Metabolic Abnormalities in Normal Weight Children Are Associated with Increased Visceral Fat Accumulation, Elevated Plasma Endotoxin Levels and a Higher Monosaccharide Intake

Abnormal distribution of fat tissue and its association with intestinal failure-associated liver disease in children and adolescents with long-time parenteral nutrition support: A case-control study

BACKGROUND

Patients with intestinal failure (IF) often present with abnormal body composition characterized by high fat mass. However, the distribution of fat and its association with the development of IF-associated liver disease (IFALD) remain unclear. This study aims to investigate the body composition and its relationship with IFALD in older children and adolescents with IF.

METHODS

This retrospective case-control study enrolled patients with IF receiving parenteral nutrition (PN) at Keio University Hospital who initiated PN before the age of 20 years (cases). The control group included patients with abdominal pain, with available computed tomography (CT) scan and anthropometric data. CT scan images of the third lumbar vertebra (L3) were used for body composition analysis and compared between the groups. Liver histology was compared with CT scan findings in IF patients who underwent biopsy.

RESULTS

Nineteen IF patients and 124 control patients were included. To account for age distribution, 51 control patients were selected. The median skeletal muscle index was 33.9 (29.1-37.3) in the IF group and 42.1 (39.1-45.7) in the control group (P < 0.01). The median visceral adipose tissue index (VATI) was 9.6 (4.9-21.0) in the IF group and 4.6 (3.0-8.3) in the control group (P = 0.018). Among the 13 patients with IF who underwent liver biopsies, 11 (84.6%) had steatosis, and there was a tendency for fibrosis to correlate with VATI.

CONCLUSION

Patients with IF exhibit low skeletal muscle mass and high visceral fat, which may be related to liver fibrosis. Routine monitoring of body composition is recommended.

Visceral Obesity: Terminology, Measurement, and Its Correlation with Inflammation

The prevalence of childhood obesity in the world is significant and it is topical issue due to the high risk of chronic non-communicable diseases development. This article presents the analysis of pathogenetic role of visceral obesity, describes modern methods for measuring visceral adipose tissue, discusses major terminology on obesity. The current data on inflammation induced by excess of visceral adipose tissue and inflammasome’s role in this process are summed up. All the findings are crucial for the development of tools for prevention any obesity associated adverse effects in children.

Nutrition, obesity, and dental development in young adolescents in Chicago

OBJECTIVES

Childhood obesity is a systemic disease with multiple downstream consequences, including shifts in timing of growth and development. It has been documented that children with high body mass index (BMI) show accelerated timing of dental development, but the mechanism for this acceleration is unknown. Prior work has suggested that inflammation and/or nutrition may play a role. We investigate the potential association between diet (caloric intake, macronutrients), obesity, and accelerated dental development.

METHODS

Children and adolescents (age 10-15; n = 112) were recruited from dental clinics at the University of Illinois Chicago. We collected subjects' height, weight, panoramic radiographic records, and each subject filled out a Block Food Frequency Questionnaire.

RESULTS

The only macronutrient level associated with BMI was a negative correlation to Total Fat consumption (p = .01), though this relationship was not significant in the path analysis (p > .05). Regression analyses indicated that BMI (p = .003) and total caloric intake (controlling for BMI; rho = 0.19; p = .04) were both significantly correlated with timing of dental development. However, when a path analysis was conducted, it was revealed that only BMI was statistically significant (p = .008).

CONCLUSIONS

Body mass index percentile, regardless of caloric intake, is positively associated with accelerated dental development. While it is possible that excess caloric intake itself plays a minor role in timing of dental development, we do not see unambiguous evidence for this in our sample. We posit that another mechanism, such as inflammation, may be the link between obesity status and dental development.

Juvenile obesity in terms of various evaluation methods

INTRODUCTION

Obesity is a civilization disease of the 21st century. The prevalence of obesity and overweight among children and adolescents is constantly increasing. BMI (body mass index) and WHR (waist to hip ratio) are methods of obesity assessment recommended by the WHO. Also, the WtHR (waist to height ratio), which takes into account height, is one of the most popular methods of diagnosing childhood obesity. A more recent diagnostic indicator is the FMI (fat mass index), which considers the percentage of the patient's body fat.

THE AIM OF THE STUDY

was to compare the methods of assessing obesity in children and adolescents using the following indicators: BMI, WHR, WtHR, and FMI and to determine the consistency of the results obtained with them.

