Definition and early diagnosis of metabolic syndrome in children

Influence of excess weight on metabolic risk factors in Argentinian preschool children

OBJECTIVES

Evaluate the differences in metabolic risk factors in preschool children with normal weight (NWG) or with some degree of excess weight (OWG).

METHODS

Body mass index (BMI), umbilical waist circumference (WC), mid-upper arm circumference (MUAC) and total body fat (TBF) in children aged 1-5.9 years. The following metabolic risk factors were measured: blood pressure, fasting glycaemia, fasting serum insulin, HOMA IR Index, total cholesterol (TC), LDL cholesterol (LDL-C) HDL cholesterol (HDL-C) and triacylglycerol (TG).

RESULTS

In population evaluated (n=689) MUAC, WC, TBF, HOMA IR were higher in OWG compared to NWG and significantly higher in OWG girls compared to boys (two ways ANOVA). Positive associations were found between diastolic blood pressure, insulin and HOMA-IR and WC, MUAC, TBF, BMI z score in the adjusted and unadjusted model.

CONCLUSIONS

MUAC may emerge as an indicator with predictive power for metabolic risk and would be very useful to measure in many setting. There is a need for in-depth research into sex difference.

Childhood obesity: The threatening apprentice of the adiposity empire

Childhood obesity is a global health problem, with its prevalence having tripled since 1975. The increase in its prevalence has been predominantly in developing countries, but also in those with high economic status. Nowadays, there are multiple obesity definitions, however, one of the most accurate is the one which defines obesity as the accumulation of excessive body adiposity and not as an body weight excess. Nevertheless, the body mass index (BMI) is the most frequently used tool for its classification, according to the cut-off points established by the Center for Disease Control and World Health Organization tables. In children and adolescents an adiposity excess is related to the appearance of cardiovascular disease in adulthood and with many comorbidities such as metabolic syndrome, insulin resistance, type 2 diabetes, hypertension and metabolic dysfunction-associated steatotic liver disease, among others. Currently, there is still controversy about which is the ideal indicator for measuring overweight and obesity. BMI is still used as a standardized measure but may miss cases in which body composition is pathological despite a BMI within the normal-weight category. An adequate knowledge of the impact on health of dysfunctional adiposity as well as its accurate diagnosis will allow health professionals to address this condition in a more precise and comprehensive manner, and substantially improve the associated cardiometabolic risk and prognosis.

Low-Carbohydrate (Ketogenic) Diet in Children with Obesity: Part 1-Diet Impact on Anthropometric Indicators and Indicators of Metabolic Syndrome and Insulin Resistance

BACKGROUND

The ketogenic diet has been successfully used in the last 100 years in the treatment of epilepsy and other neurological disorders. In recent decades, it gained wider application in the treatment of obesity, metabolic syndrome, and type 2 diabetes. However, there have been only a few studies on its use in children with obesity and associated metabolic disorders.

OBJECTIVES

To determine the clinical and metabolic effects of a well-formulated low-carbohydrate (ketogenic) diet in children with obesity.

METHODS

One hundred children with obesity and metabolic disorders underwent initial anthropometric, laboratory, and ultrasound examinations. They were placed on a well-formulated ketogenic diet and monitored for 4 months. The 58 patients who completed the study underwent follow-up examinations to assess the effects of the diet on anthropometric, clinical, and laboratory markers of metabolic syndrome and insulin resistance, cardiovascular risk factors, and certain hormone levels. Compliance with the diet, common difficulties in adhering to it, side effects, and positive changes in the patients' health were analyzed.

RESULTS

At the end of the study, the average weight loss for the entire group was 6.45 kg, with a reduction in BMI of 3.12 kg/m2. Significant improvements were also observed in insulin resistance indicators, including fasting insulin levels, HOMA-IR index, QUICKI (p < 0.0001), and adiponectin (p = 0.04). The cases of hepatosteatosis decreased twofold, the number of patients with arterial hypertension was significantly reduced, as well as the number of children receiving antihypertensive therapy. Additionally, the number of patients meeting the criteria for metabolic syndrome decreased threefold.

CONCLUSIONS

A well-formulated short-term ketogenic diet is effective in treating obesity, metabolic syndrome, and related comorbidities, and can be part of a comprehensive approach for these patients.

Relationship Between Family Factors, Food Consumption Behaviors, and Nutritional Status Among Muslim School-Age Students in Rural Southern Thailand

Purpose

The double burden of malnutrition, with both undernutrition and overweight threatening school-age children's development, presents a critical global public health challenge. This research aimed to study the relationships between family factors, food consumption behaviors, and nutritional status among Muslim school-age children in rural southern Thailand.

Samples and Methods

This study was cross-sectional descriptive research. The samples included 228 children aged 9-12 years in Thasala District, Nakhon Si Thammarat. Data were collected using demographic data, Nutritional status assessment, and food consumption behaviors assessment. Data were analyzed using descriptive, chi-square, and binary logistic regression statistics.

Results

Overall, 15.8% of the samples were classified as overweight and obese, and 18% were classified as stunted (<-1.5 SD). The samples had a normal weight-for-height (72.3%). The overall food consumption behaviors of the participants were moderate (Mean = 2.17, SD = 0.60). The number of siblings and food consumption behaviors had a significant relationship with nutritional status (p < 0.05). Confirmation with binary logistic regression results also revealed that the likelihood of appropriate nutritional status was 2.74 times higher in children with 3-4 siblings than those with 1-2 siblings (OR = 2.74; 95% CI: 1.494-5.047). Additionally, children with appropriate food consumption behaviors were 2.04 times more likely to have a proper nutritional status than those with inappropriate food consumption behaviors (OR = 2.04; 95% CI: 1.044-3.996).

Conclusion

The study found that most participants had moderately appropriate food consumption behaviors, with 15.8% showing issues like overweight and obesity. The number of siblings and food consumption behaviors significantly influenced nutritional status. Interventions should leverage Islamic religious settings and engage religious leaders to foster healthier lifestyles. Culturally and religiously sensitive nutritional education, blending scientific evidence with Islamic teachings, should be integrated into school curricula to cultivate healthy eating habits and mitigate long-term health risks.

Predictive Accuracy of Biochemical and Anthropometric Indices for Metabolic Syndrome in Children with Obesity: A Comparative Study

Children with obesity, regardless of gender, are a high-risk population that requires ongoing monitoring not only for present obesity and metabolic syndrome (MetS) but also future risks of metabolic, cardiac, musculoskeletal, and psychiatric complications. Data from a cohort of 185 obese children who underwent a second follow-up in 2019 were used for this retrospective study. The study cohort consisted of 94 boys and 91 girls who were elementary school students with a mean age of 10.2 ± 0.5 years. Following anthropometric and biochemical assessments, the cardio metabolic index (CMI), visceral adiposity index (VAI), triglyceride-glucose index (TyGI), and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated. The overall prevalence of MetS was 19.5% (12.8% in boys and 26.4% in girls). According to the receiver operating characteristic curve analysis, CMI, VAI, and TyGI performed significantly better than HOMA-IR in identifying MetS. CMI was the most accurate predictor of MetS, as indicated by the highest area under the curve value, in both genders. In conclusion, our findings suggest that the CMI can serve as a practical, efficient, and affordable screening tool for the ongoing monitoring of childhood obesity in both daily endocrine clinical practice and primary care settings.

Cross-sectional and longitudinal associations between serum vitamin D and continuous metabolic syndrome score among children and adolescents: roles of levels of inflammation in peripheral blood

BACKGROUND

Serum vitamin D deficiency is intricately linked to metabolic disorders, however, evidence on its association with continuous metabolic risk in children and adolescents remains insufficient. This study aims to elucidate the relationship between serum vitamin D levels and continuous metabolic risk.

METHODS

The cross-sectional analysis involved 4490 participants aged 6 ~ 18, and the longitudinal investigation included 1398 individuals aged 6 ~ 12 years. Serum 25(OH)D concentrations were quantified using liquid chromatography-mass spectrometry. Continuous Metabolic syndrome risk score (CMSRS), incorporating waist, blood pressure, blood lipid levels, and glucose metabolism as four components, utilizes age- and gender-specific Z scores to evaluate metabolic risk. Restricted cubic splines (RCS) were used to visualize dose-response relationships and generalized linear models (GLM) were used to estimate potential associations. Mediation analysis was used to evaluate the mediating role of levels of Neutrophil-to-lymphocyte ratio (NLR).

RESULTS

The RCS indicated a negative linear association between serum 25(OH)D levels and CMSRS (P-overall = 0.0066, P-nonlinear = 0.1393). GLM revealed that compared to Q1, with the quartiles of serum 25(OH)D concentrations increase, the β value ranged from 0.028 (95% CI: - 0.093, 0.037) to 0.001(95%CI: - 0.067, 0.069), and then to -0.074 (95%CI: -0.146, -0.003, P for trend = 0.0659). For every 10 ng/mL increase in serum 25(OH)D concentration corresponded to the β value change -0.058 (95%CI: -0.098, -0.017). This association was more pronounced in younger or overweight/obese individuals. Furthermore, in the longitudinal study, as the baseline quartile of serum 25(OH)D concentration increased, the estimated change of subsequent CMSRS indicated a decreasing trend, ranging from -0.085 (95%CI: -0.203, 0.032) to -0.166 (95%CI: - 0.285, - 0.046), and then to - 0.174 (95%CI: - 0.296, -0.053, P for trend = 0.0031). The mediating proportion of levels of NLR was 7.2%.

