Physical exercise intervention at school improved hepcidin, inflammation, and iron metabolism in overweight and obese children and adolescents.

BackgroundObesity is often associated with iron deficiency in children and adolescents. We aimed to study the effect of an 8-month physical exercise (PE) intervention on hepcidin and other markers of inflammation and on iron status in overweight/obese children and adolescents.MethodsSeventy-three overweight/obese children and adolescents participated in the 8-month-long longitudinal study. They were divided into two groups according to their participation in an after-school PE program: the PE group (n=44) and the control group (n=29). Hepcidin, interleukin (IL)-6, C-reactive protein (CRP), iron, ferritin, transferrin, and soluble transferrin receptor (sTfR) were evaluated.ResultsAt baseline, IL-6 correlated positively with hepcidin and negatively with iron and transferrin saturation, suggesting that increasing adiposity associates with increasing IL-6 and hepcidin synthesis, reducing iron availability. After 8 months, the PE group showed a decrease in BMI z-score (P=0.003), body fat mass (P=0.012), CRP (P=0.002), IL-6 (P=0.048), ferritin (P=0.013), hepcidin (P=0.040), and sTfR (P=0.010), and an increase in iron concentration (P=0.002). Moreover, the PE group, when compared with the control group, showed lower weight (P=0.026), BMI (P=0.040), waist circumference (P=0.010), and waist-to-height ratio (P=0.046).ConclusionWe showed that an 8-month-long intervention at school allowed a reduction in BMI z-score and an improvement in inflammation, reducing hepcidin levels and the disturbances in iron status.

Lysosomal acid lipase deficiency: A hidden disease among cohorts of familial hypercholesterolemia?

BACKGROUND: Lysosomal acid lipase deficiency (LALD) is an autosomal recessive disorder and an unrecognized cause of dyslipidemia. Patients usually present with dyslipidemia and altered liver function and mutations in LIPA gene are the underlying cause of LALD. OBJECTIVE: The aim of this study was to investigate LALD in individuals with severe dyslipidemia and/or liver steatosis. METHODS: Coding, splice regions, and promoter region of LIPA were sequenced by Sanger sequencing in a cohort of mutation-negative familial hypercholesterolemia (FH) patients (n = 492) and in a population sample comprising individuals with several types of dyslipidemia and/or liver steatosis (n = 258). RESULTS: This study led to the identification of LALD in 4 children referred to the Portuguese FH Study, all with a clinical diagnosis of FH. Mild liver dysfunction was present at the age of FH diagnosis; however, a diagnosis of LALD was not considered. No adults at the time of referral have been identified with LALD. CONCLUSION: LALD is a life-threatening disorder, and early identification is crucial for the implementation of specific treatment to avoid premature mortality. FH cohorts should be investigated to identify possible LALD patients, who will need appropriate treatment. These results highlight the importance of correctly identifying the etiology of the dyslipidemia.

Impact of a School-Based Intervention Protocol - ACORDA Project - On Adipokines in An Overweight and Obese Pediatric Population.

PURPOSE: There are few reliable studies assessing the effect of physical exercise (PE) on adipokines levels at young ages. Our objective was to study the effects of regular PE on plasma adipokines in pediatric overweight and obesity. METHOD: 117 overweight and obese children and adolescents (47% females; 10.2 years) participated in an 8-month longitudinal study divided in two groups: PE group (n = 80), engaged in an after-school PE program; control group (n = 37), with no PE program. Plasma lipids, C-reactive protein (CRP), adiponectin, resistin, leptin, IL-6, IL-1beta, TNF-alpha, insulin and glucose levels were determined. RESULTS: contrarily to the control group, the PE group presented reductions in body mass index z-score (BMIzsc) and body fat percentage that were accompanied by an improvement in lipid profile and insulin resistance, a reduction in CRP and TNF-alpha and an increase in adiponectin levels. The reductions in BMIzsc were inversely correlated with changes in adiponectin (r=-0.329, p = .003) and positively correlated with changes in percentage body fat (r = .262, p = .032), triglycerides (r = .228, p = .042) and leptin (r = .285, p = .010). CONCLUSIONS: Moderate reductions in adiposity improve proinflammatory status in obese children and adolescents. A more substantial reduction in BMIzsc was associated with a greater increment in adiponectin and reduction in leptin.

Adipokine Gene Single-Nucleotide Polymorphisms in Portuguese Obese Adolescents: Associations with Plasma Concentrations of Adiponectin, Resistin, IL-6, IL-1ß, and TNF-α.

