Change in Metabolic Profile after 1-Year Nutritional-Behavioral Intervention in Obese Children

Promoting Health in Pediatric Obesity: A Decade's Research of Physical Activity's Influence on Cardiometabolic Parameters

The global prevalence of childhood obesity highlights an urgent need to address its associated health complications. Cardiometabolic indicators, closely linked with obesity, can pose severe health risks, emphasizing the need for effective interventions. Among these, physical activity has shown many health benefits. However, a comprehensive understanding of the relationship between physical activity and cardiometabolic indicators in obese children remains somewhat unclear. This integrative review aims to fill this knowledge gap by critically examining relevant research over the past decade, thereby providing insights into evidence-based strategies to improve health outcomes in this vulnerable population. We conducted an integrative literature review of articles published between 2012 and 2022, retrieved from databases such as PubMed, Web of Science, Scopus, and EBSCO. Our focus was limited to Polish and English-language research with full text availability. We deployed keywords such as "physical activity", "children", "cardiometabolic indicators" and "BMI" linked using Boolean operators "and" and "or". Methodological quality was independently assessed by two authors, and Rayyan software was utilized for review compilation. Out of the assessed articles, 55 met the inclusion criteria. The majority centered around programs and interventions targeting children, examining their impact on body composition, alterations in body fat content, waist circumference, body mass index, blood pressure, heart rate, lipoprotein, triglycerides, total cholesterol, glucose, and insulin levels. Interventions focusing on increasing physical activity and reducing sedentary behavior demonstrate positive effects on body composition, aerobic capacity, and select biochemical markers in children. This underscores the potential of physical activity as a valuable tool in managing obesity-related health risks among children.

Targeted dietary approaches for the management of obesity and severe obesity in children and adolescents: A systematic review and meta-analysis

There is a need for a detailed understanding of effective dietary interventions for children with obesity. This systematic review examined the effectiveness of diets of varying energy content as a component of weight treatment in children and adolescents with obesity, severe obesity and obesity-related comorbidity. A systematic search of six databases, from 2000 to 2021, for intervention studies of targeted dietary treatment for obesity in children aged 2-18 years identified 125 studies. Dietary interventions were grouped according to diet type and energy target. Risk of bias was assessed using the Effective Public Healthcare Panacea Project assessment tool. Meta-analysis examined change in body mass index (BMI) at intervention end. A broad array of diet types were effective at reducing BMI in children with obesity. When dietary types were considered by energy target, a gradient effect was observed. Very-low energy diets were most effective with a - 4.40 kg/m² (n = 3; 95% CI -7.01 to -1.79). While dietary interventions with no specified energy target were ineffective, resulting in a BMI gain of +0.17 kg/m² (n = 22; 95% CI 0.05 to 0.40). Practical definitions of dietary energy target in the management of obesity and severe obesity are urgently required to ensure treatment seeking children have timely access to efficacious interventions.

Impact of One-Year Dietary Education on Change in Selected Anthropometric and Biochemical Parameters in Children with Excess Body Weight

Obesity is regarded as a civilization disease that increases mortality and the risk of cardiovascular complications. In Poland, the prevalence of excess body weight in the paediatric population has been steadily increasing. The consequences of excess body weight in the developmental age population affect children's health and destabilize their development. Appropriate dietary interventions are the main non-invasive methods of preventing and treating obesity. They should be aimed at the whole family, optimally with the use of simple tools such as the Healthy Eating Pyramid. Due to the increasing prevalence of excess body weight in the developmental age population and the problems with the treatment of this condition, studies were undertaken in order to determine the impact of a dietary intervention on anthropometric and biochemical parameters in children with excess body weight. A total of 68 (72.3%) children completed the study. Based on BMI SDS, 59 (86.8%) were diagnosed with obesity and 9 (13.2%) with overweight. After the completion of the one-year dietary educational program, a significant improvement in weight loss, waist and hip circumference, as well as the value of the WHtR index was demonstrated. There was also a significant increase in the percentage of muscle tissue and a decrease in the content of adipose tissue in the bodies of examined children. A significant improvement in the parameters of carbohydrate metabolism, and almost all parameters of lipid metabolism, except for total cholesterol. A significant (by 28.0%) reduction in the incidence of fatty liver was also noted. No influence of dietary education on arterial blood pressure was observed.

