Health Risks of Sarcopenic Obesity in Overweight Children and Adolescents: Data from the CHILT III Programme (Cologne).

Sarcopenic obesity is increasingly found in youth, but its health consequences remain unclear. Therefore, we studied the prevalence of sarcopenia and its association with cardiometabolic risk factors as well as muscular and cardiorespiratory fitness using data from the German Children's Health InterventionaL Trial (CHILT III) programme. In addition to anthropometric data and blood pressure, muscle and fat mass were determined with bioelectrical impedance analysis. Sarcopenia was classified via muscle-to-fat ratio. A fasting blood sample was taken, muscular fitness was determined using the standing long jump, and cardiorespiratory fitness was determined using bicycle ergometry. Of the 119 obese participants included in the analysis (47.1% female, mean age 12.2 years), 83 (69.7%) had sarcopenia. Affected individuals had higher gamma-glutamyl transferase, higher glutamate pyruvate transaminase, higher high-sensitivity C-reactive protein, higher diastolic blood pressure, and lower muscular and cardiorespiratory fitness (each p < 0.05) compared to participants who were 'only' obese. No differences were found in other parameters. In our study, sarcopenic obesity was associated with various disorders in children and adolescents. However, the clinical value must be tested with larger samples and reference populations to develop a unique definition and appropriate methods in terms of identification but also related preventive or therapeutic approaches.

Long-term obesity is associated with depression and neuroinflammation.

OBJECTIVE: Obesity is characterized by a state of chronic, low-intensity systemic inflammation frequently associated with insulin resistance and dyslipidemia. METHODS: Given that chronic inflammation has been implicated in the pathogenesis of mood disorders, we investigated if chronic obesity that was initiated early in life - lasting through adulthood - could be more harmful to memory impairment and mood fluctuations such as depression. RESULTS: Here we show that pre-pubertal male rats (30 days old) treated with a high-fat diet (40%) for 8-months gained ~50% more weight when compared to controls, exhibited depression and anxiety-like behaviors but no memory impairment. The prefrontal cortex of the obese rats exhibited an increase in the expression of genes related to inflammatory response, such as NFKb, MMP9, CCl2, PPARb, and PPARg. There were no alterations in genes known to be related to depression. CONCLUSION: Long-lasting obesity with onset in prepuberal age led to depression and neuroinflammation but not to memory impairment.

Individual Physical Activity Behaviour and Group Composition as Determinants of the Effectiveness of a Childhood Obesity Intervention Program.

INTRODUCTION: Up to now, there is limited clarity on factors that determine the effectiveness of childhood obesity interventions. OBJECTIVE: This study intends to uncover individual- and program-level predictors of BMI-SDS and fitness to achieve significant, sustainable health improvements. METHODS: Data of 249 children with obesity or overweight who participated in an outpatient multidisciplinary program were analysed and compared to 54 waitlist controls. Linear regression models were used to examine associations between individual- and group-level variables and BMI-SDS and fitness. RESULTS: Among intervention children, BMI-SDS decreased by 0.19 units and physical fitness increased by 11.5%, versus a BMI-SDS decrease of 0.07 and a 1.8% decrease in fitness in the control group. Participants who reported being physically active before the program start achieved greater improvements in BMI-SDS (ß = -0.177, p < 0.05) and physical fitness (ß = 0.174, p < 0.05) than inactive peers. BMI-SDS decreased significantly more for members of gender-heterogeneous groups (ß = 0.194, p < 0.05) with a narrow age range (ß = 0.152, p < 0.05). CONCLUSIONS: The program under review is effective in counteracting juvenile obesity. The results give reason to believe that forming mixed-gender groups with a small age range and providing increased support for reportedly inactive children may improve program effectiveness.

Long-term obesity is associated with depression and neuroinflammation

ABSTRACT Objective: Obesity is characterized by a state of chronic, low-intensity systemic inflammation frequently associated with insulin resistance and dyslipidemia. Materials and methods: Given that chronic inflammation has been implicated in the pathogenesis of mood disorders, we investigated if chronic obesity that was initiated early in life - lasting through adulthood - could be more harmful to memory impairment and mood fluctuations such as depression. Results: Here we show that pre-pubertal male rats (30 days old) treated with a high-fat diet (40%) for 8-months gained ~50% more weight when compared to controls, exhibited depression and anxiety-like behaviors but no memory impairment. The prefrontal cortex of the obese rats exhibited an increase in the expression of genes related to inflammatory response, such as NFKb, MMP9, CCl2, PPARb, and PPARg. There were no alterations in genes known to be related to depression. Conclusion: Long-lasting obesity with onset in prepuberal age led to depression and neuroinflammation but not to memory impairment.

