Risk of Cardiovascular and Metabolic Diseases in Overweight and Obese Children

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Global and Public Health".

Deadline for manuscript submissions: closed (20 December 2021) | Viewed by 37186

Special Issue Editor

Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy; Department of Pediatrics, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy
Interests: pediatrics; pediatric endocrinology; childhood obesity; pediatric translational research

Special Issue Information

Dear Colleagues,

Pediatric obesity remains a significant and prevalent public health concern. The major factors affecting weight regulation and the development of childhood obesity include genetic, environmental factors, developmental influences (“metabolic programming” or epigenetics) and the complex interactions between them. Children and adolescents with obesity are at major risk for developing a range of comorbid conditions, including cardiovascular and metabolic disease, which may significantly affect their daily lives as well as increase mortality risks. Obesity in childhood has adverse effects on adult cardiometabolic health that are independent from adult weight, suggesting the crucial role of preventive interventions.

This Special Issue aims to review the effects of obesity on health and well‐being, to consider the latest findings on the risk factors associated with cardiovascular and metabolic diseases in pediatric patients with obesity, to explore the mechanistic understanding, development of novel diagnostics, and potential therapeutic targets within cardiovascular, metabolic diseases, and to undeline the crucial role of the weight management strategies that may help patients to achieve and maintain weight loss in order to prevent obesity-related complications. Preventive interventions in children and adolescents may ameliorate the future burden of weight-related diseases.

Clinicians and researchers are invited to submit relevant original articles on both clinical and research fields, reviews, editorials, case reports, to this Special Issue of Children “Risk of Cardiovascular and Metabolic Diseases in Overweight and Obese Children”.

We look forward to your active participation.

Dr. Valeria Calcaterra
Guest Editor

Manuscript Submission Information

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Keywords

  • Obesity 
  • Overweight 
  • Children 
  • Adolescents 
  • Cardiovascular diseases 
  • Metabolic disorders 
  • Risk factors 
  • Prevention 
  • Obesity-related complications

Published Papers (15 papers)

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Editorial

Jump to: Research, Review

3 pages, 186 KiB  
Editorial
Prevention and Treatment of Cardiometabolic Diseases in Children with Overweight and Obesity: The Future of Healthcare
by Valeria Calcaterra and Gianvincenzo Zuccotti
Children 2022, 9(2), 176; https://doi.org/10.3390/children9020176 - 01 Feb 2022
Cited by 4 | Viewed by 1531
Abstract
In this Special Issue we will consider the impact of obesity on health in order to review the latest findings on the risk factors associated with cardiometabolic diseases in children with overweight and obesity as well as to explore the pathogenic mechanisms and [...] Read more.
In this Special Issue we will consider the impact of obesity on health in order to review the latest findings on the risk factors associated with cardiometabolic diseases in children with overweight and obesity as well as to explore the pathogenic mechanisms and potential therapeutic targets. The role of weight-management strategies, including exercise, dietary changes and nutritional education, in preventing obesity-related complications will be considered. The improvement of many obesity-associated complications following bariatric surgery will also be reported. The timely implementation of preventive strategies in pediatric patients with overweight and obesity may ameliorate the future burden of weight-related diseases and the future of healthcare. Full article

