Factors associated with normal-weight obesity in adolescents.

A new phenotype of obesity has been studied: normal-weight obesity (NWO), which describes individuals with normal-weight by BMI and excess body fat. Despite normal-weight, individuals with NWO have a higher cardiometabolic risk. There is still a gap in the literature on the subject, especially in adolescents, as studies with this population are scarce. This study aims to investigate the sociodemographic factors, family history of chronic non-communicable diseases, body perception, lifestyle and food consumption associated with NWO in adolescents. This is a cross-sectional study, with 506 normal-weight adolescents aged 10­19 years, of both sexes. Weight and height were obtained, and BMI/age was calculated. Body fat analysis was performed using dual-energy X-ray absorptiometry. Sociodemographic data, level of physical activity, food consumption, body self-perception and lifestyle habits were also obtained. Logistic regression with hierarchical approach was used to analyse the associations. The odds of NWO are greater with age (OR = 1·14; 95 % CI = 1·04, 1·26), lower in male adolescents (OR = 0·21; 95 % CI = 0·11, 0·41) and higher in those with a history of familial dyslipidemia (OR = 1·81; 95 % CI = 1·01, 3·28). Adolescents satisfied with their body (OR = 0·30; 95 % CI 0·16, 0·56) and physically active (OR = 0·44; 95 % CI = 0·24, 0·81) have a lower odds of NWO, compared with the others. In addition, it was observed that the odds of NWO is greater among adolescents who use sweeteners (sugar substitutes) (OR = 3·84; 95 % CI = 1·70, 8·65). The factors associated with NWO were female sex, older age, positive family history of dyslipidemia, lower body satisfaction, lower level of physical activity and greater use of sweeteners.

Cardiometabolic risk in adolescents with normal weight obesity.

BACKGROUND: Normal weight obesity (NWO), which is defined by the excess of body fat in normal weight individuals, has been neglected among adolescents, due to their normal weight and young age. Few studies were carried out on the topic with adolescents. OBJECTIVE: To analyze whether the NWO is associated with cardiometabolic risk factors in adolescents. SUBJECTS/METHODS: Cross-sectional study, with 506 normal weight adolescents aged 10-19 years, selected in schools in Brazil. Weight, height, waist circumference (WC) and neck circumference were obtained and the body mass index (BMI) and waist/height ratio (WHR) were calculated. Body composition analysis was performed using dual-energy X-ray absorptiometry. The clinical evaluation included lipid and glycid profile, platelets, leukocytes, lymphocytes, monocytes, uric acid and blood pressure, as well as the presence of metabolic syndrome (MS) and its components. NWO was defined by the presence of normal weight, according to BMI for age, and excess body fat (≥25% and ≥30% in males and females, respectively). Logistic regression models were used to analyze associations between normal weight adolescents with and without the NWO phenotype. RESULTS: NWO associated positively with abdominal obesity, analyzed through WC (OR = 1.36;95%CI = 1.27-1.47), WHR (OR = 25.89;95%CI = 10.43-64.26) and android fat (OR = 1.49;95%CI = 1.36-1.63); insulin resistance (OR = 4.09;95%CI = 1.72-9.70), hyperinsulinemia (OR = 3.83;95%CI = 1.50-9.76) and the highest values of the triglycerides-glycemia index (OR = 4.28;95%CI = 1.21-15.08); uric acid (OR = 1.81;95%CI = 1.29-2.55), as well as the changes in LDL (OR = 3.39;95%CI = 1.47-7.81), total cholesterol (OR = 2.77;95%CI = 1.22-6.29), and in at least one (OR = 1.87;95%CI = 1.04-3.37) or two (OR = 6.61;95%CI = 1.45-30.19) components of MS. CONCLUSION: NWO is associated with the presence of cardiometabolic risk factors in adolescents.

Anthropometric and body composition parameters in adolescents with the metabolically obese normal-weight phenotype.