CONCLUSIONS

Higher serum 25(OH)D concentration is significantly associated with reduced CMSRS in children and adolescents, and adequate serum vitamin D levels play a prominent role in preventing long-term metabolic disorders, partly meditating by inflammation in peripheral blood.

Prevalence of metabolic syndrome in children and adolescents with obesity: a systematic review and meta-analysis

OBJECTIVE

This study investigated the prevalence trends of metabolic syndrome (MetS) in children and adolescents with obesity by systematically analyzing global data. Additionally, it aimed to compare regional disparities and criteria used to identify at-risk subpopulations among this demographic group.

METHODS

We searched three major databases, i.e., PubMed-Medline, Scopus, and Web of Science, from inception to August 31, 2023, yielding 2432 articles. We included original research papers reporting MetS prevalence among children and adolescents with obesity, irrespective of their regions and MetS diagnostic criteria used. We aggregated prevalence estimates using random-effects models to obtain the overall prevalence and conducted subgroup analyses for MetS criteria and study regions.

RESULTS

We included 57 studies, amounting to 27,923 participants. The overall prevalence of MetS in participants with obesity varied greatly across studies, ranging from 2.1% to 74.4%, with an average prevalence of 29.4%. This high prevalence of MetS was further supported by a meta-analysis comprising 57 studies that further strengthened the observation of a high prevalence of MetS, revealing an overall prevalence of 26% (95% CI: 0.22-0.30; I2 = 98%).

CONCLUSIONS

Children and adolescents with obesity face a heightened risk of developing MetS. There is a pressing need for heightened attention to this issue, particularly in low- and middle-income countries such as those in sub-Saharan Africa.

Continuous Glucose Monitoring-New Diagnostic Tool in Complex Pathophysiological Disorder of Glucose Metabolism in Children and Adolescents with Obesity

Obesity is one of the leading causes of chronic diseases, and its prevalence is still rising in children and adolescent populations. Chronic cardiovascular complications result in metabolic syndrome (MS) and type 2 diabetes mellitus. Key factors in the development of MS are insulin resistance and low-grade inflammation. The disorder of glucose and insulin metabolism has not been fully elucidated so far, and an oral glucose tolerance test (OGTT) has been the only tool used to look into the complex metabolism disorder in children and adolescents with obesity. Continuous glucose monitoring (CGM) has become commercially available for over two decades and is primarily used to manage type 1 diabetes mellitus in pediatric populations. This review aims to present the current knowledge about the use of CGM in children and adolescent populations with obesity. CGM systems have the potential to serve as valuable tools in everyday clinical practices, not only in the better diagnosis of chronic complications associated with obesity, but CGM can also assist in interventions to make better adjustments to nutritional and therapeutic approaches based on real-time glucose monitoring data. Despite these promising benefits, further research is needed to fully understand the role of CGM in metabolic disorders in pediatric populations with obesity, which will additionally strengthen the importance of CGM systems in everyday clinical practices.

Metabolic syndrome therapy in pediatric age - between classic and modern. From diets to pipeline drugs

The metabolic syndrome, made up of the sum of the entities that define it (obesity, hypertension, dyslipidemias and non-alcoholic hepatic steatosis) has gained an important place in the research of the last decades. This aspect is mainly due to the complexity of management in pediatric practice. The main directions in his approach therefore bring together the concern of counteracting the noise or systemic, of the multiple intercurrents at the physiopathological level, as well as the negative imprint exerted on the quality of life. Its appearance and evolution are currently controversial topics, but the influence of genetic predisposition and lifestyle (diet, physical activity, psychological balance) are certainties. Considering the escalation of the incident at the global level, it is self-evident that it is necessary to know the pathogenesis and practice countermeasures for prophylactic or therapeutic purposes. The present work aims to summarize general aspects related to the metabolic syndrome encountered in pediatric age, with an emphasis on complementary therapeutic perspectives and their effectiveness, by analyzing the latest data from the specialized literature, accessed with the help of international databases (e.g., PubMed, Web of Science, Scopus, Embase, Google Scholar).

Cardiorespiratory Fitness and Body Mass Index as Predictors of Metabolic Syndrome in Schoolchildren (PACH Study)

Purpose

Metabolic syndrome (MetS) has become a condition not rarely diagnosed in children and adolescents, leading to changes in physical and mental health. Simple and cost-effective screening methods applied in schools are needed to take preventive measures and reduce the risk of the development of MetS in children.

Methods

This prospective longitudinal study aims to investigate the prevalence of MetS and its risk factors in 8-10-year-old schoolchildren (46 boys and 60 girls) over 3 consecutive years. General Linear Mixed Model (GLMM) was used to assess the effect of recommended daily levels of moderate to vigorous physical activity (MVPA), body mass index (BMI), waist circumference (WC), cardiorespiratory fitness (CRF), and obesity level on a new set of orthogonal variables formed from various parameters of MetS (eg blood pressure (BP), lipid panel and glucose homeostasis) determined by Principal Component Analysis (PCA).

Results

The prevalence of MetS was 2% in the years 2017, 2018 and 2019, while in 2020 prevalence reached 7.7%. The most prevalent combination of criteria defining MetS syndrome in children was increased WC, BP, and blood triglycerides (TG). PCA identified non-high-density lipoprotein (non-HDL), low-density lipoprotein (LDL), and total cholesterol (TCHOL) as important predictors of metabolic syndrome (MetS). Additionally, cardiorespiratory fitness (CRF) and body mass index (BMI) were found to significantly influence the variance in MetS criteria. However, moderate to vigorous physical activity (MVPA) did not have a notable effect on the variance of these criteria.

Conclusion

The prevalence of MetS in children is increasing with age. Non-HDL turned out to be the most influential parameter across all principal components. The CRF, being accessible, simple to use, non-invasive and cost-effective, proved to be a superior predictor of variance of glucose homeostasis compared to BMI.

Adolescent Metabolic Screening

This article explores metabolic syndrome (MetS) in children and adolescents, shedding light on its significant influence on long-term cardiovascular health outcomes. We navigate the complex landscape of MetS, where there is no universally accepted definition, and explore its roots in factors like obesity and insulin resistance. We also discuss the challenges of diagnosing and understanding its relevance in pediatric populations. The article also discussed the impact of the COVID-19 pandemic on the metabolic well-being of adolescents. Also, we discuss the importance of addressing associated comorbidities and risk factors in the context of MetS.

Are the EAT-Lancet dietary recommendations associated with future cardiometabolic health? - Insights from the Generation XXI cohort from childhood into early adolescence

BACKGROUND

The prospective effect of healthy and planetary diets on cardiometabolic health at young ages remains unclear.

OBJECTIVES

This study aims to investigate the prospective associations between adherence to the EAT-Lancet dietary recommendations at age 7 and the prevalence of obesity and Metabolic Syndrome (MetS) at 7, 10, and 13 y old.

METHODS

Participants are children from the Generation XXI birth cohort who completed 3-d food diaries at age 7, with complete data in variables of interest (n = 3564). Adherence to the EAT-Lancet dietary recommendations was evaluated using the World Index for Sustainability and Health (WISH); a higher score indicates a healthier and environmentally sustainable diet. At 7, 10, and 13 y, anthropometrics (weight, height, and waist circumference), blood pressure, serum-fasting triglycerides, high-density lipoprotein cholesterol, and glucose were measured. Obesity and MetS prevalence were determined by the World Health Organization and the International Diabetes Federation criteria, respectively. Adjusted custom binomial log-linear models were used to calculate prevalence ratios (PR) and the respective 95% confidence intervals (95% CI) (covariates: mother's age, education, prepregnancy body mass index (BMI), gestational diabetes, child's sex, age, Tanner stage, sports practice and total grams of the remaining food).

RESULTS

From 7 to 13 y, obesity decreased from 14.1% to 9.3% and MetS increased from 1.0% to 5.1%. Higher WISH scores at 7 y were associated with a lower prevalence of obesity, measured by both BMI (≥97th percentile: PR = 0.912; 95% CI: 0.839, 0.991; PR = 0.882; 95% CI: 0.79, 0.938, respectively at 10 and 13 y) and waist circumference (≥90th percentile: PR = 0.899; 95% CI: 0.830, 0.974; PR = 0.858; 95% CI: 0.782, 0.942, respectively at 10 and 13 y). For each 10-point increase in the WISH, a reduction of 16% in MetS prevalence at 13 y was observed (PR = 0.837; 95% CI: 0.732, 0.957). No significant effects were found at younger ages.