Impact of Lifestyle Intervention Programs for Children and Adolescents with Overweight or Obesity on Body Weight and Selected Cardiometabolic Factors-A Systematic Review

Excessive body mass is a health problem among children and adolescents that contributes to the occurrence of lipid disorders and abnormal blood pressure. Effective treatment of excessive body mass in children is essential for the health of population in the future. The aim of the study was to identify universal components of lifestyle interventions in children and adolescents with overweight or obesity leading to weight loss and improvement of selected cardiometabolic parameters. The review included studies from the PubMed and Google Scholar databases published in 2010–2019, which were analyzed for eligibility criteria including age of the participants, BMI defined as overweight or obese, nutritional intervention and the assessment of BMI and/or BMI z-score and at least one lipid profile parameter. Eighteen studies were included in the review, presenting the results of 23 intervention programs in which a total of 1587 children and adolescents participated. All interventions, except one, were multi-component. Data analysis suggests a relationship between a decrease in BMI and/or BMI z-score with diet and physical activity, the involvement of a dietician/nutrition specialist and physician in the treatment team and a longer duration of intervention. Moreover, it seems that a decrease in BMI is mostly associated with decreases in total cholesterol, triglycerides, low density lipoprotein cholesterol and blood pressure. No change in BMI and/or BMI z-score is associated with no change in blood pressure. Our data can be used by public health authorities to design effective weight loss programs for children and adolescents.

Cardiorespiratory Fitness Predicted by Fibrinogen and Leptin Concentrations in Children with Obesity and Risk for Diabetes: A Cross-Sectional Study and a ROC Curve Analysis

Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. The ability to exercise is affected by adiposity, and this mechanism involves low-grade chronic inflammation and homeostatic stress produced mainly in adipocytes, which can result in abnormal adipokine secretion. To date, the gold standard for cardiorespiratory fitness assessment is considered to be the maximum oxygen uptake (VO_2max). The aim of the present study was to assess the prognostic value of hematological parameters of childhood obesity, as potential predictors of cardiorespiratory fitness (VO_2max), using a sample of children and adolescents with obesity and risk for diabetes. A total of 84 clinically healthy children and adolescents were recruited, of which 21 were considered lean, 22 overweight and 41 obese, with a mean age of 12.0 ± 1.9, 11.4 ± 2.0, and 11.2 ± 2.1 years old, in each weight status category, respectively. Age and sex did not differ between groups. Hematologic testing was performed after 12 h of fasting including glucose, serum lipids, insulin, hc-CRP, adiponectin, leptin and fibrinogen levels. Cardiorespiratory capacity for exercise was assessed to determine VO_2max, using a cycle ergometer. The VO_2max was negatively correlated with progressive strength to the BMIz (-0.656, p ≤ 0.001), hs-CRP (r = -0.341, p ≤ 0.002), glucose (r = -0.404, p ≤ 0.001) and insulin levels (r = -0.348, p ≤ 0.001), the homeostasis model assessment of insulin resistance (HOMA-IR) (r = -0.345, p ≤ 0.002), as well as to the leptin (r = -0.639, p ≤ 0.001) and fibrinogen concentrations (r = -0.520, p ≤ 0.001). The multivariate analysis revealed that only leptin and fibrinogen concentrations could predict the VO_2max adjusted for the BMIz of participants. The receiver operating characteristic (ROC) curve for the diagnostic accuracy of leptin, hs-CRP and fibrinogen concentrations for the prediction of VO_2max revealed a good diagnostic ability for all parameters, with leptin being the most promising one (area under the curve (AUC): 99%). The results verify that in children with obesity, VO_2max may be predicted from hematological parameters (leptin and fibrinogen), possibly bypassing more invasive methods.

Effect of individual- versus collective-based nutritional-lifestyle intervention on the atherogenic index of plasma in children with obesity: a randomized trial

Background

The Atherogenic Index of Plasma is a predictive biomarker of atherosclerosis in adults but there is a lack of studies in paediatric population aimed at evaluating the longitudinal changes of the AIP and of the cardiometabolic blood profile related to nutritional interventions. The aim of this study was to compare the effect of individual- versus collective-based nutritional-lifestyle intervention on the Atherogenic Index of Plasma in schoolchildren with obesity.

