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1.
Int J Mol Sci ; 22(19)2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34639183

RESUMO

Glucocorticoids are the final products of the neuroendocrine hypothalamic-pituitary-adrenal axis, and play an important role in the stress response to re-establish homeostasis when it is threatened, or perceived as threatened. These steroid hormones have pleiotropic actions through binding to their cognate receptor, the human glucocorticoid receptor, which functions as a ligand-bound transcription factor inducing or repressing the expression of a large number of target genes. To achieve homeostasis, glucocorticoid signaling should have an optimal effect on all tissues. Indeed, any inappropriate glucocorticoid effect in terms of quantity or quality has been associated with pathologic conditions, which are characterized by short-term or long-lasting detrimental effects. Two such conditions, the primary generalized glucocorticoid resistance and hypersensitivity syndromes, are discussed in this review article. Undoubtedly, the tremendous progress of structural, molecular, and cellular biology, in association with the continued progress of biotechnology, has led to a better and more in-depth understanding of these rare endocrinologic conditions, as well as more effective therapeutic management.

2.
Nutrients ; 13(7)2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34371968

RESUMO

In recent decades, the prevalence of obesity has risen dramatically worldwide among all age groups. Obesity is characterized by excess fat accumulation and chronic low-grade inflammation. The adipose tissue functions as a metabolically active endocrine organ secreting adipokines. A novel duo of adipokines, the anti-inflammatory secreted frizzled-related protein 5 (Sfrp5) and the proinflammatory wingless type mouse mammary tumor virus (MMTV) integration site family member 5A (Wnt5a), signal via the non-canonical Wnt pathway. Recent evidence suggests that Sfpr5 and Wnt5a play a key role in the pathogenesis of obesity and its metabolic complications. This review summarizes the current knowledge on the novel regulatory system of anti-inflammatory Sfrp5 and pro-inflammatory Wnt5a, and their relation to obesity and obesity-related complications. Future studies are required to investigate the potential role of Sfrp5 and Wnt5a as biomarkers for monitoring the response to lifestyle interventions and for predicting the development of cardiometabolic risk factors. These adipokines may also serve as novel therapeutic targets for obesity-related disorders.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/fisiologia , Obesidade/etiologia , Proteína Wnt-5a/fisiologia , Tecido Adiposo/fisiopatologia , Adolescente , Adulto , Animais , Fatores de Risco Cardiometabólico , Criança , Dieta Saudável , Humanos , Inflamação/fisiopatologia , Resistência à Insulina , Estilo de Vida , Hepatopatia Gordurosa não Alcoólica , Obesidade/fisiopatologia , Obesidade/terapia
3.
Nutrients ; 13(8)2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34444842

RESUMO

Leucocyte telomere length (LTL) is a robust marker of biological aging and is associated with obesity and cardiometabolic risk factors in childhood and adolescence. We investigated the effect of a structured, comprehensive, multidisciplinary, personalized, lifestyle intervention program of healthy diet and physical exercise on LTL in 508 children and adolescents (239 males, 269 females; 282 prepubertal, 226 pubertal), aged 10.14 ± 0.13 years. Participants were classified as obese (n = 267, 52.6%), overweight (n = 174, 34.2%), or of normal BMI (n = 67, 13.2%) according to the International Obesity Task Force (IOTF) cutoff points and were studied prospectively for one year. We demonstrated that LTL increased significantly after 1 year of the lifestyle interventions, irrespective of gender, pubertal status, or body mass index (BMI). Waist circumference was the best negative predictor of LTL at initial assessment. The implementation of the lifestyle interventions also resulted in a significant improvement in clinical (BMI, BMI z-score and waist to height ratio) and body composition indices of obesity, inflammatory markers, hepatic enzymes, glycated hemoglobin (HbA1C), quantitative insulin sensitivity check index (QUICKI), and lipid profile in all participants. These findings indicate that the increased LTL may be associated with a more favorable metabolic profile and decreased morbidity later in life.