CONCLUSIONS

Adherence to the EAT-Lancet diet from an early age may help reduce cardiometabolic risk in early adolescence.

Metabolic Syndrome, Kidney-Related Adiposity, and Kidney Microcirculation: Unraveling the Damage

Metabolic syndrome (MetS) is a cluster of interrelated risk factors, including insulin resistance, hypertension, dyslipidemia, and visceral adiposity, all of which contribute to kidney microvascular injury and the progression of chronic kidney disease (CKD). However, the specific impact of each component of MetS on kidney microcirculation remains unclear. Given the increasing prevalence of obesity, understanding how visceral fat-particularly fat surrounding the kidneys-affects kidney microcirculation is critical. This review examines the consequences of visceral obesity and other components of MetS on renal microcirculation. These kidney-related fat deposits can contribute to the mechanical compression of renal vasculature, promote inflammation and oxidative stress, and induce endothelial dysfunction, all of which accelerate kidney damage. Each factor of MetS initiates a series of hemodynamic and metabolic disturbances that impair kidney microcirculation, leading to vascular remodeling and microvascular rarefaction. The review concludes by discussing therapeutic strategies targeting the individual components of MetS, which have shown promise in alleviating inflammation and oxidative stress. Integrated approaches that address both of the components of MetS and kidney-related adiposity may improve renal outcomes and slow the progression of CKD.

An Integrated Pathophysiological and Clinical Perspective of the Synergistic Effects of Obesity, Hypertension, and Hyperlipidemia on Cardiovascular Health: A Systematic Review

This review paper explores the synergistic effects of obesity, hypertension (HTN), and hyperlipidemia on cardiovascular health by integrating pathophysiological and clinical perspectives. Obesity, characterized by excessive body fat, HTN, defined by elevated blood pressure, and hyperlipidemia, indicated by high blood lipid levels, are globally prevalent conditions that significantly increase the risk of cardiovascular diseases (CVDs). The interplay between these conditions exacerbates cardiovascular risk through mechanisms such as chronic inflammation, insulin resistance, endothelial dysfunction, arterial stiffness, and atherogenesis. This review synthesizes epidemiological evidence and highlights the prevalence and co-occurrence of these conditions, with an emphasis on their combined impact on cardiovascular health. The literature search encompassed various databases, and data extraction included key study characteristics and outcomes. The findings underscore the importance of integrated management strategies, involving lifestyle interventions, pharmacological treatments, and regular monitoring, to mitigate the heightened cardiovascular risk posed by these conditions. In addition, the various public health implications are addressed, advocating for community-based interventions and policy changes. Future research directions may include exploring novel therapeutic approaches, personalized medicine strategies, and longitudinal studies to enhance the understanding and management of the synergistic effects of obesity, HTN, and hyperlipidemia on cardiovascular health.

The assessment of adolescent obesity's effects on ventricular repolarization

BACKGROUND

Currently, there is a lack of research on the Tp-Te interval and Tp-e/QT ratio in obese adolescents who have metabolic syndrome.

AIM

Our study aims to compare established ventricular repolarization parameters with these intervals and ratios in obese adolescents with or without metabolic syndrome, alongside a healthy control group, while exploring the association of these repolarization parameters with cardiovascular risk factors and echocardiographic variables.

METHODS

The study included 100 obese adolescents and 50 lean subjects, with the obese participants categorized into two subgroups. The Tp-Te interval was identified as the duration from the peak to the end of the T wave.

RESULTS

The metabolic and non-metabolic syndrome obese groups exhibited significantly elevated QTc and TpTe values compared to the control group, with no statistically significant differences observed in minimum QT, maximum QT, QT dispersion, QTc dispersion, TpTe dispersion, and TpTe/QT ratio values among obese subjects with metabolic or non-metabolic syndrome and controls. Specifically, TpTe values were significantly elevated in the non-metabolic syndrome obese groups compared to controls, while minimum TpTe values were significantly elevated in the metabolic syndrome obese groups compared to controls, and the prolongation of the QTc interval was notably elevated in the obese groups than in controls.

CONCLUSIONS

Obese adolescents demonstrated an elevated TpTe interval compared to healthy controls, without any significant differences observed in TpTe dispersion, and TpTe/QT ratio values between the two groups. Results of our study showed that a negative correlation between TpTe and HDL-cholesterol and a positive correlation between the TpTe/QT ratio and insulin sensitivity indices in adolescents with metabolic syndrome.

Impact of Maternal Pre-Pregnancy Underweight on Cord Blood Metabolome: An Analysis of the Population-Based Survey of Neonates in Pomerania (SNiP)

Intrauterine growth restriction leads to an altered lipid and amino acid profile in the cord blood at the end of pregnancy. Pre-pregnancy underweight is an early risk factor for impaired fetal growth. The aim of this study was to investigate whether a pre-pregnancy body mass index (ppBMI) of <18.5 kg/m2, as early as at the beginning of pregnancy, is associated with changes in the umbilical cord metabolome. In a sample of the Survey of Neonates in Pomerania (SNIP) birth cohort, the cord blood metabolome of n = 240 newborns of mothers with a ppBMI of <18.5 kg/m2 with n = 208 controls (ppBMI of 18.5-24.9 kg/m2) was measured by NMR spectrometry. A maternal ppBMI of <18.5 kg/m2 was associated with increased concentrations of HDL4 cholesterol, HDL4 phospholipids, VLDL5 cholesterol, HDL 2, and HDL4 Apo-A1, as well as decreased VLDL triglycerides and HDL2 free cholesterol. A ppBMI of <18.5 kg/m2 combined with poor intrauterine growth (a gestational weight gain (GWG) < 25th percentile) was associated with decreased concentrations of total cholesterol; cholesterol transporting lipoproteins (LDL4, LDL6, LDL free cholesterol, and HDL2 free cholesterol); LDL4 Apo-B; total Apo-A2; and HDL3 Apo-A2. In conclusion, maternal underweight at the beginning of pregnancy already results in metabolic changes in the lipid profile in the cord blood, but the pattern changes when poor GWG is followed by pre-pregnancy underweight.

Exploring the Link between Oxidative Stress, Selenium Levels, and Obesity in Youth

Obesity is a worldwide increasing concern. Although in adults this is easily estimated with the body mass index, in children, who are constantly growing and whose bodies are changing, the reference points to assess weight status are age and gender, and need corroboration with complementary data, making their quantification highly difficult. The present review explores the interaction spectrum of oxidative stress, selenium status, and obesity in children and adolescents. Any factor related to oxidative stress that triggers obesity and, conversely, obesity that induces oxidative stress are part of a vicious circle, a complex chain of mechanisms that derive from each other and reinforce each other with serious health consequences. Selenium and its compounds exhibit key antioxidant activity and also have a significant role in the nutritional evaluation of obese children. The balance of selenium intake, retention, and metabolism emerges as a vital aspect of health, reflecting the complex interactions between diet, oxidative stress, and obesity. Understanding whether selenium status is a contributor to or a consequence of obesity could inform nutritional interventions and public health strategies aimed at preventing and managing obesity from an early age.

Metabolic syndrome and its association with physical activity in Sudanese early adolescents - Khartoum state, Sudan: An observational study

The growing prevalence of overweight/obesity in adolescents highlights the significance of studying metabolic syndrome (MetS) in increasingly sedentary adolescents. To date, no study in Sudan has examined the association between MetS and physical activity (PA) among adolescents. This study aimed to assess the association between MetS and its components and PA among Sudanese early adolescents. A cross-sectional assessment was conducted from to 2018 to 2019 on a sample of 921 primary school students from Khartoum State, Republic of Sudan. MetS was defined according to the International Diabetes Federation criteria and a standardized questionnaire was used to assess PA. Metabolic equivalents of task were calculated, and levels of different intensities of PA (tertiles) were identified accordingly. The association between PA and MetS and its components was assessed using a logistic regression model. The participants comprised 388 boys and 533 girls with a mean age of 12.59 ± 1.21 years. The prevalence of MetS was significantly higher in subjects in the 1st PA tertile (least active) than in the 2nd and 3rd (most active) tertiles of PA, and this difference was observed in both boys and girls. After adjusting for other study factors, the odds of MetS among adolescents in the 1st PA tertile were 7 times higher than those in the highest PA tertile (adjusted odds ratio = 7.01, 95% confidence interval: 1.48, 32.99). A physically inactive lifestyle was associated with higher odds of MetS and its components, especially waist circumference and triglyceride levels, in Sudanese early adolescents. This study highlights the importance of promoting PA in this age group.

Mechanisms and risk factors of metabolic syndrome in children and adolescents

Metabolic syndrome (MetS) is a complex disorder characterized by abdominal obesity, elevated blood pressure, hyperlipidemia, and elevated fasting blood glucose levels. The diagnostic criteria for MetS in adults are well-established, but there is currently no consensus on the definition in children and adolescents. The etiology of MetS is believed to involve a complex interplay between genetic predisposition and environmental factors. While genetic predisposition explains only a small part of MetS pathogenesis, modifiable environmental risk factors play a significant role. Factors such as maternal weight during pregnancy, children's lifestyle, sedentariness, high-fat diet, fructose and branched-chain amino acid consumption, vitamin D deficiency, and sleep disturbances contribute to the development of MetS. Early identification and treatment of MetS in children and adolescents is crucial to prevent the development of chronic diseases later in life. In this review we discuss the latest research on factors contributing to the pathogenesis of MetS in children, focusing on non-modifiable and modifiable risk factors, including genetics, dysbiosis and chronic low-grade inflammation.