Research

Jump to: Editorial, Review

13 pages, 291 KiB  
Article
The Temporal Association between Body Characteristics and Speed Performance over Twenty-Five Years in Italian Adolescents
by Matteo Vandoni, Vittoria Carnevale Pellino, Annalisa De Silvestri, Nicola Lovecchio, Antonio Rovida, Alessandro Gatti, Valentina Biagioli, Gianvincenzo Zuccotti and Valeria Calcaterra
Children 2022, 9(4), 521; https://doi.org/10.3390/children9040521 - 06 Apr 2022
Cited by 7 | Viewed by 1619
Abstract
Background: Physical fitness (PF) is positively related to skeletal and metabolic health, and it had an inverse relation with obesity. Adolescents with obesity have the worst performance in PF and speed-agility (SA) that contributes to an augmented risk to develop pathologies. To the [...] Read more.
Background: Physical fitness (PF) is positively related to skeletal and metabolic health, and it had an inverse relation with obesity. Adolescents with obesity have the worst performance in PF and speed-agility (SA) that contributes to an augmented risk to develop pathologies. To the best of our knowledge, many studies analyzed the trends of obesity and SA separately, but there is a lack of data about SA ability trends in adolescents with obesity. We aimed to investigate SA trends in children with obesity in the last few decades to define the association between body weight and physical performance. Methods: We recruited 3.923 Caucasian children across the period 1985–2010 in the same school in Northern Italy, near Milan. Once a year, at the ages of 11–12- and 13-years-old, we collected anthropometric measures and SA performance. We pooled the data into 5-year-period study waves and then stratified our analysis into test-sex-age BMI-z-score specific groups. Results: We reported an undetermined trend across years. The 4×5 m run test significantly decreased in adolescents with overweight/obesity, while we did not report a decline in 30 m and 60 m run tests. Conclusions: Fitness tests highlighted differences in normal weight compared to overweight/obese children, suggesting that it is crucial to carefully monitor PF capacities through the years. Full article
9 pages, 1837 KiB  
Article
The Role of Urotensin-II in Obesity and Metabolic Syndrome in Pediatric Population
by Marko Simunovic, Andrija Jukic, Martina Paradzik, Daniela Supe-Domic, Lada Stanisic, Marina Degoricija, Anna Hummelvoll Hillestad, Veselin Skrabic and Josko Bozic
Children 2022, 9(2), 204; https://doi.org/10.3390/children9020204 - 04 Feb 2022
Cited by 3 | Viewed by 1376
Abstract
Background: Urotensin-II (U-II) is a short cyclic peptide that is widely recognized as one of the most potent vasoconstrictors. U-II plays a role in the pathophysiology of MS, participating in the development of essential hypertension, insulin resistance, hyperglycemia, and a proinflammatory state. Methods: [...] Read more.
Background: Urotensin-II (U-II) is a short cyclic peptide that is widely recognized as one of the most potent vasoconstrictors. U-II plays a role in the pathophysiology of MS, participating in the development of essential hypertension, insulin resistance, hyperglycemia, and a proinflammatory state. Methods: This study comprised 52 obese children and adolescents with a body mass index (BMI) z score > 2, aged 10 to 18 years. Serum levels of U-II were assessed using an enzyme-linked immunosorbent assay along with other standard biochemical parameters. Results: Elevated serum levels of U-II were recorded in the group of obese subjects with MS when compared with the group of obese subjects without MS (4.99 (8.97–3.16) vs. 4.17 (5.17–2.03) ng/mL, median and IQR, p = 0.026). Furthermore, a subgroup of study subjects with high blood pressure had significantly higher U-II levels in comparison with the normotensive subgroup (4.98 (7.19–3.22) vs. 3.32 (5.06–1.97) ng/mL, p = 0.027), while the subgroup with a positive family history of high blood pressure had significantly higher U-II levels when compared with subjects who had a negative family history of elevated blood pressure (5.06 (6.83–4.45) vs. 3.32 (6.13–2.21) ng/mL, p = 0.039). Conclusions: To the best of the author’s knowledge, this is the first study on the levels of U-II in obese children and adolescents, including a possible link to MS. Full article