Methods

One-hundred sixty-four children aged 6–12 years with Body Mass Index z-score > 2 referred to the Paediatric Obesity Clinic, San Paolo Hospital, Milan, Italy, were consecutively enrolled and randomized to undergo to either an individual- (n = 82) or a collective- (n = 82) based intervention promoting a balanced normo-caloric diet and physical activity. In addition, the individual intervention included a tailored personalized nutritional advice and education based on the revised Coventry, Aberdeen, and London-Refined taxonomy. Both at baseline and after 12 months of intervention, dietary habits and anthropometric measures were assessed, a fasting blood sample were taken for biochemistry analysis.

Results

The participation rate at 12 months was 93.3% (n = 153 patients), 76 children in the individual-intervention and 77 children in the collective intervention. At univariate analysis, mean longitudinal change in Atherogenic Index of Plasma was greater in the individual than collective intervention (− 0.12 vs. − 0.05), as well as change in triglyceride-glucose index (− 0.22 vs. − 0.08) and Body Mass Index z-score (− 0.59 vs. − 0.37). At multiple analysis, only change in Body Mass Index z-score remained independently associated with intervention (odds ratio 3.37).

Conclusion

In children with obesity, an individual-based nutritional and lifestyle intervention, including techniques from the CALO-RE taxonomy, could have an additional beneficial effect over a collective-based intervention, although the actual size of the effect remains to be clarified.

Trial Registration Clinical Trials NCT03728621

What Change in Body Mass Index Is Required to Improve Cardiovascular Outcomes in Childhood and Adolescent Obesity through Lifestyle Interventions: A Meta-Regression

Background: Using meta-regression, this article aims at establishing the minimum change in BMI-standard deviation score (SDS) needed to improve lipid profiles and blood pressure in children and adolescents with obesity, to aid future trials and guidelines. Methods: Studies with participants involved in lifestyle interventions, aged 4-19 years, with a diagnosis of obesity according to defined BMI thresholds, were considered for inclusion in a large systematic review. Interventions had to report pre- and post-intervention (or mean change in) BMI-SDS, plus either systolic blood pressure (SBP), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and/or triglycerides (TGs). Random-effects meta-regression quantified the relationship between mean change in BMI-SDS and mean change in cardiovascular outcomes. Results: Seventy-one papers reported various cardiovascular measurements and mean change in BMI-SDS. Fifty-four, 59, 46, and 54 studies were analyzed, reporting a change in SBP, HDL, LDL, and TG, respectively. Reduction in mean BMI-SDS was significantly related to improvements in SBP, LDL, TG, and HDL (p < 0.05); BMI-SDS reductions of 1, 1.2, and 0.7 ensured a mean reduction of SBP, LDL, and TG, respectively, although an equivalent value for HDL improvement was indeterminate. Conclusion: Reductions in mean BMI-SDS of >1, >1.2, or >0.7 are likely to reduce SBP, LDL, and TG, respectively. Further studies are needed to clarify the optimal duration, intensity, and setting for interventions. Consistency is required regarding derived BMI values to facilitate future systematic reviews and meta-analyses.

Leading dietary determinants identified using machine learning techniques and a healthy diet score for changes in cardiometabolic risk factors in children: a longitudinal analysis

BACKGROUND

Identifying leading dietary determinants for cardiometabolic risk (CMR) factors is urgent for prioritizing interventions in children. We aimed to identify leading dietary determinants for the change in CMR and create a healthy diet score (HDS) to predict CMR in children.

METHODS

We included 5676 children aged 6-13 years in the final analysis with physical examinations, blood tests, and diets assessed at baseline and one year later. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure (SBP and DBP), fasting glucose, high-density lipoprotein cholesterol (HDL-C, multiplying by - 1), and triglycerides. Machine learning was used to identify leading dietary determinants for CMR and an HDS was then computed.

RESULTS

The nine leading predictors for CMRS were refined grains, seafood, fried foods, sugar-sweetened beverages, wheat, red meat other than pork, rice, fungi and algae, and roots and tubers with the contribution ranging from 3.9 to 19.6% of the total variance. Diets high in seafood, rice, and red meat other than pork but low in other six food groups were associated with a favorable change in CMRS. The HDS was computed based on these nine dietary factors. Children with HDS ≥8 had a higher decrease in CMRS (β (95% CI): - 1.02 (- 1.31, - 0.73)), BMI (- 0.08 (- 0.16, - 0.00)), SBP (- 0.46 (- 0.58, - 0.34)), DBP (- 0.46 (- 0.58, - 0.34)), mean arterial pressure (- 0.50 (- 0.62, - 0.38)), fasting glucose (- 0.22 (- 0.32, - 0.11)), insulin (- 0.52 (- 0.71, - 0.32)), and HOMA-IR (- 0.55 (- 0.73, - 0.36)) compared to those with HDS ≦3. Improved HDS during follow-up was associated with favorable changes in CMRS, BMI, percent body fat, SBP, DBP, mean arterial pressure, HDL-C, fasting glucose, insulin, and HOMA-IR.