Not Only Metabolic Complications of Childhood Obesity

The increasing incidence of obesity in the pediatric population requires attention to its serious complications. It turns out that in addition to typical, well-known metabolic complications, obesity as a systemic disease carries the risk of equally serious, although less obvious, non-metabolic complications, such as cardiovascular diseases, polycystic ovary syndrome, chronic kidney disease, asthma, thyroid dysfunction, immunologic and dermatologic conditions, and mental health problems. They can affect almost all systems of the young body and also leave their mark in adulthood. In addition, obesity also contributes to the exacerbation of existing childhood diseases. As a result, children suffering from obesity may have a reduced quality of life, both physically and mentally, and their life expectancy may be shortened. It also turns out that, in the case of obese pregnant girls, the complications of obesity may also affect their unborn children. Therefore, it is extremely important to take all necessary actions to prevent the growing epidemic of obesity in the pediatric population, as well as to treat existing complications of obesity and detect them at an early stage. In summary, physicians treating a child with a systemic disease such as obesity must adopt a holistic approach to treatment.

C-Reactive Protein as a Marker of Inflammation in Children and Adolescents with Metabolic Syndrome: A Systematic Review and Meta-Analysis

Metabolic syndrome (MetS) in the pediatric population has been reported in many studies to be associated with an inflammatory response. However, to our knowledge, there is no definitive conclusion in the form of a meta-analysis. The issue we aimed to address is whether C-reactive protein (CRP) is a trustworthy marker in detecting inflammation in children and adolescents with MetS. We systematically searched PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, the ISI Web of Science, and SCOPUS until 31 June 2023 for studies involving children and adolescents with MetS where hsCRP or CRP were measured. After the screening process, we identified 24 full-text articles that compared 930 patients with MetS with either healthy (n = 3782) or obese (n = 1658) controls. The risk of bias in the included studies was assessed using the Begg's rank correlation test and Egger's regression test. Statistical analysis was carried out based on pooled mean differences (MDs) and an associated 95% CI. Data analysis showed that MetS is associated with higher levels of CRP than those in healthy controls (MD = 1.28, 95% CI: (0.49-2.08), p = 0.002) in obese patients (MD = 0.88, 95% CI: (0.38-1.39), p = 0.0006). However, conventional methods of CRP analysis were found to be more accurate in differentiating between children and adolescents with obesity and those with MetS, compared with hsCRP (MD = 0.60, 95% CI: (-0.08-1.28), p = 0.08). No risk of bias was assessed. In conclusion, CRP is a reliable inflammatory marker for differentiating pediatric patients with MetS from healthy ones. On the other hand, it did not prove to be very accurate in distinguishing between patients who had MetS and those who were obese. There should be more research performed in this field.

Cardiovascular Risk in Pediatrics: A Dynamic Process during the First 1000 Days of Life

The early childhood period, encompassing prenatal and early stages, assumes a pivotal role in shaping cardiovascular risk factors. We conducted a narrative review, presenting a non-systematic summation and analysis of the available literature, focusing on cardiovascular risk from prenatal development to the first 1000 days of life. Elements such as maternal health, genetic predisposition, inadequate fetal nutrition, and rapid postnatal growth contribute to this risk. Specifically, maternal obesity and antibiotic use during pregnancy can influence transgenerational risk factors. Conditions at birth, such as fetal growth restriction and low birth weight, set the stage for potential cardiovascular challenges. To consider cardiovascular risk in early childhood as a dynamic process is useful when adopting a personalized prevention for future healthcare and providing recommendations for management throughout their journey from infancy to early adulthood. A comprehensive approach is paramount in addressing early childhood cardiovascular risks. By targeting critical periods and implementing preventive strategies, healthcare professionals and policymakers can pave the way for improved cardiovascular outcomes. Investing in children's health during their early years holds the key to alleviating the burden of cardiovascular diseases for future generations.

The Impact of Metabolic Syndrome Risk Factors on Lung Function Impairment: Cross-Sectional Study

BACKGROUND

Metabolic syndrome (MetS) is a constellation of risk factors increasingly present in the world's population. People with this syndrome are at an increased risk of cardiovascular disease and type 2 diabetes mellitus. Moreover, evidence has shown that it affects different organs. MetS and its risk factors are independently associated with impaired lung function, which can be quantified through spirometric variables.

OBJECTIVE

This study aims to determine whether a high number of MetS criteria is associated with increased lung function decline.

METHODS

We conducted a descriptive cross-sectional study with a random sample of 1980 workers. Workers with acute respiratory pathology (eg, influenza), chronic respiratory pathology (eg, chronic bronchitis), or exposure to substances harmful to the lungs (eg, organic and inorganic dust) were not included. MetS was established based on harmonized criteria, and lung function was assessed according to spirometric variables. On the basis of these, classification into restrictive lung disease (RLD), obstructive lung disease, and mixed lung disease (MLD) was performed. In addition, the association between MetS and lung function was established based on analysis of covariance, linear trend analysis, and multiple linear regression.

RESULTS

MetS was associated with worse lung function according to all the spirometric parameters analyzed (percentage of predicted forced expiratory volume in 1 second: mean 83, SD 13.8 vs mean 89.2, SD 12.8; P<.001 and percentage of predicted forced vital capacity: mean 85.9, SD 11.6 vs mean 92, SD 11.3; P<.001). Moreover, those diagnosed with MetS had a higher prevalence of lung dysfunction (41% vs 21.9%; P<.001), RLD (23.4% vs 11.2%; P<.001), and MLD (7.3% vs 2.2%; P<.001). Furthermore, an increasing number of MetS criteria was associated with a greater impairment of pulmonary mechanics (P<.001). Similarly, with an increasing number of MetS criteria, there was a significant linear trend (P<.001) in the growth of the prevalence ratio of RLD (0 criteria: 1, 1: 1.46, 2: 1.52, 3: 2.53, 4: 2.97, and 5: 5.34) and MLD (0 criteria: 1, 1: 2.68, 2: 6.18, 3: 9.69, and 4: 11.37). Regression analysis showed that the alteration of all MetS risk factors, adjusted for various explanatory variables, was significantly associated with a worsening of spirometric parameters, except for forced expiratory volume in 1 second/forced vital capacity.

CONCLUSIONS

The findings have shown that an increase in cardiometabolic risk factors is associated with a more significant worsening of spirometric variables and a higher prevalence of RLD and MLD. As spirometry could be a crucial tool for monitoring patients at risk of developing chronic pathologies, we conclude that this inexpensive and easily accessible test could help detect changes in lung function in patients with cardiometabolic disorders. This highlights the need to consider the importance of cardiometabolic health in lung function when formulating public health policies.

Metabolic syndrome distribution based on diagnostic criteria and family history among adults in Al-Basra, Iraq

Background

Metabolic syndrome (MetS) is a collection of cardiovascular risk factors induced by insulin resistance and an inflammatory state that increases the likelihood of developing type 2 diabetes and a variety of cardiovascular disorders.

Objective

The study aims to determine the distribution of MetS by diagnostic criteria and family history among adults in Al- Basra province, southern Iraq.

Methods

A cross-sectional study was conducted at the Al- Fiaha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) from October 2nd, 2022, to May 1st, 2023. Following ethical approval, data was obtained using a pre-tested questionnaire. All patient information was obtained from direct interviews as well as FDEMC's digital records, which controlled patient data via a Microsoft Access program and an internal network.

Results

This study included 476 people, aged 19 to 89. The sample had an equal number of males and females (238). MetS was identified in 247 people in the entire sample using the International Diabetes Federation criteria. The proportion of participants with a family history was as follows: obesity (30.0%), hypertension (44.1%), diabetes mellitus (46.6%), and cardiovascular disease (9.3%). The diagnostic criteria for MetS were as follows: high wc (94.3%), elevated glucose (69.6%), reduced highdensity lipoprotein (HDL) (80.2%), elevated TG (40.5%), and hypertension (71.7%). Controlled on glycemic status (21.1%), hypertension (61.9%), and lipids (44.1%).

Conclusion

Large wc, reduced HDL, and family histories of obesity, hypertension, diabetes mellitus, or cardiovascular disease are the most important risk factors for MetS. Participants with MetS have difficulties controlling their blood sugar, but they regulate the other MetS components.

Challenges and Opportunities in Diagnosis and Management of Cardiometabolic Risk in Adolescents

PURPOSE OF REVIEW

This review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction of cardiometabolic risk in this population.