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11 pages, 280 KiB  
Article
Predictive Ability of the Estimate of Fat Mass to Detect Early-Onset Metabolic Syndrome in Prepubertal Children with Obesity
by Valeria Calcaterra, Elvira Verduci, Annalisa De Silvestri, Vittoria Carlotta Magenes, Francesca Siccardo, Laura Schneider, Sara Vizzuso, Alessandra Bosetti and Gianvincenzo Zuccotti
Children 2021, 8(11), 966; https://doi.org/10.3390/children8110966 - 26 Oct 2021
Cited by 5 | Viewed by 1426
Abstract
Body mass index (BMI), usually used as a body fatness marker, does not accurately discriminate between amounts of lean and fat mass, crucial factors in determining metabolic syndrome (MS) risk. We assessed the predictive ability of the estimate of FM (eFM) calculated using [...] Read more.
Body mass index (BMI), usually used as a body fatness marker, does not accurately discriminate between amounts of lean and fat mass, crucial factors in determining metabolic syndrome (MS) risk. We assessed the predictive ability of the estimate of FM (eFM) calculated using the following formula: FM = weight − exp(0.3073 × height2 − 10.0155 ×d-growth-standards/standards/body-mass-index-for-age-bmi-for-age weight− 1 + 0.004571 × weight − 0.9180 × ln(age) + 0.6488 × age0.5 + 0.04723×male + 2.8055) (exp = exponential function, score 1 if child was of black (BA), south Asian (SA), other Asian (AO), or other (other) ethnic origin and score 0 if not, ln = natural logarithmic transformation, male = 1, female = 0), to detect MS in 185 prepubertal obese children compared to other adiposity parameters. The eFM, BMI, waist circumference (WC), body shape index (ABSI), tri-ponderal mass index, and conicity index (C-Index) were calculated. Patients were classified as having MS if they met ≥ 3/5 of the following criteria: WC ≥ 95th percentile; triglycerides ≥ 95th percentile; HDL-cholesterol ≤ 5th percentile; blood pressure ≥ 95th percentile; fasting blood glucose ≥ 100 mg/dL; and/or HOMA-IR ≥ 97.5th percentile. MS occurred in 18.9% of obese subjects (p < 0.001), with a higher prevalence in females vs. males (p = 0.005). The eFM was correlated with BMI, WC, ABSI, and Con-I (p < 0.001). Higher eFM values were present in the MS vs. non-MS group (p < 0.001); the eFM was higher in patients with hypertension and insulin resistance (p < 0.01). The eFM shows a good predictive ability for MS. Additional to BMI, the identification of new parameters determinable with simple anthropometric measures and with a good ability for the early detection of MS, such as the eFM, may be useful in clinical practice, particularly when instrumentation to estimate the body composition is not available. Full article
10 pages, 612 KiB  
Article
Associations between Sclerostin and Anthropometric and Metabolic Parameters in Children and Adolescents
by Shin-Hee Kim, Yun Jung Choi, Moon Bae Ahn, Won Kyoung Cho, Kyoung Soon Cho, Min Ho Jung and Byung-Kyu Suh
Children 2021, 8(9), 788; https://doi.org/10.3390/children8090788 - 09 Sep 2021
Cited by 8 | Viewed by 1652
Abstract
(1) Background: Bone plays an important role in the regulation of the systemic glucose and energy metabolism. Sclerostin, secreted by osteocytes, is an inhibitor of the Wnt/β–catenin bone metabolic pathway, and is involved in osteoporosis and metabolic disease. The aim of this study [...] Read more.
(1) Background: Bone plays an important role in the regulation of the systemic glucose and energy metabolism. Sclerostin, secreted by osteocytes, is an inhibitor of the Wnt/β–catenin bone metabolic pathway, and is involved in osteoporosis and metabolic disease. The aim of this study was to investigate the relationship between sclerostin and anthropometric and metabolic parameters in children and adolescents with obesity or who are overweight. (2) Methods: This study included 63 children and adolescents (20 obese, 11 overweight and 32 healthy control subjects). We evaluated the correlation between serum sclerostin and anthropometric parameters, metabolic parameters related to glucose (homeostasis model assessment of insulin resistance [HOMA–IR]), lipid, and bone metabolism (osteocalcin and 25-hydroxy vitamin D). (3) Results: Sclerostin