1
|
Fiore G, Pascuzzi MC, Di Profio E, Corsello A, Agostinelli M, La Mendola A, Milanta C, Campoy C, Calcaterra V, Zuccotti G, Verduci E. Bioactive compounds in childhood obesity and associated metabolic complications: Current evidence, controversies and perspectives. Pharmacol Res 2023; 187:106599. [PMID: 36503001 DOI: 10.1016/j.phrs.2022.106599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
Obesity represents the most frequent chronic disease among children worldwide, with a significant global burden on society. Metabolically unhealthy obesity (MUO) can affect children since their first years of life, and novel therapeutic strategies to tackle metabolic complications are under investigation. This review focuses on bioactive compounds and their possible beneficial effects on obesity, particularly omega-3, docosahexaenoic acid, vitamin D, biotics, polysaccharide macromolecules, polyphenols, inositols, alpha lipoic acid, and bromelaine. Our aim is to summarize current evidence about bioactive compounds in the treatment of obesity, highlighting recent findings on their use in children and adolescents. Most studied molecules are omega-3 and vitamin D, despite the heterogeneity between the studies. Moreover, given the emerging interest in the gut-brain axis in the link between metabolic health and microbiota, various studies on prebiotics, probiotics, synbiotics, postbiotics and polysaccharide macromolecules have been considered. Some preclinical studies seem to highlight a possible role of the polyphenols, even if their clinical evidence is still discussed. Lastly, we describe possible effects of inositols and alpha-lipoic acid. Despite some dietary supplements seem to be promising in overweight subjects, only in a few of them a dose/response efficacy has been found in the pediatric age. Innovative, well-designed and targeted clinical trials are then needed to prove the beneficial effects of these compounds that could support the standard behavioral therapy for obesity.
Collapse
Affiliation(s)
- Giulia Fiore
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Italy.
| | | | - Elisabetta Di Profio
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Italy.
| | - Antonio Corsello
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Italy.
| | - Marta Agostinelli
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Italy.
| | - Alice La Mendola
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Italy.
| | - Chiara Milanta
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Italy.
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain; EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain; Spanish Network of Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada's node, Institute of Health Carlos III, 28029 Madrid, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), San Cecilio University Hospital. Health Sciences Technological Park, 18016 Granada, Spain.
| | - Valeria Calcaterra
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Italy; Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy.
| | - Gianvincenzo Zuccotti
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Italy; Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, 20144 Milan, Italy; Pediatric Clinical Research Center, Fondazione Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy.
| | - Elvira Verduci
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy.
| |
Collapse
|
2
|
Obita G, Alkhatib A. Disparities in the Prevalence of Childhood Obesity-Related Comorbidities: A Systematic Review. Front Public Health 2022; 10:923744. [PMID: 35874993 PMCID: PMC9298527 DOI: 10.3389/fpubh.2022.923744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Non-communicable diseases among children are serious consequences of childhood obesity. However, less is known about the disparities in childhood obesity comorbidities burden. This review describes the salient pattern of disparities in the prevalence of childhood obesity-related non-communicable diseases and relevant inequalities in both high- and low/medium-income countries. Method A systematic literature search was performed in MEDLINE, Embase, CINAHL, PsycInfo, Scopus, and Web of Science databases by two independent reviewers. Inclusion criteria were as follows: age 2–18 years; the prevalence or incidence of childhood obesity comorbidities reported; and studies published in English from January 2010 to date. No restrictions on the setting. The prevalence data were analyzed using range and median for subgroups based on the country's development status, gender, and geographical region. Results Our search identified 6,837 articles, out of which we examined 145 full-text articles and included 54 articles in the analysis. The median prevalence of childhood obesity-related hypertension was 35.6 vs. 12.7% among middle- and low-income countries compared with high-income countries; 37.7 vs. 32.9% among boys compared with girls; and 38.6, 25.3, and 20.1% in Asia, South America, and Europe, respectively. For metabolic syndrome, the median prevalence was 26.9 vs. 5.5% among middle- and low-income countries compared with high-income countries; 55.2 vs. 12.0% among boys compared with girls; and 40.3, 25.8, and 7.7% in South America, Asia, and Europe, respectively. The prevalence of childhood obesity-related non-alcoholic fatty liver disease was 47.5 vs. 23% among middle- and low-income countries compared with high-income countries; and 52.1, 39.7, and 23.0% in Asia, South America, and Europe, respectively. The median prevalence of dyslipidemia was 43.5 vs. 63% among middle- and low-income countries compared with high-income countries; 55.2 vs. 12.0% among boys compared to girls; and 73.7 and 49.2% in Australia and Europe, respectively. Conclusion There are disparities in the prevalence of childhood obesity-related hypertension, metabolic syndrome, and non-alcoholic fatty liver disease, with middle- and low-income countries, boys, and Asian region having higher prevalence. Implementing targeted interventions for childhood obesity comorbidities should consider socioeconomic disparities and strengthening of research surveillance methods for a better understanding of non-communicable disease burden in the pediatric population. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021288607.
Collapse
Affiliation(s)
- George Obita
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Ahmad Alkhatib
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| |
Collapse
|
3
|
Dündar İ, Akıncı A. Prevalence of type 2 diabetes mellitus, metabolic syndrome, and related morbidities in overweight and obese children. J Pediatr Endocrinol Metab 2022; 35:435-441. [PMID: 35026882 DOI: 10.1515/jpem-2021-0271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/14/2021] [Indexed: 01/08/2023]
Abstract
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.
Collapse
Affiliation(s)
- İsmail Dündar
- Department of Pediatric Endocrinology, İnonu University Faculty of Medicine, Malatya, Turkey
| | - Ayşehan Akıncı
- Department of Pediatric Endocrinology, İnonu University Faculty of Medicine, Malatya, Turkey
| |
Collapse
|
4
|
Assessment of renal function in obese and overweight children with NGAL and KIM-1 biomarkers. NUTR HOSP 2021; 34:436-442. [PMID: 32207310 DOI: 10.20960/nh.02651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Aim and background: the incidence of obesity has increased among children, and obesity has been considered an independent risk factor for chronic kidney disease. We aimed to determine the degree of kidney function impairment by evaluating urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) levels. Materials and methods: in total, 15 obese, 26 overweight, and 26 control adolescents aged 10 to 16 years were enrolled into the study. Urine samples were evaluated for NGAL and KIM-1 levels using enzyme-linked immunosorbent assay kits. We investigated the association between obesity and related comorbidities with urinary NGAL and KIM-1 excretion. Results: no significant differences were noted between the obese, overweight, and control groups in urinary NGAL and KIM-1 excretion (p = 0.327 and p = 0.917, respectively). In the obese and overweight groups urinary NGAL levels were 50.39 [30.88-74.22] in females and 26.67 [23.24-45.59] in males (p = 0.013). Also, urinary NGAL levels were increased in obese and overweight adolescents with LDL dyslipidemia at 64.12 [30.98-114.32] as compared to those without LDL dyslipidemia: 39.51 [25.59.56.37] (p = 0.024). Furthermore, a correlation was observed between insulin and homeostasis model assessment of insulin resistance levels with the NGAL/creatinine ratio in the overweight group (r = 0.515; p = 0.008, and r = 0.483; p = 0.014, respectively). Such correlation was not found in the obese group. Conclusion: the effect of obesity on renal function could not be determined in children. A longer exposure may be required for obesity-induced disruption of renal function in children. Renal function may be disrupted by dyslipidemia in obese adolescents. Furthermore, obesity impaired renal function in female adolescents. The normalization of these urinary markers as related to urine creatinine should be discussed.
Collapse
|
5
|
Calcaterra V, Cena H, Pelizzo G, Porri D, Regalbuto C, Vinci F, Destro F, Vestri E, Verduci E, Bosetti A, Zuccotti G, Stanford FC. Bariatric Surgery in Adolescents: To Do or Not to Do? CHILDREN (BASEL, SWITZERLAND) 2021; 8:453. [PMID: 34072065 PMCID: PMC8204230 DOI: 10.3390/children8060453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 01/19/2023]
Abstract
Pediatric obesity is a multifaceted disease that can impact physical and mental health. It is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors. In most cases lifestyle and behavioral modification as well as medical treatment led to poor short-term weight reduction and long-term failure. Thus, bariatric surgery should be considered in adolescents with moderate to severe obesity who have previously participated in lifestyle interventions with unsuccessful outcomes. In particular, laparoscopic sleeve gastrectomy is considered the most commonly performed bariatric surgery worldwide. The procedure is safe and feasible. The efficacy of this weight loss surgical procedure has been demonstrated in pediatric age. Nevertheless, there are barriers at the patient, provider, and health system levels, to be removed. First and foremost, more efforts must be made to prevent decline in nutritional status that is frequent after bariatric surgery, and to avoid inadequate weight loss and weight regain, ensuring successful long-term treatment and allowing healthy growth. In this narrative review, we considered the rationale behind surgical treatment options, outcomes, and clinical indications in adolescents with severe obesity, focusing on LSG, nutritional management, and resolution of metabolic comorbidities.
Collapse
Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy;
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
| | - Hellas Cena
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy; (H.C.); (D.P.)
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (F.D.); (E.V.)
| | - Debora Porri
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy; (H.C.); (D.P.)
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Corrado Regalbuto
- Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Federica Vinci
- Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Francesca Destro
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (F.D.); (E.V.)
| | - Elettra Vestri
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (F.D.); (E.V.)
| | - Elvira Verduci
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
- Department of Health Sciences, University of Milan, 20146 Milan, Italy
| | - Alessandra Bosetti
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
| | - Gianvincenzo Zuccotti
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
- “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, 20146 Milan, Italy
| | - Fatima Cody Stanford
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA;
| |
Collapse
|
6
|
Bilge S, Yılmaz R, Karaslan E, Özer S, Ateş Ö, Ensari E, Demir O. The Relationship of Leptin (+19) AG, Leptin (2548) GA, and Leptin Receptor Gln223Arg Gene Polymorphisms with Obesity and Metabolic Syndrome in Obese Children and Adolescents. Pediatr Gastroenterol Hepatol Nutr 2021; 24:306-315. [PMID: 34046334 PMCID: PMC8128779 DOI: 10.5223/pghn.2021.24.3.306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Obesity is defined as the abnormal or excessive accumulation of fat over acceptable limits. Leptin is a metabolic hormone present in the circulation in amounts proportional to fat mass. Leptin reduces food intake and increases energy expenditure, thus regulating body weight and homeostasis. Various polymorphisms are present in the leptin gene and its receptor. These polymorphisms may be associated with obesity. This study aimed to show the association of leptin (+19) AG, leptin (2548) GA, and Gln223Arg leptin receptor polymorphisms with obesity and metabolic syndrome in Turkish children aged 6-17 years, and to conduct further investigations regarding the genetic etiology of obesity. METHODS A total of 174 patients diagnosed with obesity and 150 healthy children who were treated at Tokat Gaziosmanpaşa Medical School Hospital between September 2014 and March 2015 were included in this study. The ages of the children were between 6 and 17 years, and anthropometric and laboratory results were recorded. Genotyping of leptin (+19) AG, leptin (2548) GA, and leptin receptor Gln223Arg polymorphisms was performed by polymerase chain reaction. RESULTS An association between leptin receptor Gln223Arg gene polymorphism and obesity was detected. CONCLUSION Further studies are needed to determine the role of genetic etiologies and to indicate the role of leptin signal transmission impairment in the pathogenesis of obesity. We hope that gene therapy can soon provide a solution for obesity.
