) criteria. In children, we calculated a continuous sex- and age-standardized metabolic risk score using variables corresponding to adult ATP III criteria. Metabolic syndrome prevalence in adults and risk score distribution in children were compared across levels of sociodemographic characteristics with use of Poisson and linear regression, respectively.

SETTING

Capital cities of Guatemala, El Salvador, the Dominican Republic, Honduras, Nicaragua, Panama, Costa Rica, the Mexican State of Chiapas (Tuxtla Gutiérrez city) and Belize.

SUBJECTS

Families (n 267), comprising one child aged 7-12 years and their biological parents.

RESULTS

The prevalence of metabolic syndrome was 37·9 % among women and 35·3 % among men. The most common component was low HDL cholesterol, 83·3 % in women and 78·9 % in men. Prevalence was positively associated with age. In women, metabolic syndrome was inversely related to education level whereas in men it was positively associated with household food security and height, after adjustment. The metabolic risk score in children was inversely related to parental height, and positively associated with height-for-age and with having parents with the metabolic syndrome.

CONCLUSIONS

Metabolic syndrome is highly prevalent in Mesoamerica. The burden of metabolic risk factors disproportionately affects women and children of lower socio-economic status and men of higher socio-economic status.

Cardiometabolic risk markers of normal weight and excess body weight in Brazilian adolescents

Excess body weight leads to a variety of metabolic changes and increases the risk for cardiovascular diseases (CVD) in adulthood. The objective of this study was to investigate the presence of risk markers for CVD among Brazilian adolescents of normal weight and with excess body weight. The markers included blood pressure, C-reactive protein, homocysteine, tumor necrosis factor alpha, fibrinogen, fasting insulin and glucose, homeostasis model assessment of insulin resistance (HOMA-IR), leptin, total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and triglycerides. We calculated odds ratios (OR) using logistic regression and adjusted for potential confounders such as age, sex, physical activity, and socioeconomic background. Compared with normal weight subjects, overweight/obese adolescents were more likely to have higher systolic blood pressure (OR = 3.49, p < 0.001), fasting insulin (OR = 8.03, p < 0.001), HOMA-IR (OR = 8.03, p < 0.001), leptin (OR = 5.55, p < 0.001), and LDL-c (OR = 5.50, p < 0.001) and lower serum HDL-c concentrations (OR = 2.76, p = 0.004). After adjustment for confounders, the estimates did not change substantially, except for leptin for which the risk associated with overweight increased to 11.09 (95% CI: 4.05-30.35). In conclusion, excess body weight in adolescents exhibits strong associations with several markers that are established as causes of CVD in adults. This observation stresses the importance of primary prevention and of maintaining a healthy body weight throughout adolescence to reduce the global burden of CVD.

A qualitative study of the role of food in family relationships: An insight into the families of Brazilian obese adolescents using photo elicitation

Obesity in adolescence is a major public health issue in Brazil. The relation between food and family plays an important role in both prevention and treatment, although its precise effect has not been clearly established. The purpose of this study is to investigate the meanings of food for Brazilian obese adolescents and their parents. Semi-structured interviews were conducted with 19 individuals from two medical centers in Fortaleza-CE, Brazil: seven adolescents with obesity (six girls and one boy aged between 12 and 18 years) and their parents (seven mothers, four fathers and one grandmother). The researchers used photo elicitation for the interview; that is, one photograph taken by each adolescent was used to evoke the statements we analyze here, according to Interpretative Phenomenological Analysis. The results were categorized into two principal superordinate themes. The first described the role of food in the parent-child relationship and the second, the organization of the family group. Results show that food reinforces the adolescents' dependence on their parents and the conflicts related to parental control of their food and what they can eat. The interrelations between food and family dynamics must be considered in developing therapeutic strategies for Brazilian obese adolescents and their families. These strategies must include siblings as well as grandparents.

Continuous Metabolic Syndrome Scores for Children Using Salivary Biomarkers

Background

Binary definitions of the metabolic syndrome based on the presence of a particular number of individual risk factors are limited, particularly in the pediatric population. To address this limitation, we aimed at constructing composite and continuous metabolic syndrome scores (cmetS) to represent an overall measure of metabolic syndrome (MetS) in a large cohort of metabolically at-risk children, focusing on the use of the usual clinical parameters (waist circumference (WC) and systolic blood pressure (SBP), supplemented with two salivary surrogate variables (glucose and high density lipoprotein cholesterol (HDLC). Two different approaches used to create the scores were evaluated in comparison.

