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Konuthula D, Tan MM, Burnet DL. Challenges and Opportunities in Diagnosis and Management of Cardiometabolic Risk in Adolescents. Curr Diab Rep 2023; 23:185-193. [PMID: 37273161 PMCID: PMC10240116 DOI: 10.1007/s11892-023-01513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE OF REVIEW This review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction of cardiometabolic risk in this population. RECENT FINDINGS There are multiple criticisms of how we define and approach obesity in clinical practice and scientific research, and weight stigma further complicates the process of making and communicating weight-related diagnoses. While the goal of diagnosing and managing metabolic syndrome in adolescents would be to identify individuals at elevated future cardiometabolic risk and intervene to reduce the modifiable component of this risk, there is evidence that identifying cardiometabolic risk factor clustering may be more useful in adolescents than establishing a cutoff-based diagnosis of metabolic syndrome. It has also become clear that many heritable factors and social and structural determinants of health contribute more to weight and body mass index than do individual behavioral choices about nutrition and physical activity. Promoting cardiometabolic health equity requires that we intervene on the obesogenic environment and mitigate the compounding effects of weight stigma and systemic racism. The existing options to diagnose and manage future cardiometabolic risk in children and adolescents are flawed and limited. While striving to improve population health through policy and societal interventions, there are opportunities to intervene at all levels of the socioecological model in order to decrease future morbidity and mortality from the chronic cardiometabolic diseases associated with central adiposity in both children and adults. More research is needed to identify the most effective interventions.
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Affiliation(s)
| | - Marcia M Tan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Deborah L Burnet
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
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Allalou A, Peng J, Robinson GA, Marruganti C, D’Aiuto F, Butler G, Jury EC, Ciurtin C. Impact of puberty, sex determinants and chronic inflammation on cardiovascular risk in young people. Front Cardiovasc Med 2023; 10:1191119. [PMID: 37441710 PMCID: PMC10333528 DOI: 10.3389/fcvm.2023.1191119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
Worrying trends of increased cardiovascular disease (CVD) risk in children, adolescents and young people in the Modern Era have channelled research and public health strategies to tackle this growing epidemic. However, there are still controversies related to the dynamic of the impact of sex, age and puberty on this risk and on cardiovascular health outcomes later in life. In this comprehensive review of current literature, we examine the relationship between puberty, sex determinants and various traditional CVD-risk factors, as well as subclinical atherosclerosis in young people in general population. In addition, we evaluate the role of chronic inflammation, sex hormone therapy and health-risk behaviours on augmenting traditional CVD-risk factors and health outcomes, ultimately aiming to determine whether tailored management strategies for this age group are justified.
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Affiliation(s)
- Amal Allalou
- University College London Medical School, University College London, London, United Kingdom
| | - Junjie Peng
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, United Kingdom
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
| | - George A. Robinson
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, United Kingdom
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
| | - Crystal Marruganti
- Eastman Dental Hospital, University College London Hospital, London, United Kingdom
| | - Francesco D’Aiuto
- Eastman Dental Hospital, University College London Hospital, London, United Kingdom
| | - Gary Butler
- Department of Paediatric Endocrinology, University College London Hospital, London, United Kingdom
- Institute of Child Health, University College London, London, United Kingdom
| | - Elizabeth C. Jury
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, United Kingdom
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
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3
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Wasniewska M, Pepe G, Aversa T, Bellone S, de Sanctis L, Di Bonito P, Faienza MF, Improda N, Licenziati MR, Maffeis C, Maguolo A, Patti G, Predieri B, Salerno M, Stagi S, Street ME, Valerio G, Corica D, Calcaterra V. Skeptical Look at the Clinical Implication of Metabolic Syndrome in Childhood Obesity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040735. [PMID: 37189984 DOI: 10.3390/children10040735] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Metabolic syndrome (MetS) is defined by a cluster of several cardio-metabolic risk factors, specifically visceral obesity, hypertension, dyslipidemia, and impaired glucose metabolism, which together increase risks of developing future cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D). This article is a narrative review of the literature and a summary of the main observations, conclusions, and perspectives raised in the literature and the study projects of the Working Group of Childhood Obesity (WGChO) of the Italian Society of Paediatric Endocrinology and Diabetology (ISPED) on MetS in childhood obesity. Although there is an agreement on the distinctive features of MetS, no international diagnostic criteria in a pediatric population exist. Moreover, to date, the prevalence of MetS in childhood is not certain and thus the true value of diagnosis of MetS in youth as well as its clinical implications, is unclear. The aim of this narrative review is to summarize the pathogenesis and current role of MetS in children and adolescents with particular reference to applicability in clinical practice in childhood obesity.
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Affiliation(s)
- Malgorzata Wasniewska
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Giorgia Pepe
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Tommaso Aversa
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Simonetta Bellone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Luisa de Sanctis
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Turin, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Nicola Improda
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Napoli, Italy
| | - Maria Rosaria Licenziati
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Napoli, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Alice Maguolo
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Giuseppina Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, 16128 Genova, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124 Modena, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Stefano Stagi
- Health Sciences Department, University of Florence and Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - Maria Elisabeth Street
- Unit of Paediatrics, Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Napoli "Parthenope", 80133 Napoli, Italy
| | - Domenico Corica
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, 20157 Milano, Italy
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Ghanbarnejad A, Kheirandish M, Yousefzade F, Rahimi A, Azarbad A, Nejatizadeh A, Shahmoradi M. Metabolic syndrome severity score in the middle-aged and elderly Iranian population: A cross-sectional survey of Bandare-Kong Cohort Study (the findings of PERSIAN Cohort Study). Front Public Health 2023; 10:1010735. [PMID: 36684931 PMCID: PMC9859414 DOI: 10.3389/fpubh.2022.1010735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
Background Metabolic syndrome (MetS) is defined as the presence of several metabolic risk factors. The traditional MetS criteria have been considered insufficient for evaluating individuals at risk. MetS has always been categorized using binary criteria, which deny that the risk associated with MetS is likely to exist as a continuum. Also, MetS may present differently depending on age, sex, race, or ethnicity. We aimed to derive age-sex-specific equations for MetS severity scores within a southern Iranian population. Methods This study used first-phase data from the Bandare-Kong Non-Communicable Diseases (BKNCD) Cohort Study as part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). After exclusion of the pregnant women, diabetic patients, and individuals taking antihypertensive, antihyperlipidemic, and antidiabetic medications, 2,735 individuals aged 35 to 70 years were selected for analysis. The diagnosis of MetS was based on the National Cholesterol Education Program (NCEP) criteria for the Iranian population. Confirmatory factor analysis (CFA) was performed to formulate MetS severity scores. The receiver operating characteristic (ROC) analysis was performed to validate MetS severity score equations for age-sex-specific categories. Results Triglyceride had the highest factor loading range in all age-sex categories for determining the MetS severity score. Conversely, systolic blood pressure and fasting plasma glucose (FPG) exhibited the lowest factor loadings across all age-sex groups. In both sexes, when age was considered, systolic blood pressure and FPG factor loadings were less significant among subjects aged ≥45 and 35-44 years, respectively. Conclusion MetS severity scores might be more applicable than the current criteria of MetS. Prospective population-based studies should be conducted to assess the accuracy and validity of the MetS severity score for predicting cardiometabolic diseases.
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Affiliation(s)
- Amin Ghanbarnejad
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Kheirandish
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Feysal Yousefzade
- Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Arash Rahimi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abnoos Azarbad
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Azim Nejatizadeh
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Shahmoradi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Jung HW, Lee J, Kim J. Handgrip Strength Is Associated with Metabolic Syndrome and Insulin Resistance in Children and Adolescents: Analysis of Korea National Health and Nutrition Examination Survey 2014-2018. J Obes Metab Syndr 2022; 31:334-344. [PMID: 36581591 PMCID: PMC9828701 DOI: 10.7570/jomes22053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/18/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022] Open
Abstract
Background Reduced handgrip strength (HGS) is associated with adverse cardiometabolic health outcomes. We examined HGS, metabolic syndrome (MetS), and insulin resistance (IR) in children and adolescents. Methods The following population-based data from 2,797 participants (aged 10-18 years) of the Korea National Health and Nutrition Examination Survey 2014-2018 were analyzed: complete anthropometric measures, HGS, MetS, and IR (subgroup with fasting insulin, n=555). HGS was analyzed as the combined HGS (CHGS) and the normalized CHGS (nCHGS=CHGS divided by body weight). Results At a mean age of 14.4 years, 276 participants (9.9%) had abdominal obesity, 56 (2.0%) had MetS, and 118 (20.9%) had IR. Individual components of MetS and IR were inversely associated with the nCHGS. The odds ratios (ORs) for MetS and IR decreased significantly with higher nCHGS after adjustment for sex, age, physical activity, and sedentary times. The optimal cut-off values that predicted MetS were 0.80 kg/kg (males) and 0.71 kg/kg (females), with significant associations with MetS (OR: 7.4 in males; 5.7 in females) and IR (OR: 3.3 in males; 3.2 in females) observed when nCHGS values were lower than those cut-offs. Conclusion HGS is associated with MetS and IR and might be a useful indicator of cardiometabolic risk factors in children and adolescents.