CONCLUSION

Diets high in seafood, rice, and red meat other than pork and low in refined grains, fried foods, sugar-sweetened beverages, and wheat are leading healthy dietary factors for metabolic health in children. HDS is strongly predictive of CMR factors.

Predictive capacity of triglyceride-glucose (TyG) index for insulin resistance and cardiometabolic risk in children and adolescents: a systematic review

Insulin resistance (IR) in childhood plays a key role in the development of metabolic changes in adulthood, therefore, it is important to diagnose it early. We aimed to investigate studies that evaluated the TyG index for prediction of IR risk and other cardiometabolic risk factors, as well as, the proposed cutoff points in childhood and adolescence. This is a systematic review elaborated according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The search was performed in Lilacs, PubMed and CAPES Journal Portal, using the terms "TyG index OR triglyceride-glucose index OR triglyceride and glucose index AND children OR adolescent*". Eight articles were included in this review. All were cross-sectional studies with individuals aged ≥2 and ≤20 years old, from the United States, Korea, Mexico, Brazil, and Iran. We concluded that the TyG index was positively associated with other IR prediction methods and appears to be advantageous for predicting IR risk and other cardiometabolic risk factors in children and adolescents (review registration: PROSPERO CRD42018100726).

Change in obesity-related metabolic abnormalities associated with body mass index improvement through life-style intervention: A meta-regression

The reduction in body mass index standard deviation score (BMI-SDS) associated with improvement in biomarkers relating to metabolic health in obese children is unknown. We aimed to establish the change in BMI-SDS associated with improved inflammation, liver function, and insulin resistance to inform clinical guidelines for pediatric weight management interventions and to assess the efficacy of future trials. A large-scale systematic review was conducted to identify relevant studies. Studies of children with a diagnosis of obesity according to defined BMI thresholds, participating in lifestyle interventions to reduce obesity, were included. Studies must have reported baseline (pre-) and postintervention (or change of) BMI-SDS and either fasting glucose, homeostatic model of insulin resistance (HOMA-IR), alanine aminotransferase (ALT), C-reactive protein (CRP), or interleukin-6 (IL-6). A series of meta-regressions were conducted to establish links between BMI-SDS change scores and change in metabolic markers of health. Sixty-eight articles were identified. From the meta-regression analyses, across all study subsets, greater mean falls in all four parameters, (HOMA-IR, Glucose, ALT, and CRP) were observed with greater mean loss of BMI-SDS, but the trends were only statistically significant for HOMA-IR and CRP (P = .003; P = .021). However, we could not find minimum changes in BMI-SDS that would ensure a fall in these outcomes. At this time, we are unable to recommend a definitive value of BMI-SDS reduction needed to improve the markers of metabolic health. Future trials should aim to report additional indices of derived BMI values, which may better reflect changes in actual adiposity.

Improving the Metabolic and Mental Health of Children with Obesity: A School-Based Nutrition Education and Physical Activity Intervention in Wuhan, China

This study aimed to evaluate the effectiveness of a school-based nutrition education and physical activity intervention on cardiovascular risk profile and mental health outcomes among Chinese children with obesity. Two primary schools were randomly allocated to the control group (CG) and the intervention group (IG). We selected children with obesity from 1340 students in the third and fourth grades as participants. The IG received 8 months of nutrition education and physical activity intervention, while the CG was waitlisted. A generalized estimating equation model was applied to assess repeated variables over time. A total of 171 children with obesity (99 IG and 72 CG) aged 9.8 ± 0.7 years completed the post-intervention stage. Compared with baseline, significant reductions were observed within the IG for depression and fasting plasma glucose at post-intervention. After adjusting for confounders, group and time interaction effects showed that the IG achieved improvements in the risk of poor well-being (p = 0.051) and social anxiety (p = 0.029), had decreased diastolic blood pressure (p = 0.020) and fasting plasma glucose (p < 0.001), and had significantly increased high-density lipoprotein (p < 0.001) from baseline to post-intervention relative to the CG. The effects of school-based nutrition education and physical activity intervention on children with obesity are diverse, including not only the improvement of metabolic health but also mental health promotion.

