Obesity Is Strongly Associated With Low Testosterone and Reduced Penis Growth During Development.

CONTEXT: Growth of male genitalia represents an important marker of sexual development. Testicle size is the primary measure and little is known regards penile length changes during puberty. OBJECTIVE: This work aims to assess penis growth and testosterone levels in obese vs normal-weight children and adolescents, to evaluate a possible influence of obesity on genital development in boys, and to establish a new method for measuring penis length that allows comparison of normal-weight and overweight boys. METHODS: We assessed anthropometric and genital development in 1130 boys from birth to age 20 years. Testosterone levels were also measured. A new method for penile length measurement was employed to minimize errors when comparing obese and nonobese children. Penis length was measured with a gentle, painless, straight positioning on a centimetric ruler without stretching, which is doable from the first years of life until the end of adolescence. RESULTS: Penis length and testosterone are strongly related in children during puberty. Penile length growth is significantly decreased (by about 10%) in obese boys when compared to normal-weight boys, with concomitantly reduced testosterone levels, across puberal phases. CONCLUSION: Childhood obesity represents an important determinant of lower testosterone level and reduced penis development. A new method should be employed to improve penis measurement in normal-weight and overweight/obese boys. The possible significance of these observations for adult genital development and reproductive potential will require large longitudinal studies.

Myoinositol and D-Chiro Inositol in Improving Insulin Resistance in Obese Male Children: Preliminary Data.

Myoinositol and D-chiro inositol, which are inositol isomers, have been shown to possess insulin-mimetic properties and to improve insulin resistance, especially in women with polycystic ovary syndrome. However, it has not been determined if this relationship exists also in children. Based on these previous findings, we hypothesized that inositol could be effective in improving insulin sensitivity in children with insulin resistance. To evaluate this hypothesis, we administered both inositol formulations before carrying out an oral glucose tolerance test (OGTT) in a group of obese insulin-resistant male children with high basal insulin levels and compared the values obtained with an OGTT previously conducted without inositol, in the same group, with unchanged BMI. Our results confirm that myoinositol and D-chiro inositol acutely reduce insulin increase after glucose intake mainly in children with high basal insulin level.

Plasma long-chain fatty acids profile and metabolic outcomes in normolipidaemic obese children after one-year nutritional intervention.

AIM: To assess the association between changes in plasma long-chain polyunsaturated fatty acids (LCPUFAs) profile and metabolic outcomes after 1-year nutritional intervention in normolipidaemic obese children. METHODS: Fifty-seven normolipidaemic obese children, aged 8-13 years, were recruited in the study. Body mass index (BMI) z-scores were calculated. Fasting blood samples were analysed for insulin, glucose, lipid profile and fatty acid (FA) levels at baseline and after an 1-year nutritional-behaviour intervention. Insulin resistance was estimated by homeostatic model assessment (HOMA). RESULTS: Fifty-one obese children completed the study. At the end of the intervention, the children showed decreased BMI z-score (mean reduction 0.25; 95% confidence interval [CI], 0.18-0.31), HOMA index (1.6; 0.6-2.5), plasma-saturated FA (1.49; 0.67-2.31 mg/dL), C20:3n-9 (0.05; 0.02-0.07 mg/dL) and increased plasma levels of monounsaturated FA (mean increase 1.35; 0.63-2.07 mg/dL), n-6 PUFA (1.02; 0.08-1.97 mg/dL), n-3 PUFA (0.24; 0.07-0.40 mg/dL), C20:4n-6 (0.37; 0.11-0.63 mg/dL), C18:3n-3 (0.04; 0.01-0.07 mg/dL), C22:6n-3 (0.30; 0.17-0.42 mg/dL) and the C22:6n-3/C20:4n-6 ratio (0.02; 0.01-0.03 mg/dL) ratio. CONCLUSIONS: Nutritional interventions may improve plasma LCPUFA profile and metabolic outcomes of normolipidaemic obese children.

Liver fat change in obese children after a 1-year nutrition-behavior intervention.

OBJECTIVES: To evaluate whether a 1-year nutrition-behavior intervention based on normocaloric balanced diet and physical exercise may reduce liver fat in obese children. PATIENTS AND METHODS: Twenty-six obese children (11 boys and 15 girls), aged 6 to 14 years, underwent anthropometric, nutritional, metabolic, and liver magnetic resonance imaging (MRI) examinations at baseline and after a 1-year nutrition-behavior intervention. Anthropometry included weight, height, waist and hip circumference, and total upper arm area. Body mass index z scores were calculated. Biochemistry included serum aminotransferases, lipid profile, glucose, and insulin. Liver steatosis was judged as hepatic fat fraction (FF) by MRI and was > or =9%. RESULTS: Prevalence of steatosis was 34.6% at baseline and declined to 7.7% after intervention (P < 0.0001). Mean (95% CI) reduction of liver FF was 8.0% (4.0%-12.0%). In 77.8% of children with liver steatosis at baseline, the FF declined lower than 9% at the end of intervention, going from a mean (SD) of 18.7% (9.1) to 1.3% (4.1), (P < 0.0001). At the end of the intervention, children showed a mean reduction in body mass index z score of 0.26 (0.11-0.41) and waist circumference of 1.46 (0.34-2.60) cm. Triglycerides, total cholesterol, apolipoprotein A1, apolipoprotein B, ApoA1/ApoB ratio, and gamma-glutamyltransferase plasma values in plasma decreased at the end of intervention (P < 0.05). CONCLUSIONS: The results suggest that in obese children nutritional-behavior interventions may reduce the liver fat.

Influence of parental attitudes in the development of children eating behaviour.