RECENT FINDINGS

There are multiple criticisms of how we define and approach obesity in clinical practice and scientific research, and weight stigma further complicates the process of making and communicating weight-related diagnoses. While the goal of diagnosing and managing metabolic syndrome in adolescents would be to identify individuals at elevated future cardiometabolic risk and intervene to reduce the modifiable component of this risk, there is evidence that identifying cardiometabolic risk factor clustering may be more useful in adolescents than establishing a cutoff-based diagnosis of metabolic syndrome. It has also become clear that many heritable factors and social and structural determinants of health contribute more to weight and body mass index than do individual behavioral choices about nutrition and physical activity. Promoting cardiometabolic health equity requires that we intervene on the obesogenic environment and mitigate the compounding effects of weight stigma and systemic racism. The existing options to diagnose and manage future cardiometabolic risk in children and adolescents are flawed and limited. While striving to improve population health through policy and societal interventions, there are opportunities to intervene at all levels of the socioecological model in order to decrease future morbidity and mortality from the chronic cardiometabolic diseases associated with central adiposity in both children and adults. More research is needed to identify the most effective interventions.

Neuroendocrine Effects on the Risk of Metabolic Syndrome in Children

The endocrine and nervous systems reciprocally interact to manage physiological individual functions and homeostasis. The nervous system modulates hormone release through the hypothalamus, the main cerebrally specialized structure of the neuroendocrine system. The hypothalamus is involved in various metabolic processes, administering hormone and neuropeptide release at different levels. This complex activity is affected by the neurons of various cerebral areas, environmental factors, peripheral organs, and mediators through feedback mechanisms. Therefore, neuroendocrine pathways play a key role in metabolic homeostasis control, and their abnormalities are associated with the development of metabolic syndrome (MetS) in children. The impaired functioning of the genes, hormones, and neuropeptides of various neuroendocrine pathways involved in several metabolic processes is related to an increased risk of dyslipidaemia, visceral obesity, insulin resistance, type 2 diabetes mellitus, and hypertension. This review examines the neuroendocrine effects on the risk of MetS in children, identifying and underlying several conditions associated with neuroendocrine pathway disruption. Neuroendocrine systems should be considered in the complex pathophysiology of MetS, and, when genetic or epigenetic mutations in "hot" pathways occur, they could be studied for new potential target therapies in severe and drug-resistant paediatric forms of MetS.

Malattia grassa del fegato: tra fattori ambientali e predisposizione genetica

Nonalcoholic fatty liver disease (NAFLD) is now recognized as the hepatic manifestation of the metabolic syndrome and is the most common cause of chronic liver disease in both adults and children. It is assumed that a genetic predisposition associated with epigenetic factors participates in the evolution of this condition. Visceral obesity and insulin-resistence (IR) have always been considered as key factors linking Metabolic Syndrome (MetS) and NAFLD, but a multifactorial pathogenesis characterized by the interaction between genetic background and environmental factors is increasingly recognized as a key point in the development of metabolic disorders associated with NAFLD. In fact, in patients with NAFLD, insulin resistance, arterial hypertension, abdominal obesity, dyslipidemia and reduced intestinal permeability have often been found, as well as a higher prevalence of comorbidities such as coronary artery disease, obstructive sleep apnea, polycystic ovary syndrome and osteopenia, which define a MetS framework. Early diagnosis is needed to prevent disease progression through primarily lifestyle interventions. Unfortunately, to date, there is no recommended pharmacological intervention in a pediatric setting. However, a variety of new pharmacological agents are under clinical study. To achieve this, studies on the pathways that link the genetic background to the environment before and after birth to the development of NAFLD and MetS and on the molecular mechanisms that define NASH should be increased. Therefore, it is desirable that future studies may be useful in terms of population screening to identify individuals at risk for NAFLD and Mets.

Triglyceride glucose index, pediatric NAFLD fibrosis index, and triglyceride-to-high-density lipoprotein cholesterol ratio are the most predictive markers of the metabolically unhealthy phenotype in overweight/obese adolescent boys

Introduction

The prevalence of obesity constantly increases worldwide and definitely increases the risk of premature death in early adulthood. While there is no treatment yet with proven efficacy for the metabolic clamp such as arterial hypertension, dyslipidemia, insulin resistance, diabetes type 2, and fatty liver disease, it is imperative to find a way to decrease cardiometabolic complications. Early prevention strategies beginning in childhood are the most logical step to reduce future cardiovascular morbidity and mortality. Therefore, the aim of the current study is to determine the most sensitive and specific predictive markers of the metabolically unhealthy phenotype with high cardiometabolic risk in overweight/obese adolescent boys.

Methods

This study was carried out at the Ternopil Regional Children's hospital (Western Ukraine) and involved 254 randomly chosen adolescent overweight or obese boys [median age was 16.0 (15.0,16.1) years]. A control group of 30 healthy children with proportional body weight comparable in gender and age to the main group was presented. A list of anthropometrical markers with biochemical values of carbohydrate and lipid metabolism with hepatic enzymes was determined. All overweight/obese boys were divided into three groups: 51.2% of the boys with metabolic syndrome (MetS) based on the IDF criteria; 19.7% of the boys were metabolically healthy obese (MHO) without hypertension, dyslipidemia, and hyperglycemia; and the rest of the boys (29.1%) were classified as metabolically unhealthy obese (MUO) with only one criterion (hypertension, dyslipidemia, or hyperglycemia).

Results

Based on multiple logistic regression analysis that included all anthropometric and biochemical values and calculated indexes in boys from the MHO group and MetS, it was revealed that the maximum likelihood in the prediction of MetS makes the combination of triglyceride glucose index, pediatric nonalcoholic fatty liver disease fibrosis index (PNFI), and triglyceride-to-high-density lipoprotein cholesterol ratio (R² =0.713, p<0.000). By tracing the receiver operating characteristic curve, the model is confirmed as a good predictor of MetS (AUC=0.898, odds ratio=27.111 percentage correct=86.03%) in overweight and obese boys.

Conclusion

Triglyceride glucose index, pediatric NAFLD fibrosis index, and triglyceride-to-high-density lipoprotein cholesterol ratio are a valuable combination of predictive markers of the metabolically unhealthy phenotype in Ukrainian overweight/obese boys.

Comparison of Diagnostic Models to Estimate the Risk of Metabolic Syndrome in a Chilean Pediatric Population: A Cross-Sectional Study

The pediatric population has various criteria for measuring metabolic syndrome (MetS). The diversity of consensus for diagnosis has led to different non-comparable reported prevalence. Given the increase in its prevalence in pediatric ages, it is necessary to develop efficient methods to encourage early detection. Consequently, early screening for the risk of MetS could favor timely action in preventing associated comorbidities in adulthood. This study aimed to establish the diagnostic capacity of models that use non-invasive (anthropometric) and invasive (serum biomarkers) variables for the early detection of MetS in Chilean children. A cross-sectional study was carried out on 220 children aged 6 to 11. Multivariate logistic regressions and discriminant analyses were applied to determine the diagnostic capacity of invasive and non-invasive variables. Based on these results, four diagnostic models were created and compared: (i) anthropometric, (ii) hormonal (insulin, leptin, and adiponectin), (iii) Lipid A (high-density cholesterol lipoprotein [HDL-c] and triglycerides [TG]) and (iv) Lipid B (TG/HDL-c). The prevalence of MetS was 26.8%. Lipid biomarkers (HDL-c and TG) and their ratio (TG/HDL-c) presented higher diagnostic capacity, above 80%, followed by body mass index (BMI, 0.71-0.88) and waist-to-height ratio (WHtR, 0.70-0.87). The lipid model A was the most accurate (sensitivity [S] = 62.7%, specificity [E] = 96.9%, validity index 87.7%), followed by the anthropometric model (S = 69.5%, E = 88.8% and validity index = 83.6%). In conclusion, detecting MetS was possible through invasive and non-invasive methods tested in overweight and obese children. The proposed models based on anthropometric variables, or serum biomarkers of the lipid model A, presented acceptable validity indices. Moreover, they were higher than those that measured adipokines, leptin, and adiponectin. The anthropometric model was the most cost-effective and easy to apply in different environments.

Second-generation antipsychotic medications and metabolic disturbance in children and adolescents

Background

The second-generation antipsychotics (SGAs) are a group of antipsychotic drugs, used to treat psychiatric conditions. SGAs have been shown to precipitate rapid weight gain and dyslipidemia, as well as to promote insulin resistance, leading to the emergence of type 2 diabetes and metabolic syndrome. Prescriptions of SGAs in children have increased 6- to 10-fold during the last decade. This research work designed to find correlation between duration of second-generation antipsychotics (SGA) use, in children and adolescent, and the increase in metabolic syndrome disturbance components including weight gain, hypertension, hyperlipidemia and diabetes mellitus. This is cross-sectional analytic study was carried out in Suez Canal University Hospital, Psychiatry Outpatient Clinic on Children and adolescent aged 4–17 years. It included 151 children and adolescents diagnosed by Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). They were divided into two groups, 72 patients who regular on (SGA) as treated group and 79 patients who did not receive pharmacological medication as control group.

