Emerging pathomechanisms involved in obesity.

OBJECTIVE: Overweight/obesity prevalence has increased dramatically worldwide. Recent evidence suggests sleep deprivation/fragmentation, fructose-exceedingly rich diets, and exposure to endocrine disruptors (eg, bisphenol A, BPA) as emerging additional factors involved in pathomechanisms and in the treatment resistance of obesity and its complications. Our study focuses on these factors for further preventive/therapeutic approaches in paediatric obesity. METHODS: Fifty-four Italian children (cases: n = 31 overweight/obese; controls: n = 23 normal weight) were clinically/anthropometrically characterised. Parents completed questionnaires on the relation between obesogenic factors and childhood obesity. BPA was measured by gas chromatography/tandem mass spectrometry on early morning urine samples. Correlations between the continuous variables were analysed using Spearman rank correlation. RESULTS: Sleep deprivation/fragmentation, nocturnal breathing problems, and daytime sleepiness increased with increasing body mass index, correlating with the presence of clinical markers of metabolic syndrome (eg, acanthosis nigricans). Frequency of sugar-enriched drink consumption and the amount of fructose per portion and/or per week increased, paralleling the ponderal excess and all the other anthropometric parameters. In the entire sample population, free and total BPA levels increased paralleling the body mass index increase (r > 0.8), whereas the conjugate demonstrated the opposite trend. The re-use of disposable plastic showed a positive correlation with urinary BPA levels. CONCLUSIONS: Despite its exploratory nature, the results of our pilot study confirm the close relation between certain factors and paediatric obesity, underscoring their role as emerging targets for prevention and therapy.

Perceived difficulty with physical tasks, lifestyle, and physical performance in obese children.

We estimated perceived difficulty with physical tasks, lifestyle, and physical performance in 382 children and adolescents (163 obese, 54 overweight, and 165 normal-weight subjects) and the relationship between perceived physical difficulties and sports participation, sedentary behaviors, or physical performance. Perceived difficulty with physical tasks and lifestyle habits was assessed by interview using a structured questionnaire, while physical performance was assessed through the six-minute walking test (6 MWT). Obese children had higher perceived difficulty with several activities of daily living, were less engaged in sports, and had lower physical performance than normal-weight or overweight children; on the contrary, they did not differ with regard to time spent in sedentary behaviors. Perceived difficulty in running and hopping negatively predicted sports participation (P < 0.05 and <0.01, resp.), while perceived difficulty in almost all physical activities negatively predicted the 6 MWT, independently of BMI (P < 0.01). Our results indicate that perception of task's difficulty level may reflect an actual difficulty in obese children. These findings may have practical implications for approaching physical activity in obese children. Exploring both the perception of a task's difficulty level and physical performance may be useful to design exercise programs that allow safe and successful participation.

Determinants of weight gain in children from 7 to 10 years.

BACKGROUND AND AIM: To determine the influence of the family risk factors (parental weight, socioeconomic status and cultural level) on the distribution of overweight or obesity in prepubertal children and the dynamics of their weight gain. METHODS AND RESULTS: Three hundred forty-one children (183 boys) attending the second grade of primary school (age 7.4+/-0.5 years) were enrolled in a longitudinal study in Southern Italy. Overweight and obesity status were defined by a body mass index (BMI) above the percentile having respectively the value of 25 and 30 kg/m(2) at 18 years, according to national reference data; overweight extent was expressed as BMI standard deviation score (BMI-SDS). Information about BMI and socioeconomic conditions (occupation and educational level) of parents were collected. Distribution of overweight and obese schoolchildren and variations of BMI-SDS were evaluated over a 3-year period; relationships with family risk factors were also sought. The distribution of overweight/obese children at baseline was high (40%). Tracking rates of overweight and obesity were 73% and 80%, respectively. The higher the BMI-SDS at 7 years, the higher the BMI-SDS at 10 years (r 0.86, P=0.0001). The highest BMI value and the highest distribution of overweight/obese children were observed in subjects with the highest amount of family risk factors. Children exhibiting accelerated weight gain (delta BM I>1/year) showed higher male/female ratio, higher baseline BMI values, higher maternal BMI values, lower maternal educational level and a dramatic increase in the percentage of overweight/obese children than children with normal weight gain. CONCLUSIONS: Children who are overweight/obese at 7 years tend to maintain this condition during prepubertal age. Paediatricians should be alerted when dealing with a child showing a BMI increase above than 1U/year during primary school. Targeted intervention should be directed at young children with overweight parents and low socio-cultural level.