Collapse
Affiliation(s)
- Serap Bilge
- Department of Pediatrics, Gaziosmanpaşa University Hospital, Tokat, Turkey
| | - Resul Yılmaz
- Department of Pediatrics, Gaziosmanpaşa University Hospital, Tokat, Turkey
| | - Erhan Karaslan
- Department of Pediatrics, Gaziosmanpaşa University Hospital, Tokat, Turkey
| | - Samet Özer
- Department of Pediatrics, Gaziosmanpaşa University Hospital, Tokat, Turkey
| | - Ömer Ateş
- Department of Biochemistry, Gaziosmanpaşa University Hospital, Tokat, Turkey
| | - Emel Ensari
- Department of Medical Biology, Gaziosmanpaşa University Hospital, Tokat, Turkey
| | - Osman Demir
- Department of Biostatistics, Gaziosmanpaşa University Hospital, Tokat, Turkey
| |
Collapse
|
7
|
Guner Ozenen G, Aksoylar S, Goksen D, Gozmen S, Darcan S, Ozek G, Kansoy S. Metabolic syndrome and risk factors after hematopoietic stem cell transplantation in children and adolescents. J Pediatr Endocrinol Metab 2021; 34:485-493. [PMID: 33639046 DOI: 10.1515/jpem-2020-0584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The early and late complications after hematopoietic stem cell transplantation (HSCT) determine the patients' prognosis and life quality. We aim to determine the metabolic syndrome development frequency after HSCT in children to find out the risk factors and compare them with healthy adolescents. METHODS Thirty-six children who underwent HSCT at least two years ago were analyzed prospectively and cross-sectionally. Our study included 18 healthy children between the ages of 11 and 17 as a control group. All of the cases were assessed in terms of metabolic syndrome (MS) through the use of Modified WHO Criteria. RESULTS The patients' median age was 10.6 (5.1-17) years, the median time of follow-up after HCST was 4.1 (2-13.5) years and 70% were male. Two cases were diagnosed with MS (5.6%). When considered in terms of the sub-components of MS, 2 cases (5.6%) were found to have obesity, 17 cases (47%) abnormal glucose tolerance, 11 cases (30.7%) dyslipidemia, and 3 cases (8.6%) hypertension. The MS rate was not different when compared with the 11-17 year-old healthy control group (0 vs. 11%, p=0.48). Myeloablative conditioning regimen (65 vs. 20%) and the increased age at which HSCT was performed were considered to be risk factors in terms of insulin resistance (p=0.025 and 0.002). CONCLUSIONS Age and conditioning regimens were found to be the risk factors for insulin resistance development. The long-term follow-up of the cases who had undergone HSCT in childhood in terms of MS and its sub-components is important in order to increase life quality.
Collapse
Affiliation(s)
- Gizem Guner Ozenen
- Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Serap Aksoylar
- Department of Pediatric Hematology & Oncology and Bone Marrow Transplantation, Medical School of Ege University, Izmir, Turkey
| | - Damla Goksen
- Department of Pediatric Endocrinology and Diabetes, Medical School of Ege University, Izmir, Turkey
| | - Salih Gozmen
- Department of Pediatric Hematology & Oncology and Bone Marrow Transplantation, Medical School of Ege University, Izmir, Turkey
| | - Sukran Darcan
- Department of Pediatric Endocrinology and Diabetes, Medical School of Ege University, Izmir, Turkey
| | - Gulcihan Ozek
- Department of Pediatric Hematology & Oncology and Bone Marrow Transplantation, Medical School of Ege University, Izmir, Turkey
| | - Savas Kansoy
- Department of Pediatric Hematology & Oncology and Bone Marrow Transplantation, Medical School of Ege University, Izmir, Turkey
| |
Collapse
|
8
|
Prevalence of Metabolic Syndrome among Children and Adolescents in High-Income Countries: A Systematic Review and Meta-Analysis of Observational Studies. BIOMED RESEARCH INTERNATIONAL 2021. [DOI: 10.1155/2021/6661457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction. Metabolic syndrome (MetS) is an assemblage of interconnected cardiovascular risk factors that are prevalent among children and adolescents in high-income countries (HICs). Despite the presence of several studies on the issue, the study findings are incongruent due to the absence of a gold standard diagnostic method of MetS in children. Thus, the findings of the original studies are inconclusive for policy makers and other stakeholders. This systematic review and meta-analysis is aimed at giving conclusive evidence about MetS among children and adolescents in HICs. Methods. We conducted searches using electronic databases (PubMed, Scopus, Web of Science, CINAHL (EBSCOhost), EMBASE (Elsevier), and Medline (EBSCOhost)) and other sources (Google Scholar and Google) up to September 2020. Observational studies reporting the prevalence of MetS were eligible in this study. The pooled estimates were computed in fixed and random effect models using six diagnostic methods (IDF, ATP III, de Ferranti et al., WHO, Weiss et al., and Cruz and Goran). Publication bias was verified using funnel plots and Egger’s regression tests. Subgroup and sensitivity analysis were performed in case of higher heterogeneities among the included studies. Result. In this study, 77 studies with a total population of 125,445 children and adolescents were used in the final analysis. Metabolic syndrome among the overweight and obese population was computed from 28 studies with the pooled prevalence of 25.25%, 24.47%, 39.41%, 29.52%, and 33.36% in IDF, ATP III, de Ferranti et al., WHO, and Weiss et al. criteria, respectively. Likewise, 49 studies were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, MetS was found in 3.70% (IDF), 5.40% (ATP III), 14.78% (de Ferranti et al.), 3.90% (WHO), and, 4.66% (Cruz and Goran) of study participants. Regarding the components of MetS, abdominal obesity in the overweight and obese population, and low HDL-C in the general population were the most common components. Besides, the prevalence of Mets among males was higher than females. Conclusion. This study demonstrates that MetS among children and adolescents is undoubtedly high in HICs. The prevalence of MetS is higher among males than females. Community-based social and behavioral change communications need to be designed to promote healthy eating behaviors and physical activities. Prospective cohort studies could also help to explore all possible risk factors of MetS and to design specific interventions accordingly.
Collapse
|
9
|
Fernández-Aparicio Á, Perona JS, Schmidt-RioValle J, González-Jiménez E. Concordance among diagnostic criteria for metabolic syndrome is inconsistent in Spanish adolescents. Eur J Clin Invest 2021; 51:e13384. [PMID: 32810293 DOI: 10.1111/eci.13384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/23/2020] [Accepted: 08/06/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The metabolic syndrome (MetS), although more frequent in adults, is a growing health problem in adolescent population. There are different criteria for the diagnosis, however without a consensus of which is the best to be used in this population. The heterogeneity of the different diagnostic criteria makes it necessary to carry out more studies that analyse the degree of agreement among these criteria. The present study was aimed to evaluate the agreement between different criteria for diagnosis of MetS in adolescents. MATERIALS AND METHODS A cross-sectional study was performed on 981 adolescents (13.2 ± 1.2 years) randomly recruited from 18 schools in south-east Spain. MetS was diagnosed by eight different criteria. RESULTS The criteria proposed by the IDF showed the highest mean values for WC and systolic blood pressure in boys and girls with MetS, and the lowest for glucose and triglycerides in boys. Depending on the diagnostic criteria used, the prevalence of MetS cases in boys ranged from 5.5% to 14.9%, while in girls varied from 3.4% to 32.6%. Both in boys and girls, the criteria proposed by the IDF was the less concordant with the other suggested criteria, while those proposed by Duncan et al, Rodriguez-Moran et al and Cruz and Goran, were very concordant among each other. However, in girls, concordance values were not as high as those found for boys. CONCLUSION The variability observed in the agreement among the existing criteria suggests the need to validate uniform criteria for the diagnosis of MetS in adolescents.
Collapse
Affiliation(s)
| | - Javier S Perona
- Department of Food and Health, Instituto de la Grasa-CSIC, Campus of the University Pablo de Olavide, Seville, Spain
| | | | | |
Collapse
|
10
|
Smetanina N, Valickas R, Vitkauskiene A, Albertsson-Wikland K, Verkauskienė R. Prevalence of Metabolic Syndrome and Impaired Glucose Metabolism among 10- to 17-Year-Old Overweight and Obese Lithuanian Children and Adolescents. Obes Facts 2021; 14:271-282. [PMID: 33951670 PMCID: PMC8255643 DOI: 10.1159/000514720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Overweight (Ow) and obesity among adults and children increases the risk of metabolic consequences. Metabolic syndrome (MS) and impaired glucose metabolism are well-known risk factors for cardiovascular diseases and type 2 diabetes. The aim of this study was to evaluate the prevalence of MS and impaired glucose metabolism among Ow and obese (Ob) children and adolescents (aged 10-17 years) in Lithuania, and to evaluate the associations between insulin resistance (IR) indices and anthropometric parameters as well as metabolic disturbances. METHODS The study population consisted of 344 OwOb children and adolescents of all pubertal stages. Oral glucose tolerance tests (OGTTs), IR and β cell function indices, lipid profile, and anthropometric parameters of all subjects were analyzed. MS was defined according to the International Diabetes Federation consensus guidelines. RESULTS MS was found in 21.3% of the OwOb children and adolescents, and 12.1% had impaired glucose metabolism (6.9% with impaired fasting glucose, 4.5% with impaired glucose tolerance, and 0.6% with type 2 diabetes). IR was directly related to body mass index and waist circumference, waist-to-height and waist-to-hip ratios, and sum of skin-fold thicknesses. Children with MS were more insulin-resistant, had higher odds ratio for prediabetes and had a more disturbed lipid profile than subjects without MS. Moreover, total cholesterol and low-density lipoprotein cholesterol levels were significantly lower in the more mature OwOb adolescents. CONCLUSION MS and lipid profile disturbances are common in OwOb children and adolescents. MS is directly associated with IR. Therefore, OwOb children and adolescents should be carefully followed up for metabolic abnormalities during late childhood as these can persist into adulthood.