Methods

Data from 8,112 Kuwaiti children (10.00 ± 0.67 years) were used to construct two cmetS for each subject. The first cmetS (cmetS-Z) was created by summing standardized residuals of each variable regressed on age and gender; and the second cmetS (cmetS-PCA) was defined as the first principal component from gender-specific principal component analysis based on the four variables.

Results

There was a graded relationship between both scores and the number of adverse risk factors. The areas under the curve using cmetS-Z and cmetS-PCA as predictors for severe metabolic syndrome (defined as the presence of ≥3 metabolic risk factors) were 0.935 and 0.912, respectively. cmetS-Z was positively associated with WC, SBP, and glucose, but inversely associated with HDLC. Except for the lack of association with glucose, cmetS-PCA was similar to cmetS-Z in boys, but had minimum loading on HDLC in girls. Analysis using quantile regression showed an inverse association of fitness level with cmetS-PCA (p = 0.001 for boys; p = 0.002 for girls), and comparison of cmetS-Z and cmetS-PCA suggested that WC and SBP were main contributory components. Significant alterations in the relationship between cmetS and salivary adipocytokines were demonstrated in overweight and obese children as compared to underweight and normal-weight children.

Conclusion

We have derived continuous summary scores for MetS from a large-scale pediatric study using two different approaches, incorporating salivary measures as surrogate for plasma measures. The derived scores were viable expressions of metabolic risk, and can be utilized to study the relationships of MetS with various aspects of the metabolic disease process.

Severity of non-alcoholic fatty liver disease is associated with high systemic levels of tumor necrosis factor alpha and low serum interleukin 10 in morbidly obese patients

Morbid obesity has been shown to increase the risk to develop hepatic steatosis, also referred to as non-alcoholic fatty liver disease (NAFLD). Emerging evidence suggests that the severity of NAFLD may associate with increased serum levels of inflammatory markers as well as decreased concentration of mediators with anti-inflammatory actions, such as tumor necrosis factor alpha (TNF-α) and interleukin (IL) 10, respectively. We thus examined the serum levels of TNF-α and IL-10 in 102 morbidly obese women and men (body mass index > 40 kg/m(2)), exhibiting different grades of NAFLD. Blood glucose, glycated hemoglobin, insulin, the homeostatic model assessment of insulin resistance (HOMA-IR), total cholesterol, triglycerides, high- and low-density lipoproteins, parameters of liver function, TNF-α, and IL-10 were measured in each subject. The stage of NAFLD was estimated by abdominal ultrasound imaging. In comparison with morbidly obese subjects without steatosis, morbidly obese patients with NAFLD showed increased age (39.23 ± 9.80 years), HOMA-IR (6.74 ± 1.62), total cholesterol (219.7 ± 9.58 mg/dl), aspartate aminotransferase (36.25 ± 3.24 UI/l), gamma-glutamyl transpeptidase (37.12 ± 3.41 UI/l), and TNF-α (37.41 ± 1.72 pg/ml) as well as decreased serum levels of IL-10 (61.05 ± 2.43 pg/ml). Interestingly, the systemic levels of TNF-α increased, while IL-10 decreased in accordance with the severity of NAFLD, which supports a role for systemic inflammatory mediators in promoting steatosis progression. Further clinical prospective studies need to be addressed to elucidate the role of TNF-α and IL-10 in the development of NAFLD while also establishing their clinical utility in the assessment of morbidly obese patients at higher risk to develop severe steatosis.

Indicators of the metabolic syndrome in obese adolescents

INTRODUCTION

To assess the prevalence of metabolic risk indicators for the metabolic syndrome (MS) in a sample of obese Egyptian adolescents and to compare anthropometric and biochemical parameters in subjects with one or two parameters of the MS with those who meet MS criteria.