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Affiliation(s)
- Hae Woon Jung
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea,Corresponding author Jaehyun Kim https://orcid.org/0000-0002-0203-7443 Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7287 Fax: +82-31-787-4054 E-mail:
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Fernández-Aparicio Á, Perona JS, Schmidt-RioValle J, Montero-Alonso MA, Navarro-Pérez CF, González-Jiménez E. cMetS Based on Z-Scores as an Accurate and Efficient Scoring System to Determine Metabolic Syndrome in Spanish Adolescents. J Pers Med 2022; 13:jpm13010010. [PMID: 36675671 PMCID: PMC9865991 DOI: 10.3390/jpm13010010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
The definition of metabolic syndrome (MetS) based on dichotomous cut-off points is efficient in the adult population. However, to date, there is no international consensus on how to define MetS in the pediatric population. For that reason, a continuous MetS score (cMetS) has been proposed for the pediatric population. However, despite multiple attempts, cMetS has not been fully validated as there is no agreement about the most accurate score to calculate it. The purpose of the present study was to compare the validity of different scores (three siMS scores, z-score, principal components analysis (PCA), the sum of PCA, and confirmatory factor analysis) to calculate cMetS and determine MetS in Spanish adolescents. There were 981 subjects, ranging 11-16 years old, recruited for this cross-sectional study. Seven different approaches to pediatric cMetS scores were calculated. All cMetS scores calculated strongly correlated with each other, especially siMS scores. The area under the curve obtained from receiving operating characteristic curves was particularly elevated for z-scores 0.81 (95% CI: 0.784-0.838), showing a specificity of 64.4%. Our study shows that cMetS based on z-scores is accurate and efficient to be used for research instead of the dichotomized definition of MetS in adolescents; and cMetS based on siMS scores is useful for clinical practice.
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Affiliation(s)
- Ángel Fernández-Aparicio
- Department of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, 52005 Melilla, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
| | - Javier S. Perona
- Department of Food and Health, Instituto de la Grasa-CSIC, Campus of the University Pablo de Olavide, 41013 Seville, Spain
| | - Jacqueline Schmidt-RioValle
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Correspondence: ; Tel.: +34-958-243-495
| | - Miguel A. Montero-Alonso
- Department of Statistics and O.I., Faculty of Medicine, University of Granada, 18016 Granada, Spain
| | - Carmen Flores Navarro-Pérez
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
| | - Emilio González-Jiménez
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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Tasdighi E, Barzin M, Mahdavi M, Valizadeh M, Dehghan P, Moghaddam AM, Azizi F, Momenan AA, Hosseinpanah F. Association of childhood obesity phenotypes with early adulthood Carotid Intima-Media Thickness (CIMT): Tehran lipid and glucose study. Nutr Metab Cardiovasc Dis 2022; 32:249-257. [PMID: 34802846 DOI: 10.1016/j.numecd.2021.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Over the past few years, obesity and metabolic syndrome prevalence among children and adolescence have an increasing trend. This study aims to investigate the association of obesity phenotypes during childhood and adolescence with early adulthood carotid intima-media thickness (CIMT). METHODS AND RESULTS Participants were divided into four obesity phenotypes: Metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Participants were followed for 18 years. Multivariate-adjusted Risk Ratios (RRs) were calculated for high CIMT (≥95% percentile) incidence. In this cohort study 1220 children and adolescents with the average age of 10.9 ± 4.0 years were included. CIMT values had a significantly increasing trend from MHNW to MUO group (p for trend<0.001). Individuals with normal weight status, even with an unhealthy metabolic profile did not have higher risk of high CIMT. Similarly, Children with obesity but healthy metabolic status was not at higher risk. On the other hand, MUO phenotype during childhood was associated with increased risk of high CIMT in early adulthood (RR = 2.13, 95%CI (1.02-4.48)). This association became insignificant for all obesity phenotypes after adjusting for adulthood BMI. CONCLUSION Adulthood CIMT has an increasing trend based on childhood and adolescence obesity phenotypes from MHNW to MUO. Children with MUO phenotype was the only ones that had an increased risk of high CIMT incidence in early adulthood.
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Affiliation(s)
- Erfan Tasdighi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Pooneh Dehghan
- Imaging Department, Taleghani Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Amin M Moghaddam
- Imaging Department, Taleghani Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Amir A Momenan
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
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Vermeiren E, Bruyndonckx L, De Winter B, Verhulst S, Van Eyck A, Van Hoorenbeeck K. The effect of weight regain on cardiometabolic health in children with obesity: A systematic review of clinical studies. Nutr Metab Cardiovasc Dis 2021; 31:2575-2586. [PMID: 34172320 DOI: 10.1016/j.numecd.2021.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 01/19/2023]
Abstract
AIMS Children with obesity are treated by a lifestyle intervention to obtain weight loss. Nevertheless, weight regain often occurs. This systematic review examines the effect of weight regain on cardiometabolic health and summarizes these results in the metabolic syndrome prevalence as integrated endpoint. DATA SYNTHESIS A literature search was performed in PubMed and Web of Science. Studies were selected if they included participants aged <18 years with obesity and presented data before and after weight loss and after weight regain hereby reporting minimally 1 cardiovascular risk factor at every assessment. After screening, nine articles remained. Generally, the diastolic BP re-increased after weight regain, whereas for systolic BP a sustained result for 6 months was reported with an increase during longer follow-up. No significant changes in fasting glucose were reported after weight regain compared to baseline. Regarding triglycerides, a complete weight regain re-increased the lowered values to baseline, whereas a partial regain resulted in a sustained decrease in triglycerides in 2 studies and an increase to intermediate levels in 1 paper. HDL-cholesterol only rose several months after initiating treatment. Hs-CRP remained lowered for a longer period than the moment where the weight loss nadir was achieved. CONCLUSION Research on weight regain and cardiometabolic health in children with obesity is scarce. No convincing evidence was found for a worsening of the cardiometabolic profile after weight regain. Some benefits even persisted despite weight recovery. Subsequently, the metabolic syndrome prevalence seems temporarily lowered after weight loss, despite weight regain.
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Affiliation(s)
- Eline Vermeiren
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium.
| | - Luc Bruyndonckx
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Benedicte De Winter
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Stijn Verhulst
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium; Department of Pediatrics, University Hospital of Antwerp, Wilrijkstraat 10, Edegem, Belgium
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium; Department of Pediatrics, University Hospital of Antwerp, Wilrijkstraat 10, Edegem, Belgium
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9
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Rice AJ, Schvey NA, Shank LM, Neyland MH, Lavender JM, Solomon S, Hennigan K, Schindler R, Sbrocco T, Jorgensen S, Stephens M, Haigney M, Klein DA, Quinlan J, Yanovski JA, Tanofsky-Kraff M. Weight-Based Teasing and Metabolic Syndrome Components among Adolescent Military Dependents at Risk for Adult Obesity. Child Obes 2021; 17:116-124. [PMID: 33434443 PMCID: PMC7984651 DOI: 10.1089/chi.2020.0256] [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] [Indexed: 11/12/2022]
Abstract
Background: Among adults, weight stigma is associated with markers of poor cardiometabolic health. Although weight-based teasing (WBT) is common among youth with high body weight, few studies have examined its associations with cardiometabolic markers. Owing to unique stressors (e.g., parental deployment and frequent moves), military-dependent youth may be at particularly high risk for obesity, WBT, and poor cardiometabolic health. We, therefore, assessed associations between WBT and cardiometabolic health markers among adolescent military dependents presenting for a weight gain prevention trial. Methods: Participants underwent fasting phlebotomy; had fasting weight, height, and waist circumference measured; and completed assessments of WBT, anxiety, and loss-of-control eating. Multivariate analysis of covariance, adjusting for relevant covariates including demographics and body composition, was used to examine differences in metabolic syndrome (MetS) components (waist circumference, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, triglycerides, and glucose) between youth reporting WBT and youth reporting no WBT. Bootstrapped models examined whether WBT mediated the relationship between BMIz and MetS components. Results: Data from 142 youth (57.7% female; 14.4 ± 1.6 years; 51.2% non-Hispanic White, 20.9% non-Hispanic Black; BMIz: 1.9 ± 0.4) were analyzed. WBT was not significantly associated with any MetS component. Relationships were observed between BMIz and all MetS components (except systolic blood pressure and glucose), although WBT did not significantly mediate these relationships (p's > 0.05). Conclusions: This study did not find support for a relationship between WBT and MetS components in adolescent military dependents at risk for adult obesity. Prospective research is needed to determine whether associations between WBT and adverse cardiometabolic outcomes emerge primarily in adulthood.