Collapse
Affiliation(s)
- Natalija Smetanina
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- *Natalija Smetanina,
| | - Raimondas Valickas
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Astra Vitkauskiene
- Department of Laboratory Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kerstin Albertsson-Wikland
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Rasa Verkauskienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
11
|
Aslan Çin NN, Yardımcı H, Koç N, Uçaktürk SA, Akçil Ok M. Triglycerides/high-density lipoprotein cholesterol is a predictor similar to the triglyceride-glucose index for the diagnosis of metabolic syndrome using International Diabetes Federation criteria of insulin resistance in obese adolescents: a cross-sectional study. J Pediatr Endocrinol Metab 2020; 33:777-784. [PMID: 32447329 DOI: 10.1515/jpem-2019-0310] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 03/16/2020] [Indexed: 01/11/2023]
Abstract
Objectives Metabolic syndrome (MS) is a fatal endocrinopathy that begins with insulin resistance (IR) and causes abdominal obesity, glucose intolerance, or systemic disorders. This study was aimed to determine the cut-off values for the triglyceride (TG)/high-density lipoprotein cholesterol (TG/HDL-C) ratio, the TG glucose (TyG) index and homeostasis model assessment (HOMA-IR) for the diagnosis of MS in obese adolescents, and to compare which of the three indexes would offer a more accurate approach to diagnosis. Methods The study population comprised 1,171 obese adolescents (639 females and 532 males aged 10-16 years, Body Mass Index (BMI)>=95th percentile). Indirect measures of IR screening for MS were the TG/HDL ratio, TyG index, and HOMA-IR. The cut-off values of the TG/HDL ratio, TyG index, and HOMA-IR were obtained from receiver operation characteristic (ROC) curves. Results HOMA-IR had a significant positive correlation with the TyG index (r=0.352, p<0.001) and TG/HDL-C (r=0.291, p<.001). The TyG index and TG/HDL-C showed a strong positive correlation (r=0.901, p<0.001). The TG/HDL-C ratio showed a larger ROC Area under Curve (AUC=0.849) than HOMA-IR index (AUC=0.689), but as a predictor similar to TyG index (AUC=0.833) when screening for MS. The cut-off values for MS were as follows: TG/HDL-C ratio>2.16 (sensitivity: 88.8%; specificity: 49.7%), TyG index>8.50 (sensitivity: 85.6%; specificity: 57.0%) and HOMA-IR>2.52 (sensitivity: 83.2%; specificity: 40.4%). Conclusions Both the TyG index and TG/HDL-C ratio are better markers than HOMA-IR to determine the risk of metabolic syndrome according to IDF criteria. Besides, the TyG index and TG/HDL-C ratio have similar differentiating powers to determine this risk in obese Turkish adolescents.
Collapse
Affiliation(s)
- Nazlı Nur Aslan Çin
- Ankara University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Fatih Cad. Tepebaşı Mah, No:197/A, 06300, Ankara, Kecioren, Turkey
| | - Hülya Yardımcı
- Ankara University Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Nevra Koç
- Health Sciences University, Ministry of Health Ankara City Hospital, Department of Child Nutrition and Metabolism, Ankara, Turkey
| | - Seyit Ahmet Uçaktürk
- Health Sciences University, Ministry of Health Ankara City Hospital, Department of Child Nutrition and Metabolism, Ankara, Turkey
| | - Mehtap Akçil Ok
- Baskent University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Baglica Campus, Ankara,Turkey
| |
Collapse
|
12
|
Yayıcı Köken Ö, Kara C, Can Yılmaz G, Aydın HM. Prevalence of Obesity and Metabolic Syndrome in Children with Type 1 Diabetes: A Comparative Assessment Based on Criteria Established by the International Diabetes Federation, World Health Organisation and National Cholesterol Education Program. J Clin Res Pediatr Endocrinol 2020; 12:55-62. [PMID: 31434460 PMCID: PMC7127892 DOI: 10.4274/jcrpe.galenos.2019.2019.0048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/16/2019] [Indexed: 01/04/2023] Open
Abstract
Objective To determine the prevalence of obesity and metabolic syndrome (MetS) in children and adolescents with type 1 diabetes (T1D) and to compare the widely accepted and used diagnostic criteria for MetS established by the International Diabetes Federation (IDF), World Health Organisation (WHO) and National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII). Methods We conducted a descriptive, cross sectional study including T1D patients between 8-18 years of age. The three sets of criteria were used to determine the prevalence of MetS and findings compared. Risk factors related to MetS were extracted from hospital records. Results The study included 200 patients with T1D (52% boys). Of these, 18% (n=36) were overweight/obese (body mass index percentile ≥85%). MetS prevalence was 10.5%, 8.5% and 13.5% according to IDF, WHO and NCEP criteria, respectively. There were no statistically significant differences in age, gender, family history of T1D and T2D, pubertal stage, duration of diabetes, hemoglobin A1c levels and daily insulin doses between patients with or without MetS. In the overweight or obese T1D patients, the prevalence of MetS was 44.4%, 38.8% and 44.4% according to IDF, WHO and NCEP-ATPIII criteria, respectively. Conclusion Obesity prevalence in the T1D cohort was similar to that of the healthy population of the same age. Prevalence of MetS was higher in children and adolescents with T1D compared to the obese population in Turkey. The WHO criteria include microvascular complications which are rare in childhood and the NCEP criteria do not include a primary criterion while diagnosing non-obese patients according to waist circumference as MetS because the existence of diabetes is considered as a direct criterion. Our study suggests that IDF criteria which allows the diagnosis of MetS with obesity and have accepted criteria for the childhood are more suitable for the diagnosis of MetS in children and adolescents with T1D.
Collapse
Affiliation(s)
- Özlem Yayıcı Köken
- University of Health Sciences Turkey, Dr. Sami Ulus Training and Research Hospital, Clinic of Pediatric Neurology, Ankara, Turkey
| | - Cengiz Kara
- İstinye University Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey
| | - Gülay Can Yılmaz
- Mardin State Hospital, Clinic of Pediatric Endocrinology, Mardin, Turkey
| | - Hasan Murat Aydın
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| |
Collapse
|
13
|
Impact of Recreational Sports Activities on Metabolic Syndrome Components in Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010143. [PMID: 31878170 PMCID: PMC6981663 DOI: 10.3390/ijerph17010143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 01/19/2023]
Abstract
We investigated the impact of a sports activities program on metabolic syndrome (MetS) components and pre-MetS among adolescents. Blood samples, blood pressure, weight, height, body mass index, waist circumference, body fat percentage, frequency of food consumption, daily time in moderate-to-vigorous physical activity (MVPA), and sedentary behavior (SB) of 92 male adolescents aged 14-18 years (16.07 ± 0.93) were evaluated. From this initial sample, 36 participants (39.1%) were diagnosed with pre-MetS or MetS and were invited to participate in the intervention program. Twelve individuals diagnosed with pre-MetS or MetS agreed to participate in a recreational sports activities program lasting 14 weeks. The pre- and post-sport program comparison showed a reduction in total cholesterol, low-density lipoprotein, and non-high-density lipoprotein (HDL), and an increase in HDL and MVPA time in the intervention group. Sports activities accounted for 42% of the MVPA daily recommendation, and at the end of the intervention period, only seven subjects maintained a positive diagnosis for pre-MetS or MetS. This study showed that recreational sports activities had a significant impact on the lipid profile.
Collapse
|
14
|
Bozbulut R, Ertaş-Öztürk Y, Döğer E, Bideci A, Köksal E. Increased Obesity Awareness and Adherence to Healthy Lifestyle-Diet Reduce Metabolic Syndrome Risk in Overweight Children. J Am Coll Nutr 2019; 39:432-437. [PMID: 31755852 DOI: 10.1080/07315724.2019.1691951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Obesity is a common epidemic issue in all over the world. In order to prevent obesity it is essential to know about obesity and its detrimental consequences. This study aimed to evaluate children's awareness about obesity and to determine the associations between level of awareness, healthy lifestyle, dietary habits and risk factors for metabolic syndrome.Methods: Two hundred and thirty-six overweight children (119 boys and 117 girls) aged 10-14 years were enrolled to the study. Anthropometric and biochemical measurements were taken and metabolic syndrome (MetS) definition were done according to the International Diabetes Federation (IDF) consensus and divided into two groups as MetS (+) and MetS (-). Obesity awareness scale (OBA) and Adapted Healthy Lifestyle-Diet Index for Turkey (HLD-TR) were performed.Results: Among children, the prevalence of having MetS was found as 26.3%. Obesity awareness and HLD-TR index sores were lower in MetS (+) group than MetS (-) group. Metabolic syndrome related biochemical parameters and anthropometric measurements were associated with obesity awareness level of the children. The binary logistic regression model shows that a one-unit increase in the OBA index score increases the odd of not having MetS for 1.12 times after adjustments for age, gender, body mass index, and HLD-TR index score.Conclusions: Increased awareness about obesity among children will help to reduce the risk of metabolic syndrome, type 2 diabetes and atherosclerotic cardiovascular diseases in the future.
Collapse
Affiliation(s)
- Rukiye Bozbulut
- Faculty of Medicine, Department of Pediatric Endocrinology, Gazi University, Ankara, Turkey
| | - Yasemin Ertaş-Öztürk
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| | - Esra Döğer
- Faculty of Medicine, Department of Pediatric Endocrinology, Gazi University, Ankara, Turkey
| | - Aysun Bideci
- Faculty of Medicine, Department of Pediatric Endocrinology, Gazi University, Ankara, Turkey
| | - Eda Köksal
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| |
Collapse
|
15
|
Guilherme FR, Nascimento MAD, Molena-Fernandes CA, Guilherme VR, Santos SRD, Elias RGM, Rinaldi W. COMPARISON OF DIFFERENT CRITERIA IN THE PREVALENCE OF METABOLIC SYNDROME IN STUDENTS FROM PARANAVAÍ, PARANÁ. REVISTA PAULISTA DE PEDIATRIA 2019; 37:332-337. [PMID: 31166466 PMCID: PMC6868564 DOI: 10.1590/1984-0462/;2019;37;3;00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/10/2018] [Indexed: 01/19/2023]
Abstract
Objective: To investigate the difference in the proportion of students with metabolic
syndrome, diagnosed according to different criteria. Methods: The sample consisted of 241 students (136 boys and 105 girls) aged 10 to 14
years, from public and private schools in Paranavaí, Paraná. We used three
distinct diagnostic criteria for metabolic syndrome, considering the
presence of at least three of the following risk factors: increased waist
circumference, hypertension, fasting hyperglycemia, low HDL-C, and elevated
triglycerides. Results: The prevalence of metabolic syndrome found was 1.7% (confidence interval of
95% - 95%CI 0-3.3) for the IDF criterion; 3.3% (95%CI 1.0-5.6) for Cook; and
17.4% (95%CI 12.6-22.3) for Ferranti. Analyzing the criteria in pairs, the
agreement between IDF and Cook was 97.5% (k=0.95); between IDF and Ferranti,
83.4% (k=0.67); and between Cook and Ferranti, 85.9% (k=0.72). Onlyone
student (0.4%) was diagnosed with metabolic syndrome solely by the IDF
criterion, while 34 (14.1%) were diagnosed exclusively by Ferranti. The
comparison of the three criteria showed that Ferranti presented the highest
proportion of metabolic syndrome (p<0.001), and Cook had a greater
proportion than IDF (p<0.001). Conclusions: We found a significant difference in the proportion of metabolic syndrome in
the three criteria. The choice of which criterion to use can compromise not
only the percentage of metabolic syndrome prevalence but also interfere in
strategies of intervention and prevention in children and adolescents with
and without metabolic syndrome, respectively.