Assuntos
Envelhecimento/genética , Leucócitos/patologia , Obesidade Pediátrica/genética , Telômero/patologia , Programas de Redução de Peso/métodos , Adolescente , Terapia Comportamental/métodos , Composição Corporal , Índice de Massa Corporal , Criança , Exercício Físico/fisiologia , Feminino , Humanos , Estilo de Vida , Masculino , Obesidade Pediátrica/sangue , Obesidade Pediátrica/terapia , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Resultado do Tratamento , Circunferência da Cintura
4.
Nutrients ; 13(6)2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-34205537

RESUMO

In clinical practice, differences in glucocorticoid sensitivity among healthy subjects may influence the outcome and any adverse effects of glucocorticoid therapy. Thus, a fast and accurate methodology that could enable the classification of individuals based on their tissue glucocorticoid sensitivity would be of value. We investigated the usefulness of untargeted plasma metabolomics in identifying a panel of metabolites to distinguish glucocorticoid-resistant from glucocorticoid-sensitive healthy subjects who do not carry mutations in the human glucocorticoid receptor (NR3C1) gene. Applying a published methodology designed for the study of glucocorticoid sensitivity in healthy adults, 101 healthy subjects were ranked according to their tissue glucocorticoid sensitivity based on 8:00 a.m. serum cortisol concentrations following a very low-dose dexamethasone suppression test. Ten percent of the cohort, i.e., 11 participants, on each side of the ranking, with no NR3C1 mutations or polymorphisms, were selected, respectively, as the most glucocorticoid-sensitive and most glucocorticoid-resistant of the cohort to be analyzed and compared with untargeted blood plasma metabolomics using gas chromatography-mass spectrometry (GC-MS). The acquired metabolic profiles were evaluated using multivariate statistical analysis methods. Nineteen metabolites were identified with significantly lower abundance in the most sensitive compared to the most resistant group of the cohort, including fatty acids, sugar alcohols, and serine/threonine metabolism intermediates. These results, combined with a higher glucose, sorbitol, and lactate abundance, suggest a higher Cori cycle, polyol pathway, and inter-tissue one-carbon metabolism rate and a lower fat mobilization rate at the fasting state in the most sensitive compared to the most resistant group. In fact, this was the first study correlating tissue glucocorticoid sensitivity with serine/threonine metabolism. Overall, the observed metabolic signature in this cohort implies a worse cardiometabolic profile in the most glucocorticoid-sensitive compared to the most glucocorticoid-resistant healthy subjects. These findings offer a metabolic signature that distinguishes most glucocorticoid-sensitive from most glucocorticoid-resistant healthy subjects to be further validated in larger cohorts. Moreover, they support the correlation of tissue glucocorticoid sensitivity with insulin resistance and metabolic syndrome-associated pathways, further emphasizing the need for nutritionists and doctors to consider the tissue glucocorticoid sensitivity in dietary and exercise planning, particularly when these subjects are to be treated with glucocorticoids.


Assuntos
Dexametasona/farmacologia , Dieta , Glucocorticoides/farmacologia , Estilo de Vida Saudável , Metaboloma , Hormônio Adrenocorticotrópico/sangue , Adulto , Dexametasona/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Hidrocortisona/sangue , Masculino , Receptores de Glucocorticoides/genética , Adulto Jovem
5.
Front Endocrinol (Lausanne) ; 12: 672302, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34194393

RESUMO

Diabetes mellitus can independently contribute to cardiovascular disease and represents a severe risk factor for premature development of cardiovascular disease. A three-fold higher mortality than the general population has been observed in type 1 diabetes mellitus whereas a two- to four-fold increased probability to develop cardiovascular disease has been observed in type 2 diabetes mellitus. Cardiovascular magnetic resonance, a non-radiative modality, is superior to all other modalities in detecting myocardial infarction. The main cardiovascular magnetic resonance sequences used include a) balanced steady-state free precession (bSSFP) for function evaluation; b) T2-W for oedema detection; c) T1 W for ischemia detection during adenosine stress; and d) late gadolinium enhanced T1-W images (LGE), evaluated 15 min after injection of paramagnetic contrast agent gadolinium, which permit the diagnosis of replacement fibrosis, which appears white in the middle of suppressed, nulled myocardium. Although LGE is the technique of choice for diagnosis of replacement fibrosis, it cannot assess diffuse myocardial fibrosis. The application of T1 mapping (native or pre contrast and post contrast) allows identification of diffuse myocardial fibrosis, which is not detectable my other means. Native T1 and Contrast-enhanced T1 mapping are involved in the extracellular volume fraction (ECV) calculation. Recently, 1H-cardiovascular magnetic resonance spectroscopy has been applied to calculate the amount of myocardial triglycerides, but at the moment it is not part of the routine assessment of diabetes mellitus. The multifaceted nature of cardiovascular magnetic resonance has the great potential of concurrent evaluation of function and myocardial ischemia/fibrosis in the same examination and represents an indispensable tool for accurate diagnosis of cardiovascular disease in diabetes mellitus.