BACKGROUND: The genetic contribution to obesity and to circulating adipokine levels has not been completely clarified. We aimed to evaluate adipokine genes' single-nucleotide polymorphism (SNP) prevalence and its association with circulating adipokine levels and risk factors for cardiovascular disease in an obese Portuguese pediatric population. METHODS: Two hundred forty-eight obese adolescents (mean age 13.4 years old; 47.2% females) participated in a cohort study. We screened 12 SNPs by direct sequencing in five adipokine genes: adiponectin (ADIPOQ: rs16861194, rs17300539, rs266729, rs2241766, rs1501299), interleukin-1ß (IL-1ß; rs1143627), IL-6 (IL-6; rs1800795), tumor necrosis factor-α (TNF-α; rs1800629), and resistin (RETN; rs1862513, rs3219177, rs3745367, rs3745368). Biochemical analysis included determination of circulating adipokines, C-reactive protein (CRP) levels, lipid profile, and markers of insulin resistance. RESULTS: Compared to males, females presented higher circulating levels of insulin, adiponectin, IL-6, resistin, and leptin concentrations, but lower TNF-α levels. No statistically significant differences were found for genotype or allelic distributions between genders. In the whole sample population, adiponectin levels were influenced by ADIPOQ rs17300539 (c.-1138G>A; lower in subjects with GG genotype). When only males were considered, IL-1ß, IL-6, and TNF-α levels were associated with ADIPOQ rs1501299 (c.214 + 62G>T; higher in GG subjects). TNF-α concentrations were modulated by TNF-α rs1800629 (c.-488G>A; lower in GG males), RETN rs1862513 (c.-216C>G; higher in CC subjects), and RETN rs3219177 (c.118 + 39C>T; higher in CC subjects). Leptin levels were influenced by IL-1ß rs1143627 (c.-118C>T) presenting TT individuals' lower levels. CONCLUSIONS: Our data demonstrate that in pediatric obese patients, some adipokine gene SNPs have an association with circulating adipokine levels and lipid profile.

Effect of laparoscopic adjustable gastric banding on modifiable cardiovascular risk factors in extremely obese adolescents.

Recently, surgical intervention has gained increasing support in adolescents with extreme obesity. This study summarizes the analysis into the effect of laparoscopic adjustable gastric bands (LAGB) on cardiovascular risk factors in 14 extremely obese Portuguese adolescent patients. Data collected both pre- and postoperatively included age, gender, body mass index (BMI), percentage of excess weight loss, cardiovascular risk factors, and cardiovascular outcomes. Ten girls and four boys aged from 13.5 to 17.5 years underwent LABG. The mean preoperative weight and BMI were 127.4 kg and 46.1 kg/m(2), respectively. The average percentage of weight loss calculated was 32 % at 1 year, 38.8 % at 2 years, and 48.1 % at 3 years of follow-up. Simultaneously, blood pressure and insulin resistance index returned to normal, and there was an increase in high-density lipoprotein levels, 3 years after the LABG was fitted. LABG fitting is a safe and effective treatment strategy for the improvement of cardiovascular status following weight loss.

Resistência à insulina e excesso de peso corporal / Insulin resistance and risk of obesity

Os objectivos do presente estudo consistiram em: (1) verificar a prevalência dos factores de risco das doenças cardiovasculares (FRDCV) e da resistência à insulina (RI); (2) verificar se há associação entre a RI e os FRDCV num grupo de crianças e adolescentes. Com um desenho transversal, esta pesquisa é caracterizada por uma amostra não aleatória de 84 crianças e adolescentes, de ambos os sexos (meninas: n = 50 e meninos: n = 34), com idades compreendidas entre os 8 e 15 anos de um Hospital Pediátrico da Cidade do Porto que apresentavam sobrepeso/obesidade. Os parâmetros metabólicos (colesterol HDL e LDL, triglicerídeos, glicose), a tensão arterial sistólica (TAS) e diastólica (TAD), as variáveis antropométricas e as características físicas foram obtidos durante uma consulta médica. Para a avaliação da actividade física (AF) recorremos a um questionário previamente utilizado em jovens portugueses, o qual apresentou um valor significativo de fiabilidade (ICC:92 -. 96) e coerência (a =. 87) para avaliação da AF diária. A RI foi calculada através do HOMA (Homeostasis Model Assement Insulin Resistance). Aproximadamente 31% das crianças e adolescentes apresentaram valores elevados de RI. Verificamos uma prevalência elevada de FRDCV. A RI apresentou associação (p=0,05) com as variáveis TAS e TAD em ambos os sexos. Crianças e adolescentes com valores elevados de RI apresentaram valores médios superiores (Test-T; p=0,05) assim como uma prevalência superior de FRDCV. Resultados sugerem a hipótese da RI com um importante parâmetro associado ao sobrepeso e a obesidade no desenvolvimento dos FRDCV nas crianças e adolescentes.

The purpose of this study was examined the prevalence of cardiovascular risk factors (CRF) and insulin resistance (IR) and the relationship between these variables in a sample of children and adolescents. This is a cross-sectional study characterized by a non probability sample selected by convenience among children and adolescents of both genders (girls: n = 50 and boys: n = 34), aged between 8 and 15 years old from Pediatrics Hospital of Porto. The metabolic parameters (HDL and LDL cholesterol, triglycerides, glucose), systolic blood pressure (SBP) and diastolic blood pressure (DBP), the anthropometric variables and the physical characteristics were measured during a medical visit. Physical Activity (PA) was assessed by a questionnaire that was previously used with good reliability (ICC: .92 to .96) and consistency (a = .87) in a Portuguese context. IR was calculated by HOMA (Homeostasis Model Assement Insulin Resistance). Approximately 31% (26) of the children and adolescents showed high values of IR. The prevalence of CRF was significantly higher. The IR was associated (p = 0.05) with SBP and DBP in both gender. The children and adolescents with high IR values had higher mean values (Test-T; P = 0.05) as well as higher prevalence of CRF. Results indicate the IR as an important parameter associated to overweight and obesity in the development of CRF in children and adolescents.