Collapse
Affiliation(s)
- Flávio Ricardo Guilherme
- Universidade Estadual do Paraná, Brazil; Faculdade de Tecnologia e Ciências do Norte do Paraná, Brazil
| | | | | | | | | | | | | |
Collapse
|
16
|
Yılmaz R, Ateş Ö, Gül A, Kasap T, Özer S, Ensari E. Association Between Trp64arg Polymorphism of the β3 adrenoreceptor Gene and Female Sex in Obese Turkish Children and Adolescents. Pediatr Gastroenterol Hepatol Nutr 2019; 22:460-469. [PMID: 31555571 PMCID: PMC6751107 DOI: 10.5223/pghn.2019.22.5.460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/07/2019] [Accepted: 03/23/2019] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The β3-adrenergic receptor (ADRB3) is expressed in visceral adipose tissue and has been speculated to contribute to lipolysis, energy metabolism, and regulation of the metabolic rate. In this study, we aimed to investigate the association of polymorphism of the ADRB3 gene with the sex of children with obesity and related pathologies. METHODS ADRB3 gene trp64arg genotyping was conducted in 441 children aged 6-18 years. Among these subjects, 264 were obese (103 boys; 161 girls) and 179 were of normal weight (81 boys; 98 girls). In the obese group, fasting lipids, glucose and insulin levels, and blood pressure were measured. Metabolic syndrome (MS) was defined according to the modified World Health Organization criteria adapted for children. RESULTS The frequency of trp64arg genotype was similar in obese and normal weight children. In obese children, serum lipid, glucose, and insulin levels; homeostasis model assessment of insulin resistance (HOMA-IR) scores; and MS were not different between arg allele carriers (trp64arg) and noncarriers (trp64trp). In 264 obese children, genetic analysis results revealed that the arg allele carriers were significantly higher in girls than in boys (p=0.001). In the normal weight group, no statistically significant difference was found between genotypes of boys and girls (p=0.771). CONCLUSION Trp64arg polymorphism of the ADRB3 gene was not associated with obesity and MS in Turkish children and adolescents. Although no relationships were observed between the genotypes and lipids, glucose/insulin levels, or HOMA-IR, the presence of trp64arg variant was frequent in obese girls, which can lead to weight gain as well as difficulty in losing weight in women.
Collapse
Affiliation(s)
- Resul Yılmaz
- Division of Pediatric Critical Care, Department of Pediatrics, Selcuk University School of Medicine, Konya, Turkey
| | - Ömer Ateş
- Department of Medical Biology and Genetics, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Ali Gül
- Department of Pediatrics, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Tuba Kasap
- Department of Pediatrics, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Samet Özer
- Clinic of Pediatrics, Memorial Hospital, Kayseri, Turkey
| | - Emel Ensari
- Department of Medical Biology and Genetics, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| |
Collapse
|
17
|
Abstract
OBJECTIVES Cardiovascular (CV) diseases play a leading role in the mortality of adult liver transplant (LT) recipients. However, data regarding CV risk factors in children after LT remain sparse. The present study assessed the presence of CV risk factors and signs of CV impairment in LT children. METHODS A total of 42 LT recipients (21 men, age 9.93 ± 3.57 years) were studied. Body composition [body mass index standard deviation score, percentage of body fat (by bioimpedance analysis)], lipid profiles, glycemic control, blood pressure, and arterial stiffness [assessed by aortic pulse wave velocity (PWV)] were evaluated. The effect of different treatment modalities [tacrolimus (TAC) (n = 30) or cyclosporine (CyA) (n = 11)] was also analyzed. RESULTS Almost 18% of children were overweight or obese. Patients on TAC had a significantly higher body fat mass and percentage of body fat compared with the CyA group (P < 0.02). Borderline to high lipid values were present in 40% of patients. Children on CyA had higher serum cholesterol levels compared to TAC (P < 0.004). Nineteen percent of patients had hypertension. Half of the patients had glomerular filtration rate values <90 mL/min/1.73 m, whereas PWV values were above the 95th percentile in 12%. CONCLUSIONS Increased body fat, chronic kidney disease, high lipid content, hypertension, and increased arterial stiffness are already present and are in part related to the type of immunosuppression regimen in LT children >5 years following transplantation. Long-term follow-up is needed to evaluate their impact on CV health and survival.
Collapse
|
18
|
Güngör D, Nadaud P, LaPergola CC, Dreibelbis C, Wong YP, Terry N, Abrams SA, Beker L, Jacobovits T, Järvinen KM, Nommsen-Rivers LA, O'Brien KO, Oken E, Pérez-Escamilla R, Ziegler EE, Spahn JM. Infant milk-feeding practices and cardiovascular disease outcomes in offspring: a systematic review. Am J Clin Nutr 2019; 109:800S-816S. [PMID: 30982872 PMCID: PMC6500930 DOI: 10.1093/ajcn/nqy332] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND During the Pregnancy and Birth to 24 Months Project, the US Departments of Agriculture and Health and Human Services initiated a review of evidence on diet and health in these populations. OBJECTIVES The aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding, and 4) lower versus higher intensities of human milk fed to mixed-fed infants with intermediate and endpoint cardiovascular disease (CVD) outcomes in offspring. METHODS The Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published January 1980-March 2016, dual-screened the results using predetermined criteria, extracted data from and assessed the risk of bias for each included study, qualitatively synthesized the evidence, developed conclusion statements, and graded the strength of the evidence. RESULTS The 4 systematic reviews included 13, 24, 6, and 0 articles, respectively. The evidence was insufficient to draw conclusions about endpoint CVD outcomes across all 4 systematic reviews. Limited evidence suggests that never versus ever being fed human milk is associated with higher blood pressure within a normal range at 6-7 y of age. Moderate evidence suggests there is no association between the duration of any human milk feeding and childhood blood pressure. Limited evidence suggests there is no association between the duration of exclusive human milk feeding and blood pressure or metabolic syndrome in childhood. Additional evidence about intermediate outcomes for the 4 systematic reviews was scant or inconclusive. CONCLUSIONS There is insufficient evidence to draw conclusions about the relationships between infant milk-feeding practices and endpoint CVD outcomes; however, some evidence suggests that feeding less or no human milk is not associated with childhood hypertension.
Collapse
Affiliation(s)
- Darcy Güngör
- Panum Group, Bethesda, MD,Address correspondence to DG (e-mail: )
| | | | | | | | | | - Nancy Terry
- National Institutes of Health Library, Bethesda, MD
| | - Steve A Abrams
- Dell Medical School at the University of Texas, Austin, TX
| | - Leila Beker
- US Food and Drug Administration, contractor, College Park, MD
| | | | | | | | | | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA and Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | | | | |
Collapse
|
19
|
Haroun D, Mechli R, Sahuri R, AlKhatib S, Obeid O, El Mallah C, Wood L, AlSuwaidi K. Metabolic syndrome among adolescents in Dubai, United Arab Emirates, is attributable to the high prevalence of low HDL levels: a cross-sectional study. BMC Public Health 2018; 18:1284. [PMID: 30463538 PMCID: PMC6249919 DOI: 10.1186/s12889-018-6215-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 11/12/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) describes a combination of risk factors that increase the risk of developing chronic diseases. The prevalences of MetS and its risk factors are increasing, especially in the Arab region. A cross-sectional study was carried out to assess the prevalences of MetS and its associated risk factors among adolescents in the United Arab Emirates (UAE). METHODS A total of 596 students (308 boys and 288 girls) aged 10 to 15.9 years old were recruited from 14 public secondary schools in Dubai, UAE. Anthropometric and biochemical data were measured. RESULTS According to the International Diabetes Federation (IDF) criteria, the prevalence of MetS was 3.7%, and it was more common among boys than girls (12 boys versus 10 girls). MetS was also more likely to be found in students who were obese or overweight than those with normal weight. The most prevalent and significant MetS risk factor was low high-density lipoprotein (HDL) cholesterol levels. CONCLUSIONS This study indicates the importance of carrying out further investigations about the constituents of HDL and their atherogenic effects. Additionally, these results strongly recommend setting a consensus for HDL measurement, since small variations in methodologies may lead to substantial deviations in results.
Collapse
Affiliation(s)
- Dalia Haroun
- Department of Public Health and Nutrition, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates.
| | - Rola Mechli
- Department of Public Health and Nutrition, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | - Razan Sahuri
- Department of Public Health and Nutrition, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | - Safa AlKhatib
- Department of Public Health and Nutrition, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | - Omar Obeid
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Carla El Mallah
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Lesley Wood
- Department of Public Health and Nutrition, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | - Khulood AlSuwaidi
- School Health Center, Ministry of Health and Prevention, Dubai, United Arab Emirates
| |
Collapse
|
20
|
Liu Z, Han T, Werner H, Rosen CJ, Schaffler MB, Yakar S. Reduced Serum IGF-1 Associated With Hepatic Osteodystrophy Is a Main Determinant of Low Cortical but Not Trabecular Bone Mass. J Bone Miner Res 2018; 33:123-136. [PMID: 28902430 PMCID: PMC5771972 DOI: 10.1002/jbmr.3290] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/31/2017] [Accepted: 09/06/2017] [Indexed: 12/11/2022]
Abstract
Hepatic osteodystrophy is multifactorial in its pathogenesis. Numerous studies have shown that impairments of the hepatic growth hormone/insulin-like growth factor-1 axis (GH/IGF-1) are common in patients with non-alcoholic fatty liver disease, chronic viral hepatitis, liver cirrhosis, and chronic cholestatic liver disease. Moreover, these conditions are also associated with low bone mineral density (BMD) and greater fracture risk, particularly in cortical bone sites. Hence, we addressed whether disruptions in the GH/IGF-1 axis were causally related to the low bone mass in states of chronic liver disease using a mouse model of liver-specific GH-receptor (GHR) gene deletion (Li-GHRKO). These mice exhibit chronic hepatic steatosis, local inflammation, and reduced BMD. We then employed a crossing strategy to restore liver production of IGF-1 via hepatic IGF-1 transgene (HIT). The resultant Li-GHRKO-HIT mouse model allowed us to dissect the roles of liver-derived IGF-1 in the pathogenesis of osteodystrophy during liver disease. We found that hepatic IGF-1 restored cortical bone acquisition, microarchitecture, and mechanical properties during growth in Li-GHRKO-HIT mice, which was maintained during aging. However, trabecular bone volume was not restored in the Li-GHRKO-HIT mice. We found increased bone resorption indices in vivo as well as increased basal reactive oxygen species and increased mitochondrial stress in osteoblast cultures from Li-GHRKO and the Li-GHRKO-HIT compared with control mice. Changes in systemic markers such as inflammatory cytokines, osteoprotegerin, osteopontin, parathyroid hormone, osteocalcin, or carboxy-terminal collagen cross-links could not fully account for the diminished trabecular bone in the Li-GHRKO-HIT mice. Thus, the reduced serum IGF-1 associated with hepatic osteodystrophy is a main determinant of low cortical but not trabecular bone mass. © 2017 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Zhongbo Liu
- David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology New York University College of Dentistry New York, NY 10010-4086
| | - Tianzhen Han
- David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology New York University College of Dentistry New York, NY 10010-4086
| | - Haim Werner
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | | | | | - Shoshana Yakar
- David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology New York University College of Dentistry New York, NY 10010-4086
| |
Collapse
|
21
|
Engin A. The Definition and Prevalence of Obesity and Metabolic Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 960:1-17. [PMID: 28585193 DOI: 10.1007/978-3-319-48382-5_1] [Citation(s) in RCA: 632] [Impact Index Per Article: 90.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Increase in prevalence of obesity has become a worldwide major health problem in adults, as well as among children and adolescents. Furthermore, total adiposity and truncal subcutaneous fat accumulation during adolescence are positively and independently associated with atherosclerosis at adult ages. Centrally accumulation of body fat is associated with insulin resistance, whereas distribution of body fat in a peripheral pattern is metabolically less important. Obesity is associated with a large decrease in life expectancy. The effect of extreme obesity on mortality is greater among younger than older adults. In this respect, obesity is also associated with increased risk of several cancer types. However, up to 30% of obese patients are metabolically healthy with insulin sensitivity similar to healthy normal weight individuals, lower visceral fat content, and lower intima media thickness of the carotid artery than the majority of metabolically "unhealthy" obese patients.Abdominal obesity is the most frequently observed component of metabolic syndrome. The metabolic syndrome; clustering of abdominal obesity, dyslipidemia, hyperglycemia and hypertension, is a major public health challenge. The average prevalence of metabolic syndrome is 31%, and is associated with a two-fold increase in the risk of coronary heart disease, cerebrovascular disease, and a 1.5-fold increase in the risk of all-cause mortality.