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Affiliation(s)
- Alexander J. Rice
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University, Bethesda, MD, USA.,Metis Foundation, San Antonio, TX, USA
| | - Natasha A. Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD, USA.,Address correspondence to: Natasha A. Schvey, PhD, Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Lisa M. Shank
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University, Bethesda, MD, USA.,Metis Foundation, San Antonio, TX, USA.,Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - M.K. Higgins Neyland
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University, Bethesda, MD, USA.,Metis Foundation, San Antonio, TX, USA
| | - Jason M. Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University, Bethesda, MD, USA.,Metis Foundation, San Antonio, TX, USA
| | - Senait Solomon
- Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University, Bethesda, MD, USA.,Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA
| | - Kathrin Hennigan
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University, Bethesda, MD, USA.,Metis Foundation, San Antonio, TX, USA
| | - Rachel Schindler
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University, Bethesda, MD, USA.,Metis Foundation, San Antonio, TX, USA
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA
| | | | - Mark Stephens
- Pennsylvania State University, Old Main, State College, PA, USA
| | - Mark Haigney
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University, Bethesda, MD, USA
| | - David A. Klein
- Department of Family Medicine, Uniformed Services University, Bethesda, MD, USA.,Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA
| | - Jeffrey Quinlan
- Department of Family Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University, Bethesda, MD, USA.,Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD, USA
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10
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Christian Flemming GM, Bussler S, Körner A, Kiess W. Definition and early diagnosis of metabolic syndrome in children. J Pediatr Endocrinol Metab 2020; 33:821-833. [PMID: 32568734 DOI: 10.1515/jpem-2019-0552] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/06/2020] [Indexed: 12/25/2022]
Abstract
With this review, we aim to focus the attention on some established as well as new concepts for the metabolic syndrome (MetS) in children and adolescents spanning from definition to recommendations for the diagnostic approach. Even though there is no international commonly used definition of the metabolic syndrome in children and adolescents, all definitions include obesity as precondition for the development of MetS even in children. Obesity is one of the major cardiometabolic risk factors and it is strongly linked to other metabolic diseases like hyperlipidemia, hyperinsulinemia as well as hypertension. The metabolic syndrome is commonly known as a constellation of the mentioned morbidities. Pediatricians and researchers agree that early diagnosis and early interventions of the MetS are important to improve the prevention of cardiovascular disease and type 2 diabetes in adulthood. However, this requires appropriate screening tools for children and adolescents at risk for the MetS and its comorbidities. Due to controversies regarding the definition of MetS and the lack of consensus thresholds for the single components in children and adolescents, there is no internationally accepted diagnostic pathway for MetS available. However, several consensus statements and national guidelines for the assessment of obesity and its comorbidities in children and adolescents are available. Obesity seems to be the driving factor for the development of the other risk factors of MetS. In order to avoid conflicts concerning the definition of overweight and obesity, we recommend using the WHO definition of overweight (one standard deviation body mass index for age and sex and obesity; two standard deviations body mass index for age and sex) in children and adolescents.
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Affiliation(s)
| | - Sarah Bussler
- Hospital for Children and Adolescents, Leipzig University, Leipzig, Germany
| | - Antje Körner
- Hospital for Children and Adolescents, Leipzig University, Leipzig, Germany.,LIFE-Child-Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany.,Centre of Pediatric Research (CPL), Leipzig University, Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, Leipzig University, Leipzig, Germany.,LIFE-Child-Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany.,Centre of Pediatric Research (CPL), Leipzig University, Leipzig, Germany
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11
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Association of Iron Storage Markers with Metabolic Syndrome and Its Components in Chinese Rural 6-12 Years Old Children: The 2010-2012 China National Nutrition and Health Survey. Nutrients 2020; 12:nu12051486. [PMID: 32443740 PMCID: PMC7284848 DOI: 10.3390/nu12051486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Elevated ferritin, which is often used to represent iron storage, is known to increase the risk of metabolic syndrome (MetS) or its components, but its increase is affected by many factors. Therefore, it is necessary to analyze the relationship between other indicators of iron storage, and MetS and its components in order to fully understand the role of iron in the occurrence and development of these diseases. Although there are many studies to analyze the relationship involved in adults and adolescents, in children there is limited research. In this study, we aim to estimate the association of whole blood iron, ferritin, and total body iron with metabolic syndrome, and especially its components in Chinese rural children aged 6–12 years old. Method: A total of 1333 children aged 6–12 years old were enrolled from the 2010–2012 China National Nutrition and Health Survey in this study. Markers of iron storage (whole blood iron, ferritin, and total body iron (TBI)) and MetS component parameters (waist, blood pressure, high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and fast glycose) were collected. A multivariate logistic regression analysis was performed to confirm the independent relationship between iron storage markers, and the incident of metabolic syndrome and its components. Results: After adjusting for age, gender, C-reactive protein (CRP), and body mass index (BMI), a negative association was found between whole blood iron, ferritin, and TBI and incidence of reduced HDL-C (odds ratio (OR) = 0.63, 0.49, and 0.57, respectively). The highest tertile of whole blood iron increased the risk of the incidence of hyperglycemia (OR = 1.74), while TBI decreased the risk by 61%. No significant association was found between ferritin tertiles and the incidence of hyperglycemia. Conclusion: An iron storage level within the normal range in children is associated with a risk of MetS components, especially in hyperglycemia and reduced HDL-C. The relationship between the three iron indexes and metabolic syndrome and its components is not completely consistent, which suggests that the underlying mechanism is complex and needs to be further explored.
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12
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Meamar R, Amini M, Aminorroaya A, Nasri M, Abyar M, Feizi A. Severity of the metabolic syndrome as a predictor of prediabetes and type 2 diabetes in first degree relatives of type 2 diabetic patients: A 15-year prospective cohort study. World J Diabetes 2020; 11:202-212. [PMID: 32477456 PMCID: PMC7243485 DOI: 10.4239/wjd.v11.i5.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) has high morbidity and mortality worldwide, therefore there is of paramount importance to identify the risk factors in the populations at risk early in the course of illness. A strong correlation between severity of metabolic syndrome (MetS) and HbA1c, fasting insulin and insulin resistance has been reported. Accordingly, the MetS severity score (or MestS Z-score) can potentially be used to predict the risk of T2DM progression over time. AIM To evaluate the association the of MestS Z-score in first degree relatives (FDRs) of T2DM with the risk of prediabetes and type 2 diabetes in future. METHODS A prospective open cohort study was conducted between 2003-2018. At baseline, the sample comprised of 1766 FDRs of patients with T2DM who had a normal glucose tolerance test. Relative risk (RR) and 95% confidence interval were calculated based on logistic regression. The receiver-operator characteristic analysis and area under the curve based on MetS Z-score were used to evaluate the risk of prediabetes and diabetes among the FDR population. RESULTS Baseline MetS Z-scores were associated with the its latest values (P < 0.0001). Compared with individuals who were T2DM free at the end of follow up, those who developed T2DM had higher MetS Z-score at baseline (P < 0.001). In multivariable logistic regression analyses for every unit elevation in MetS Z-score at the baseline, the RR for developing future T2DM and prediabetes was (RR = 1.94, RR = 3.84), (RR = 1.5, RR = 2.17) in total population and female group, respectively (P < 0.05). The associations remained significant after adjusting the potential confounding variables. A cut off value of 0.97 and 0.94 was defined in the receiver-operator characteristic curve based on the MetS Z-score for differentiating female patients with diabetes and prediabetes from the normal population, respectively. CONCLUSION The MetS Z-score was associated with an increased risk of future T2DM. Appropriate interventions at earlier stages for preventing and attenuating MetS effects may be considered as an effective strategy for FDR as at-risk population.
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Affiliation(s)
- Rokhsareh Meamar
- Isfahan Endocrine and Metabolism Research Center, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Maryam Nasri
- Grovemead Health Center, London NW4-3EB, United Kingdom
| | - Majid Abyar
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Awat Feizi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
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13
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Börnhorst C, Russo P, Veidebaum T, Tornaritis M, Molnár D, Lissner L, Marild S, De Henauw S, Moreno LA, Intemann T, Wolters M, Ahrens W, Floegel A. Metabolic status in children and its transitions during childhood and adolescence-the IDEFICS/I.Family study. Int J Epidemiol 2020; 48:1673-1683. [PMID: 31098634 DOI: 10.1093/ije/dyz097] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study aimed to investigate metabolic status in children and its transitions into adolescence. METHODS The analysis was based on 6768 children who participated in the European IDEFICS/I.Family cohort (T0 2007/2008, T1 2009/2010 and/or T3 2013/2014; mean ages: 6.6, 8.4 and 12.0 years, respectively) and provided at least two measurements of waist circumference, blood pressure, blood glucose and lipids over time. Latent transition analysis was used to identify groups with similar metabolic status and to estimate transition probabilities. RESULTS The best-fitting model identified five latent groups: (i) metabolically healthy (61.5%; probability for group membership at T0); (ii) abdominal obesity (15.9%); (iii) hypertension (7.0%); (iv) dyslipidaemia (9.0%); and (v) several metabolic syndrome (MetS) components (6.6%). The probability of metabolically healthy children at T0 remaining healthy at T1 was 86.6%; when transitioning from T1 to T3, it was 90.1%. Metabolically healthy children further had a 6.7% probability of developing abdominal obesity at T1. Children with abdominal obesity at T0 had an 18.5% probability of developing several metabolic syndrome (MetS) components at T1. The subgroup with dyslipidaemia at T0 had the highest chances of becoming metabolically healthy at T1 (32.4%) or at T3 (35.1%). Only a minor proportion of children showing several MetS components at T0 were classified as healthy at follow-up; 99.8% and 88.3% remained in the group with several disorders at T1 and T3, respectively. CONCLUSIONS Our study identified five distinct metabolic statuses in children and adolescents. Although lipid disturbances seem to be quite reversible, abdominal obesity is likely to be followed by further metabolic disturbances.