The present paper is a review of available data on effects of parental feeding attitudes and styles on child nutritional behaviour. Food preferences develop from genetically determined predispositions to like sweet and salty flavours and to dislike bitter and sour tastes. There is evidence for existence of some innate, automatic mechanism that regulate appetite. However, from birth genetic predispositions are modified by experience. There are mechanisms of taste development: mere exposure, medicine effect, flavour learning, flavour nutrient learning. Parents play a pivotal role in the development of their child's food preferences and energy intake, with research indicating that certain child feeding practices, such as exerting excessive control over what and how much children eat, may contribute to childhood overweight. Mothers are of particular interest on children's eating behaviour, as they have been shown to spend significantly more time than fathers in direct interactions with their children across several familial situations.A recent paper describes two primary aspects of control: restriction, which involves restricting children's access to junk foods and restricting the total amount of food, and pressure, which involves pressuring children to eat healthy foods (usually fruits and vegetables) and pressuring to eat more in general. The results showed significant correlations between parent and child for reported nutritional behaviour like food intake, eating motivations, and body dis- and satisfaction. Parents create environments for children that may foster the development of healthy eating behaviours and weight, or that may promote overweight and aspects of disordered eating. In conclusion positive parental role model may be a better method for improving a child's diet than attempts at dietary control.

Plasma long-chain fatty acids and the degree of obesity in Italian children.

AIM: To examine whether the plasma levels of long-chain polyunsaturated fatty acids (LC-PUFAs) are associated with the degree of obesity in children. METHODS: Sixty-seven normolipidaemic obese children, aged 8-12 y, and 67 age- and sex-matched normal-weight children were included in the study. Obesity was defined in accordance with the International Obesity Task Force. BMI z-scores were calculated. Fasting blood samples were analysed for insulin, glucose, lipid profile and fatty acid (FA) levels (expressed as % total FA). Insulin resistance was estimated by homeostatic model assessment (HOMA). RESULTS: Compared with normal-weight children, obese children exhibited lower mean plasma total PUFA (37.8% vs 39.7%), omega-6 PUFAs (35.0% vs 36.8%) and C22:6omega-3-to-C18:3omega-3 ratio (5.52 vs 7.61), and higher total monounsaturated FA (26.6% vs 25.0%), C18:3omega-3 (0.28% vs 0.25%) and C20:5omega-3 (0.45% vs 0.39%). In obese children, the BMI z-score was negatively related to plasma PUFA, omega-3 PUFAs, C22:6omega-3, and the C22:6omega-3-to-C20:6omega-6 and C22:6omega-3-to-C18:3omega-3 ratios, and positively with total saturated FA and C20:3omega-9. CONCLUSION: In obese children, plasma LC-PUFA profile may be associated with the degree of obesity.

PPAR-gamma2 Pro12Ala variant, insulin resistance and plasma long-chain polyunsaturated fatty acids in childhood obesity.

Pro12Ala variant of peroxisome-proliferator-activated receptor-gamma2 (PPAR-gamma2) may be linked to insulin sensitivity. This study examined whether an association of PPAR-gamma2 Pro12Ala with insulin resistance and plasma LCPUFAs may exist in obese children. One hundred and forty Italian normolipidemic obese children (58 girls and 82 boys, mean age [SD], 10.2 [2.7] y) entered the study. Obesity was defined according to International Obesity Task Force. BMI Z-scores were calculated. Fasting blood glucose, insulin, lipids and plasma fatty acids were measured. Insulin resistance was estimated by the homeostatic model assessment (HOMA-IR). The frequency of Ala allele was 9%. Mean [SD] values of fasting insulin and HOMA-IR in Pro/Pro versus Pro12Ala groups were: 19.3 [10.6] versus 14.1 [10.4] microU/mL (p = 0.017) and 4.2 [2.3] versus 3.0 [2.3] (p = 0.022). Mean [SD] values of plasma C20:3n-9 and of C20:4n-6, C20:5n-3, C22:6n-3 and n-6/n-3 LCPUFA in phospholipds in Pro/Pro versus Pro12Ala groups were: 0.15 [0.07] versus 0.12 [0.08] % (p = 0.014), 8.9 [1.9] versus 10.2 [2.6] % (p = 0.023), 0.34 [0.15] versus 0.42 [0.11] % (p = 0.005), 2.1 [0.9] versus 2.6 [0.9] % (p = 0.032) and 4.8 [1.2] versus 4.2 [0.7] (p = 0.017). Pro12Ala may be associated with higher insulin sensitivity and higher LCPUFAs, particularly n-3, levels in plasma phosholipids of obese children.

Exclusive versus predominant breastfeeding in Italian maternity wards and feeding practices through the first year of life.

Determinants of exclusive versus predominant breastfeeding in the maternity ward and the relationship with later feeding practices were investigated in 1656 mothers who breastfed exclusively or predominantly in the maternity ward. Mothers were interviewed through 12 months postdelivery about feeding practices. Information about the World Heath Organization's (WHO's) 10 steps was collected. At hospital stay, breastfeeding was predominant in 43% of infants. Cesarean section (odds ratio [OR] = 1.75), mother's overweight (OR = 1.74), and non-compliance with the WHO's steps 6 (OR = 1.58), 7 (OR = 1.43), and 8 (OR = 1.76) were determinants of predominant, as opposed to exclusive, breastfeeding. Mothers exclusively, rather than predominantly, breastfeeding in the hospital showed a longer duration of full breastfeeding (mean = 3.6 vs 3.1 months), later introduction of formula (3.8 vs 3.3 months), and lower rate of introduction of formula within 1 month (23% vs 30%). Hospitals need to be compliant with the WHO's steps, and Baby-Friendly Hospital Initiatives should be promoted.