Collapse
Affiliation(s)
- Atilla Engin
- Faculty of Medicine, Department of General Surgery, Gazi University, Besevler, Ankara, Turkey. .,, Mustafa Kemal Mah. 2137. Sok. 8/14, 06520, Cankaya, Ankara, Turkey.
| |
Collapse
|
22
|
Gul A, Ateş Ö, Özer S, Kasap T, Ensari E, Demir O, Sönmezgöz E. Role of the Polymorphisms of Uncoupling Protein Genes in Childhood Obesity and Their Association with Obesity-Related Disturbances. Genet Test Mol Biomarkers 2017; 21:531-538. [PMID: 28704105 DOI: 10.1089/gtmb.2017.0068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Obesity, one of the most common disorders observed in clinical practice, has been associated with energy metabolism-related protein genes such as uncoupling proteins (UCPs). Herein, we evaluated UCPs as candidate genes for obesity and its morbidities. METHODS A total of 268 obese and 185 nonobese children and adolescents were enrolled in this study. To determine dyslipidemia, hypertension, and insulin resistance, laboratory tests were derived from fasting blood samples. UCP1-3826 A/G, UCP2 exon 8 deletion/insertion (del/ins), and UCP3-55C/T variants were also genotyped, and the relationships among the polymorphisms of these UCPs and obesity morbidities were investigated. RESULTS The mean ages of the obese and control groups were 11.61 ± 2.83 and 10.74 ± 3.36 years, respectively. The respective genotypic frequencies of the AA, AG, and GG genotypes of UCP1 were 46.3%, 33.2%, and 20.5% in obese subjects and 46.5%, 42.2%, and 11.4% in the controls (p = 0.020). G alleles were more frequent in obese subjects with hypertriglyceridemia (42.9%; p = 0.048) than in those without, and the GG genotype presented an odds ratio for obesity of 2.02 (1.17-3.47; p = 0.010). The polymorphisms of UCP2 exon 8 del/ins and UCP3-55C/T did not influence obesity risk (p > 0.05). The I (ins) allele was associated with low HDL cholesterolemia (p = 0.023). CONCLUSION The GG genotype of the UCP1-3826 A/G polymorphism appears to contribute to the onset of childhood obesity in Turkish children. The GG genotype of UCP1, together with the del/del genotype of the UCP2 polymorphism, may increase the risk of obesity with synergistic effects. The ins allele of the UCP2 exon 8 del/ins polymorphism may contribute to low HDL cholesterolemia.
Collapse
Affiliation(s)
- Ali Gul
- 1 Department of Pediatrics, Gaziosmanpasa University School of Medicine , Tokat, Turkey
| | - Ömer Ateş
- 2 Department of Medical Biology and Genetics, Gaziosmanpasa University School of Medicine , Tokat, Turkey
| | - Samet Özer
- 1 Department of Pediatrics, Gaziosmanpasa University School of Medicine , Tokat, Turkey
| | - Tuba Kasap
- 1 Department of Pediatrics, Gaziosmanpasa University School of Medicine , Tokat, Turkey
| | - Emel Ensari
- 2 Department of Medical Biology and Genetics, Gaziosmanpasa University School of Medicine , Tokat, Turkey
| | - Osman Demir
- 3 Department of Biostatistics, Gaziosmanpasa University School of Medicine , Tokat, Turkey
| | - Ergün Sönmezgöz
- 1 Department of Pediatrics, Gaziosmanpasa University School of Medicine , Tokat, Turkey
| |
Collapse
|
23
|
Vanlancker T, Schaubroeck E, Vyncke K, Cadenas-Sanchez C, Breidenassel C, González-Gross M, Gottrand F, Moreno LA, Beghin L, Molnár D, Manios Y, Gunter MJ, Widhalm K, Leclercq C, Dallongeville J, Ascensión M, Kafatos A, Castillo MJ, De Henauw S, Ortega FB, Huybrechts I. Comparison of definitions for the metabolic syndrome in adolescents. The HELENA study. Eur J Pediatr 2017; 176:241-252. [PMID: 28058532 DOI: 10.1007/s00431-016-2831-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 02/06/2023]
Abstract
Various definitions are used to define metabolic syndrome in adolescents. This study aimed to compare, in terms of prevalence and differences, five frequently used definitions for this population: International Diabetes Federation, National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP) modified by Cook, pediatric American Heart Association (AHA), World Health Organization, and Jolliffe and Janssen. A sample of 1004 adolescents (12.5-17.0 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study was considered. The components of the definitions (waist circumference/BMI, plasma lipids, glycemia, and blood pressure) were applied, and definitions were compared by using crosstabs, sensitivity, specificity, and kappa coefficient. The prevalence of metabolic syndrome varied from 1.6 to 3.8% depending on the used definitions. Crosstabs comparing the definitions showed the fewest cases being misclassified (having metabolic syndrome or not) between NCEP-ATP and AHA. Analyses for kappa coefficient, sensitivity, and specificity confirmed this finding. CONCLUSION The different definitions do not classify the same adolescents as having MS and prevalence varied between diagnostic methods. The modified NCEP-ATP and the AHA definitions were most analogous in defining subjects as having metabolic syndrome or not. What is known? • Metabolic syndrome is not only a problem of adulthood but is already present in children and adolescents. • Several diagnostic methods are used to define metabolic syndrome in adolescents. What is new? • Comparing the most frequently used definitions of metabolic syndrome in adolescents showed that they do not indicate the same adolescents as having metabolic syndrome. • The modified National Cholesterol Education Program Adult Treatment Panel III and the pediatric American Heart Association definitions were most analogous in defining subjects as having metabolic syndrome or not.
Collapse
Affiliation(s)
- Tine Vanlancker
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Emmily Schaubroeck
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Krishna Vyncke
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Cristina Cadenas-Sanchez
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Christina Breidenassel
- Institut für Ernährungs und Lebensmittelwissenschaften Ernährungphysiologie, Rheinische Friedrich Wilhelms, Universität Bonn, Bonn, Germany
- ImFINE Research Group, Faculty of Physical Activity and Sport-INEF, Department of Health and Human Performance, Technical University of Madrid, Madrid, Spain
| | - Marcela González-Gross
- ImFINE Research Group, Faculty of Physical Activity and Sport-INEF, Department of Health and Human Performance, Technical University of Madrid, Madrid, Spain
- CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Frederic Gottrand
- Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, Université Lille, 59000, Lille, France
- Inserm, CHU Lille, CIC 1403-Centre d'investigation clinique, Université Lille, 59000, Lille, France
| | - Luis A Moreno
- GENUD-Growth, Exercise, Nutrition and Development, University of Zaragoza, Zaragoza, Spain
- School of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Laurent Beghin
- Inserm, CHU Lille, U995-LIRIC-Lille Inflammation Research International Center, Université Lille, 59000, Lille, France
- Inserm, CHU Lille, CIC 1403-Centre d'investigation clinique, Université Lille, 59000, Lille, France
| | - Denes Molnár
- Medical Faculty, Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Marc J Gunter
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Kurt Widhalm
- Department of Paediatrics, Private Medical University Salzburg, Salzburg, Austria
| | | | - Jean Dallongeville
- Department of Epidemiology and Public Health, U-744 INSERM, Institut Pasteur de Lille, Universite Lille Nord de France, Lille, France
| | - Marcos Ascensión
- Food Science and Technology and Nutrition Institute, Spanish National Research Council, Metabolism and Nutrition, Immunonutrition Research Group, Madrid, Spain
| | - Anthony Kafatos
- School of Medicine, Preventive Medicine and Nutrition Unit, Heraklion, University of Crete, Crete, Greece
| | - Manuel J Castillo
- Department of Medical Physiology, School of Medicine, Granada University, Granada, Spain
| | | | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Inge Huybrechts
- Department of Public Health, Ghent University, Ghent, Belgium.
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France.
| |
Collapse
|
24
|
Comparison of the Clinical and Biochemical Profile of Metabolic Syndrome Between Obese Children Below and Above 10-Years Old Attending Paediatric Clinic Hospital Universiti Sains Malaysia from 2006 to 2015. J ASEAN Fed Endocr Soc 2017; 32:132-138. [PMID: 33442096 PMCID: PMC7784198 DOI: 10.15605/jafes.032.02.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/21/2017] [Indexed: 01/19/2023] Open
Abstract
Objectives We aim to compare the clinical and biochemical profile of metabolic syndrome between obese children below and above 10 years attending Paediatric clinic Hospital Universiti Sains Malaysia (HUSM) from 2006 to 2015. This is to determine if age, particularly the transition to puberty, modifies the prevalence of components of metabolic syndrome in obese children. Methodology The medical records of 84 obese children under 18 years of age seen at Paediatric clinic HUSM from 2006 to 2015 were reviewed. Demographic (age, gender, ethnicity), anthropometric (weight and height), clinical [body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP)] and biochemical [serum total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), fasting plasma glucose (FPG)] parameters were recorded, analyzed and compared. Results Majority of subjects in both age groups were boys, with 68.2% <10 years old. Mean age was 9.69 years (±3.36). The clinical and biochemical parameters of metabolic syndrome were similar between those <10 years old and >10 years, with the exception of BMI, waist circumference, SBP and TG level. Multivariate regression analysis showed that the parameters of metabolic syndrome significantly associated with age ≥10 years were systolic hypertension (adjusted OR 7.17, 95% CI, 1.48 to 34.8) and BMI >30 kg/m2 (adjusted OR 3.02, 95% CI, 1.16 to 7.86). Conclusion There were similar clinical and biochemical parameters of metabolic syndrome in both age groups. The proportions of children with metabolic syndrome were similar regardless of age group. The overall prevalence rate of metabolic syndrome was 27.3%. In view of the alarming presence of components of metabolic syndrome even in children less than 10 years of age, efforts aimed at the prevention of childhood obesity in the community should be intensified.