MATERIAL AND METHODS

A descriptive, cross-sectional study was conducted on 300 obese adolescents, with a mean age of 15.45 ±2.54 years. Variables examined included body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), systolic and diastolic blood pressure (BP), fasting blood glucose, cholesterol, triglycerides (TG), high-density lipoprotein (HDL), low-density lipoproteins (LDL), insulin and insulin resistance (IR) measured by Homeostasis Model Assessment-Insulin Resistance (HOMA-IR). Receiver operating characteristic (ROC) curve analysis was used to determine the predictive powers of anthropometric parameters associated with increased risk for the MS.

RESULTS

The overall prevalence of the MS was 20%. Individuals meeting 3 or more MS criteria had significantly higher levels of BP, TG, glucose, insulin and HOMA-R and low HDL levels compared with those who had 1 or 2 MS criteria. Area under the curve (AUC) for identifying the MS risk factors was the highest for WHR, followed by WC and BMI in both genders (p < 0.001).

CONCLUSIONS

The most prevalent metabolic risk factors that compose the MS were arterial hypertension, low HDL and hypertriglyceridemia; BMI tended to be the weakest index for identifying MS risk factors, while WHR was the best predictive index in both genders.

Obesity prevalence and metabolic syndrome in a park users

Background -Overweight and obesity are associated with metabolic syndrome and abdominal obesity, thereby increasing the risk of type 2 diabetes mellitus and cardiovascular diseases. In Brazil, there are still no precise data on the prevalence of these disorders, especially among individuals who carry out some kind of physical activity in public spaces and there are no education and prevention programs for obesity.

AIM

To investigate the prevalence of metabolic syndrome and obesity among park users.

METHODS

A prospective, cross-sectional, descriptive study was conducted with 619 individuals assessed and stratified by profile according to a specific protocol. The group was characterized as follows: female (50.1%) and mean age =50.6±14.8, with predominance of individuals aged between 50 and 59 years (26.8%) and with higher education (68%) and a household income of between 4 and 10 minimum wages (29.2%).

RESULTS

Regular physical exercise was reported by 78% of the individuals and it was found that 70.7% were nevertheless of above normal weight: 45% overweight and 25.7% obese, of whom 20.7% had obesity grade I, 3.9% grade II and 1.1% grade III. The prevalence of metabolic syndrome was 4.3%, mostly in men (6.3%). Arterial hypertension and type 2 diabetes mellitus were detected in 17.8% and 5.5%, respectively. In view of the influence of obesity on the occurrence of type 2 diabetes mellitus and metabolic syndrome, it was found that this association was not significant for the two conditions (p=0.014 and 0.017, respectively).

CONCLUSION

The findings demonstrate a high prevalence of overweight and obesity in the studied population, and metabolic syndrome in 4.3%, despite the fact that 70% reported engaging in regular physical activity.

Evidence of Insulin Resistance and Other Metabolic Alterations in Boys with Duchenne or Becker Muscular Dystrophy

Aim. Our aim was (1) to determine the frequency of insulin resistance (IR) in patients with Duchenne/Becker muscular dystrophy (DMD/BMD), (2) to identify deleted exons of DMD gene associated with obesity and IR, and (3) to explore some likely molecular mechanisms leading to IR. Materials and Methods. In 66 patients with DMD/BMD without corticosteroids treatment, IR, obesity, and body fat mass were evaluated. Molecules involved in glucose metabolism were analyzed in muscle biopsies. Results show that 18.3%, 22.7%, and 68% were underweight, overweight, or obese, and with high adiposity, respectively; 48.5% and 36.4% presented hyperinsulinemia and IR, respectively. Underweight patients (27.3%) exhibited hyperinsulinemia and IR. Carriers of deletions in exons 45 (OR = 9.32; 95% CI = 1.16-74.69) and 50 (OR = 8.73; 95% CI = 1.17-65.10) from DMD gene presented higher risk for IR than noncarriers. We observed a greater staining of cytoplasmic aggregates for GLUT4 in muscle biopsies than healthy muscle tissue. Conclusion. Obesity, hyperinsulinemia, and IR were observed in DMD/BMD patients and are independent of corticosteroids treatment. Carriers of deletion in exons 45 or 50 from DMD gene are at risk for developing IR. It is suggested that alteration in GLUT4 in muscle fibers from DMD patients could be involved in IR.

[Physical, clinical, and psychosocial parameters of adolescents with different degrees of excess weight]

OBJECTIVE:

To compare body composition, hemodynamic parameters, health-related physical fitness, and health-related quality of life of adolescents with anthropometric diagnosis of overweight, obesity, and severe obesity.