and osteocalcin levels did not differ between obese and control groups. Sclerostin level was higher in boys than in girls (median 20.7 vs. 18.9 pmol/L, respectively; p = 0.04). In all subjects, sclerostin levels were negatively correlated with fasting insulin (r = −0.26; p = 0.04) and HOMA–IR (r = −0.28; p = 0.03), and positively correlated with serum concentrations of triglycerides (r = 0.29; p = 0.04), alkaline phosphatase (r = 0.41; p = 0.002), and osteocalcin (r = 0.33; p = 0.008). In obese patients, sclerostin levels were correlated negatively with fasting glucose (r = −0.49; p = 0.03) and HOMA–IR (r = −0.48; p = 0.03) and positively correlated with triglyceride levels (r = 0.53; p = 0.02). In the healthy control, sclerostin levels were correlated negatively with fasting insulin levels (r = −0.61; p < 0.001) and HOMA–IR (r = −0.36; p = 0.04). After adjusting for age, sex, and height SDS, a negative correlation between sclerostin and HOMA–IR was found (r = −0.39; p = 0.003) in all of the subjects. This association was more evident in obese patients (r = −0.60; p = 0.01) than in healthy controls (r = −0.39; p = 0.047). (4) Conclusions: Among children and adolescents with obesity, serum sclerostin was negatively correlated with HOMA–IR. Further studies are needed to clarify the mechanisms involved to understand how sclerostin affects the glucose metabolism. Full article
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9 pages, 257 KiB  
Article
“Fitness and Fatness” in Children and Adolescents: An Italian Cross-Sectional Study
by Matteo Vandoni, Valeria Calcaterra, Vittoria Carnevale Pellino, Annalisa De Silvestri, Luca Marin, Gian Vincenzo Zuccotti, Valeria Tranfaglia, Matteo Giuriato, Roberto Codella and Nicola Lovecchio
Children 2021, 8(9), 762; https://doi.org/10.3390/children8090762 - 31 Aug 2021
Cited by 17 | Viewed by 3065
Abstract
Children with obesity tend to have lower level of physical activity compared to non-obese peers. In fact, sedentary behaviors are prevalent in obese children causing difficulties to perform motor tasks and engaging in sport activities. This, in turn, has direct repercussions on adiposity [...] Read more.
Children with obesity tend to have lower level of physical activity compared to non-obese peers. In fact, sedentary behaviors are prevalent in obese children causing difficulties to perform motor tasks and engaging in sport activities. This, in turn, has direct repercussions on adiposity and related comorbidities. The aim of the study was to investigate several components of fitness and their relationship with the degree of fatness in children. We considered 485 Italian schoolchildren (9.5 ± 1.12 years). BMI and prediction modelling outputs of fat mass were employed as markers of body fatness. Physical fitness (PF) was assessed by the 9-item test battery (explosive power, leg muscle power, arm muscle power, upper body power, coordination, agility, speed and endurance). Differences between groups in the PF tests (p < 0.05) were noted. A similar pattern was reflected in both genders. The relationship between anthropometrics’ characteristics and PF tests showed that weight and fat mass had a high level of correlation with different PF tests. Our findings highlight the importance of investigating the degree of fatness in relation with different components of fitness, in children and adolescents. This combination of proxies may cover an unexpectedly helpful screening of the youth population, for both health and performance. Full article
14 pages, 2049 KiB  
Article
Interaction between Autonomic Regulation, Adiposity Indexes and Metabolic Profile in Children and Adolescents with Overweight and Obesity
by Valeria Calcaterra, Carlo Palombo, Mara Malacarne, Massimo Pagani, Giovanni Federico, Michaela Kozakova, Gianvincenzo Zuccotti and Daniela Lucini
Children 2021, 8(8), 686; https://doi.org/10.3390/children8080686 - 09 Aug 2021
Cited by 7 | Viewed by 1822
Abstract
Early obesity predicts initial modifications in cardiac and vascular autonomic regulation. The aim of this study was to assess the possible interaction between non-invasive measures of autonomic cardiovascular control and peripheral endothelium regulation in children with overweight and obesity. We involved 114 young [...] Read more.