We aimed to investigate the anthropometric and body composition parameters associated with the metabolically obese normal-weight (MONW) phenotype. This cross-sectional study was conducted with 506 adolescents in Brazil (aged 10-19 y). The MONW phenotype was defined as normal-weight, according to BMI/age, and at least one metabolic alteration. Anthropometric measurements were obtained and the DEXA was used for body composition analysis. Crude and adjusted Poisson regression models with robust variance were used to estimate the associations. The phenotype was positively associated with waist circumference (male: prevalence ratio (PR) = 1·05; 95% CI 1·01, 1·09; female: PR = 1·06; 95% CI 1·02, 1·09), waist:height ratio (male: PR = 1·26; 95% CI 1·07, 1·49; female: PR = 1·29; 95% CI 1·07, 1·56) and android:gynoid fat ratio (male: PR = 1·25; 95% CI 1·03, 1·51; female: PR = 1·39; 95% CI 1·20, 1·62), in both sexes. Furthermore, there was a positive association of phenotype with waist:hip ratio (PR = 1·32; 95% CI 1·06, 1·65) and trunk:arm fat ratio (PR = 1·13; 95% CI 1·02, 1·24) only in males and with trunk:leg fat ratio (PR = 2·84; 95% CI 1·46, 5·53), BAIp (PR = 1·06; 95% CI 1·01, 1·12), fat mass index (PR = 1·24; 95% CI 1·10, 1·41) and regional indices of metabolic load and capacity (PR = 1·29; 95% CI 1·09, 1·53), in females. Anthropometric and body composition parameters indicative of central and total fat are associated with the MONW phenotype.

Visceral adiposity index is positively associated with blood pressure: A systematic review.

PURPOSE: This systematic review aimed to investigate the association between VAI and blood pressure. METHODS: The study was according to the PRISMA standards and the bibliographic search in the PubMed, EMBASE and Cochrane Library databases. RESULTS: This review included 32 articles, with 60,482 individuals - children to elderly people between 7 and 102 years old - of different age groups, most of them female (54.9%; n = 26,478). The year of publication ranged from 2010 to 2020, indicating that it is a recent theme, applied in almost all continents (America, Europe, Africa and Asia). The authors used data as continuous or into quantiles; blood pressure data also varied, with different cutoff points for the classification of arterial hypertension or continuously. The vast majority of studies have shown a positive association between VAI and blood pressure, both the sexes, in different age groups. The evaluation of the quality of the articles used by the Tool of the Joanna Briggs Institute according to their design. CONCLUSION: Individuals with increased VAI have higher blood pressure levels. Registration (PROSPERO: CRD42020205965).

Dietary inflammatory potential, cardiometabolic risk and inflammation in children and adolescents: a systematic review.

The Dietary Inflammatory Index (DII®) is a tool developed for quantifying the dietary inflammatory potential of individuals' diets, with the goal of assessing the effect of diet-associated inflammation on health outcomes. With most studies focusing on adults, little is known about the consequences for health of a more proinflammatory diet early in life. Hence, this study analyzed the available evidence on the association between the DII or the children's C-DII (C-DIITM) and cardiometabolic risk and inflammatory biomarkers in children and adolescents. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed at the LILACS, ScienceDirect, Cochrane and PubMed databases, without any restriction regarding the dates of the publications. A total of six observational studies qualified; including three cross-sectional and three longitudinal studies focused on children and adolescents between 3 and 18 years of age representing both sexes. All papers found a positive association between the DII or C-DII with cardiometabolic markers. These included adiposity (i.e., BMI, waist and hip circumference, waist-to-height ratio and fat mass index), and/or to inflammatory biomarkers (interleukins 1, 2 and 6, tumor necrosis factor-alpha, interferon gamma, and soluble vascular cell adhesion molecule-1). In conclusion, findings currently available in the literature indicate that a proinflammatory diet is associated with a higher risk of early development of cardiometabolic and inflammatory changes during childhood. Also, the findings show the applicability of the DII and C-DII in epidemiological studies and underscore the need for strategies to encourage healthy, anti-inflammatory diets to prevent chronical illnesses. Systematic Review Registration Number (PROSPERO: CRD42019123939).

Cardiometabolic risk and health behaviours in adolescents with normal-weight obesity: a systematic review.

OBJECTIVE: To analyse the presence of cardiometabolic risk factors in adolescents with normal-weight obesity (NWO), as well as to investigate health behaviours related to the phenotype. DESIGN: The study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and the bibliographic search was carried out in the PubMed, Scielo and ScienceDirect databases. SETTING: School, university and population. PARTICIPANTS: Adolescents between 10 and 19 years old. RESULTS: A total of eight papers were included. Most studies have found a relationship between NWO and the presence of cardiometabolic risk factors, such as high waist circumference, unfavourable lipid and glycid profile. As for health behaviours, three of the eight studies included evaluated eating habits; however, the results were not conclusive. In addition, four studies analysed the practice of physical activity or physical fitness, which was lower in NWO. CONCLUSIONS: The available evidence indicates that NWO is related to the early development of cardiometabolic changes, physical inactivity and less physical fitness in adolescents. The results also reveal the importance of early detection of the phenotype, as well as the need for further research on the associated factors to prevent future diseases. Registration (PROSPERO: CRD42020161204).