6.
Int J Mol Sci ; 22(11)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34073101

RESUMO

Stress is defined as a state of threatened or perceived as threatened homeostasis. The well-tuned coordination of the stress response system is necessary for an organism to respond to external or internal stressors and re-establish homeostasis. Glucocorticoid hormones are the main effectors of stress response and aberrant glucocorticoid signaling has been associated with an increased risk for psychiatric and mood disorders, including schizophrenia, post-traumatic stress disorder and depression. Emerging evidence suggests that life-stress experiences can alter the epigenetic landscape and impact the function of genes involved in the regulation of stress response. More importantly, epigenetic changes induced by stressors persist over time, leading to increased susceptibility for a number of stress-related disorders. In this review, we discuss the role of glucocorticoids in the regulation of stress response, the mechanism through which stressful experiences can become biologically embedded through epigenetic alterations, and we underline potential associations between epigenetic changes and the development of stress-related disorders.


Assuntos
Glucocorticoides/fisiologia , Receptores de Glucocorticoides/metabolismo , Transtornos de Estresse Pós-Traumáticos/metabolismo , Estresse Psicológico/metabolismo , Epigênese Genética , Humanos , Transdução de Sinais
7.
JMIR Mhealth Uhealth ; 9(7): e26290, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34048353

RESUMO

BACKGROUND: Obesity is a major public health problem globally and in Europe. The prevalence of childhood obesity is also soaring. Several parameters of the living environment are contributing to this increase, such as the density of fast food retailers, and thus, preventive health policies against childhood obesity must focus on the environment to which children are exposed. Currently, there are no systems in place to objectively measure the effect of living environment parameters on obesogenic behaviors and obesity. The H2020 project "BigO: Big Data Against Childhood Obesity" aims to tackle childhood obesity by creating new sources of evidence based on big data. OBJECTIVE: This paper introduces the Obesity Prevention dashboard (OPdashboard), implemented in the context of BigO, which offers an interactive data platform for the exploration of objective obesity-related behaviors and local environments based on the data recorded using the BigO mHealth (mobile health) app. METHODS: The OPdashboard, which can be accessed on the web, allows for (1) the real-time monitoring of children's obesogenic behaviors in a city area, (2) the extraction of associations between these behaviors and the local environment, and (3) the evaluation of interventions over time. More than 3700 children from 33 schools and 2 clinics in 5 European cities have been monitored using a custom-made mobile app created to extract behavioral patterns by capturing accelerometer and geolocation data. Online databases were assessed in order to obtain a description of the environment. The dashboard's functionality was evaluated during a focus group discussion with public health experts. RESULTS: The preliminary association outcomes in 2 European cities, namely Thessaloniki, Greece, and Stockholm, Sweden, indicated a correlation between children's eating and physical activity behaviors and the availability of food-related places or sports facilities close to schools. In addition, the OPdashboard was used to assess changes to children's physical activity levels as a result of the health policies implemented to decelerate the COVID-19 outbreak. The preliminary outcomes of the analysis revealed that in urban areas the decrease in physical activity was statistically significant, while a slight increase was observed in the suburbs. These findings indicate the importance of the availability of open spaces for behavioral change in children. Discussions with public health experts outlined the dashboard's potential to aid in a better understanding of the interplay between children's obesogenic behaviors and the environment, and improvements were suggested. CONCLUSIONS: Our analyses serve as an initial investigation using the OPdashboard. Additional factors must be incorporated in order to optimize its use and obtain a clearer understanding of the results. The unique big data that are available through the OPdashboard can lead to the implementation of models that are able to predict population behavior. The OPdashboard can be considered as a tool that will increase our understanding of the underlying factors in childhood obesity and inform the design of regional interventions both for prevention and treatment.


Assuntos
COVID-19 , Criança , Europa (Continente) , Grécia , Humanos , SARS-CoV-2 , Suécia
8.
Nutrients ; 13(3)2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33800142

RESUMO

Primary aldosteronism (PA), a condition characterized by autonomous aldosterone hypersecretion, constitutes the most common cause of secondary hypertension. Over the last decade, major breakthroughs have been made in the field of genetics underpinning PA. The advent and wide application of Next Generation Sequencing (NGS) technology led to the identification of several somatic and germline mutations associated with sporadic and familial forms of PA. Somatic mutations in ion-channel genes that participate in aldosterone biosynthesis, including KCNJ5, CACNA1D, ATP1A1, and ATP2B3, have been implicated in the development of aldosterone-producing adenomas (APAs). On the other hand, germline variants in CLCN2, KCNJ5, CACNA1H, and CACNA1D genes have been implicated in the pathogenesis of the familial forms of PA, FH-II, FH-III, and F-IV, as well as PA associated with seizures and neurological abnormalities. However, recent studies have shown that the prevalence of PA is higher than previously thought, indicating the need for an improvement of our diagnostic tools. Further research is required to recognize mild forms of PA and to investigate the underlying molecular mechanisms.