Increased coronary arteriolar contraction to serotonin in juvenile pigs with metabolic syndrome.

Metabolic syndrome (MetS) is associated with alterations in coronary vascular smooth muscle and endothelial function. The current study examined the contractile response of the isolated coronary arterioles to serotonin in pigs with and without MetS and investigated the signaling pathways responsible for serotonin-induced vasomotor tone. The MetS pigs (8-weeks old) were fed with a hyper-caloric, fat/cholesterol diet and the control animals (lean) were fed with a regular diet for 12 weeks (n = 6/group). The coronary arterioles (90-180 µm in diameter) were dissected from the harvested pig myocardial tissues and the in vitro coronary arteriolar response to serotonin was measured in the presence of pharmacological inhibitors. The protein expressions of phospholipase A2 (PLA2), TXA2 synthase, and the thromboxane-prostanoid (TP) receptor in the pigs' left ventricular tissue samples were measured using Western blotting. Serotonin (10-9-10-5 M) induced dose-dependent contractions of coronary-resistant arterioles in both non-MetS control (lean) and MetS pigs. This effect was more pronounced in the MetS vessels compared with those of non-MetS controls (lean, P < 0.05]. Serotonin-induced contraction of the MetS vessels was significantly inhibited in the presence of the selective PLA2 inhibitor quinacrine (10-6 M), the COX inhibitor indomethacin (10-5 M), and the TP receptor antagonist SQ29548 (10-6 M), respectively (P < 0.05). MetS exhibited significant increases in tissue levels of TXA2 synthase and TP receptors (P < 0.05 vs. lean), respectively. MetS is associated with increased contractile response of porcine coronary arterioles to serotonin, which is in part via upregulation/activation of PLA2, COX, and subsequent TXA2, suggesting that alteration of vasomotor function may occur at an early stage of MetS and juvenile obesity.

Microvascular insulin resistance in skeletal muscle and brain occurs early in the development of juvenile obesity in pigs.

Impaired microvascular insulin signaling may develop before overt indices of microvascular endothelial dysfunction and represent an early pathological feature of adolescent obesity. Using a translational porcine model of juvenile obesity, we tested the hypotheses that in the early stages of obesity development, impaired insulin signaling manifests in skeletal muscle (triceps), brain (prefrontal cortex), and corresponding vasculatures, and that depressed insulin-induced vasodilation is reversible with acute inhibition of protein kinase Cß (PKCß). Juvenile Ossabaw miniature swine (3.5 mo of age) were divided into two groups: lean control ( n = 6) and obese ( n = 6). Obesity was induced by feeding the animals a high-fat/high-fructose corn syrup/high-cholesterol diet for 10 wk. Juvenile obesity was characterized by excess body mass, hyperglycemia, physical inactivity (accelerometer), and marked lipid accumulation in the skeletal muscle, with no evidence of overt atherosclerotic lesions in athero-prone regions, such as the abdominal aorta. Endothelium-dependent (bradykinin) and -independent (sodium nitroprusside) vasomotor responses in the brachial and carotid arteries (wire myography), as well as in the skeletal muscle resistance and 2A pial arterioles (pressure myography) were unaltered, but insulin-induced microvascular vasodilation was impaired in the obese group. Blunted insulin-stimulated vasodilation, which was reversed with acute PKCß inhibition (LY333-531), occurred alongside decreased tissue perfusion, as well as reduced insulin-stimulated Akt signaling in the prefrontal cortex, but not the triceps. In the early stages of juvenile obesity development, the microvasculature and prefrontal cortex exhibit impaired insulin signaling. Such adaptations may underscore vascular and neurological derangements associated with juvenile obesity.

Sociocultural Influence on Obesity and Lifestyle in Children: A Study of Daily Activities, Leisure Time Behavior, Motor Skills, and Weight Status.

BACKGROUND: Juvenile overweight is increasing, and effective preventive measures are needed. After years of arbitrarily assigning these measures disregarding socioeconomic and/or cultural differences, it has become necessary to tailor interventions more specific to these target groups. Providing data for such an intervention is the objective of this study. METHODS: Influencing variables on children's weight status, motor skills and lifestyle have been analyzed among 997 first graders (53.2% male) involved in the Children's Health InterventionaL Trial (CHILT). RESULTS: Median age was 6.9 years; 7.3% were obese, 8.8% were overweight. Children with low socioeconomic status (SES) were more likely to be obese (p = 0.029). Low SES (p ˂ 0.001), migration background (p = 0.001) and low sports activity levels (p = 0.007) contributed most to an increased consumption of television. Migration background (p = 0.003) and male gender (p < 0.001) were the strongest factors in predicting a greater consumption of computer/video games. Children with higher SES (p = 0.02), lower BMI (p = 0.035), and males (p = 0.001) performed better in motor tests. CONCLUSION: Children with a low SES and migration background were more likely to exhibit unfavorable health behavior patterns, higher BMI scores, and poorer motor skills. Interventions should integrate motivational and targeting strategies and consider cultural and educational differences to address these vulnerable groups.