Collapse
|
25
|
Abstract
UNLABELLED Aim The purpose of our study was to evaluate the association between insulin resistance and left ventricular size and function in obese children. Material and methods A total of 79 cases aged 10-16 years and diagnosed with obesity and 79 healthy and non-obese cases as controls were included in the study. Patient and control groups were divided into three groups in terms of age as group 1 (10-12 years), group 2 (12-14 years), and group 3 (14-16 years). Fasting blood glucose, lipid profile, and fasting insulin levels of the cases were assessed. Mitral valve E and A waves, left ventricular ejection fraction, fractional shortening, end-diastolic and end-systolic diameters, left atrium diameter, and septal wall thickness were measured using echocardiography. RESULTS Measurements of septal diastolic thicknesses, left atrium diameter, and left ventricular end-systolic diameter of all the three groups obtained by echocardiography were statistically higher compared with the controls. In all the patient groups, the mitral valve E/A ratio was >1. In groups 2 and 3, there was a positive correlation between fasting insulin levels and HOMA-IR and left ventricular end-systolic diameter, end-diastolic diameter, and septal systolic and diastolic wall thicknesses. CONCLUSION In paediatric obesity, identification of early cardiac changes will be significant in allowing early diagnosis and treatment of cardiovascular diseases.
Collapse
|
26
|
|
27
|
Matsushita R, Isojima T, Takaya R, Satake E, Yamaguchi R, Kitsuda K, Nagata E, Sano S, Nakanishi T, Nakagawa Y, Ohzeki T, Ogata T, Fujisawa Y. Development of waist circumference percentiles for Japanese children and an examination of their screening utility for childhood metabolic syndrome: a population-based cross-sectional study. BMC Public Health 2015; 15:1121. [PMID: 26566772 PMCID: PMC4644326 DOI: 10.1186/s12889-015-2447-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 10/23/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In Japan, waist circumference (WC) percentiles to screen for childhood metabolic syndrome (MetS) are unavailable. The objectives of this study were to develop WC and WC-to-height ratio (WC/Ht) percentile curves by age and sex for Japanese children, and to test their utility in screening for MetS in children with obesity who are otherwise healthy. METHODS The WC and WC/Ht percentiles were developed using the LMS method of summarizing growth standards, which monitors changing skewness (L), medians (M), and coefficients of variation (S) in childhood distributions. A representative dataset was used, which consisted of 3,634 boys and 3,536 girls aged 4.5-12.75 years in Shizuoka prefecture, Japan, between 2010 and 2012. Children who were obese (355 boys and 230 girls) aged 6-12 years from Osaka prefecture, Japan, were screened for childhood MetS using the new percentiles and the International Diabetes Federation's (IDF's) definition of MetS. RESULTS The number of participants with certain metabolic abnormalities (high systolic and diastolic blood pressure, and a high level of triglycerides) was significantly higher in boys aged 10-12 years, with a WC ≥ 90th percentile, than among those with a WC < 90th percentile. None of the participants with a WC < 90th percentile exhibited two or more metabolic abnormalities, regardless of their age or sex. Among the participants aged 10-12 years, 11.4 % of boys and 4.4 % of girls with a WC ≥ 90th percentile were diagnosed with MetS. CONCLUSIONS The new percentiles may have a certain level of potential to screen Japanese children for childhood MetS in accordance with the IDF definition.
Collapse
Affiliation(s)
- Rie Matsushita
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Tsuyoshi Isojima
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Ryuzo Takaya
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan.
| | - Eiichiro Satake
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Rie Yamaguchi
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Kazuteru Kitsuda
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Eiko Nagata
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Shinichiro Sano
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Toshiki Nakanishi
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Yuichi Nakagawa
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Takehiko Ohzeki
- Department of Nursing, Kyoritsu Women's University and Junior College, 3-27 Kanda Jimbocho, Chiyoda-ku, Tokyo, 101-0051, Japan.
| | - Tsutomu Ogata
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Yasuko Fujisawa
- Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| |
Collapse
|
28
|
Zheng R, Yang M, Bao Y, Li H, Shan Z, Zhang B, Liu J, Lv Q, Wu O, Zhu Y, Lai M. Prevalence and Determinants of Metabolic Health in Subjects with Obesity in Chinese Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:13662-77. [PMID: 26516886 PMCID: PMC4661606 DOI: 10.3390/ijerph121113662] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/14/2015] [Accepted: 10/14/2015] [Indexed: 02/05/2023]
Abstract
Background: The study was to investigate the prevalence of metabolic health in subjects with obesity in the Chinese population and to identify the determinants related to metabolic abnormality in obese individuals. Methods: 5013 subjects were recruited from seven provincial capitals in China. The obesity and metabolic status were classified based on body mass index (BMI) and the number of abnormalities in common components of metabolic syndrome. Results: 27.9% of individuals with obesity were metabolically healthy. The prevalence of the metabolically healthy obese (MHO) phenotype was significantly decreased with age in women (ptrend < 0.001), but not significantly in men (ptrend = 0.349). Central obesity (odds ratio [OR] = 4.07, 95% confidence interval [CI] = 1.93–8.59), longer sedentary time (OR = 1.97, 95%CI = 1.27–3.06), and with a family history of obesity related diseases (hypertension, diabetes, dyslipidemia) (OR = 1.85, 95%CI = 1.26–2.71) were significantly associated with having metabolic abnormality in obese individuals. Higher levels of physical activity and more fruit/vegetable intake had decreased ORs of 0.67 (95%CI = 0.45–0.98) and 0.44 (95%CI = 0.28–0.70), respectively. Conclusion: 27.9% of obese participants are in metabolic health. Central obesity, physical activity, sedentary time, fruits/vegetables intake and family history of diseases are the determinants associated with metabolic status in obesity.
Collapse
Affiliation(s)
- Ruizhi Zheng
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou 310058, China.
| | - Min Yang
- Department of Nutrition, School of Public Health, Zhejiang University, Hangzhou 310058, China.
| | - Yuqian Bao
- Shanghai Diabetes Institute, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
| | - Hong Li
- Department of Endocrinology, Sir Run Run Shaw Hospital, Affiliated to School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang, China.
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, China Medical University, Beier Road No. 92, Shenyang 110001, China.
| | - Bo Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Juan Liu
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
| | - Qinguo Lv
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Ou Wu
- Department of Chronic and Noncommunicable Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China.
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou 310058, China.
| | - Maode Lai
- Department of Pathology, Zhejiang University School of Medicine, Hangzhou 310058, China.
| |
Collapse
|
29
|
Morandi A, Maffeis C. Predictors of metabolic risk in childhood obesity. Horm Res Paediatr 2015; 82:3-11. [PMID: 24923289 DOI: 10.1159/000362237] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 03/14/2014] [Indexed: 11/19/2022] Open
Abstract
Most of the complications of juvenile obesity are due to metabolic disturbances induced by an excessive accumulation of fat which leads to chronic diseases like type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Finding effective ways of identifying obese paediatric patients who are at increased risk of developing cardiovascular and metabolic complications has been recognised to be a promising strategy to improve prevention of complications of early obesity. Moreover, correctly identifying obese children who are already affected by metabolic co-morbidities should be a clinical priority. According to the state of the art summarised in this review, traditional metabolic variables included in the definitions of metabolic syndrome (MS), pre-diabetes, non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steato-hepatitis and, in obese girls, the presence of polycystic ovary syndrome are the best available longitudinal predictors of CVD and T2DM among obese children and adolescents. In clinical practice, traditional metabolic variables included in the definitions of MS should be assessed in all obese children and adolescents; fasting metabolic variables have been proposed to identify obese patients likely to be affected by impaired glucose tolerance or T2DM, and ultrasound has proved to be a valid surrogate for biopsy in the diagnosis of NAFLD. Further large longitudinal and cross-sectional studies are needed to improve our chances of identifying obese youth at the highest metabolic risk.
Collapse
Affiliation(s)
- Anita Morandi
- Regional Centre for Pediatric Diabetes, Clinical Nutrition and Obesity, ULSS 20, and University of Verona, Verona, Italy
| | | |
Collapse
|
30
|
Prevalencia de síndrome metabólico en niños con obesidad y sin ella. Med Clin (Barc) 2015; 144:198-203. [DOI: 10.1016/j.medcli.2013.10.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/18/2013] [Accepted: 10/24/2013] [Indexed: 11/22/2022]
|
31
|
Barseem NF, Helwa MA. Homeostatic model assessment of insulin resistance as a predictor of metabolic syndrome: Consequences of obesity in children and adolescents. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2015. [DOI: 10.1016/j.epag.2014.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
32
|
Fadzlina AA, Harun F, Nurul Haniza MY, Al Sadat N, Murray L, Cantwell MM, Su TT, Majid HA, Jalaludin MY. Metabolic syndrome among 13 year old adolescents: prevalence and risk factors. BMC Public Health 2014; 14 Suppl 3:S7. [PMID: 25437226 PMCID: PMC4251137 DOI: 10.1186/1471-2458-14-s3-s7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Obesity and metabolic syndrome is prevalent among Malaysian adolescents and has been associated with certain behavioural factors such as duration of sleep, screen time and physical activity. The aim of the study is to report the prevalence of overweight/obesity, metabolic syndrome and its risk factors among adolescents. Methods A multi-staged cluster sampling method was used to select participants from urban and rural schools in Selangor, Perak and Wilayah Persekutuan Kuala Lumpur. Participants underwent anthropometric measurement and physical examination including blood pressure measurement. Blood samples were taken for fasting glucose and lipids and participants answered a self-administered questionnaire. Overweight and obesity was defined using the extrapolated adult body mass index (BMI) cut-offs of >25 kg/m2 and >30 kg/m2, according to the International Obesity Task Force (IOTF) criteria. Metabolic syndrome was defined based on International Diabetes Federation (IDF) 2007 criteria. Results Data were collected from 1361 participants. After excluding incomplete data and missing values for the variables, we analysed a sample of 1014 participants. Prevalence of overweight and obesity in this population was 25.4% (N = 258). The prevalence of metabolic syndrome was 2.6% in the population and 10% among the overweight and obese adolescents. Participants who slept between 7 and 9 hours a day has a lower risk of developing metabolic syndrome OR 0.38(0.15-0.94). Conclusion Our results provide the prevalence of metabolic syndrome in Malaysian adolescents. Adequate sleep between 7 and 9 hours per day reduces the risk of developing metabolic syndrome.
Collapse
|
33
|
Cruz IRD, Mourão DM, Freitas DA, Souza AGS, Pereira AR, Aidar FJ, Carneiro ALG. Nutritional Status Associated with Metabolic Syndrome in Middle-School Children in the City of Montes Claros - MG, Brazil. J Hum Kinet 2014; 43:97-104. [PMID: 25713649 PMCID: PMC4332189 DOI: 10.2478/hukin-2014-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to investigate the association between nutritional status and prevalence of metabolic syndrome (MS) in middle-school students in the city of Montes Claros - MG. The sample consisted of 382 students, aged 10-16 years. Nutritional status was evaluated using the Body Mass Index (BMI). Metabolic syndrome (MS) was defined as the presence of two or more criteria in accordance with definition of the International Diabetes Federation. The overall prevalence of MS was 7.9%. 9.7% of students with MS were overweight and 72.4% were obese. Therefore, it can be inferred that carrying excess weight considerably increases the chances for a child to develop MS, and concomitantly increases the child's risk for developing cardiovascular disease.