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Affiliation(s)
- Claudia Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Department of Biometry and Data Management, Bremen, Germany
| | - Paola Russo
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - Toomas Veidebaum
- National Institute for Health Development, Estonian Centre of Behavioral and Health Sciences, Tallinn, Estonia
| | | | - Dénes Molnár
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Lauren Lissner
- Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Staffan Marild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | | | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - Timm Intemann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Epidemiological Methods and Etiological Research, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Maike Wolters
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Epidemiological Methods and Etiological Research, Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Epidemiological Methods and Etiological Research, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Anna Floegel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Epidemiological Methods and Etiological Research, Bremen, Germany
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14
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5840] [Impact Index Per Article: 973.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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15
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Assessing and Managing the Metabolic Syndrome in Children and Adolescents. Nutrients 2019; 11:nu11081788. [PMID: 31382417 PMCID: PMC6723651 DOI: 10.3390/nu11081788] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/10/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
The metabolic syndrome (MetS) is a group of cardiovascular risk factors that are associated with insulin resistance and are driven by underlying factors, including visceral obesity, systemic inflammation, and cellular dysfunction. These risks increasingly begin in childhood and adolescence and are associated with a high likelihood of future chronic disease in adulthood. Efforts should be made at both recognition of this metabolic risk, screening for potential associated Type 2 diabetes, and targeting affected individuals for appropriate treatment with an emphasis on lifestyle modification. Effective interventions have been linked to reductions in MetS-and in adults, reductions in the severity of MetS have been linked to reduced diabetes and cardiovascular disease.
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16
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Low S, Khoo KCJ, Wang J, Irwan B, Sum CF, Subramaniam T, Lim SC, Wong TKM. Development of a metabolic syndrome severity score and its association with incident diabetes in an Asian population-results from a longitudinal cohort in Singapore. Endocrine 2019; 65:73-80. [PMID: 31161560 DOI: 10.1007/s12020-019-01970-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Metabolic syndrome (MetS) is a constellation of clinical factors that indicates elevated risk of diabetes. It is diagnosed based on three or more abnormalities in its components. This does not take into account that MetS can likely present as a continuum of risk. We aim to develop a MetS severity score and assess its association with incident diabetes. METHODS In total, 4149 subjects without baseline diabetes participated in a community screening programme in 2013-2017. MetS was defined according to International Diabetes Federation criteria. A MetS severity z-score was derived from standardised loading coefficients of a confirmatory factor analysis for waist circumference, triglycerides, HDL-cholesterol, blood pressure and fasting plasma glucose (FPG). Multivariable cox proportional hazards regression model was used to assess the risk of diabetes by the score with adjustment for demographics and MetS components. RESULTS Diabetes occurred in 130 subjects. Quintile 5 of the baseline MetS severity z-score was significantly associated with development of diabetes even in fully adjusted model with HR 2.63 (95% CI: 1.04-6.64; p = 0.040). The relationship between MetS and incident diabetes became attenuated and non-significant in fully adjusted model with HR 0.67 (95% CI: 0.34-1.29; p = 0.228). Mediation analysis showed that MetS severity z-score accounted 61.0% of the association between increasing body mass index and development of diabetes (p < 0.001). CONCLUSIONS The MetS severity z-score is an inexpensive and clinically-available continuous measure of MetS to identify individuals at high risk of diabetes.
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Affiliation(s)
- Serena Low
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Jiexun Wang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Bastari Irwan
- Transformation Office, Hospital Administration, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
| | | | - Su Chi Lim
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore.
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
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17
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Collins SM, Broadney MM, Ghane N, Davis EK, Jaramillo M, Shank LM, Brady SM, Yanovski JA. Free Fatty Acids as an Indicator of the Nonfasted State in Children. Pediatrics 2019; 143:peds.2018-3896. [PMID: 31053621 PMCID: PMC6564057 DOI: 10.1542/peds.2018-3896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ensuring children are fasting for blood draws is necessary to diagnose abnormalities in glucose homeostasis. We sought to determine if serum free fatty acid (FFA) concentrations might be a useful marker to differentiate the fed and fasted states among children. METHODS A total of 442 inpatient (fasting) and 323 (postglucose load) oral glucose tolerance test samples of glucose, insulin, and FFA from children (age 5-18 years) who had healthy weight, overweight, or obesity were examined by receiver operating characteristic (ROC) curve analysis to identify a cut point for nonfasting. In a cross-sectional study, we compared mean FFA and percentage of FFA values below this cut point as a function of inpatient (n = 442) versus outpatient (n = 442) setting. RESULTS The area under the curve of FFA was significantly better (P values < .001) than the area under the curve of glucose or insulin for identifying nonfasting. FFA <287 mEq/mL had 99.0% sensitivity and 98.0% specificity for nonfasting. Mean FFA was lower in outpatients than inpatients (P < .001); only 1.6% inpatient but 9.7% outpatient FFA values were consistent with nonfasting (P < .001). CONCLUSIONS Clinicians cannot assume that pediatric patients are adequately fasted on arrival for fasting blood work. On the basis of having significantly lower outpatient than inpatient FFA values and more frequently suppressed FFA, children appeared less likely to be fasting at outpatient appointments. FFA value <287 mEq/mL was a sensitive and specific cutoff for nonfasting in children that may prove clinically useful.
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Affiliation(s)
- Shavonne M. Collins
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and,Meharry Medical College, Nashville, Tennessee; and
| | - Miranda M. Broadney
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and,Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Nejla Ghane
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and
| | - Elisabeth K. Davis
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and
| | - Manuela Jaramillo
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Lisa M. Shank
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Sheila M. Brady
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and,Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research and
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18
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Lee K. Comparison of Body Mass Index Percentiles to Detect Metabolic Syndrome Using the Korean, United States Centers for Disease Control and Prevention, and World Health Organization References in Korean Children Aged 10–16 Years. Metab Syndr Relat Disord 2019; 17:210-216. [DOI: 10.1089/met.2018.0126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Kayoung Lee
- Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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19
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Abstract
The continued rise of pediatric obesity globally has raised concerns for related sequalae. One marker of risk is the metabolic syndrome, a cluster of cardiovascular risk factors that is associated with future cardiovascular disease and type 2 diabetes. MetS has at its core visceral adipocytes exhibiting dysfunction as a result of excess fat content. MetS in children and adolescents is linked to unhealthy lifestyle practices such as sedentary lifestyles and excess consumption calories. As such, the optimal means of addressing MetS is targeting a decrease in adiposity through lifestyle modification, a decrease in MetS following increases in physical activity and improvements in the quality and content of food intake. Efforts remain needed in increasing motivation to these changes and maintaining adherence to avoid long-term sequelae.
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Affiliation(s)
- Linda X Wang
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mark D Deboer
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA -
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20
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Han JC, Reyes-Capo DP, Liu CY, Reynolds JC, Turkbey E, Turkbey IB, Bryant J, Marshall JD, Naggert JK, Gahl WA, Yanovski JA, Gunay-Aygun M. Comprehensive Endocrine-Metabolic Evaluation of Patients With Alström Syndrome Compared With BMI-Matched Controls. J Clin Endocrinol Metab 2018; 103:2707-2719. [PMID: 29718281 PMCID: PMC6276679 DOI: 10.1210/jc.2018-00496] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alström syndrome (AS), a monogenic form of obesity, is caused by recessive mutations in the centrosome- and basal body-associated gene ALMS1. AS is characterized by retinal dystrophy, sensory hearing loss, cardiomyopathy, childhood obesity, and metabolic derangements. OBJECTIVE We sought to characterize the endocrine and metabolic features of AS while accounting for obesity as a confounder by comparing patients with AS to body mass index (BMI)-matched controls. METHODS We evaluated 38 patients with AS (age 2 to 38 years) who were matched with 76 controls (age 2 to 48 years) by age, sex, race, and BMI. Fasting biochemistries, mixed meal test (MMT), indirect calorimetry, dual-energy X-ray absorptiometry, and MRI/magnetic resonance spectroscopy were performed. RESULTS Frequent abnormalities in AS included 76% obesity, 37% type 2 diabetes mellitus (T2DM), 29% hypothyroidism (one-third central, two-thirds primary), 3% central adrenal insufficiency, 57% adult hypogonadism (one-third central, two-thirds primary), and 25% female hyperandrogenism. Patients with AS and controls had similar BMI z scores, body fat, waist circumference, abdominal visceral fat, muscle fat, resting energy expenditure (adjusted for lean mass), free fatty acids, glucagon, prolactin, ACTH, and cortisol. Compared with controls, patients with AS were shorter and had lower IGF-1 concentrations (Ps ≤ 0.001). Patients with AS had significantly greater fasting and MMT insulin resistance indices, higher MMT glucose, insulin, and C-peptide values, higher HbA1c, and higher prevalence of T2DM (Ps < 0.001). Patients with AS had significantly higher triglycerides, lower high-density lipoprotein cholesterol, and a 10-fold greater prevalence of metabolic syndrome (Ps < 0.001). Patients with AS demonstrated significantly greater liver triglyceride accumulation and higher transaminases (P < 0.001). CONCLUSION Severe insulin resistance and T2DM are the hallmarks of AS. However, patients with AS may present with multiple other endocrinopathies affecting growth and development.