Results

The overall prevalence of metabolic syndrome in the current study was high 27.81% in SGA-treated children compared to 0.60% in control group. In the SGA-treated group, 22.22% had type 2 diabetes, compared with 2.53% in the control group. SGA-treated patients showed a highly significant increase in their weight, body mass index and waist circumference compared to their control group patients. The correlation of different metabolic syndrome indices and SGAs duration showed positive correlation with body mass index, fasting blood sugar, and blood lipids (low density lipoproteins and cholesterol) but negative correlation with high density lipoproteins. Blood pressure did not correlate with SGA-duration in the studied patients. Indices which showed correlation could be predictors of the metabolic syndrome developments. Although the correlation and regression model showed moderate degree of association, this is considered important issue for the young patients.

Conclusion

SGA treatment in children and adolescence confers a significantly increased risk for metabolic syndrome and SGA-treatment duration is important for MtS development.

The influence of growth hormone on pediatric body composition: A systematic review

BACKGROUND

Growth hormone (GH) affects metabolism and regulates growth in childhood. The most prominent feature of GH deficiency (GHD) in children is diminished height velocity that eventually leads to short stature. In adult-onset GHD, lean body mass (LBM) is reduced, and visceral fat mass (FM) increased. Beneficial effects of GH treatment on body composition in adults with GHD, including an increase in muscle mass and a decrease in FM, are well established. Relatively few studies have investigated the effects of GH treatment on the body composition of pediatric patients with idiopathic or hypothalamic-pituitary disease-associated GH deficiency. This systematic review aimed to summarize available evidence relating to the effects of GH treatment on body composition in children with GHD.

METHODS

The PubMed, Science Direct, Cochrane Trials, and Embase databases, were searched with keywords including "GH", "body composition", "children", and "growth hormone" for English-language articles, published between January 1999 and March 2021. Two reviewers independently evaluated the search results and identified studies for inclusion based on the following criteria: participants had a confirmed diagnosis of GHD (as defined in each study); participants were pediatric patients who were receiving GH or had stopped GH treatment, regardless of whether they were pre- or post-pubertal; the intervention was recombinant human GH (rhGH; somatropin); and outcomes included changes in body composition during or after stopping GH therapy. Data extracted from each study included study quality, study sample characteristics, study interventions, and body composition. Data on fat-free mass and LBM were combined into a single category of LBM.

RESULTS

Sixteen studies reporting changes in body composition (i.e., FM and LBM) associated with GH treatment in children with GHD were identified and included in the review. Collectively, these studies demonstrated that FM decreased, and LBM increased in response to GH replacement therapy.

CONCLUSION

Despite study limitations (i.e., potential effects of diet and physical activity were not considered), we concluded that a periodic body composition assessment is required to ensure that a satisfactory body composition is achieved during GH replacement therapy in children with GHD.

cMetS Based on Z-Scores as an Accurate and Efficient Scoring System to Determine Metabolic Syndrome in Spanish Adolescents

The definition of metabolic syndrome (MetS) based on dichotomous cut-off points is efficient in the adult population. However, to date, there is no international consensus on how to define MetS in the pediatric population. For that reason, a continuous MetS score (cMetS) has been proposed for the pediatric population. However, despite multiple attempts, cMetS has not been fully validated as there is no agreement about the most accurate score to calculate it. The purpose of the present study was to compare the validity of different scores (three siMS scores, z-score, principal components analysis (PCA), the sum of PCA, and confirmatory factor analysis) to calculate cMetS and determine MetS in Spanish adolescents. There were 981 subjects, ranging 11-16 years old, recruited for this cross-sectional study. Seven different approaches to pediatric cMetS scores were calculated. All cMetS scores calculated strongly correlated with each other, especially siMS scores. The area under the curve obtained from receiving operating characteristic curves was particularly elevated for z-scores 0.81 (95% CI: 0.784-0.838), showing a specificity of 64.4%. Our study shows that cMetS based on z-scores is accurate and efficient to be used for research instead of the dichotomized definition of MetS in adolescents; and cMetS based on siMS scores is useful for clinical practice.

Association of CYP2R1 and VDR Polymorphisms with Metabolic Syndrome Components in Non-Diabetic Brazilian Adolescents

Associations between vitamin D deficiency and metabolic syndrome (MS) have been reported; however, the underlying biological mechanisms remain controversial. The aim of this study was to investigate the associations of CYP2R1 and VDR variants with MS and MS components in non-diabetic Brazilian adolescents. This cross-sectional study included 174 adolescents who were classified as overweight/obese. Three CYP2R1 variants and four VDR variants were identified by allelic discrimination. The CYP2R1 polymorphisms, rs12794714 (GG genotype) (odds ratio [OR] = 3.54, 95% confidence interval [CI] = 1.24–10.14, p = 0.023) and rs10741657 (recessive model—GG genotype) (OR = 3.90, 95%CI = 1.18–12.92, p = 0.026) were significantly associated with an increased risk of MS and hyperglycemia, respectively. The AG + GG genotype (dominant model) of the rs2060793 CYP2R1 polymorphism was associated with hyperglycemia protection (OR = 0.28, 95%CI = 0.08–0.92, p = 0.037). Furthermore, the CC genotype (recessive model) of the rs7975232 VDR polymorphism was significantly associated with a risk of hypertension (OR = 5.91, 95%CI = 1.91–18.32, p = 0.002). In conclusion, the CYP2R1 rs12794714 polymorphism could be considered a possible new molecular marker for predicting the risk of MS; CYP2R1 rs10741657 polymorphism and VDR rs7975232 polymorphism are associated with an increased risk of diabetes and hypertension in adolescents with overweight/obesity.

Prevalence of metabolic syndrome among adolescents in India: a population-based study

BACKGROUND

In India, the prevalence of overweight among adolescents is on the rise, setting the stage for an increase in metabolic syndrome (MS). This paper presents the national prevalence of MS in adolescents in India.

METHODS

A nationally representative data of adolescents (10-19 years) from the Comprehensive National Nutrition Survey was used. MS was defined based on the NCEP-ATP III criteria for adolescents. Bivariate analysis was used to report socio-demographic differentials in prevalence and to assess interstate variability. Multivariate logistic regression model was constructed to measure the association between socio-demographic characteristics and prevalence of MS. Census data from 2011 was projected to 2017 to calculate burden.

RESULTS

The prevalence of MS was 5.2% among adolescents. 11.9%, 15.4%, 26.0%, 31.9% and 3.7% had central obesity, high blood pressure, hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, respectively. The prevalence was higher among males (5.7% vs. 4.7%, adjusted odds ratio (AOR): 1.3, 95% confidence interval [CI]: 1.0, 1.6), those residing in urban areas (7.9% vs 4.2%, AOR: 1.4, 95% CI: 1.1, 1.8), and from wealthier households as compared to their counterparts (8.3% vs. 2.4%, AOR: 3.4, 95% CI: 2.1, 5.5). There was wide interstate variability in the prevalence of MS (0.5% - 16.5%). In 2017, 14.2 million adolescents had MS in India.

CONCLUSIONS

The prevalence of MS among adolescents in India is low and clustered in urban areas and richer households. Early prevention interventions promoting a healthy lifestyle, especially in high prevalence areas, are needed to keep MS from becoming a public health issue.

Metabolic, behavioral health, and disordered eating comorbidities associated with obesity in pediatric patients: An Obesity Medical Association (OMA) Clinical Practice Statement 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. This CPS will be followed by a companion CPS covering further comorbidities, including genetics and social consequences related to overweight and obesity. These CPSs are intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 95th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA.

Methods

The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results

This OMA statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. It provides clinical information regarding identifying and treating metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children over the 95th percentile of weight/height for age.

Conclusions

This OMA clinical practice statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children and provides an overview of current recommendations. These recommendations lay out a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.

The Cardiovascular Disease (CVD) Risk Continuum from Prenatal Life to Adulthood: A Literature Review

The risk of developing cardiovascular diseases (CVDs) arises from the interaction of prenatal factors; epigenetic regulation; neonatal factors; and factors that affect childhood and adolescence, such as early adiposity rebound (AR) and social and environmental influences. Thus, CVD risk varies between the group of low-risk metabolically healthy normal-weight subjects (MHNW); the intermediate-risk group, which includes metabolically healthy obese (MHO) and metabolically unhealthy normal-weight subjects (MUHNW); and the high-risk group of metabolically unhealthy obese (MUHO) subjects. In this continuum, several risk factors come into play and contribute to endothelial damage, vascular and myocardial remodeling, and atherosclerotic processes. These pathologies can occur both in prenatal life and in early childhood and contribute to significantly increasing CVD risk in young adults over time. Early intervention in the pediatric MUHO population to reduce the CVD risk during adulthood remains a challenge. In this review, we focus on CVD risk factors arising at different stages of life by performing a search of the recent literature. It is urgent to focus on preventive or early therapeutic strategies to stop this disturbing negative metabolic trend, which manifests as a continuum from prenatal life to adulthood.