METHODS:

220 adolescents with excess body weight were enrolled. They were beginners in a intervention program that included patients based on age, availability, presence of excess body weight, place of residence, and agreement to participate in the study

.

This study collected anthropometric and hemodynamic variables, health-related physical fitness, and health-related quality of life of the adolescents. To compare the three groups according to nutritional status, parametric and non-parametric tests were applied. Significance level was set at p<0.05.

RESULTS:

There was no significant difference in resting heart rate, health-related physical fitness, relative body fat, absolute and relative lean mass, and health-related quality of life between overweight, obese, and severely obese adolescents (p>0.05). Body weight, body mass index, waist and hip circumference, and systolic blood pressure increased as degree of excess weightincreased (p<0.05). Dyastolic blood pressure of the severe obesity group was higher than the other groups (p<0.05). There was an association between the degree of excess weight and the prevalence of altered blood pressure (overweight: 12.1%; obesity: 28.1%; severe obesity: 45.5%; p<0.001). The results were similar when genders were analyzed separately.

CONCLUSION:

Results suggest that overweight adolescents presented similar results compared to obese and severely obese adolescents in most of the parameters analyzed.

Physical, clinical, and psychosocial parameters of adolescents with different degrees of excess weight

OBJECTIVE: To compare body composition, hemodynamic parameters, health-related physical fitness, and health-related quality of life of adolescents with anthropometric diagnosis of overweight, obesity, and severe obesity.METHODS: 220 adolescents with excess body weight were enrolled. They were beginners in a intervention program that included patients based on age, availability, presence of excess body weight, place of residence, and agreement to participate in the study. This study collected anthropometric and hemodynamic variables, health-related physical fitness, and health-related quality of life of the adolescents. To compare the three groups according to nutritional status, parametric and non-parametric tests were applied. Significance level was set at p<0.05.RESULTS: There was no significant difference in resting heart rate, health-related physical fitness, relative body fat, absolute and relative lean mass, and health-related quality of life between overweight, obese, and severely obese adolescents (p>0.05). Body weight, body mass index, waist and hip circumference, and systolic blood pressure increased as degree of excess weightincreased (p<0.05). Dyastolic blood pressure of the severe obesity group was higher than the other groups (p<0.05). There was an association between the degree of excess weight and the prevalence of altered blood pressure (overweight: 12.1%; obesity: 28.1%; severe obesity: 45.5%; p<0.001). The results were similar when genders were analyzed separately.CONCLUSION: Results suggest that overweight adolescents presented similar results compared to obese and severely obese adolescents in most of the parameters analyzed.

Metabolic syndrome in young people

PURPOSE OF REVIEW

The prevalence of obesity is on the increase, and consequently metabolic syndrome is also becoming a serious health problem in children and adolescents all over the world. This review attempts to summarize the recent literature on metabolic syndrome in children and adolescents.

RECENT FINDINGS

To date, a standard definition of metabolic syndrome for the pediatric population is not available. Recently, the International Diabetes Federation has proposed a new set of criteria to define metabolic syndrome in children and adolescents aged 6-16 years. The relationships between obesity, insulin resistance and metabolic syndrome may be explained by the pattern of lipid partitioning. Fatty liver plays a central role in the insulin-resistant state in obese adolescents. Although insulin resistance has been proposed as the central factor leading to the abnormalities observed in metabolic syndrome, most definitions of metabolic syndrome use impaired fasting glucose as a marker. Nutrition impairment during both prenatal and early postnatal life can cause metabolic disturbances leading to insulin-resistance, type 2 diabetes, hypertension and cardiovascular disease.

SUMMARY

Metabolic syndrome prevalence in children and adolescents is on the increase. Therefore, the emphasis in all studies and programs related to metabolic syndrome should be focused on prevention, early detection of metabolic risk factors and interventions that will have a significant impact on future adult health.

Prevalence of cardiometabolic risk factors and metabolic syndrome in obese Kuwaiti adolescents

BACKGROUND

Childhood and adolescent obesity is associated with insulin resistance, abnormal glucose metabolism, hypertension, dyslipidemia, inflammation, liver disease, and compromised vascular function. The purpose of this pilot study was to determine the prevalence of cardiometabolic risk factor abnormalities and metabolic syndrome (MetS) in a sample of obese Kuwaiti adolescents, as prevalence data might be helpful in improving engagement with obesity treatment in future.