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Affiliation(s)
- Joan C Han
- Unit on Metabolism and Neuroendocrinology, Eunice Kennedy Shriver National
Institute of Child Health and Human Development, National Institutes of Health, Bethesda,
Maryland
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of
Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Departments of Pediatrics and Physiology, University of Tennessee Health
Science Center and Le Bonheur Children’s Foundation Research Institute, Memphis,
Tennessee
- Correspondence and Reprint Requests: Joan C. Han, MD, Departments of Pediatrics and Physiology, University of Tennessee
Health Science Center and Le Bonheur Children’s Foundation Research Institute, 50 North
Dunlap Street, Room 454R, Memphis, Tennessee 38103. E-mail:
| | - Daniela P Reyes-Capo
- Unit on Metabolism and Neuroendocrinology, Eunice Kennedy Shriver National
Institute of Child Health and Human Development, National Institutes of Health, Bethesda,
Maryland
| | - Chia-Ying Liu
- Radiology and Imaging Sciences, National Institutes of Health Clinical Research
Center, Bethesda, Maryland
| | - James C Reynolds
- Radiology and Imaging Sciences, National Institutes of Health Clinical Research
Center, Bethesda, Maryland
| | - Evrim Turkbey
- Radiology and Imaging Sciences, National Institutes of Health Clinical Research
Center, Bethesda, Maryland
| | - Ismail Baris Turkbey
- Center for Cancer Research, National Cancer Institute, National Institutes of
Health, Bethesda, Maryland
| | - Joy Bryant
- Human Biochemical Genetics Section, Medical Genetics Branch, National Human
Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - William A Gahl
- Human Biochemical Genetics Section, Medical Genetics Branch, National Human
Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Jack A Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of
Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Meral Gunay-Aygun
- Human Biochemical Genetics Section, Medical Genetics Branch, National Human
Genome Research Institute, National Institutes of Health, Bethesda, Maryland
- The McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics,
Johns Hopkins School of Medicine, Baltimore, Maryland
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Vikram NK. Cardiovascular and Metabolic Complications - Diagnosis and Management in Obese Children. Indian J Pediatr 2018; 85:535-545. [PMID: 29218646 DOI: 10.1007/s12098-017-2504-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/20/2017] [Indexed: 02/06/2023]
Abstract
The world at present is facing a burden of rising prevalence of obesity in children and adolescents. The developing countries are particularly facing the dual burden on under-nutrition and obesity. This is associated with appearance and clustering of cardiometabolic abnormalities at an early age with development of chronic complications early and possible decrease in life span of these children and adolescents. In adults this clustering has been termed as 'metabolic syndrome' with definitions that can be used universally. However, in children and adolescents there is no consensus on a uniform definition of metabolic syndrome that can be applicable across the age groups and various ethnicities. Further, as childhood is a period of growth and development, changes in body composition and insulin sensitivity that occur with puberty may influence the thresholds of components used to define metabolic syndrome. Children of South Asian ethnicity appear to be more predisposed to develop abnormalities of metabolic syndrome, possible due to their adverse body fat patterning and genetic influences. The definition of pediatric metabolic syndrome proposed by International Diabetes Federation is useful across different ethnicities. Presence of at least one component of metabolic syndrome should lead to detailed screening for other components and complications. A multimodality approach including therapeutic lifestyle changes targeted at the individual, family and community is essential for management. Pharmacotherapy for individual components may be required if initial management strategies fail to achieve the goals.
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Affiliation(s)
- Naval K Vikram
- Department of Medicine, Metabolic Research Group, All India Institute of Medical Sciences, New Delhi, 110029, India.
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22
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Wang LX, Filipp SL, Urbina EM, Gurka MJ, DeBoer MD. Longitudinal Associations of Metabolic Syndrome Severity Between Childhood and Young Adulthood: The Bogalusa Heart Study. Metab Syndr Relat Disord 2018; 16:208-214. [PMID: 29584578 PMCID: PMC5984565 DOI: 10.1089/met.2017.0160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Childhood metabolic syndrome (MetS) is associated with insulin resistance and increased risk for later development of type 2 diabetes (T2DM) and cardiovascular disease (CVD). In using MetS severity z-scores, our objective was to assess longitudinal associations in MetS severity, fasting insulin levels as a sign of insulin resistance and risk for T2DM, and uric acid levels as a biomarker of oxidative stress leading to CVD. METHODS We used linear regression to analyze longitudinal data from 285 white and black participants from the Bogalusa Heart Study evaluated at baseline at ages 5-19 and as young adults after a mean of 12.0 years follow-up. We assessed correlations between childhood MetS severity and young-adult MetS severity, fasting insulin, and uric acid levels, both overall and by sex- and racial subgroups. RESULTS Overall, childhood MetS z-scores were positively associated with young-adult MetS z-scores (r = 0.52), insulin (r = 0.34), and uric acid (r = 0.28) (all P < 0.001). These associations were consistent across all sex- and racial subgroups, except for young adult uric acid in white males in which childhood MetS-z was not associated (r = 0.15, P = 0.243). There was a strong cross-sectional association of young-adult MetS z-scores with insulin (r = 0.70) and uric acid (r = 0.57) (both P < 0.001), which was consistent for all sex- and racial subgroups. CONCLUSIONS These positive longitudinal correlations between childhood MetS z-scores and markers of later insulin resistance and oxidative stress suggest long-term durability of risk for CVD and T2DM. This suggests potential for MetS severity to serve as an indicator to monitor for future risk of T2DM and CVD.
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Affiliation(s)
- Linda X. Wang
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Stephanie L. Filipp
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida
| | - Elaine M. Urbina
- Department of Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Matthew J. Gurka
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, Florida
| | - Mark D. DeBoer
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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23
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Li G, Esangbedo IC, Xu L, Fu J, Li L, Feng D, Han L, Xiao X, Li M, Mi J, Li M, Gao S, Willi SM. Childhood retinol-binding protein 4 (RBP4) levels predicting the 10-year risk of insulin resistance and metabolic syndrome: the BCAMS study. Cardiovasc Diabetol 2018; 17:69. [PMID: 29759068 PMCID: PMC5950249 DOI: 10.1186/s12933-018-0707-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/21/2018] [Indexed: 02/08/2023] Open
Abstract
Background Elevated retinol-binding protein 4 (RBP4) levels may contribute to the development of metabolic abnormalities, but prospective studies evaluating the association between childhood RBP4 levels and metabolic syndrome (MS) in adulthood are lacking. We investigated whether RBP4 levels during childhood predict cardiometabolic risk at 10-year follow-up. Methods The relationships between RBP4 levels, the established adipokines (leptin and adiponectin) and the components of MS were examined in 3445 school-aged children recruited in 2004 for the Beijing Child and Adolescent Metabolic Syndrome study. In 2015, 352 of these individuals completed an in-depth follow-up examination. Results Participants with higher childhood RBP4 levels had adverse cardiometabolic profiles at follow-up. Those with incident or persistent MS had higher baseline RBP4 levels than those who never exhibited the elements of MS. Moreover, baseline RBP4 predicted hyperglycemia (OR per SD increase = 1.48, P = 0.009), elevated triglyceride (OR = 1.54, P < 0.001), elevated blood pressures (OR = 1.46, P = 0.015), MS (OR = 1.68, P = 0.002) and insulin resistance (OR = 1.44, P = 0.015) in the 10-year follow-up phase, independent of baseline BMI. Significant improvements were seen for the net reclassification improvement and integrated discrimination index after adding childhood RBP4 levels into the risk models using conventional cardiometabolic risk factors in predicting MS at follow-up (P < 0.05). Leptin and adiponectin demonstrated the expected associations with metabolic disorders. Conclusions Childhood RBP4 serves as a risk factor for subsequent development of MS and its components, independent of pediatric obesity. Incorporating childhood RBP4 into conventional cardiometabolic risk assessment models significantly improves the prediction of MS. Electronic supplementary material The online version of this article (10.1186/s12933-018-0707-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ge Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Issy C Esangbedo
- Health Weight Program, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Lu Xu
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Junling Fu
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Lujiao Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Dan Feng
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
| | - Lanwen Han
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
| | - Xinhua Xiao
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Mingyao Li
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jie Mi
- Department of Epidemiology, Capital Institute of Paediatrics, Beijing, 100020, China
| | - Ming Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.
| | - Shan Gao
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China.
| | - Steven M Willi
- Department of Endocrinology/Diabetes, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, 19104, USA
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24
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4782] [Impact Index Per Article: 683.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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Magge SN, Goodman E, Armstrong SC, Daniels S, Corkins M, de Ferranti S, Golden NH, Kim JH, Magge SN, Schwarzenberg SJ, Sills IN, Casella SJ, DeMeglio LA, Gonzalez JL, Kaplowitz PB, Lynch JL, Wintergerst KA, Bolling CF, Armstrong SC, Muth ND, Rausch JC, Rogers VW, Schwartz RP, COMMITTEE ON NUTRITION, SECTION ON ENDOCRINOLOGY, SECTION ON OBESITY. The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering. Pediatrics 2017; 140:peds.2017-1603. [PMID: 28739653 DOI: 10.1542/peds.2017-1603] [Citation(s) in RCA: 254] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Metabolic syndrome (MetS) was developed by the National Cholesterol Education Program Adult Treatment Panel III, identifying adults with at least 3 of 5 cardiometabolic risk factors (hyperglycemia, increased central adiposity, elevated triglycerides, decreased high-density lipoprotein cholesterol, and elevated blood pressure) who are at increased risk of diabetes and cardiovascular disease. The constellation of MetS component risk factors has a shared pathophysiology and many common treatment approaches grounded in lifestyle modification. Several attempts have been made to define MetS in the pediatric population. However, in children, the construct is difficult to define and has unclear implications for clinical care. In this Clinical Report, we focus on the importance of screening for and treating the individual risk factor components of MetS. Focusing attention on children with cardiometabolic risk factor clustering is emphasized over the need to define a pediatric MetS.