Metabolic Syndrome (MetS), Systemic Inflammatory Response Syndrome (SIRS), and Frailty: Is There any Room for Good Outcome in the Elderly Undergoing Emergency Surgery?

BACKGROUND

Patients with MetS or SIRS experience higher rates of mortality and morbidity, across both cardiac and noncardiac surgery. Frailty assessment has acquired increasing importance in recent years as it predisposes elderly patients to a worse outcome. The aim of our study was to investigate the influence of MetS, SIRS, and with or without frailty on elderly patients undergoing emergency surgical procedures.

METHODS

We analyzed data of all patients with nonmalignant diseases requiring an emergency surgical procedure from January 2017 to December 2020. The occurrence of MetS was identified using modified definition criteria used by the NCEP-ATP III Expert Panel: obesity, hypertension, diabetes, or if medication for high triglycerides or for low HDL cholesterol was taken. Systemic inflammatory response syndrome (SIRS) was evaluated according to the original consensus study (Sepsis-1). The frailty profile was investigated by the 5-modified Frailty Index (5-mFI) and the Emergency Surgery Frailty Index (EmSFI). Postoperative complications have been reported and categorized according to the Clavien-Dindo (C-D) classification system. Morbidity and mortality have been mainly considered as the 30-day standard period definition.

RESULTS

Of the 2,318 patients included in this study, 1,010 (43.6%) fulfilled the criteria for MetS (MetsG group). Both 5-Items score and EmsFI showed greater fragility in patients with MetS. All patients with MetS showed more frequently a CACI index greater than 6. The occurrence of SIRS was higher in MetSG. LOS was longer in patients with MetS (MetSG 11.4 ± 12 days vs. n-MetSG 10.5 ± 10.2 days, p = 0.046). MetSG has a significantly higher rate of morbidity (353 (35.%) vs. 385 (29.4%), p = 0.005). The mortality rate in patients with MetS (98/1010, 10%) was similar to that in patients without it (129/1308, 10%). Considering patients with MetS who developed SIRS and those who had frailty or both, the occurrence of these conditions was associated with a higher rate of morbidity and mortality.

CONCLUSION

Impact of MetS and SIRS on elderly surgical patient outcomes has yet to be fully elucidated. The present study showed a 43.6% incidence of MetS in the elderly population. In conclusion, age per se should be not considered anymore as the main variable to estimate patient outcomes, while MetS and Frailty should have always a pivotal role.

Serum spexin levels are not associated with size at birth but are associated with metabolic syndrome components in prepubertal children born at term

BACKGROUND

Babies born small for gestational age (SGA) are at risk of obesity and metabolic syndrome (MetS). Spexin (SPX) is a novel peptide implicated in food intake and obesity. Spexin levels are lower in obese subjects. This study investigated the potential association of SPX and some obesity related peptides such as leptin and active ghrelin with size at birth and MetS components in prepubertal children born term and either SGA or appropriate for GA (AGA). Secondary aim was to identify whether any of the investigated peptides were associated with MetS components.

METHODS

We conducted a cross-sectional study of 37 consecutive (median age: 5.6 y) SGA- and 50 (median age: 5.9 y) AGA-born children. Clinical evaluations were performed using standard methods. Several biochemical variables (SPX, total leptin, and active ghrelin levels) were analyzed. Age-dependent cut-off values were used to define MetS components, including excess adiposity, hypertension, insulin resistance, and dyslipidemia. The associations between the assessed clinical and laboratory variables and MetS components were investigated.

RESULTS

Children born SGA had higher frequencies of MetS components than AGA-born peers (p < 0.01). None of the investigated peptides were different between children born SGA and AGA after correcting for body mass index (p > 0.05 for all). Serum SPX levels were lower in children with at least one metS component than those without MetS components (p = 0.018).

CONCLUSIONS

Size at birth had no association with serum SPX. Serum SPX levels are decreased in prepubertal children with MetS components.

Prevalence of type 2 diabetes mellitus, metabolic syndrome, and related morbidities in overweight and obese children

OBJECTIVES

The aim of the study was to determine the prevalence of metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM), and other comorbidities in overweight and obese children in Malatya, Turkey.

METHODS

Retrospective cross-sectional study. We studied 860 obese and overweight children and adolescents (obese children Body mass index (BMI) >95th percentile, overweight children BMI >85th percentile) aged between 6 and 18 years. The diagnosis of MetS, impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and T2DM were defined according to modified the World Health Organization criteria adapted for children. Other comorbidities were studied.

RESULTS

Subjects (n=860) consisted of 113 overweight and 747 obese children of whom 434 (50.5%) were girls. MetS was significantly more prevalent in obese than overweight children (43.8 vs. 2.7%, p<0.001), and in pubertal than prepubertal children (41.1 vs. 31.7%, p<0.001). Mean homeostasis model assessment for insulin ratio (HOMA-IR) was 3.6 ± 2.0 in the prepubertal and 4.9 ± 2.4 in pubertal children (p<0.001). All cases underwent oral glucose tolerance test and IGT, IFG, and T2DM were diagnosed in 124 (14.4%), 19 (2.2%), and 32 (3.7%) cases, respectively. Insulin resistance (IR) was present in 606 cases (70.5%).

CONCLUSIONS

Puberty and obesity are important risk factors for MetS, T2DM, and IR. The prevalence of MetS, T2DM, and other morbidities was high in the study cohort. Obese children and adolescents should be carefully screened for T2DM, insulin resistance, hyperinsulinism, dyslipidemia, hypertension, IGT, and IFG. The prevention, early recognition, and treatment of obesity are essential to avoid associated morbidities.

Mediterranean Diet and Genetic Determinants of Obesity and Metabolic Syndrome in European Children and Adolescents

Childhood obesity and metabolic syndrome (MetS) are multifactorial diseases influenced by genetic and environmental factors. The Mediterranean Diet (MD) seems to modulate the genetic predisposition to obesity or MetS in European adults. The FTO gene has also been shown to have an impact on the MD benefits to avoid obesity or MetS. Since these interaction effects have been scarcely analyzed in European youth, the aim was to describe the gene–MD interplay, analyzing the impact of the genetic factors to reduce the obesity and MetS risk through MD adherence, and the MD impact in the obesity and MetS genetic profile. From the limited evidence on gene–MD interaction studies in European youth, a study showed that the influence of high MD adherence on adiposity and MetS was only observed with a limited number of risk alleles; the gene–MD interplay showed sex-specific differences, being higher in females. Most results analyzed in European adults elucidate that, the relationship between MD adherence and both obesity and MetS risk, could be modulated by obesity genetic variants and vice versa. Further research is needed, to better understand the inter-individual differences in the association between MD and body composition, and the integration of omics and personalized nutrition considering MD.

Value of Adding Bioelectrical Impedance Analysis to Anthropometric Indices in the Diagnosis of Metabolic Syndrome in 10–16 Years Old Schoolgirls

The use of bioelectrical impedance analysis (BIA) in clinical settings is common. However, the value of BIA-based parameters in diagnosing metabolic syndrome (MetS) in children is under-investigated. Herein, we aimed to study the usefulness of BIA-indices in the diagnoses of MetS in 6–10-year-old girls. Therefore, a diagnostic accuracy case-control study was conducted, which included 75 girls aged 10–16 years, divided into three age-matched groups (normal, None-MetS, and MetS). Anthropometric indices, BIA parameters (including fat-free mass (FFM), body fat percent (BFP), and total body water (TBW)), blood pressure (BP), and blood samples were collected. Our main findings show that for girls in None-MetS and MetS groups, the waist circumference (WC) correlated positively with waist-hip ratio and mid-arm circumference (r = 0.58, 0.47, respectively), but not with BFP based on skinfold thickness (SFT), or mid-arm muscle area. WC was positively correlated with FFM and TBW, while high-density lipoprotein was inversely correlated with FFM. However, fasting blood glucose, triglycerides and BP showed no association with anthropometric measurements and BIA components. WC was the best indicator of MetS (AUC = 0.88, cut-off = 81.5 cm), followed by BMI (AUC = 0.84, cut-off = 26.9 kg/m²), while BFP based on SFT was the least sensitive (62.5%). In conclusion, apart from the FM index, anthropometric parameters such as WC are more valuable in diagnosing MetS in young adolescent girls.

Omentin as an Independent Predictor of Metabolic Syndrome and Obesity Among Adolescents in Northeast China

PURPOSE

We investigated the association of omentin with metabolic syndrome (MetS), MetS components, and obesity in adolescents.

METHODS

A total of 742 middle-school students from Liaoyang City were enrolled in this cross-sectional study using the stratified cluster sampling method. Clinical information and blood samples were collected, and serum omentin levels were measured using enzyme-linked immunosorbent assay.