Early obesity predicts initial modifications in cardiac and vascular autonomic regulation. The aim of this study was to assess the possible interaction between non-invasive measures of autonomic cardiovascular control and peripheral endothelium regulation in children with overweight and obesity. We involved 114 young subjects (77M/37F, 12.7 ± 2.2 years) with normal weight (NW, n = 46) to overweight or obesity (OB, n = 68). Multivariate statistical techniques utilizing a collection of modern indices of autonomic regulation, adiposity indexes and metabolic profile were employed. Resting values show substantial equivalence of data. Conversely, blood pressure variance is greater in NW/OB groups. The correlation matrix between major autonomic and metabolic/hemodynamic variables shows a clustered significant correlation between homogeneous indices. A significant correlation between metabolic indices and endothelial and autonomic control, mostly in its vascular end, was recorded. Particularly, the alpha index is significantly correlated with triglycerides (r = −0.261) and endothelial indices (RHI, r = 0.276). Children with obesity show a link between indices of autonomic and endothelial function, fat distribution and metabolic profile. The optimization of autonomic control, for instance by exercise/nutrition interventions, could potentially prevent/delay the occurrence of structural vascular damage leading to reduced cardiovascular health. Full article
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13 pages, 786 KiB  
Article
Multidisciplinary Approach for Hypothalamic Obesity in Children and Adolescents: A Preliminary Study
by Daniele Tessaris, Patrizia Matarazzo, Gerdi Tuli, Antonella Tuscano, Ivana Rabbone, Alessandra Spinardi, Antonella Lezo, Giorgia Fenocchio, Raffaele Buganza and Luisa de Sanctis
Children 2021, 8(7), 531; https://doi.org/10.3390/children8070531 - 22 Jun 2021
Cited by 5 | Viewed by 1901
Abstract
Hypothalamic obesity (HO) is delineated by an inexorable weight gain in subjects with hypothalamic disorder (congenital or acquired). The aim of the present study was to evaluate the effect of a multidisciplinary approach on weight trend and metabolic outcome in children and adolescents [...] Read more.
Hypothalamic obesity (HO) is delineated by an inexorable weight gain in subjects with hypothalamic disorder (congenital or acquired). The aim of the present study was to evaluate the effect of a multidisciplinary approach on weight trend and metabolic outcome in children and adolescents with hypothalamic disease who were overweight or obese. Thirteen patients (aged 8.1–16.1 years) received a personalized diet, accelerometer-based activity monitoring, and psychological assessment. Height, weight, body mass index (BMI), and serum metabolic parameters were assessed at baseline (T0) and after six months (T1). Metformin was introduced at T1 in four subjects who were then re-evaluated after six months (T2). At T1, weight gain was significantly reduced compared with T0 (0.29 ± 0.79 kg/month vs. 0.84 ± 0.55 kg/month, p = 0.03), and weight standard deviation score (SDS) and BMI SDS did not change significantly, as serum metabolic parameters. The four subjects treated with metformin showed a reduction of weight SDS and BMI SDS at T2. In conclusion, patients treated with our multidisciplinary approach showed, after 6 months, favorable results characterized by decreased weight gain and stabilization of weight SDS and BMI SDS in a condition usually characterized by inexorable weight gain. However, further analysis, larger cohorts, and longer follow-up are needed to confirm these preliminary data. Full article
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9 pages, 258 KiB  
Article
Self-Reported Physical Fitness in Children and Adolescents with Obesity: A Cross-Sectional Analysis on the Level of Alignment with Multiple Adiposity Indexes
by Matteo Vandoni, Nicola Lovecchio, Vittoria Carnevale Pellino, Roberto Codella, Valentina Fabiano, Virginia Rossi, Gian Vincenzo Zuccotti and Valeria Calcaterra
Children 2021, 8(6), 476; https://doi.org/10.3390/children8060476 - 04 Jun 2021
Cited by 12 | Viewed by 3309
Abstract