MATERIAL AND METHODS

The study included 195 children aged 11-18 years, from whom the following data were collected: height, weight, waist circumference, and percentage of body fat. The calculated indices (BMI, WHR, WtHR, FMI), expressed in SDS, were compared using the Bland-Altman test, Passing-Bablok regression, and the slope chart.

RESULTS

The fewest diagnoses of obesity were shown by FMI SDS (15.9%) and the highest by WHR SDS (28.7%). WHR SDS showed the least consistent results with BMI SDS. Significant statistical differences were found between BMI SDS and both FMI SDS and WtHR SDS.

CONCLUSIONS

BMI, as the most acceptable obesity indicator, can be used as a screening method for assessing obesity. However, patients with boundary BMI values should be examined more precisely, using more than one index. FMI is recommended.

Insufficient Physical Fitness and Deficits in Basic Eating Habits in Normal-Weight Obese Children Are Apparent from Pre-School Age or Sooner

Normal-weight obesity appears to be an extended diagnosis/syndrome associated with insufficient physical fitness levels and inadequate eating habits at least from school years. However, its relation to long term health parameters in pre-school children remains unknown, even though pre-school age is crucial for the determining healthy lifelong habits. Therefore, the aim of the current study was to investigate the differences in physical fitness level and basic eating habits between normal-weight obese, normal-weight non-obese, and overweight and obese preschoolers. The research sample consisted of 188 preschoolers aged 4.0–6.9 years (M_age = 5.52 ± 0.8 year), normal-weight obese = 25; normal-weight non-obese = 143, overweight and obese = 20. Body composition was measured using bio-impedance InBody230. Six tests assessed the physical fitness level: sit-ups; standing long jump; shuttle running 4 × 5 meters; throwing with a tennis ball; multistage fitness tests; sit and reach. A four-item eating habits questionnaire for parents focusing on breakfast regularity, consumption of sweet foods and drinks, selection of food and attitude towards eating was used. A non-parametric analysis of variance and Fisher’s exact test along with suitable effect sizes were used for data processing of physical fitness tests and the basic eating habits questionnaire, respectively. Normal-weight obese children performed significantly worse (from p = 0.03 to p < 0.001, ES ω2-G = low to medium) in muscular fitness, cardiorespiratory fitness and running agility compared to normal-weight non-obese counterparts and did not significantly differ in the majority of physical fitness performance tests from overweight and obese peers. In basic eating habits, normal-weight obese boys preferred significantly more sweet foods and drinks (p = 0.003 ES = 0.35, large), while normal-weight obese girls had significantly more negative attitude towards eating (p = 0.002 ES = 0.33, large) in comparison to their normal-weight non-obese peers. Normal-weight obesity seems to develop from early childhood and is associated with low physical fitness and deficits in eating habits which might inhibit the natural necessity for physically active life from pre-school age or sooner.

Intraindividual double-burden of anthropometric undernutrition and "metabolic obesity" in Indian children: a paradox that needs action

Background

Intraindividual coexistence of anthropometrically defined undernutrition and “metabolic obesity”, characterised by presence of at least one abnormal cardiometabolic risk factor, is rarely investigated in young children and adolescents, particularly in Low-and-Middle-Income-Countries undergoing rapid nutrition transition.

Methods

Prevalence of biomarkers of metabolic obesity was related to anthropometric and socio-demographic characteristics in 5-19 years old participants from the population-based Comprehensive National Nutrition Survey in India (2016-2018). The biomarkers, serum lipid-profile (total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides), fasting glucose, and glycosylated hemoglobin (HbA1C), and all jointly were analysed in 22567, 23192, 25962 and 19143 participants, respectively.

Results

Overall (entire dataset), the prevalence of abnormalities was low (4.3-4.5%) for LDL and TC, intermediate for dysglycemia (10.9-16.1%), and high for HDL and triglycerides (21.725.8%). Proportions with ≥1 abnormal metabolic obesity biomarker(s) were 56.2% overall, 54.2% in thin (BMI-for-age <-2SD) and 59.3% in stunted (height-for-age <-2SD) participants. Comparable prevalence was evident in mild undernutrition (-1 to -2 SD). Clustering of two borderline abnormalities occurred in one-third, warranting active life-style interventions. Metabolic obesity prevalence increased with BMI-for-age. Among those with metabolic obesity, only 9% were overweight/obese (>1SD BMI-for-age). Among poor participants, triglyceride, glucose and HDL abnormalities were higher.

Conclusions

A paradoxical, counter-intuitive prevalence of metabolic obesity biomarker(s) exists in over half of anthropometrically undernourished and normal-weight Indian children and adolescents. There is a crucial need for commensurate investments to address overnutrition along with undernutrition. Nutritional status should be characterized through additional reliable biomarkers, instead of anthropometry alone.