METHODS

Eighty obese Kuwaiti adolescents (40 males) with a mean (standard deviation) age of 12.3 years (1.1 years) participated in the present study. All participants had a detailed clinical examination and anthropometry, blood pressure taken, and assessment of fasting levels of C-reactive protein, intracellular adhesion molecule, interleukin-6, fasting blood glucose, insulin, liver function tests (alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase), lipid profile (cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides), insulin resistance by homeostasis model assessment, and adiponectin. MetS was assessed using two recognized criteria modified for use in younger individuals.

RESULTS

The cardiometabolic risk factors with highest prevalence of abnormal values included aspartate aminotransferase (88.7% of the sample) and insulin resistance by homeostasis model assessment (67.5%), intracellular adhesion molecule (66.5%), fasting insulin (43.5%), C-reactive protein (42.5%), low-density lipoprotein cholesterol (35.0%), total cholesterol (33.5%), and systolic blood pressure (30.0%). Of all participants, 96.3% (77/80) had at least one impaired cardiometabolic risk factor as well as obesity. Prevalence of MetS was 21.3% according to the International Diabetes Federation definition and 30% using the Third Adult Treatment Panel definition.

CONCLUSION

The present study suggests that obese Kuwaiti adolescents have multiple cardiometabolic risk factor abnormalities. Future studies are needed to test the benefits of intervention in this high-risk group. They also suggest that prevention of obesity in children and adults should be a major public health goal in Kuwait.

Evaluation of Body Mass Index (BMI) Percentile cut-off Levels with Reference to Insulin Resistance: A Comparative Study on South Indian Obese and Non-Obese Adolescents

OBJECTIVES

To investigate the relationship of Body Mass Index (BMI) percentile cut off with Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), a surrogate marker for insulin resistance in obese, overweight and non-obese adolescents.

STUDY DESIGN

A cross-sectional analysis of 120 adolescents (divided into sixty overweight/obese and an equal number of non-obese) was performed on nondiabetic, nonpregnant (11 to 18 year old school going) adolescents in south Indian (Puducherry) population. The main outcome measure of insulin resistance was calculated as HOMA-IR (greater than 3.16). Obesity was defined as per the BMI criteria, BMI greater than or equal to 95(th) percentile,overweight greater than or equal to 85(th) percentile and non-obese less than 84.9(th) percentile. All adolescents were subjected to analysis of anthropometric parameters that included weight, height and BMI (body mass index). Biochemical parameters, namely venous plasma glucose (fasting) and venous plasma insulin (fasting) were included for insulin resistance calculation by HOMA-IR.

RESULTS

Having a BMI of greater than or equal to 85(th) percentilewas associated with high HOMA-IR levels. As the BMI percentile increased, HOMA-IR levels also increased. Prevalence of insulin resistance for a BMI percentile of less than 84.9 was nil. Prevalence of insulin resistance for a BMI percentile of 85-94.9 was 26%.Prevalence of insulin resistance for BMI of greater than or equal to 95(th) percentile was 64%.

CONCLUSION

Insulin resistance is highly prevalent in obese and overweight adolescents as compared to that in non-obese adolescents. The onset of Impaired Fasting Glucose (IFG) is associated with the development of severe hyper-insulinaemia in obese adolescents and early primordial and primary prevention can thus alleviate the burden of future cardiometabolic disorders.

Does excess weight interfere with bone mass accumulation during adolescence?

Obesity and osteoporosis are important global health problems characterized by increasing prevalence with high impact on morbidity and mortality. The objective of this review was to determine whether excess weight during adolescence interferes with bone mass accumulation. If bone mineral gain can be optimized during puberty, adults are less likely to suffer from the devastating complications of osteoporosis. The increased fracture risk in obese children has also been attributed to a lower bone mass for weight compared to non-obese children. Thus, adiposity present in this age group may not result in the protection of bone mass, in contrast to what has been observed in adults. However, studies involving adolescents have reported both protective and detrimental effects of obesity on bone. The results and mechanisms of these interactions are controversial and have not been fully elucidated, a fact highlighting the extreme relevance of this topic and the need to monitor intervening and interactive variables.