Obesity has been associated with several alterations that could limit physical activity (PA) practice. In pediatrics, some studies have highlighted the importance of enjoyment as a motivation to begin and maintain adherence in PA. Since self-reported physical (SRPF) fitness was related to motivation, [...] Read more.
Obesity has been associated with several alterations that could limit physical activity (PA) practice. In pediatrics, some studies have highlighted the importance of enjoyment as a motivation to begin and maintain adherence in PA. Since self-reported physical (SRPF) fitness was related to motivation, the aim of this study was to investigate the existence of differences between SRPF in children with obesity (OB) compared to normal weight (NW). The International Fitness Enjoyment Scale (IFIS) questionnaire was administered to 200 OB and 200 NW children. In all the subjects, height, weight, and BMI and in OB children adiposity indexes including waist circumference (WC), body shape index (ABSI), triponderal mass index (TMI), and fat mass were measured. NW group showed higher IFIS item scores than the OB group (p < 0.01), except in muscular strength. In OB, the anthropometric outcomes were inversely correlated to SRPF outcome except for muscular strength. OB children reported a lower perception of fitness that could limit participation in PA/exercise programs. The evaluation of anthropometric patterns may be useful to prescribe a tailored exercise program considering individual better self-perception outcomes to obtain an optimal PA adherence. Full article
14 pages, 257 KiB  
Article
Sex-Specific Differences in the Relationship between Insulin Resistance and Adiposity Indexes in Children and Adolescents with Obesity
by Valeria Calcaterra, Elvira Verduci, Laura Schneider, Hellas Cena, Annalisa De Silvestri, Sara Vizzuso, Federica Vinci, Chiara Mameli and Gianvincenzo Zuccotti
Children 2021, 8(6), 449; https://doi.org/10.3390/children8060449 - 26 May 2021
Cited by 9 | Viewed by 2386
Abstract
New indexes of adiposity have been introduced to evaluate body-fat distribution and cardiometabolic risk. However, data on the correlation between Insulin Resistance (IR) and these new indexes are limited. We therefore evaluated the relationship between IR and adiposity indexes in children and adolescents [...] Read more.
New indexes of adiposity have been introduced to evaluate body-fat distribution and cardiometabolic risk. However, data on the correlation between Insulin Resistance (IR) and these new indexes are limited. We therefore evaluated the relationship between IR and adiposity indexes in children and adolescents with obesity, focusing on gender differences. We retrospectively enrolled 586 patients with obesity (10.80 ± 2.63; 306F/279M). As adiposity indexes we considered body mass index (BMI), BMI-z score, WC, waist-to-height ratio (WHtR), a body shape index (ABSI), triponderal mass index (TMI), visceral adiposity index (VAI) and conicity index (ConI). The homeostasis model assessment for insulin resistance (HOMA-IR), HOMA of percentage β-cell function (HOMA-β), quantitative insulin sensitivity check index (QUICKI), and triglyceride and glucose index (TyG-index) were measured and recorded as IR surrogates. In both sexes, WC and VAI significantly correlated with all IR measurements (p < 0.001). BMI significantly correlated (p < 0.001) with all IR parameters except for the TyG-index in females. Fat mass and TMI correlated with IR parameters only in females, BMI-z score with IR markers except for HOMA-β in males, WHtR with HOMA-β in both sexes (p < 0.05), free fat mass with HOMA-IR and QUICKI only in females (p < 0.01), ConI correlated with the TyG index in females (p = 0.01). Tryglicerides and SBP were correlated with all IR measurements (p < 0.001), in both sexes. Correlations between different sex parameters were significantly more evident in middle puberty. The relationship between IR surrogates and obesity indexes is influenced by gender in pediatrics. Sex-specific differences in obesity-related complications should be considered in preventive intervention decision-making. Full article
15 pages, 1338 KiB  
Article
Waist Circumference Is Not Associated with Impaired Fasting Blood Glucose in a Sample of Mexican Children and Teenagers: Results from a State Screening Program