Effects of Telephone Aftercare Intervention for Obese Hispanic Children on Body Fat Percentage, Physical Fitness, and Blood Lipid Profiles

We investigated effects of 10-month telephone aftercare intervention following primary obesity intervention on changes in body fat percentage, physical fitness, and lipid profiles in obese Hispanic children. Seventy-one obese children were randomly assigned to (1) primary intervention and 10-month telephone aftercare intervention (PITI; N = 26), (2) primary intervention only (PI; n = 25), and (3) control (CON; N = 20). Anthropometric data, physical fitness, and blood samples were obtained before (PRE) and after (POST) eight-week primary intervention, and 10-month telephone aftercare intervention (1YEAR). Eight weeks of primary intervention significantly reduced body fat percentage, total cholesterol, triglycerides, and low-density lipoprotein (LDL-C) with increases in VO_2max, flexibility, muscular strength, and HDL-C (PITI and PI, p < 0.05). 1YEAR measurements returned to baseline for the PI whereas those measurements in PITI remained significantly different when compared to PRE (p < 0.05). CON observed negative changes in all variables at POST, which were improved slightly during the subsequent school year. Levels of cholesterol, triglycerides, and LDL-C are correlated to changes in body fat percentage, suggesting that fat loss is effective in preventing and managing obesity-related disorders. Results indicate that telephone intervention is an effective aftercare in stabilizing positive changes obtained from a short-term intensive intervention.

A real-world evaluation of a tertiary care childhood obesity intervention to reduce metabolic risk in a hard-to-reach urban population

Background

Research on outcomes associated with lifestyle interventions serving pediatric populations in urban settings, where a majority have severe obesity, is scarce. This study assessed whether participation in a lifestyle intervention improved body mass index (BMI) percentile, BMI z-score, blood pressure, and lipid levels for children and adolescents.

Methods

The Live Light Live Right program is a lifestyle intervention that uses medical assessment, nutritional education, access to physical fitness classes, and behavioral modification to improve health outcomes. Data was analyzed for 144 subjects aged 2–19 who participated for a minimum of 12 consecutive months between 2002 and 2016. McNemar tests were used to determine differences in the proportion of participants who moved from abnormal values at baseline to normal at follow-up for a given clinical measure. Paired sample t-tests assessed differences in blood pressure and lipid levels. Multiple linear regression assessed the change in blood pressure or lipid levels associated with improvement in BMI%₉₅ and BMI z-score.

Results

The majority were female (62.5%), mean age was 9.6, and 71% were Black. At baseline, 70.1% had severe obesity, systolic hypertension was present in 44, and 13.9% had diastolic hypertension. One-third had abnormally low high-density lipoprotein (HDL) at baseline, 35% had elevated low-density lipoprotein (LDL), and 47% had abnormal total cholesterol (TC). The average difference in percentage points of BMI%₉₅ at follow-up compared was − 3.0 (95% CI: − 5.0, − 1.1; p < 0.003). The mean difference in BMI z-score units at follow-up was − 0.15 (95% CI: − 0.2, − 0.1; p < 0.0001). Participants with systolic or diastolic hypertension had an average improvement in blood pressure of − 15.3 mmHg (p < 0.0001) and − 9.6 mmHg (p < 0.0001), respectively. There was a mean improvement of 4.4 mg/dL for participants with abnormal HDL (p < 0.001) and − 7.8 mg/dL for those with abnormal LDL at baseline (p = 0.036). For those with abnormal baseline TC, a one-unit improvement in BMI%₉₅ was associated with a 0.61 mg/dL improvement in TC while holding constant age, contact hours, and months since enrollment (p = 0.043).

Conclusions

Participation in the program resulted in significant improvements in BMI percentile, BMI z-score, blood pressure, and lipid levels.