Metabolic Syndrome in Children and Adolescents.

BACKGROUND: Juvenile obesity is associated with multiple cardiometabolic comorbidities, which may culminate in the metabolic syndrome (MetS). METHODS: Based on a narrative review, the current knowledge of prevalence and the underlying metabolic principles regarding juvenile obesity and MetS are summarized to compile up-to-date information. In addition, the role of lifestyle as well as positive and negative influencing factors are focused on. RESULTS: The prevalence of MetS occurs between 1 and up to 23% in the total pediatric population and in up to 60% amongst the obese and overweight. It can be considered as the consequence of multiple processes in terms of lifestyle, perinatal programming, and (epi-)genetic pathways; however, the complex underlying mechanisms and their interplay are not completely understood. CONCLUSION: Besides preventive approaches, the growing number of obese children and youth as well as its consequences call for effective and lasting therapeutic measures.

[Case series: BMI long courses in patients with extreme juvenile obesity. Short- and long-term success of long-term inpatient treatment]. / Fallserie zu BMI-Langzeitverläufen bei Patienten mit extremer juveniler Adipositas : Kurz- und langfristige Erfolge einer stationären Langzeittherapie.

BACKGROUND: Extreme obesity in adolescents is considered largely resistant to therapy. The aim of this study was to demonstrate the short- and long-term BMI histories of patients who have successfully participated in an inpatient weight loss program, and to look for factors influencing the very good success. METHODS: For the case series 10 youths were selected, who participated in an inpatient weight reduction program for 6-12 months and who succeeded in reducing BMI for the short and for the long term. The inpatient weight reduction program was based on a lifestyle intervention. Information on BMI (kg/m(2)) per patient are available for time of baseline examination (T0, admission), final examination (T1, end of inpatient treatment) and follow-up (T2, 3-18 years after the beginning of the intervention). Socio-demographic data were collected within the first consultation (T0). RESULTS: Mean BMI was 41.9 kg/m(2) (BMI-SDS: 3.22) at time of admission. It clearly decreased under therapy and continued decreasing after the end of inpatient treatment. At time of follow-up (T2) 9 patients had a BMI < 30 kg/m(2) and were not any longer rated as obese, 4 patients had normal weight (BMI: 18.5-24.9 g/m(2)). The majority of patients had at least one normal-weight parent, all families had an average or high socioeconomic status (SES) and the majority of young people attended school for at least 10 years. Occurrence of binge eating before the inpatient treatment was rejected by two thirds of patients. CONCLUSIONS: The case series shows that there is a group of patients who have a clear and lasting decrease of BMI and thus benefit for the long term from an inpatient weight reduction program. In literature discussed predictors of long-term weight reduction such as normal weight of parents, high SES of parents and a high school education of the patients were observed in this selective group. In individual cases, a long-term inpatient therapy leading to lasting lifestyle changes should firstly be preferred to bariatric surgery.

Juvenile obesity aggravates disease severity in a rat model of atopic dermatitis.

PURPOSE: There is increasing epidemiological evidence of an association between childhood obesity and atopic dermatitis, but little is known about the underlying mechanism(s). In the present study, we used a rat model of atopic dermatitis to assess whether juvenile obesity, induced by reduction of litter size, aggravated the signs of atopic dermatitis and, if so, whether this aggravation was associated with changes in plasma concentration of adipokines, such as leptin and adiponectin. METHODS: Dermatitis was induced by neonatal capsaicin treatment. Body weight, dermatitis score, serum IgE, skin nerve growth factor (NGF), serum leptin and adiponectin, and cytokine mRNA expression in the skin lesion were compared between small (SL, 5 pups) and large litters (LL, 15 pups). RESULTS: The body weight of juvenile rats up to 6 weeks of age was significantly heavier in the SL group, compared with those in the LL group. The SL group showed more robust development of dermatitis, and higher levels of serum IgE and skin NGF than the LL group. Additionally, the SL group demonstrated higher levels of leptin and pro-inflammatory cytokine mRNA but lower levels of adiponectin than the LL group. CONCLUSIONS: These results suggest a causal link between a decrease in immunological tolerance, induced by juvenile obesity, and aggravation of atopic dermatitis.