Collapse
Affiliation(s)
- Igor Raineh Durães Cruz
- Integrated Colleges of Northern Minas Gerais – Funorte, Brazil
- University of Tras-os-Montes and Alto Douro, Vila Real, Portugal
| | - Daniella Mota Mourão
- Integrated Colleges of Northern Minas Gerais – Funorte, Brazil
- University of Tras-os-Montes and Alto Douro, Vila Real, Portugal
| | | | - Andrey George Silva Souza
- Integrated Colleges of Northern Minas Gerais – Funorte, Brazil
- University of Tras-os-Montes and Alto Douro, Vila Real, Portugal
| | - Alessandra Ribeiro Pereira
- Integrated Colleges of Northern Minas Gerais – Funorte, Brazil
- University of Tras-os-Montes and Alto Douro, Vila Real, Portugal
| | - Felipe José Aidar
- University of Tras-os-Montes and Alto Douro, Vila Real, Portugal
- University President Antônio Carlos - UNIPAC, Uberlândia, MG, Brazil
- Fire Department of the State of Minas Gerais, 5th Battalion Fire Department, Uberlândia, MG, Brazil
- University Center Triangle - UNITRI, Uberlândia, MG, Brazil
| | - André Luiz Gomes Carneiro
- University of Tras-os-Montes and Alto Douro, Vila Real, Portugal
- University President Antônio Carlos - UNIPAC, Uberlândia, MG, Brazil
| |
Collapse
|
34
|
Inanc BB. Metabolic syndrome in school children in mardin, South-eastern of Turkey. Eurasian J Med 2014; 46:156-63. [PMID: 25610318 DOI: 10.5152/eajm.2014.39] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 11/04/2013] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine the prevalence of the metabolic syndrome (MES) in a school children population. MATERIALS AND METHODS Three thousand four hundred and sixty children aged between 7 and 15 in three elementary schools in the city of Mardin, located in the south-eastern region of Turkey, were included in this study in April and May 2011. Age, gender, height, weight, waist circumference (WC), hip circumference, waist/hip ratio, systolic and diastolic blood pressure were measured and a variety of blood tests were done. The International Diabetes Federation (IDF) criteria were used for the diagnosis of MES. RESULTS It was found that 9.42% of those tested were overweight, and 8.0% were obese. The study found that more girls (9.1%) were obese than girls (6.9%). The prevalence of obesity was significantly higher among girls than boys (p<0.001). A positive correlation was found between body mass index (BMI) and the other parameters, namely waist and hip circumference, waist/hip ratio, systolic and diastolic blood pressure (BP), triglyceride (TG) (p=0.0001). It was found that total cholesterol (T-Chol), TG, BMI, systolic and diastolic BP were significantly different among obese MES's group and non-obese children (p<0.05). The waist/hip ratio reference value in girls was significantly higher than boys (p>0.05). The prevalence of MES was 6.3%. The number of components of MES was higher in girls and obese children. The rate of MES was 30.3% in obese children. CONCLUSION The frequency of obesity, hypertension and MES in childhood period have been steadily increasing. Children who are classified having central obesity and high body mass index should be more carefully evaluated to its potential to progress to MES. And the quality of the life should be improved by reducing the risks resulted from life style changes, necessary treatments and follow ups.
Collapse
|
35
|
Sewaybricker LE, Antonio MÂRGM, Mendes RT, Barros Filho ADA, Zambon MP. Metabolic syndrome in obese adolescents: what is enough? Rev Assoc Med Bras (1992) 2013; 59:64-71. [PMID: 23440144 DOI: 10.1590/s0104-42302013000100013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/14/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To study the agreement among three distinct criteria for metabolic syndrome (MS) adapted to adolescents, and to identify associated factors for MS. METHODS Cross-sectional study with 65 obese subjects aged 10 to 18 years, attended to at the Outpatient Clinic for Obese Children and Adolescents at the Clinical Hospital of the Universidade Estadual de Campinas (Unicamp). MS was defined using the criteria of the World Health Organization (WHO), the International Diabetes Federation (IDF), and the Adult Treatment Panel III (ATP III). Clinical, anthropometrical, and laboratorial data were associated to MS. RESULTS From the 65 subjects, none had MS according to the WHO criteria, while 18 were diagnosed with MS (27.6%) according to the IDF, and 19 (29.2%) according to the ATP III. Agreement between IDF and ATP III was excellent (kappa 81%). In this study, puberty and triglycerides levels showed significant statistical difference when comparing subjects with and without MS, the first for ATP III (p = 0.03), and the second for IDF (p = 0.005) and ATP III (p = 0.001) criteria. CONCLUSION The WHO criteria does not seem to be adequate for adolescents. IDF and ATP III criteria had an excellent agreement. Puberty and triglycerides were associated with MS.
Collapse
Affiliation(s)
- Leticia Esposito Sewaybricker
- Postgraduate Course in Child and Adolescent Health, Medical School, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | | | | | | |
Collapse
|
36
|
Abstract
There have been dramatic increases over the past several decades in the prevalence of childhood obesity and childhood metabolic syndrome in the United States and other industrialized nations. Since the 2 conditions carry negative health implications, both during childhood and later in life, it is important for health care professionals to stay abreast of the current literature relative to both conditions. This review will examine definitional issues, prevalence rates, causative factors, and health consequences associated with childhood obesity and the metabolic syndrome, as well as current thinking regarding prevention and treatment efforts. The review will conclude with recommendations relative to future research needs.
Collapse
Affiliation(s)
- Scott Owens
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, University, Mississippi
| |
Collapse
|
37
|
Hristova MG. Metabolic syndrome--from the neurotrophic hypothesis to a theory. Med Hypotheses 2013; 81:627-34. [PMID: 23899630 DOI: 10.1016/j.mehy.2013.07.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 07/08/2013] [Indexed: 02/06/2023]
Abstract
Metabolic syndrome (MetS) is a complex and heterogeneous disease characterized by central obesity, impaired glucose metabolism, dyslipidemia, arterial hypertension, insulin resistance and high-sensitivity C-reactive protein. In 2006, a neurotrophic hypothesis of the etiopathogenesis of MetS was launched. This hypothesis considered the neurotrophins a key factor in MetS development. Chronic inflammatory and/or psychoemotional distress provoke a series of neuroimmunoendocrine interactions such as increased tissue and plasma levels of proinflammatory cytokines and neurotrophins, vegetodystonia, disbalance of neurotransmitters, hormones and immunity markers, activation of the hypothalamo-pituitary-adrenal axis, insulin resistance, and atherosclerosis. An early and a late clinical stage in the course of MetS are defined. Meanwhile, evidence of supporting results from the world literature accumulates. This enables the transformation of the definition of the neurotrophic hypothesis into a neurotrophic theory of MetS. The important role of two neurotrophic factors, i.e. the nerve growth factor and brain-derived neurotrophic factor as well as of the proinflammatory cytokines, neurotransmitters, adipokines and, especially, of leptin for the development of MetS, obesity and type 2 diabetes mellitus is illustrated. There are reliable scientific arguments that the metabotrophic deficit due to reduced neurotrophins could be implicated in the pathogenesis of MetS, type 2 diabetes mellitus, and atherosclerosis as well. A special attention is paid to the activity of the hypothalamo-pituitary-adrenal axis after stress. The application of the neurotrophic theory of MetS could contribute to the etiological diagnosis and individualized management of MetS by eliminating the chronic distress, hyponeurotrophinemia and consequent pathology. It helps estimating the risk, defining the prognosis and implementing the effective prevention of this socially significant disease as evidenced by the dramatic recent growth of the world publication output on this interdisciplinary topic.
Collapse
Affiliation(s)
- M G Hristova
- Division of Endocrinology, Medical Centre of Varna, Varna, Bulgaria.
| |
Collapse
|
38
|
Wang Q, Yin J, Xu L, Cheng H, Zhao X, Xiang H, Lam HS, Mi J, Li M. Prevalence of metabolic syndrome in a cohort of Chinese schoolchildren: comparison of two definitions and assessment of adipokines as components by factor analysis. BMC Public Health 2013; 13:249. [PMID: 23514611 PMCID: PMC3608951 DOI: 10.1186/1471-2458-13-249] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 03/13/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although attention to metabolic syndrome (MetS) in children has increased, there is still no universally accepted definition and its pathogenesis remains unclear. Our aim was to compare the current definitions of childhood MetS in a Chinese cohort and to examine the clustering pattern of MetS risk factors, particularly inclusion of leptin and adiponectin as additional components. METHODS 3373 schoolchildren aged 6 to 18 years were recruited. Anthropometric and biochemical parameters and adipokines were measured. MetS was identified using both the International Diabetes Federation (IDF) and a modified Adult Treatment Panel III (ATP III) definitions. Exploratory factor analysis was performed to establish grouping of metabolic characteristics. RESULTS For children ≥ 10 years, the prevalence of MetS was 14.3% in the obese group and 3.7% in the overweight group according to the new IDF definition, and 32.3% in the obese group and 8.4% in the overweight group according to the modified ATPIII definition. Frequency of hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), impaired fasting glucose, elevated blood pressure, and central obesity according to the new IDF definition was 16.7%, 20.7%, 15.8%, 25.5% and 75.5% in obese boys and 14.7%, 24.0%, 12.0%, 11.0% and 89.0% in obese girls, respectively. Metabolic abnormalities in children under 10 years of age were also noted. Using factor analysis on eight conventional variables led to the extraction of 3 factors. Waist circumference (WC) provided a connection between two factors in boys and all three factors in girls, suggesting its central role in the clustering of metabolic risk factors. Addition of leptin and adiponectin also led to the extraction of 3 factors, with leptin providing a connection between two factors in girls. When using WC, mean arterial pressure, triglyceride/HDL-C ratio, HOMA-IR and leptin/adiponectin ratio as variables, a single-factor model was extracted. WC had the biggest factor loading, followed by leptin/adiponectin ratio. CONCLUSIONS MetS was highly prevalent amongst obese children and adolescents in this cohort, regardless of the definition used. Central obesity is the key player in the clustering of metabolic risk factors in children, supporting the new IDF definition. Moreover, our findings suggest that a common factor may underlie MetS. Leptin/adiponectin ratio as a possible component of MetS deserves further consideration.