by Edtna Jáuregui-Ulloa, Alejandro Gaytán-González, Mayra Elizalde-Villarreal, Esmeralda González-Navarro, Alberto Ocampo-Chavarría and Juan López-Taylor
Children 2021, 8(3), 172; https://doi.org/10.3390/children8030172 - 24 Feb 2021
Viewed by 1854
Abstract
A high waist circumference (WC) is used as a risk factor for impaired fasting blood glucose (IFG) in adults. This association is less studied in children and teenagers. The purpose of this study was to analyze the association between having a high WC [...] Read more.
A high waist circumference (WC) is used as a risk factor for impaired fasting blood glucose (IFG) in adults. This association is less studied in children and teenagers. The purpose of this study was to analyze the association between having a high WC and IFG by sex and age in a sample of Mexican children and teenagers. We analyzed the data of 12979 participants aged 5 to 17 years to calculate percentile references for uncorrected WC, corrected for height (WC/HT) and by height squared (WC/HT2) with quantile regression. A subsample of 2309 participants with fasting blood glucose samples (FBG), WC, WC/HT and WC/HT2 values was analyzed with logistic regression. A high WC, WC/HT, and WC/HT2 were considered at the sex- and age-specific 90th percentile from the subsample. The IFG was considered as FBG ≥100 mg/dL. Having a high WC, WC/HT, nor WC/HT2 was not significantly associated with IFG for either sex and age group (all p > 0.05). A high WC, either on its uncorrected or corrected for height values, was not an important assessment for predicting IFG in a sample of Mexican children and teenagers. This study provides percentile reference values specific for sex and age. Full article
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12 pages, 1612 KiB  
Article
An Approach to Early Detection of Metabolic Syndrome through Non-Invasive Methods in Obese Children
by Rafael Molina-Luque, Natalia Ulloa, Andrea Gleisner, Martin Zilic, Manuel Romero-Saldaña and Guillermo Molina-Recio
Children 2020, 7(12), 304; https://doi.org/10.3390/children7120304 - 17 Dec 2020
Cited by 2 | Viewed by 2168
Abstract
Background: Metabolic Syndrome (MetS) has a high prevalence in children, and its presence increases in those with a high BMI. This fact confirms the need for early detection to avoid the development of other comorbidities. Non-invasive variables are presented as a cost-effective and [...] Read more.
Background: Metabolic Syndrome (MetS) has a high prevalence in children, and its presence increases in those with a high BMI. This fact confirms the need for early detection to avoid the development of other comorbidities. Non-invasive variables are presented as a cost-effective and easy to apply alternative in any clinical setting. Aim: To propose a non-invasive method for the early diagnosis of MetS in overweight and obese Chilean children. Methods: We conducted a cross-sectional study on 221 children aged 6 to 11 years. We carried out multivariate logistic regressions, receiver operating characteristic curves, and discriminant analysis to determine the predictive capacity of non-invasive variables. The proposed new method for early detection of MetS is based on clinical decision trees. Results: The prevalence of MetS was 26.7%. The area under the curve for the BMI and waist circumference was 0.827 and 0.808, respectively. Two decision trees were calculated: the first included blood pressure (≥104.5/69 mmHg), BMI (≥23.5 Kg/m2) and WHtR (≥0.55); the second used BMI (≥23.5 Kg/m2) and WHtR (≥0.55), with validity index of 74.7% and 80.5%, respectively. Conclusions: Early detection of MetS is possible through non-invasive methods in overweight and obese children. Two models (Clinical decision trees) based on anthropometric (non-invasive) variables with acceptable validity indexes have been presented. Clinical decision trees can be applied in different clinical and non-clinical settings, adapting to the tools available, being an economical and easy to measurement option. These methods reduce the use of blood tests to those patients who require confirmation. Full article
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Review