Dietary quality score is positively associated with serum adiponectin level in Indonesian preschool-age children living in the urban area of Jakarta

An unhealthy diet during childhood directly impacts the risk of developing noncommunicable diseases (NCDs) later on in life. However, well-documented information on this issue is lacking. We investigated the dietary quality of young Indonesian children and assessed the relationship to serum adiponectin levels as an early marker of NCDs. Eighty-five (44 girls and 41 boys) Indonesian preschool-age children in East Jakarta were included in this study. Dietary intake data were gathered by collecting repeated 24-hour recalls for one weekday and one day during the weekend, which were then further converted into participants' Healthy Eating Index (HEI) 2015 scores. Meanwhile, an enzyme-linked immunosorbent assay was performed to determine the serum adiponectin level. A multiple regression analysis was performed to assess the association between the HEI 2015 score and serum adiponectin, adjusting for potential confounders. The mean HEI 2015 score was 33.2 ± 8.3 points, which was far below the recommended score of ≥ 80 points, while the mean serum adiponectin was 10.3 ± 4.1 μg/mL. Multiple linear regression testing showed that a one-point increase in the HEI 2015 score was significantly associated with an increase in the serum adiponectin level by 0.115 μg/mL after adjusting for exclusive breastfeeding history (β = 0.115; 95% CI = 0.010-0.221; p = 0.032). In conclusion, better adherence of young children to a healthy diet has a positive association with their adiponectin level. This result suggests that strengthening children's dietary quality from an early age by involving all parties in the children's environment (e.g., parents, teachers at school, policymakers) may help to reduce the risk of NCDs later on in childhood and during adult life.

Added values of DXA-derived visceral adipose tissue to discriminate cardiometabolic risks in pre-pubertal children

BACKGROUND

The new generation of dual energy X-ray absorptiometry (DXA) scanners provide visceral adipose tissue (VAT) estimates by applying different algorithms to the conventional DXA-derived fat parameters such as total fat, trunk fat and android fat for the same image data.

OBJECTIVE

This cross-sectional study aimed to investigate whether VAT estimates from Hologic scanners are better predictors of VAT than conventional DXA parameters in pre-pubertal children, and to explore the discrimination ability of these VAT methods for cardiometabolic risks.

METHODS

Healthy pre-pubertal children aged 7-10 years were recruited for basic anthropometric, DXA and magnetic resonance imaging (MRI) measurements. Laboratory tests included lipid profile, glycaemic tests and blood pressure.

RESULTS

All VAT methods had acceptable to excellent performance for the diagnosis of dyslipidaemia (area under the curve [AUC] = 0.753-0.837) and hypertensive risk (AUC = 0.710-0.821) in boys, but suboptimal performance for these risks in girls, except for VAT by MRI in the diagnosis of dyslipidaemia. In both sexes, all VAT methods had no or poor discrimination ability for diabetes risk.

CONCLUSIONS

DXA-derived VAT estimates are very highly correlated with standard methods but has equivalent discrimination abilities compared to the existing DXA-derived fat estimates.

Plasma Adipokines Profile in Prepubertal Children with a History of Prematurity or Extrauterine Growth Restriction

Adipose tissue programming could be developed in very preterm infants with extrauterine growth restriction (EUGR), with an adverse impact on long-term metabolic status, as was studied in intrauterine growth restriction patterns. The aim of this cohort study was to evaluate the difference in levels of plasma adipokines in children with a history of EUGR. A total of 211 school age prepubertal children were examined: 38 with a history of prematurity and EUGR (EUGR), 50 with a history of prematurity with adequate growth (PREM), and 123 healthy children born at term. Anthropometric parameters, blood pressure, metabolic markers and adipokines (adiponectin, resistin, leptin) were measured. Children with a history of EUGR showed lower values of adiponectin (μg/mL) compared with the other two groups: (EUGR: 10.6 vs. PREM: 17.7, p < 0.001; vs. CONTROL: 25.7, p = 0.004) and higher levels of resistin (ng/mL) (EUGR: 19.2 vs. PREM: 16.3, p =0.007; vs. CONTROL: 7.1, p < 0.001. The PREM group showed the highest values of leptin (ng/mL), compared with the others: PREM: 4.9 vs. EUGR: 2.1, p = 0.048; vs. CONTROL: 3.2, p = 0.029). In conclusion, EUGR in premature children could lead to a distinctive adipokines profile, likely associated with an early programming of the adipose tissue, and likely to increase the risk of adverse health outcomes later in life.