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Affiliation(s)
- Sheela N. Magge
- Division of Endocrinology and Diabetes, and Center for Translational Science, Children's National Health System, Washington, District of Columbia
| | - Elizabeth Goodman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
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26
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6371] [Impact Index Per Article: 796.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Asghari G, Eftekharzadeh A, Hosseinpanah F, Ghareh S, Mirmiran P, Azizi F. Instability of different adolescent metabolic syndrome definitions tracked into early adulthood metabolic syndrome: Tehran Lipid and Glucose Study (TLGS). Pediatr Diabetes 2017; 18:59-66. [PMID: 26825860 DOI: 10.1111/pedi.12349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/28/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVE There are substantial controversies about the clinical utility of adolescent metabolic syndrome (MetS). The current study examined the stability of adolescent MetS by assessing the agreement and discriminative abilities of four different definitions of adolescent MetS and the adult MetS definition during a 10.4-yr follow up. SUBJECTS AND METHODS For this study, 1424 adolescents (55.2% female), who participated in the framework of the Tehran Lipid and Glucose Study were included. Kappa was calculated for agreement between adolescent MetS definitions [Cook, de Ferranti, pediatric National Cholesterol Education Program (NCEP) and pediatric International Diabetes Federation (IDF)] and the adulthood MetS definition defined by the joint interim statement (JIS) criteria. MetS persistence, instability, and incidence were assessed, and for each of the four adolescent definitions, sensitivity, specificity, and area under receiver operating curve (AUC) for the counting of categorical adulthood MetS components was evaluated. RESULTS The agreement between the four adolescent MetS definitions and JIS was poor (κ = 0.094-0.255). All definitions showed low sensitivity and high specificity, except for de Ferranti's, which contrary to other definitions, had higher sensitivity and lower specificity. All four adolescent definitions revealed generally low AUCs (0.601-0.647). Compared with the pubertal group (11-14 yr), the predictive power was slightly higher in the late-pubertal group (15-18 yr). Cook's and de Ferranti's definitions showed fairly better predictive powers (0.647 and 0.644, respectively). Across all definitions, instability ranged between 5.4 and 19.6%. CONCLUSION The adolescent definitions show considerable amount of instability defined as poor agreement and low discriminative abilities tracked into early adulthood.
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Affiliation(s)
- Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anita Eftekharzadeh
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Ghareh
- Faculty of Medicine, Islamic Azad University, Mashhad Medical Branch, Mashhad, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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DeBoer MD, Gurka MJ. Clinical utility of metabolic syndrome severity scores: considerations for practitioners. Diabetes Metab Syndr Obes 2017; 10:65-72. [PMID: 28255250 PMCID: PMC5325095 DOI: 10.2147/dmso.s101624] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The metabolic syndrome (MetS) is marked by abnormalities in central obesity, high blood pressure, high triglycerides, low high-density lipoprotein-cholesterol, and high fasting glucose and appears to be produced by underlying processes of inflammation, oxidative stress, and adipocyte dysfunction. MetS has traditionally been classified based on dichotomous criteria that deny that MetS-related risk likely exists as a spectrum. Continuous MetS scores provide a way to track MetS-related risk over time. We generated MetS severity scores that are sex- and race/ethnicity-specific, acknowledging that the way MetS is manifested may be different by sex and racial/ethnic subgroup. These scores are correlated with long-term risk for type 2 diabetes mellitus and cardiovascular disease. Clinical use of scores like these provide a potential opportunity to identify patients at highest risk, motivate patients toward lifestyle change, and follow treatment progress over time.
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Affiliation(s)
- Mark D DeBoer
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
- Correspondence: Mark D DeBoer, Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia School of Medicine, 409 Lane Road, Room 2017, PO Box 800386, Charlottesville, VA 22908, USA, Tel +1 434 924 9833, Fax +1 434 924 9181, Email
| | - Matthew J Gurka
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
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Magnussen CG, Cheriyan S, Sabin MA, Juonala M, Koskinen J, Thomson R, Skilton MR, Kähönen M, Laitinen T, Taittonen L, Hutri-Kähönen N, Viikari JSA, Raitakari OT. Continuous and Dichotomous Metabolic Syndrome Definitions in Youth Predict Adult Type 2 Diabetes and Carotid Artery Intima Media Thickness: The Cardiovascular Risk in Young Finns Study. J Pediatr 2016; 171:97-103.e1-3. [PMID: 26681473 DOI: 10.1016/j.jpeds.2015.10.093] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/02/2015] [Accepted: 10/29/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To examine the utility of continuous metabolic syndrome (cMetS) scores vs a dichotomous metabolic syndrome (MetS) definition in youth to predict adult type 2 diabetes mellitus (T2DM) and carotid intima-media thickness (IMT). STUDY DESIGN Participants (n = 1453) from the population-based, prospective, observational Cardiovascular Risk in Young Finns Study who were examined in youth (when aged 9-18 years) and re-examined 15-25 years later. Four cMetS scores were constructed according to procedures most often used in the literature that comprised the youth risk factor inputs of body mass index, blood pressure, glucose, insulin, high-density lipoprotein-cholesterol, and triglycerides. Adult outcomes included T2DM and high carotid IMT (≥ 90 th percentile). RESULTS For a 1 SD increase in cMetS scores in youth, participants had a 30%-78% increased risk of T2DM and 12%-61% increased risk of high carotid IMT. Prediction of adult T2DM and high carotid IMT using cMetS scores in youth was essentially no different to a dichotomous MetS definition with area under the receiver-operating characteristic curve ranging from 0.54-0.60 (continuous definitions) and 0.55-0.59 (dichotomous) with 95% CIs often including 0.5, and integrated discrimination improvement from -0.2% to -0.6%. CONCLUSIONS cMetS scores in youth are predictive of cardiometabolic outcomes in adulthood. However, they do not have increased predictive utility over a dichotomous definition of MetS.
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Affiliation(s)
- Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
| | - Sanith Cheriyan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Matthew A Sabin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Pediatrics, University of Melbourne, Parkville, Australia
| | - Markus Juonala
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Juha Koskinen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Russell Thomson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Michael R Skilton
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Leena Taittonen
- Department of Pediatrics, Vaasa Central Hospital, Vaasa, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku, Finland
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30
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3809] [Impact Index Per Article: 380.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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31
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Radin RM, Tanofsky-Kraff M, Shomaker LB, Kelly NR, Pickworth CK, Shank LM, Altschul AM, Brady SM, Demidowich AP, Yanovski SZ, Hubbard VS, Yanovski JA. Metabolic characteristics of youth with loss of control eating. Eat Behav 2015; 19. [PMID: 26210388 PMCID: PMC4644474 DOI: 10.1016/j.eatbeh.2015.07.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Preliminary data in adults suggest that binge eating is associated with greater prevalence of metabolic syndrome (MetS) components. However, there are limited data in youth, and little is known of the role of binge episode size in these relationships. METHODS We examined the relationship between loss of control eating and metabolic characteristics in a convenience sample of 329 treatment-seeking and non-treatment-seeking adolescent boys and girls. The sample was enriched by design with adolescents who were overweight or obese and with individuals who reported episodes of loss of control over their eating (either objectively large binge episodes, OBEs or subjectively large binge episodes, SBEs, in the past month), as assessed by clinical interview. MetS components (blood pressure, lipids, glucose, and waist circumference) were the primary variables of interest. RESULTS 46% of the cohort reported loss of control eating; among those, 53% reported SBEs only and 47% reported OBEs. Youth with loss of control eating had higher systolic blood pressure (p=.001) and higher low-density lipoprotein cholesterol (LDL-c) (p=.002) compared to those without loss of control eating, in analyses adjusted for intervention-seeking status, fat mass and sociodemographic characteristics. Youth reporting OBEs had higher LDL-c (p=.013) compared to those reporting only SBEs. CONCLUSIONS Adolescents reporting loss of control episodes had greater dysfunction in some components of the MetS compared to youth without loss of control; episode size may contribute to metabolic dysfunction.