Circulating Salicylic Acid and Metabolic Profile after 1-Year Nutritional⁻Behavioral Intervention in Children with Obesity

Objectives and Study: Salicylic acid (SA), a phenolic compound produced by plants, may play a beneficial role on health. A pilot study showed that children with obesity had lower serum SA than normal-weight children. The aim of this trial was to evaluate the effect of a 1-year nutritional–behavioral intervention on serum SA levels and to study a possible association between SA levels and metabolic profile changes in children with obesity. Methods: This was an interventional longitudinal observational uncontrolled cohort study. Forty-nine children with obesity, aged >6 years were evaluated. BMI (body mass index) z-scores were calculated. Fasting blood samples were analyzed for lipids, insulin, and glucose. The most significant metabolic variables were calculated. Serum SA was measured using a gas chromatography–mass spectrometry method. The 1-year intervention was based on the promotion of a balanced and normocaloric diet, in accordance with the national guidelines for treatment of childhood obesity. Additionally, behavioral education, based on the revised CALO-RE (Coventry, Aberdeen, and London-REfined) taxonomy, was performed. Results: At the end of intervention, children showed an increase in serum SA levels (mean (Standard Deviation, SD) 0.06 (0.02) vs. 0.09 (0.05) µmol/L; p < 0.001), a reduction of BMI z-score (3.14 (0.79) vs. 3.02 (0.82); p < 0.001), TyG index (4.52 (0.20) vs. 4.48 (0.23); p < 0.001), AIP (atherogenic index of plasma) (0.36 (0.21) vs. 0.27 (0.25); p < 0.001), and triglycerides/HDL (high density lipoprotein) cholesterol (2.57 (1.28) vs. 2.18 (1.22); p < 0.001) ratio. No statistically significant change in HOMA-IR (homeostasis model assessment index) was observed (4.20 (3.29) vs. 4.03 (2.28)). An association between the longitudinal variation of serum SA and HOMA-IR was found (correlation coefficient: −0.338, p = 0.02). Conclusion: Nutritional–behavioral intervention may improve the circulating SA and the metabolic profile in children with obesity. Serum SA could influence mainly glucose metabolism. Further larger studies are needed to evaluate whether a nutritional intervention based on specific advice regarding the quantity and type of fruit and vegetables (FV) consumption could provide benefits in terms of metabolic syndrome.

The TyG index cutoff point and its association with body adiposity and lifestyle in children

OBJECTIVE

To investigate the factors associated with insulin resistance in children aged 4-7 years, and to identify the cutoff point of the triglyceride-glucose index for the prediction of insulin resistance in this population.

METHODS

A cross-sectional study was conducted with 403 children from a retrospective cohort. Insulin resistance was also evaluated in a sub-sample using the HOMA index. Four indicators of body adiposity were assessed: body mass index, waist-to-height ratio, and the percentages of total and central body fat. Food habits were evaluated by the identification of dietary patterns, using principal component analysis. Information was also collected on lifestyle, socioeconomic status, and breastfeeding time.

RESULTS

The median index observed in the sample was 7.77, which did not differ between the genders. The shorter the time spent in active activities, the higher the triglyceride-glucose value; and increase in the values of body adiposity indicators was positively associated with triglyceride-glucose. The cutoff point with the best balance between sensitivity and specificity values was 7.88 (AUC=0.63, 95% CI: 0.51-0.74).

CONCLUSION

The present study identified that total and central body adiposity and shorter time spent in lively activities was positively associated with insulin resistance, evaluated through the triglyceride-glucose index. The cutoff point of 7.88 may be used in this population for insulin resistance risk screening, but caution is required when using it in other populations.

Metabolomics of Dynamic Changes in Insulin Resistance Before and After Exercise in PCOS

Background: Plasma elevated levels of branched chain amino acids (BCAA) and aromatic amino acids (AAA) have been associated with obesity and insulin resistance, but their relationship to stimulated insulin resistance (IR) in PCOS and in response to exercise is unknown. Indeed, it is unknown whether the mechanism of IR in PCOS is mediated through changes in the metabolome. Methods: Twelve women with polycystic ovary syndrome (PCOS) and ten age and body mass index matched controls completed an 8 week supervised exercise program at 60% maximal oxygen consumption. Before and after the exercise program, all participants underwent maximal IR stimulation with intralipid infusions followed by insulin sensitivity (IS) measurement by hyperinsulinaemic euglycaemic clamps. Amino acid profiles and metabolites were taken at baseline and at maximal insulin resistance stimulation before and after the exercise program. Results: At baseline, PCOS subjects showed increased leucine/isoleucine, glutamate, methionine, ornithine, phenylalanine, tyrosine and proline (p < 0.05) that, following exercise, did not differ from controls. While compering within the groups, no significant changes in the amino acid levels before and after exercise were observed. Exercise improved VO2 max (p < 0.01) but did not alter weight. Amino acid profiles were unaffected by an acute increase in IR induced by the lipid infusion. IS was lower in PCOS (p < 0.001) and was further decreased by the lipid infusion in both PCOS and controls. Although, exercise improved IS in both PCOS and in controls, the IS remained compromised in PCOS. Conclusion: The baseline amino acid profile in PCOS reflected that seen in obese subjects and differed to controls. After exercise, and despite no change in weight in either group, there were no differences in the amino acid profile between PCOS and controls. This shows that exercise may normalize the amino acid metabolome, irrespective of weight. ISRCTN number: ISRCTN42448814.