Jump to: Editorial, Research

21 pages, 1537 KiB  
Review
Adipose Tissue Immunomodulation and Treg/Th17 Imbalance in the Impaired Glucose Metabolism of Children with Obesity
by Stefania Croce, Maria Antonietta Avanzini, Corrado Regalbuto, Erika Cordaro, Federica Vinci, Gianvincenzo Zuccotti and Valeria Calcaterra
Children 2021, 8(7), 554; https://doi.org/10.3390/children8070554 - 27 Jun 2021
Cited by 9 | Viewed by 2960
Abstract
In the last few decades, obesity has increased dramatically in pediatric patients. Obesity is a chronic disease correlated with systemic inflammation, characterized by the presence of CD4 and CD8 T cell infiltration and modified immune response, which contributes to the development of obesity [...] Read more.
In the last few decades, obesity has increased dramatically in pediatric patients. Obesity is a chronic disease correlated with systemic inflammation, characterized by the presence of CD4 and CD8 T cell infiltration and modified immune response, which contributes to the development of obesity related diseases and metabolic disorders, including impaired glucose metabolism. In particular, Treg and Th17 cells are dynamically balanced under healthy conditions, but imbalance occurs in inflammatory and pathological states, such as obesity. Some studies demonstrated that peripheral Treg and Th17 cells exhibit increased imbalance with worsening of glucose metabolic dysfunction, already in children with obesity. In this review, we considered the role of adipose tissue immunomodulation and the potential role played by Treg/T17 imbalance on the impaired glucose metabolism in pediatric obesity. In the patient care, immune monitoring could play an important role to define preventive strategies of pediatric metabolic disease treatments. Full article
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20 pages, 723 KiB  
Review
Bariatric Surgery in Adolescents: To Do or Not to Do?
by Valeria Calcaterra, Hellas Cena, Gloria Pelizzo, Debora Porri, Corrado Regalbuto, Federica Vinci, Francesca Destro, Elettra Vestri, Elvira Verduci, Alessandra Bosetti, Gianvincenzo Zuccotti and Fatima Cody Stanford
Children 2021, 8(6), 453; https://doi.org/10.3390/children8060453 - 27 May 2021
Cited by 14 | Viewed by 5084
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 [...] Read more.
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. Full article
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19 pages, 740 KiB  
Review
Neck and Wrist Circumferences as Indicators of Metabolic Alterations in the Pediatric Population: A Scoping Review
by Evelyn Valencia-Sosa, Guillermo Julián González-Pérez, Erika Martinez-Lopez and Roberto Rodriguez-Echevarria
Children 2021, 8(4), 297; https://doi.org/10.3390/children8040297 - 13 Apr 2021
Cited by 4 | Viewed by 3714
Abstract
Neck circumference (NC) and wrist circumference (WrC) have been proposed as practical and inexpensive tools with the capacity to indicate metabolic alterations to some extent. Nevertheless, their application in the pediatric population is relatively recent. Thus, the aim of this scoping review was [...] Read more.
Neck circumference (NC) and wrist circumference (WrC) have been proposed as practical and inexpensive tools with the capacity to indicate metabolic alterations to some extent. Nevertheless, their application in the pediatric population is relatively recent. Thus, the aim of this scoping review was to review and analyze the reported evidence regarding the correlation of NC and WrC with metabolic alterations in the pediatric stage. The literature search was performed in January 2021 in seven indexes and databases. A total of 26 articles published between 2011 and 2020 were included. Most significant results were grouped into three categories: serum lipid profile, glucose homeostasis, and blood pressure. The parameter that showed the most significant results regardless of the anthropometric indicator analyzed for association was blood pressure. In contrast, total cholesterol and LDL-cholesterol showed non-significant associations along with conflicting results. We conclude that the use of NC and WrC, in addition to other well-established indicators, could facilitate the identification of metabolic alterations, specifically in plasma insulin and blood pressure. In fact, further studies are required to address the potential use of NC and WrC as predictors of early metabolic alterations, especially in countries with a fast-growing prevalence in obesity. Full article
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