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Affiliation(s)
- Rachel M. Radin
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892-1103,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892-1103,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Lauren B. Shomaker
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892-1103,Colorado State University, Fort Collins, Colorado, 80523, USA
| | - Nichole R. Kelly
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892-1103,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Courtney K. Pickworth
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892-1103
| | - Lisa M. Shank
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892-1103,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Anne M. Altschul
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892-1103
| | - Sheila M. Brady
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892-1103
| | - Andrew P. Demidowich
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892-1103
| | - Susan Z. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892-1103,Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, NIH
| | - Van S. Hubbard
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, NIH,Division of Nutrition Research Coordination, NIH
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892-1103,Corresponding Author: Jack A. Yanovski, MD, PhD, Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, NICHD, NIH, 10 Center Drive, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland, 20892-1103, USA; Phone: 301-496-0858; Fax: 301-402-0574;
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DeBoer MD, Gurka MJ, Woo JG, Morrison JA. Severity of the metabolic syndrome as a predictor of type 2 diabetes between childhood and adulthood: the Princeton Lipid Research Cohort Study. Diabetologia 2015; 58:2745-52. [PMID: 26380985 PMCID: PMC4734129 DOI: 10.1007/s00125-015-3759-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to determine the long-term associations of a sex- and race/ethnicity-specific metabolic syndrome (MetS) severity z score from childhood and adulthood with a future diagnosis of type 2 diabetes mellitus. METHODS We performed a prospective cohort study with evaluations from the Cincinnati Clinic of the National Heart Lung and Blood Institute Lipids Research Clinic (LRC) 1973-1976 and Princeton Follow-up Study (PFS) 1998-2003, and further disease status from the Princeton Health Update (PHU) 2010-2014. We assessed MetS severity as a predictor of incident type 2 diabetes among 629 cohort participants assessed at both the LRC and PFS and 354 participants at the PHU. RESULTS Cohort participants had a mean age of 12.9 years at baseline (LRC), 38.4 years at the PFS and 49.6 years at the most recent follow-up. Childhood MetS z scores were associated with adult MetS z scores (p < 0.01). Compared with individuals who were disease-free at all time-points, those who developed type 2 diabetes by 1998-2003 and 2010-2014 had higher MetS severity z scores in childhood (p < 0.05). For every one-unit elevation in childhood MetS z score, the OR of developing future type 2 diabetes was 2.7 for incident disease by a mean age of 38.5 years (p < 0.01) and 2.8 for incident disease by a mean age of 49.6 years (p < 0.05). Regarding associations with the change in z score from childhood to adulthood, for every one-unit increase in MetS z score over time the OR of developing incident type 2 diabetes by a mean age of 49.6 years was 7.3 (p < 0.01). CONCLUSIONS/INTERPRETATION The severity of MetS in childhood was associated with the incidence of adult type 2 diabetes and the degree of increase in this severity predicted future disease. These findings provide evidence of potential clinical utility in assessing MetS severity to detect risk and follow clinical progress over time.
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Affiliation(s)
- Mark D DeBoer
- Division of Pediatric Endocrinology, University of Virginia, P.O. Box 800386, Charlottesville, VA, 22908, USA.
| | - Matthew J Gurka
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John A Morrison
- Division of Cardiology, University of Cincinnati, Cincinnati, OH, USA
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Yanovski JA. Pediatric obesity. An introduction. Appetite 2015; 93:3-12. [PMID: 25836737 DOI: 10.1016/j.appet.2015.03.028] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 01/04/2023]
Abstract
The prevalence of child and adolescent obesity in the United States increased dramatically between 1970 and 2000, and there are few indications that the rates of childhood obesity are decreasing. Obesity is associated with myriad medical, psychological, and neurocognitive abnormalities that impact children's health and quality of life. Genotypic variation is important in determining the susceptibility of individual children to undue gains in adiposity; however, the rapid increase in pediatric obesity prevalence suggests that changes to children's environments and/or to their learned behaviors may dramatically affect body weight regulation. This paper presents an overview of the epidemiology, consequences, and etiopathogenesis of pediatric obesity, serving as a general introduction to the subsequent papers in this Special Issue that address aspects of childhood obesity and cognition in detail.
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Affiliation(s)
- Jack A Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD 20892, USA.
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2014; 131:e29-322. [PMID: 25520374 DOI: 10.1161/cir.0000000000000152] [Citation(s) in RCA: 4522] [Impact Index Per Article: 411.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Psoriasis is a common, chronic inflammatory dermatosis that often has its onset during childhood. There is increasing evidence that psoriasis in adults is associated with obesity, the metabolic syndrome, and associated comorbidities, including insulin resistance/type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease. This association is postulated to arise, at least in part, as a result of a systemic proinflammatory state that is mediated by adipose tissue. Several recent observational studies suggest that children and adolescents with psoriasis may be at increased risk of being overweight and obese as well as having an increased risk for features of the metabolic syndrome. Such an association raises concern with regards to the long-term health implications for children and adolescents with psoriasis and suggests that better awareness, evaluation, and management of overweight and obese patients and associated metabolic disease are warranted in this population.
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Affiliation(s)
- Iris Gutmark-Little
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Kara N Shah
- Division of Pediatric Dermatology, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 3004, Cincinnati, OH 45229.
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Marlatt KL, Steinberger J. Metabolic Syndrome: A Construct with Limited Relevance to Children. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0402-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Validation of a BMI cut-off point to predict an adverse cardiometabolic profile with adiposity measurements by dual-energy X-ray absorptiometry in Guatemalan children. Public Health Nutr 2014; 18:951-8. [PMID: 24955816 DOI: 10.1017/s1368980014001207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To identify a body fat percentage (%BF) threshold related to an adverse cardiometabolic profile and its surrogate BMI cut-off point. DESIGN Cross-sectional study. SETTING Two public schools in poor urban areas on the outskirts of Guatemala City. SUBJECTS A convenience sample of ninety-three healthy, prepubertal, Ladino children (aged 7-12 years). RESULTS Spearman correlations of cardiometabolic parameters were higher with %BF than with BMI-for-age Z-score. BMI-for-age Z-score and %BF were highly correlated (r=0·84). The %BF threshold that maximized sensitivity and specificity for predicting an adverse cardiometabolic profile (elevated homeostasis model assessment-insulin resistance index and/or total cholesterol:HDL-cholesterol ratio) according to receiver operating characteristic curve analysis was 36 %. The BMI-for-age Z-score cut-off point that maximized the prediction of BF ≥ 36 % by the same procedure was 1·5. The area under the curve (AUC) for %BF and for BMI data showed excellent accuracy to predict an adverse cardiometabolic profile (AUC 0·93 (sd 0·04)) and excess adiposity (AUC 0·95 (sd 0·02)). CONCLUSIONS Since BMI standards have limitations in screening for adiposity, specific cut-off points based on ethnic-/sex- and age-specific %BF thresholds are needed to better predict an adverse cardiometabolic profile.
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Hosseinpanah F, Asghari G, Barzin M, Ghareh S, Azizi F. Reply: To PMID 24011762. J Pediatr 2014; 164:1502-3. [PMID: 24698452 DOI: 10.1016/j.jpeds.2014.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golaleh Asghari
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Ghareh
- Faculty of Medicine, Islamic Azad University, Mashhad Medical Branch, Mashhad, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Brown RJ, Yanovski JA. Estimation of insulin sensitivity in children: methods, measures and controversies. Pediatr Diabetes 2014; 15:151-61. [PMID: 24754463 PMCID: PMC4035238 DOI: 10.1111/pedi.12146] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/12/2014] [Accepted: 03/21/2014] [Indexed: 01/05/2023] Open
Abstract
Insulin resistance is defined as a state where insulin produces a diminished biological response, primarily in its capacity as a glucose-regulating hormone. Insulin resistance is commonly diagnosed by pediatric clinicians, but is rarely measured directly in children or adolescents. This review provides an overview of the techniques that can be used to assess insulin sensitivity in children, summarizing the methods involved, the assumptions, pitfalls, and appropriate uses of each technique, as well as their validation and reproducibility in pediatric samples.
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Affiliation(s)
- Rebecca J. Brown
- Diabetes, Endocrinology, and Obesity Branch, National Institute of
Diabetes and Digestive and Kidney Diseases, National Institutes of Health,
DHHS
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Developmental
Endocrinology and Genetics. Eunice Kennedy Shriver National Institute of Child
Health and Human Development, National Institutes of Health, DHHS
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Abstract
BACKGROUND Metabolic syndrome (MetS) is a clustering of risks associated with cardiometabolic disease in adults. Obesity is considered the major etiologic factor. However, unlike obesity, the natural history of MetS as adolescents transition to adulthood is unknown. OBJECTIVE The purpose of this study was to characterize the typology of MetS as adolescents transition to young adulthood and to explore determinants of that typology. DESIGN/PARTICIPANTS A total of 458 participants from a school-based longitudinal cohort study of baseline 5th to 12th graders were followed for 9 years. METHODS Based on the presence or absence of MetS at study visits (year [Y] 1, Y4, Y8, and Y10), a MetS typology was defined, and its characteristics were explored using multinomial regression modeling. RESULTS Both obesity and MetS increased (obesity from 21.0% to 33.4% and MetS from 2.8% to 17.9%). MetS typology was as follows: never, 76.9%; incident, 16.4%; unstable/remitted, 5.7%; and persistent, 1.1%. Of Y1 MetS-positive cases, 61.5% remitted, as did 36.4% of Y4 MetS-positive cases and 25% of Y8 MetS-positive cases. Most incident cases (56.0%, n = 42) occurred in Y10; only 12% (n = 9) occurred in Y4. Obesity increased the odds of MetS (incident: odds ratio [OR] = 4.42, 95% confidence interval [CI] = 2.23-8.76; unstable/remitted: OR = 7.79, 95% CI = 3.12-19.41; persistent: OR = 31.36, 95% CI = 2.99-328.98). In addition, changes in body mass index over the study were associated with persistent (OR = 1.27, 95% CI = 1.03-1.56) and incident MetS (OR = 1.49, 95% CI = 1.31-1.71), but not unstable/remitted MetS (OR = 1.09, 95% CI = 0.99-1.19). Of note, body mass index increased for 77% of those with unstable/remitted MetS, including 90% (n = 9/10) of persistently obese youth with unstable/remitted MetS. CONCLUSIONS During the transition to adulthood, the diagnosis of MetS is highly unstable and fluctuates even among those who are obese and gaining weight.