Recommended reference values for serum lipids during early and middle pregnancy: a retrospective study from China

Background

Disturbances in maternal lipid metabolism have been shown to increase the risk of adverse pregnancy outcomes. However, there is no consensus as to what constitutes normal maternal lipid values during pregnancy. Thus, the aim of this study was to establish serum lipid reference ranges during early and middle pregnancy.

Methods

We conducted a retrospective survey in Beijing from 2013 to 2014. A total of 17,610 singleton pregnancies with lipid data from early and middle pregnancy were included. First, after excluding women with adverse pregnancy outcomes, we performed a descriptive analysis of total cholesterol (TC), triglycerides (TG), high-density lipid cholesterol (HDL-C) and low-density lipid cholesterol (LDL-C) levels using means and standard deviations to determine appropriate percentiles. Second, in the total population, we examined the lipid levels in different trimesters with the risk of adverse pregnancy outcomes using categorical analyses and logistic regression models. Third, we determined the lipid reference range in early and middle pregnancy based on the first two results. Finally, based on the reference ranges we determined, we assessed whether the number of abnormal lipid values affected the risk of adverse pregnancy outcomes.

Results

(1) Serum levels of TC, TG, LDL-C and HDL-C all increased significantly from early to middle pregnancy, with the greatest increase in TG. (2) A trend towards an increasing incidence of adverse pregnancy outcomes was observed with increasing levels of TC, TG, and LDL-C and decreasing levels of HDL-C in both early and middle pregnancy. (3) We recommend that serum TC, TG and LDL-C reference values in early and middle pregnancy should be less than the 95th percentiles, whereas that of HDL-C should be greater than the 5th percentile, i.e., in early pregnancy, TC < 5.64 mmol/L, TG < 1.95 mmol/L, HDL-C > 1.23 mmol/L, and LDL-C < 3.27 mmol/L, and in middle pregnancy, TC < 7.50 mmol/L, TG < 3.56 mmol/L, HDL-C > 1.41 mmol/L, and LDL-C < 4.83 mmol/L. (4) Higher numbers out-of-range lipids during early and middle pregnancy were correlated with a higher risk of adverse pregnancy outcomes.

Conclusions

The reference ranges recommended in this paper can identify pregnant women with unfavourable lipid values.

Monitoring and management of hypertension with obesity in adolescents

Largely due to the childhood obesity epidemic, there has been an increase in the prevalence of hypertension in children and adolescents. Obesity associated hypertension is the most common hypertension phenotype among adolescents. Approximately 30% of obese adolescents have elevated blood pressure (BP) or hypertension. Updated definitions of elevated BP and hypertension in adolescents are now similar to definitions of BP status in adults. For adolescents ≥13 years of age, elevated BP is 120 to 129/<80 mm Hg. Hypertension, stage 1, is ≥130 to 139/80 to 89 mm Hg, and hypertension, stage 2, is ≥140/90 mm Hg. BP measurements over separate clinic visits are necessary to verify the diagnosis of elevated BP or hypertension. Ambulatory BP monitoring, when available, provides confirmatory data on BP status. Causal mechanisms for obesity associated hypertension include increased sympathetic nervous system activity, increased renal sodium retention secondary to insulin resistance/hyperinsulinemia, and obesity mediated inflammation. The primary treatment for obesity associated hypertension is weight reduction with lifestyle changes in diet and physical activity. Although difficult to achieve, even modest weight reduction can be beneficial. The diet should be rich in fruits, vegetables, fiber, and low-fat dairy with reduction in salt intake. When lifestyle changes are insufficient to achieve BP control, pharmacologic therapy is indicated to achieve a goal BP of <130/80 mm Hg or <90th percentile, whichever is lower. Regular BP monitoring is necessary for ongoing management of obesity associated hypertension in adolescents.