Collapse
Affiliation(s)
- Qiaoxuan Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing 100730, China
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
The absence of insulin resistance in metabolic syndrome definition leads to underdiagnosing of metabolic risk in obese patients. Eur J Pediatr 2012; 171:1331-7. [PMID: 22450765 DOI: 10.1007/s00431-012-1724-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 03/15/2012] [Indexed: 02/06/2023]
Abstract
This study explores in a group of obese children and adolescents aged 10 to 16 years, the prevalence of metabolic syndrome (MS) according to the criteria of International Diabetes Federation (IDF). In addition, the prevalence of insulin resistance (IR) was investigated to find correlations between MS and IR. IDF definition was compared to a modified WHO definition. A total of 159 obese patients (74 male and 85 female; median age 12.7 years) were included in the study. Anthropometric measurements, blood pressure, and serum fasting lipids were evaluated. An oral glucose tolerance test (OGTT) was performed, and serum glucose and insulin levels were measured at 0, 30, 60, 90, and 120 min. Homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), fasting glucose/insulin ratio (FGIR), Matsuda index, and total insulin levels during OGTT were calculated. For the IR diagnosis, we used cutoff values described in previous publications (HOMA-IR of >3.16, QUICKI of <0.357, FGIR of <7, and/or the sum of insulin levels during OGTT of >300 mIU/mL). MS prevalence, defined according to IDF criteria, was 34.6 %. Using the IDF definition, there was no statistically significant difference for the surrogate IR indices between patients with or without MS (QUICKI, 94.5 vs. 83.7 %), FGIR (81.1 vs. 78.8 %), HOMA-IR (70.9 vs. 63.5 %), and total insulin levels during OGTT (61.8 vs. 51.9 %). The Matsuda index values, the prevalence of fasting hyperinsulinemia, and impaired glucose tolerance were also similar in these two groups. In conclusion, IR was prominent in obese patients with and without MS. IDF definition of MS fails to discover individuals with IR, unless it is specifically investigated.
Collapse
|
40
|
Fürst-Recktenwald S, Dörr HG, Quinkler M, Dötsch J, Stewart PM. Is there sufficient evidence to consider the use of 11β-hydroxysteroid dehydrogenase type 1 inhibition in children? Clin Endocrinol (Oxf) 2012; 77:159-68. [PMID: 22486586 DOI: 10.1111/j.1365-2265.2012.04406.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Manifestations of the metabolic syndrome [obesity, dyslipidaemia, hypertension, blood glucose derangements including prediabetes or type 2 diabetes mellitus (T2DM)] in juvenile populations are becoming increasingly prevalent throughout the world and are at the point of being a global public health concern. Derangements in cortisol regeneration seem to be involved in the pathophysiology. Treatment with selective 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) inhibitors could be a therapeutic strategy in paediatric patients with manifestations of the metabolic syndrome. Based on preclinical and clinical data regarding development of the 11β-HSD1 enzyme, it appears that maturation occurs within the first year of life. Different changes in biomarkers for assessing the efficacy and safety of 11β-HSD1 inhibitors are to be expected in paediatric patients compared to adults, reflecting differences in metabolism. The effect of 11β-HSD1 treatment in children on bone differentiation and development as well as adrenocorticotropic hormone (ACTH), circulating and local cortisol tissue concentrations, androgens and respective stress response is not yet known. Based on current literature, the concept of inhibition of 11β-HSD1 is considered a potentially effective mean to regulate local cortisol levels in the paediatric population, and 11β-HSD1 inhibitors may provide a valuable target and treatment option for the metabolic syndrome in paediatric patients. However, the uncertainty over effects on the developing skeleton combined with mild increases in adrenal androgen levels raises potential concerns regarding growth as well as onset of puberty as to their future use in children. Future clinical studies are needed to thoroughly assess the risks and benefits of this new class of drugs in the paediatric population.
Collapse
|
41
|
Enes Romero P, Cano Gutiérrez B, Alvarez Gil N, Martín-Frías M, Alonso Blanco M, Barrio Castellanos R. [Ethnic influence on the prevalence of metabolic syndrome in an obese pediatric population]. An Pediatr (Barc) 2012; 78:75-80. [PMID: 22749673 DOI: 10.1016/j.anpedi.2012.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 03/27/2012] [Accepted: 04/16/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Obesity in children is becoming more prevalent. Obesity and type 2 diabetes is higher in the Latin American immigrant population. OBJECTIVE To analyze the influence of ethnicity on the prevalence of metabolic syndrome (MS) and its components in an obese pediatric population. PATIENTS AND METHODS A retrospective study of 616 obese children and adolescents (BMI ≥2 SD [Hernández 88-04]), was conducted on 142 Latin American children and 474 Caucasians, which compared the prevalence of metabolic syndrome and its components according to modified Cook criteria (2003): obesity+2 or more of the following components: HDL-cholesterol <40mg/dl, triglycerides >110mg/dl, systolic and/or diastolic blood pressure >p90 (Task Force 2004), and impaired glucose metabolism (ADA 2011). Hepatic function, family history of MS, HbA1c, insulin resistance (HOMA) and BMI evolution at one year of treatment with changes in lifestyle (diet and exercise) were also assessed. RESULTS Almost one-third (30.5%) of Latin American children had MS compared to 15.5% of Caucasians (OR=2.4 [CI 95%: 1.5-3.8]), P<.005] and OR=2.5 adjusting for sex, SD-BMI and puberty. Latin American children also had a higher insulin resistance (58.6% vs 42.8%, P<.005) and a worse outcome after one year of treatment. CONCLUSION There is a higher prevalence of MS in our Latin American obese pediatric population with poor adherence to the measures of change in lifestyle, making these patients a group with potentially increased risks of cardiovascular disease in adulthood.
Collapse
Affiliation(s)
- P Enes Romero
- Unidad de Diabetes y Endocrinología Pediátrica, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
42
|
Cai H, Huang J, Xu G, Yang Z, Liu M, Mi Y, Liu W, Wang H, Qian D. Prevalence and determinants of metabolic syndrome among women in Chinese rural areas. PLoS One 2012; 7:e36936. [PMID: 22590636 PMCID: PMC3349636 DOI: 10.1371/journal.pone.0036936] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 04/13/2012] [Indexed: 12/22/2022] Open
Abstract
Background and Aims Metabolic syndrome (MS) is prevalent in recent years but few data is reported in the rural areas in China. The aim of this study was to examine MS prevalence and its risk factors among women in rural China. Methods and Results The Nantong Metabolic Syndrome Study (NMSS), a population based cross-sectional study, was conducted during 2007–2008 in Nantong, China. In person interviews, blood glucose and lipid measurements were completed for 13,505 female participants aged 18–74 years. The International Diabetes Federation (IDF), the US Third Report of the National Cholesterol Education Program, the Adult Treatment Panel (ATPIII) and modified ATPIII for Asian population has determined three criteria of MS. These criteria for MS were used and compared in this study. The prevalence of MS was 22.0%, 16.9% and 23.3% according to IDF, ATPIII and ATPIII-modified criteria, respectively. Levels of agreement of these criteria for MS were above 0.75. We found that vigorous-intensity of occupational physical activity was associated with a low prevalence of MS with OR of 0.76 (95% confidence interval (CI): 0.63–0.91). Rice wine drinkers (alcohol >12.8 g/day) had about 34% low risks of developing MS with OR of 0.66 (95% CI: 0.48–0.91), compared with non-drinkers. Odds ratio of MS was 1.81 (95% CI: 1.15–2.84) in women who smoked more than 20 pack-years, compared to non-smokers. Odds ratio of MS was 1.56 (95% CI: 1.25–1.95) in women who had familial history of diseases, including hypertension, diabetes and stroke, compared to women without familial history of those diseases. Conclusion MS is highly prevalent among women in rural China. Both physical activity and rice wine consumption play a protective role, while family history and smoking are risk factors in MS development. Educational programs should be established for promoting healthy lifestyles and appropriate interventions in rural China.
Collapse
Affiliation(s)
- Hui Cai
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, Jiangsu, China.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Martínez-Vizcaino V, Ortega FB, Solera-Martínez M, Ruiz JR, Labayen I, Eensoo D, Harro J, Loit HM, Veidebaum T, Sjöström M. Stability of the factorial structure of metabolic syndrome from childhood to adolescence: a 6-year follow-up study. Cardiovasc Diabetol 2011; 10:81. [PMID: 21933439 PMCID: PMC3193025 DOI: 10.1186/1475-2840-10-81] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 09/21/2011] [Indexed: 12/13/2022] Open
Abstract
Background Metabolic syndrome (MS) is a clustering of cardiometabolic risk factors that is considered a predictor of cardiovascular disease, type 2 diabetes and mortality. There is no consistent evidence on whether the MS construct works in the same way in different populations and at different stages in life. Methods We used confirmatory factor analysis to examine if a single-factor-model including waist circumference, triglycerides/HDL-c, insulin and mean arterial pressure underlies metabolic syndrome from the childhood to adolescence in a 6-years follow-up study in 174 Swedish and 460 Estonian children aged 9 years at baseline. Indeed, we analyze the tracking of a previously validated MS index over this 6-years period. Results The estimates of goodness-of-fit for the single-factor-model underlying MS were acceptable both in children and adolescents. The construct stability of a new model including the differences from baseline to the end of the follow-up in the components of the proposed model displayed good fit indexes for the change, supporting the hypothesis of a single factor underlying MS component trends. Conclusions A single-factor-model underlying MS is stable across the puberty in both Estonian and Swedish young people. The MS index tracks acceptably from childhood to adolescence.
Collapse
|
44
|
Kelishadi R, Poursafa P, Keramatian K. Overweight, air and noise pollution: Universal risk factors for pediatric pre-hypertension. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2011; 16:1234-50. [PMID: 22973395 PMCID: PMC3430051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 09/13/2011] [Indexed: 11/20/2022]
Abstract
Pediatric pre-hypertension (pre-HTN) has a complex multifactorial etiology. Although most cases are secondary to other disorders, a substantial number of children and adolescents have primary or essential HTN and pre-HTN. The gene-gene and gene-environment interactions should be considered in this context. The strong relationship of pre-HTN with environmental factors such as air pollution, noise pollution and passive smoking and obesity suggest that its prevalence will be escalating.Exposure to ambient particulate matters may increase blood pressure (BP) within hours to days. The underlying biologic pathways include autonomic nervous system imbalance and arterial vascular dysfunction or vasoconstriction because of systemic oxidative stress and inflammation. Likewise, tobacco smoke exposure of pregnant mothers increases systolic BP of their offspring in early infancy. Parental smoking also independently affects systolic BP among healthy preschool children. Noise exposure, notably in night, is associated with catecholamine secretion, increased BP and a pre-HTN state even in pre-school age children.Excess weight is associated with dysfunction of the adipose tissue, consisting of enlarged hypertrophied adipocytes, increased infiltration by macrophages and variations in secretion of adipokines and free fatty acids. These changes would result in chronic vascular inflammation, oxidative stress, activation of the renin-angiotensin-aldosterone system and sympathetic response, and ultimately to pre-HTN from childhood.Prevention and control of the modifiable risk factors of pre-HTN from prenatal period can have long-term health impact on primordial and primary prevention of chronic non-communicable diseases. This review presents a general view on the diagnosis, prevalence and etiology of pre-HTN along with practical measures for its prevention and control.
Collapse
Affiliation(s)
- Roya Kelishadi
- Professor, Department of Paediatrics, Child Health Promotion Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parinaz Poursafa
- Environment Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,
Corresponding Author: Parinaz Poursafa E-mail:
| | - Kasra Keramatian
- Child Health Promotion Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|