Juvenile Obesity Aggravates Disease Severity in a Rat Model of Atopic Dermatitis

PURPOSE: There is increasing epidemiological evidence of an association between childhood obesity and atopic dermatitis, but little is known about the underlying mechanism(s). In the present study, we used a rat model of atopic dermatitis to assess whether juvenile obesity, induced by reduction of litter size, aggravated the signs of atopic dermatitis and, if so, whether this aggravation was associated with changes in plasma concentration of adipokines, such as leptin and adiponectin. METHODS: Dermatitis was induced by neonatal capsaicin treatment. Body weight, dermatitis score, serum IgE, skin nerve growth factor (NGF), serum leptin and adiponectin, and cytokine mRNA expression in the skin lesion were compared between small (SL, 5 pups) and large litters (LL, 15 pups). RESULTS: The body weight of juvenile rats up to 6 weeks of age was significantly heavier in the SL group, compared with those in the LL group. The SL group showed more robust development of dermatitis, and higher levels of serum IgE and skin NGF than the LL group. Additionally, the SL group demonstrated higher levels of leptin and pro-inflammatory cytokine mRNA but lower levels of adiponectin than the LL group. CONCLUSIONS: These results suggest a causal link between a decrease in immunological tolerance, induced by juvenile obesity, and aggravation of atopic dermatitis.

Moderate intensity physical activity prevents increased blood glucose concentrations, fat pad deposition and cardiac action potential prolongation following diet-induced obesity in a juvenile-adolescent rat model.

BACKGROUND: Both obesity and a lack of physical activity have been associated with an elevated risk of cardiovascular disease (CVD). The incidence of obesity is increasing, especially in juvenile-adolescents. While there is limited research examining the chronic effects of obesity in adolescent humans and animal models of this condition, little is also known concerning how moderate physical activity might prevent or attenuate secondary cardiovascular complications induced by obesity during adolescence. We investigated the effects of diet-induced obesity (consisting of a high-fat, high-carbohydrate diet (HFHC)) on biometric indices, vascular and airway function, cardiovascular function, systemic oxidative stress and markers of inflammation in a juvenile-adolescent rodent model. Four groups were used: control (CON), physical activity (PA) treated, HFHC and HFHC + PA (n = 16 per group). HFHC feeding started at 4 weeks of age for a period of 12 weeks. Physical activity treatment was initiated (PA and HFHC + PA groups) when the animals were 8 weeks of age, for 8 weeks. RESULTS: Physical activity in juvenile-adolescent healthy rats showed no change in comparison to the CON group in all experimental parameters except for increases in lipid peroxidation, decreases in inflammatory cytokines, improvements in vascular reactivity and decreased atrial responses to positive chronotropic agents. The HFHC animals were mildly hyperglycemic, hypertensive, displayed renal hypertrophy and showed increased retroperitoneal fat pad deposition compared to the CON group. HFHC + PA rats were also hypertensive, however showed improvements in cardiac electrophysiology, body weight, fat pad deposition and inflammatory signaling, in comparison to the HFHC fed rats and CON animals. CONCLUSION: In conclusion, in a juvenile-adolescent animal model of diet-induced obesity engagement in physical activity is beneficial in reducing the inflammatory effects of obesity.

El sobrepeso y la obesidad como un problema de salud / Overweight and obesity as an universal health problem

Se destaca al sobrepeso y obesidad como el principal condicionante actual de patología crónica no transmisible. Se identifican y discuten las principales comorbilidades asociadas al sobrepeso y obesidad, analizando las evidencias que las apoyan. Se destaca el rol de la adiposidad en la etiopatogenia del síndrome metabólico y en forma muy especial de la DM. Se analiza la asociación entre indicadores de masa corporal y tejido adiposo y tasas de mortalidad, destacando un significativo incremento de la mortalidad a medida que la masa corporal o grasa se incrementa. Se destacan los rangos asociados a la menor mortalidad, nadires que fundamentan los rangos de peso normal. Se discute en forma separada la asociación entre sobrepeso yobesidad en la infancia y adolescencia y salud, en especial su posible rol en la incidencia de patologías crónicas al alcanzar la adultez.

The article highlights overweight and obesity as the main factor in some current chronic diseases. Also it identifies and discusses major co-morbidities associated with overweight and obesity, analyzing the evidence that support them. The role of adiposity in the pathogenesis of metabolic syndrome especially in the development of mellitus diabetes 2 is discussed. We analyze the association between indicators of body mass and adipose tissue and mortality, highlighting a significant increase in mortality as the fat body mass increases and shows the range associated with lower mortality, basing the normal weight ranges. Will be discussing separately the association between overweight and obesity in childhood and adolescence health, especially its possible role in the incidence of chronic diseases that will develop at adulthood.