RESULTS

Mean plasma omentin levels were lower in male than in female participants (88.25 (interquartile range 63.02-133.61) vs 99.46 (interquartile range 69.08-188.35) ng/L, P = 0.004). The participants were divided into four groups according to the quartile (Q) values of omentin from low to high. With increasing omentin levels from Q1 to Q4, the age of adolescents and the proportion of males gradually increased (P < 0.05), whereas the body mass index (BMI) (P < 0.05) and prevalence of MetS (P > 0.05) tended to decrease. Omentin levels were significantly and negatively correlated with waist circumference and BMI (correlation coefficients of -0.099 and -0.115, respectively). Regression analysis showed that omentin level was independently associated with the risk of MetS (Odds ratio, OR = 0.639, 95% confidence interval, CI (0.432, 0.945)), which was attributed to the association with central obesity (OR = 0.775, 95% CI (0.605, 0.993)) among MetS components. Increased omentin levels also indicated a reduced risk of obesity (OR = 0.700, 95% CI (0.563, 0.870)).

CONCLUSION

Omentin is an independent predictor of MetS and obesity among adolescents in northeast China.

Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children - From Disease Pathogenesis to Complications

The prevalence of overweight and obesity among youth patients with diabetes type 1 is increasing. It is estimated, that even up to 35% of young patients with this type of diabetes, considered so far to be characteristic for slim figure, are overweight or even obese. General increase of obesity in children's population complicates differential diagnosis of the type of diabetes in youths. Coexistence of obesity has clinical implications for all stages of diabetes course. It is confirmed that obesity is the risk factor for autoimmune diabetes, and is connected with the earlier onset of diabetes in predisposed patients. Many diabetic patients with obesity present additional risk factors for macroangiopathy, and are recognised to present metabolic syndrome, insulin resistance, and typical for diabetes type 2 - polycystic ovary syndrome, or non-alcoholic fatty liver disease. The prevalence of obesity rises dramatically in adolescence of diabetic child, more often in girls. It has negative impact on metabolic control, glycaemic variability and insulin demand. The risk for microangiopathic complications increases as well. The treatment is difficult and includes not only insulinotherapy and non-pharmacological trials. Recently treatment of insulin resistance with biguanids, and treatment with typical for type 2 new diabetes drugs like GLP-1 analogues, SGLT-2 receptor inhibitors, or even cases of bariatric surgery also has been reported.

The Different Effects of Skeletal Muscle and Fat Mass on Height Increment in Children and Adolescents Aged 6-11 Years: A Cohort Study From China

OBJECTIVE

This study aimed to investigate the contribution of body composition including skeletal muscle mass (SMM) and body fat mass (BFM) to longitudinal growth among children and adolescents aged 6-11 years old.

METHODS

This cohort study was conducted from the annual health examination between 2019 and 2020. Annual height gain and weight gain and changes in SMM and BFM were calculated and compared between sexes, different nutritional status, and growth curve shifting mode. Spearman analyses and multiple linear regression analysis were performed to identify the impact of SMM, BFM, or body mass index (BMI) on height gain.

RESULTS

Of the 584 subjects, the annual height gains of boys (4.76 cm in the 6-9-year group and 4.63 cm in the 10-11-year group) were significantly lower than those of girls (5.48 and 5.74 cm, respectively). Spearman analysis showed that SMM gain and height gain were positively and significantly correlated in each examination of all children (r = 0.535 for boys and 0.734 for girls, p < 0.001). Conversely, BFM and height gains were negatively (r = -0.5240 for boys and -0.232 for girls, p < 0.001) correlated. Multiple linear regression analysis identified SMM gain as an independent predictor (95% CI: 1.20,1.44) of height gain after adjusting for age, gender, BMI, BFM gain, and percentage of body fat (PBF).

CONCLUSION

SMM gains, rather than BFM gains, were associated with height gains in children and adolescents aged 6-11 years. Monitoring SMM changes in routine healthcare might motivate children and adolescents to achieve dietary and exercise recommendations, thereby growing taller without gaining excessive weight.

The Role of Bioactive Compounds from Dietary Spices in the Management of Metabolic Syndrome: An Overview

Metabolic syndrome (MetS) is a combination of physiologically dysregulated parameters that can include elevated fasting blood glucose, high blood pressure, central obesity, increased triglyceride levels, insulin resistance, diabetes, elevated low density lipoprotein levels, and reduced high density lipoprotein levels in the blood. Effective clinical management of MetS is critical as it is strongly associated with long lasting and fatal complications in patients. Alongside standard care of lifestyle changes and medication, dietary supplements derived from herbal resources could be an alternative therapeutic strategy that is safe, efficient, culturally acceptable, and has few side effects. Of the dietary supplements, spicy foods have always been considered a great source of functional bioactive compounds. Herbal therapy is broadly used in many countries as a treatment or as a preventive measure in the management of MetS risk factors, including blood glucose, blood pressure, and blood lipid levels. Herein, an attempt is made to evaluate the recent studies in the management of MetS with herbal alternatives, and to explore the possibility of their use as therapeutic treatments or supplements.

Opportunities to Address Obesity Disparities Among High-Risk Latino Children and Adolescents

PURPOSE OF REVIEW

This review highlights obesity-related disparities among Latino children and adolescents, discusses the social determinants of health (SDoH) that drive disparities, and presents case studies of strategies for reducing disparities and promoting health equity.

RECENT FINDINGS

Recommended strategies for reducing obesity-related disparities include the use of culturally grounded programming, multi-sector collaborations, and technology. We present two exemplar studies that demonstrate that integrating cultural values and enhancing the overall cultural fit of prevention programs can increase engagement among high-risk Latino families. We also examine the use of multi-sector collaborations to build community capacity and address key SDoH that impact health behaviors and outcomes. Our last example study demonstrates the utility of technology for engaging youth and extending the reach of prevention strategies in vulnerable communities. To address growing obesity-related disparities, there is an urgent need to develop and test these strategies among high-risk, vulnerable populations like Latino children and adolescents.

Investigation of the prevalence of cardiovascular risk factors in obese patients diagnosed with metabolic syndrome in childhood and examination of left ventricular function by echocardiography

OBJECTIVES

The objective of this study is to investigate the cardiovascular risk factors associated with metabolic syndrome (MetS), which is increasingly becoming prevalent in childhood obesity.

METHODS

A total of 113 patients, 76 of whom were between the ages of 10 and 17 (mean age: 14.5 ± 1.8 years) and diagnosed with obesity (30 non-MetS and 46 MetS using IDF) and 37 of whom constituted the control group, participated in the study. Echocardiographic examination and atherogenicity parameters (Atherogenic index of plasma [AIP: logTG/HDL], total cholesterol/HDL, and TG/HDL ratio and non-HDL) were evaluated.

RESULTS

The most common component accompanying obese MetS was found to be hypertension and low HDL. While obesity duration, body mass index (BMI), blood pressure, fasting insulin, insulin resistance, atherogenicity parameters were determined to be significantly higher in the obese-MetS group. Echocardiography showed that while the thickness, volume, and diameter of LV end-diastolic wall, left ventricular mass (LVM), LVM index (LVMI g/m²) and relative wall thickness (RWT) were significantly high in the MetS group, however, mitral E/A ratio was significantly lower (p<0.05). Change in LV geometry consistent with concentric remodeling (increased RWT, normal LVMI) was visible in obese groups. LVM were positively significantly related to BMI, waist circumference, insulin resistance, blood pressure, LDL level, and negative to mitral E/A ratio. In the obese-MetS group, LVMI was positively correlated to office systolic BP, left atrium end-diastolic volume/index.

CONCLUSIONS

LVMI and atherogenicity parameters that were found to be significantly higher in obese MetS exhibit increased cardiovascular risk in childhood.

An Association of Pediatric Psoriasis with Metabolic Syndrome in Thai Children: 20 Years Retrospective Study

Purpose

To explore epidemiological data of pediatric psoriasis age under 18 years old regarding, types of psoriasis, the correlation with metabolic syndrome (MetS), treatments, and treatment outcomes of at least one year follow-up.

Patients and Methods

This was a 20-year-retrospective study of pediatric psoriasis patients in a single tertiary pediatric referral center, Faculty of Medicine, Khon Kaen University, Thailand, between January 2001 and December 2020. The diagnosis of psoriasis was based on recorded diagnosis from ICD-10, and medical record was evaluated by certified pediatricians.

Results

There were 177 pediatric psoriasis in the study population. The mean age was 10.50, SD 4.80. The mean body mass index (BMI) was 19.10 (SD 5.44). There were 52 cases (29.37%) with MetS. Pediatric psoriasis patients over the age of 12 years old developed MetS 27 out of 70 cases (0.38) compared to the patients younger than 12 years old (25 out of 107 cases, 0.23), absolute risk reduction = 0.15, 95% CI 0.01–0.29, P = 0.029. The overall outcomes of pediatric psoriasis were good even though traditional topical and systemic treatments were provided in the study population.

Conclusion

The present study revealed that there was 15% increased MetS in the pediatric psoriasis patients over the age of 12 years old as compared to the patients of prepubertal age (≤12 years old). Increased attention to the early detection of MetS in pediatric psoriasis is recommended. Biologic therapy would be an alternative option in severe recalcitrant pediatric psoriasis cases in the future.