Progress in pediatrics in 2015: choices in allergy, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, nephrology, neurology, nutrition, oncology and pulmonology

This review focuses key advances in different pediatric fields that were published in Italian Journal of Pediatrics and in international journals in 2015. Weaning studies continue to show promise for preventing food allergy. New diagnostic tools are available for identifying the allergic origin of allergic-like symptoms. Advances have been reported in obesity, short stature and autoimmune endocrine disorders. New molecules are offered to reduce weight gain and insulin-resistance in obese children. Regional investigations may provide suggestions for preventing short stature. Epidemiological studies have evidenced the high incidence of Graves' disease and Hashimoto's thyroiditis in patients with Down syndrome. Documentation of novel risk factors for celiac disease are of use to develop strategies for prevention in the population at-risk. Diagnostic criteria for non-celiac gluten sensitivity have been reported. Negative effect on nervous system development of the supernumerary X chromosome in Klinefelter syndrome has emerged. Improvements have been made in understanding rare diseases such as Rubinstein-Taybi syndrome. Eltrombopag is an effective therapy for immune trombocytopenia. Children with sickle-cell anemia are at risk for nocturnal enuresis. Invasive diseases caused by Streptococcus pyogenes are still common despite of vaccination. No difference in frequency of antibiotic prescriptions for acute otitis media between before the publication of the national guideline and after has been found. The importance of timing of iron administration in low birth weight infants, the effect of probiotics for preventing necrotising enterocolitis and perspectives for managing jaundice and cholestasis in neonates have been highlighted. New strategies have been developed to reduce the risk for relapse in nephrotic syndrome including prednisolone during upper respiratory infection. Insights into the pathophysiology of cerebral palsy, arterial ischemic stroke and acute encephalitis may drive advances in treatment. Recommendations on breastfeeding and complementary feeding have been updated. Novel treatments for rhabdomyosarcoma should be considered for paediatric patients. Control of risk factors for bronchiolitis and administration of pavilizumab for preventing respiratory syncytial virus infection may reduce hospitalization. Identification of risk factors for hospitalization in children with wheezing can improve the management of this disease. Deletions or mutations in genes encoding proteins for surfactant function may cause diffuse lung disease.

An Integrative Analysis of the Effect of Lifestyle and Pharmacological Interventions on Glucose Metabolism in the Prevention and Treatment of Youth-Onset Type 2 Diabetes

Preventing and managing youth-onset type 2 diabetes are a major challenge. This paper reviews the evidence of lifestyle and drug therapies in improving glucose, insulin, and insulin sensitivity. Forty-four interventions were analyzed, of which 11 were drug (mainly metformin) interventions combined with lifestyle while the remainder used lifestyle strategies only. Fewer than a dozen out of 44 interventions reported significant improvements in glucose-related outcomes. Metformin in addition to lifestyle therapy did not necessarily enhance intervention effects. The overall lack of findings can be partially attributed to the heterogeneity of study populations, the lack of intervention intensity, under-powered study design, and the challenging lives of at-risk populations. New treatment options in both drugs and lifestyle strategies are direly needed.

Double Burden of Undernutrition and Obesity in Palestinian Schoolchildren

Background:

The coexistence of underweight and overweight (double burden) remains a major problem in many developing countries. Little is known about the factors associated with the double burden of malnutrition in Palestinian children.

Objective:

To assess factors associated with undernutrition and overnutrition in 1500 schoolchildren aged 5 to 16 years, in the West Bank.

Methods:

We surveyed a sample of 22 schools run by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the Palestinian government. Binary logistic regression was used to examine the factors associated with malnutrition. The hunger index, a composite score from 8 questions, was used to measure food insecurity.

Results:

In the 1484 children enrolled in UNRWA and government schools in the West Bank, the prevalence of stunting was 7% and underweight 3%. Around 12% of students were overweight and 6% obese. The hunger index was negatively associated with height for age. Factors associated with being underweight were male sex, mother being unemployed, and households not having enough food to eat for at least 2 days in the previous month. Factors associated with obesity were older age and time spent watching television. When overweight and obesity were combined in the analysis, they were inversely associated with increasing number of days spent playing sports.

Conclusion:

Our results show that the important nutritional risks for school-age children in the West Bank would seem to be the simultaneous occurrence of undernutrition and obesity. The study highlights the need to balance obesity management and prevention with interventions to tackle undernutrition.