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Affiliation(s)
- Takara L Stanley
- Pediatric Endocrine Unit (T.L.S.) and Center for Child and Adolescent Health Research and Policy (M.L.C., E.G.), Massachusetts General Hospital for Children, Boston, Massachusetts 02114; and Harvard Medical School (T.L.S., M.L.C., E.G.), Boston, Massachusetts 02114
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129:e28-e292. [PMID: 24352519 PMCID: PMC5408159 DOI: 10.1161/01.cir.0000441139.02102.80] [Citation(s) in RCA: 3573] [Impact Index Per Article: 324.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Involvement of the neutral amino acid transporter SLC6A15 and leucine in obesity-related phenotypes. PLoS One 2013; 8:e68245. [PMID: 24023709 PMCID: PMC3762852 DOI: 10.1371/journal.pone.0068245] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/27/2013] [Indexed: 11/19/2022] Open
Abstract
Brain pathways, including those in hypothalamus and nucleus of the solitary tract, influence food intake, nutrient preferences, metabolism and development of obesity in ways that often differ between males and females. Branched chain amino acids, including leucine, can suppress food intake, alter metabolism and change vulnerability to obesity. The SLC6A15 (v7-3) gene encodes a sodium-dependent transporter of leucine and other branched chain amino acids that is expressed by neurons in hypothalamus and nucleus of the solitary tract. We now report that SLC6A15 knockout attenuates leucine's abilities to reduce both: a) intake of normal chow and b) weight gain produced by access to a high fat diet in gender-selective fashions. We identify SNPs in the human SLC6A15 that are associated with body mass index and insulin resistance in males. These observations in mice and humans support a novel, gender-selective role for brain amino acid compartmentalization mediated by SLC6A15 in diet and obesity-associated phenotypes.
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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: 52] [Impact Index Per Article: 4.3] [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.
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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
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Abstract
Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors associated with an increased risk for the development of cardiovascular diseases and type 2 diabetes. The prevalence of the MetS is not particularly high in the overall pediatric population (3 %-4 %) but it is as high as 30 %-50 % among overweight youth. Several definitions of the MetS have been used, thus, generating confusion and difficulties in defining the true prevalence of this syndrome. The recent definition of the International Diabetes Federation has tried to standardize the diagnostic criteria. However, there are still some concerns about use of cut-offs values and dichotomous variables, and some debate as to whether a continuous cardiometabolic risk score could be more appropriate for the pediatric population. Although there are some studies that have shown the association between childhood and adolescent MetS with long-term outcomes, further prospective studies are needed to clarify the true value of diagnosing MetS in youth.
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Affiliation(s)
- M Loredana Marcovecchio
- Department of Paediatrics, University of Chieti and Center of Excellence on Aging, G. D'Annunzio University Foundation, University of Chieti, Via dei Vestini 5, 66100, Chieti, Italy
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 2013; 127:e6-e245. [PMID: 23239837 PMCID: PMC5408511 DOI: 10.1161/cir.0b013e31828124ad] [Citation(s) in RCA: 3389] [Impact Index Per Article: 282.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Magnussen CG, Koskinen J, Juonala M, Chen W, Srinivasan SR, Sabin MA, Thomson R, Schmidt MD, Nguyen QM, Xu JH, Skilton MR, Kähönen M, Laitinen T, Taittonen L, Lehtimäki T, Rönnemaa T, Viikari JS, Berenson GS, Raitakari OT. A Diagnosis of the Metabolic Syndrome in Youth That Resolves by Adult Life Is Associated With a Normalization of High Carotid Intima-Media Thickness and Type 2 Diabetes Mellitus Risk. J Am Coll Cardiol 2012; 60:1631-9. [DOI: 10.1016/j.jacc.2012.05.056] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 04/16/2012] [Accepted: 05/11/2012] [Indexed: 10/27/2022]
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Tanofsky-Kraff M, Shomaker LB, Stern EA, Miller R, Sebring N, DellaValle D, Yanovski SZ, Hubbard VS, Yanovski JA. Children's binge eating and development of metabolic syndrome. Int J Obes (Lond) 2012; 36:956-62. [PMID: 22234282 PMCID: PMC3454442 DOI: 10.1038/ijo.2011.259] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Binge eating predisposes children to excessive weight gain. However, it is unknown if pediatric binge eating predicts other obesity-associated adverse health outcomes. OBJECTIVE The objective of this study was to investigate the relationship between binge eating and metabolic syndrome (MetS) in children. METHOD Children aged 5-12 years at high risk for adult obesity, either because they were overweight/obese when first examined or because their parents were overweight/obese, were recruited from Washington, DC and its suburbs. Children completed a questionnaire assessment of binge eating at baseline and underwent measurements of MetS components at baseline and at a follow-up visit approximately 5 years later. Magnetic resonance imaging was used to measure the visceral adipose tissue (VAT) in a subset. RESULTS In all, 180 children were studied between July 1996 and August 2010. Baseline self-reported binge eating presence was associated with a 5.33 greater odds of having MetS at follow-up (95% confidence interval (CI): 1.47, 19.27, P=0.01). The association between binge eating and body mass index (BMI) only partially explained changes in MetS components: baseline binge eating predicted higher follow-up triglycerides, even after accounting for baseline triglycerides, baseline BMI, BMI change, sex, race, baseline age and time in study (P = 0.05). Also, adjusting for baseline VAT and demographics, baseline binge eating predicted greater follow-up L(2-3) VAT (P = 0.01). DISCUSSION Children's reports of binge eating predicted development of MetS, worsening triglycerides and increased VAT. The excessive weight gain associated with children's binge eating partly explained its adverse metabolic health outcomes. Reported binge eating may represent an early behavioral marker upon which to focus interventions for obesity and MetS.
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Affiliation(s)
- Marian Tanofsky-Kraff
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, MD 20814, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Lauren B. Shomaker
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, MD 20814, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Elizabeth A. Stern
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, MD 20814, USA
| | - Rachel Miller
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, MD 20814, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Nancy Sebring
- Nutrition Department, Clinical Center, NIH, Bethesda, MD 20814, USA
| | - Diane DellaValle
- Nutrition Department, Clinical Center, NIH, Bethesda, MD 20814, USA
| | - Susan Z. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, MD 20814, USA
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20814, USA
| | - Van S. Hubbard
- Division of Nutrition Research Coordination, NIH, Bethesda, MD 20814, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, MD 20814, USA
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Affiliation(s)
- Alan R Sinaiko
- Department of Pediatrics, Division of Nephrology and School of Public Health, Division of Epidemiology, University of Minnesota Medical School, Minneapolis, MN, USA.
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Keil MF, Graf J, Gokarn N, Stratakis CA. Anthropometric measures and fasting insulin levels in children before and after cure of Cushing syndrome. Clin Nutr 2012; 31:359-63. [PMID: 22154461 PMCID: PMC3319516 DOI: 10.1016/j.clnu.2011.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 11/14/2011] [Accepted: 11/15/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Children with Cushing syndrome present with growth delay and excess adiposity that tends to be generalized rather than centripetal. There are no prospective studies of this phenotype as it evolves before and after treatment in children. The aims of this study were to evaluate children prior to and one-year after surgical cure compared to controls and to determine fasting insulin levels and their possible association with waist circumference and waist-height ratio, pre- and post-cure of Cushing syndrome. METHODS 30 children with Cushing syndrome were evaluated prior to and one-year post-treatment and compared to 14 age and body mass index-matched controls. RESULTS Only triceps skin fold z- score showed a significant difference between patients with active Cushing syndrome and controls. A positive correlation between fasting insulin levels and waist circumference z- score was found for children with Cushing syndrome; this association persisted one-year following cure. CONCLUSIONS Unlike adults affected with Cushing syndrome, upper arm muscle area of children with Cushing syndrome did not differ from obese children without Cushing syndrome. The persistence of a positive correlation between waist circumference and fasting insulin despite remission of Cushing syndrome suggests that children with a history of Cushing syndrome may have an increased risk for adverse long-term effects of increased abdominal fat mass.
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Affiliation(s)
- Margaret F Keil
- Section on Endocrinology Genetics, Program on Developmental Endocrinology Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
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