Assuntos
Aldosterona/biossíntese , Hiperaldosteronismo/genética , Mutação em Linhagem Germinativa , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Hipertensão/genética , Canais Iônicos/genética , Mutação
9.
Nutrients ; 13(3)2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33803093

RESUMO

Fast self-reported eating rate (SRER) has been associated with increased adiposity in children and adults. No studies have been conducted among high-school students, and SRER has not been validated vs. objective eating rate (OBER) in such populations. The objectives were to investigate (among high-school student populations) the association between OBER and BMI z-scores (BMIz), the validity of SRER vs. OBER, and potential differences in BMIz between SRER categories. Three studies were conducted. Study 1 included 116 Swedish students (mean ± SD age: 16.5 ± 0.8, 59% females) who were eating school lunch. Food intake and meal duration were objectively recorded, and OBER was calculated. Additionally, students provided SRER. Study 2 included students (n = 50, mean ± SD age: 16.7 ± 0.6, 58% females) from Study 1 who ate another objectively recorded school lunch. Study 3 included 1832 high-school students (mean ± SD age: 15.8 ± 0.9, 51% females) from Sweden (n = 748) and Greece (n = 1084) who provided SRER. In Study 1, students with BMIz ≥ 0 had faster OBER vs. students with BMIz < 0 (mean difference: +7.7 g/min or +27%, p = 0.012), while students with fast SRER had higher OBER vs. students with slow SRER (mean difference: +13.7 g/min or +56%, p = 0.001). However, there was "minimal" agreement between SRER and OBER categories (κ = 0.31, p < 0.001). In Study 2, OBER during lunch 1 had a "large" correlation with OBER during lunch 2 (r = 0.75, p < 0.001). In Study 3, fast SRER students had higher BMIz vs. slow SRER students (mean difference: 0.37, p < 0.001). Similar observations were found among both Swedish and Greek students. For the first time in high-school students, we confirm the association between fast eating and increased adiposity. Our validation analysis suggests that SRER could be used as a proxy for OBER in studies with large sample sizes on a group level. With smaller samples, OBER should be used instead. To assess eating rate on an individual level, OBER can be used while SRER should be avoided.


Assuntos
Índice de Massa Corporal , Inquéritos sobre Dietas/estatística & dados numéricos , Comportamento Alimentar , Autorrelato/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Fatores de Tempo , Adolescente , Peso Corporal , Estudos Transversais , Ingestão de Alimentos , Feminino , Grécia/epidemiologia , Humanos , Almoço , Masculino , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/etiologia , Reprodutibilidade dos Testes , Suécia/epidemiologia
10.
Nutrients ; 13(4)2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33924457

RESUMO

Overweight and obesity in childhood and adolescence represent major public health problems of our century, and account for increased morbidity and mortality in adult life. Irisin and Fibroblast Growth Factor 21 (FGF-21) have been proposed as prognostic and/or diagnostic biomarkers in subjects with obesity and metabolic syndrome, because they increase earlier than other traditional biomarkers. We determined the concentrations of Irisin and FGF-21 in children and adolescents with overweight and obesity before and after one year of a life-style intervention program of diet and physical exercise and explored the impact of body mass index (BMI) reduction on the concentrations of Irisin, FGF-21 and other cardiometabolic risk factors. Three hundred and ten (n = 310) children and adolescents (mean age ± SD: 10.5 ± 2.9 years) were studied prospectively. Following one year of the life-style intervention program, there was a significant decrease in BMI (p = 0.001), waist-to-hip ratio (p = 0.024), waist-to-height ratio (p = 0.024), and Irisin concentrations (p = 0.001), and an improvement in cardiometabolic risk factors. There was no alteration in FGF-21 concentrations. These findings indicate that Irisin concentrations decreased significantly as a result of BMI reduction in children and adolescents with overweight and obesity. Further studies are required to investigate the potential role of Irisin as a biomarker for monitoring the response to lifestyle interventions and for predicting the development of cardiometabolic risk factors.


Assuntos
Fatores de Crescimento de Fibroblastos/sangue , Fibronectinas/sangue , Estilo de Vida Saudável , Sobrepeso/diagnóstico , Obesidade Pediátrica/diagnóstico , Adolescente , Biomarcadores/sangue , Índice de Massa Corporal , Fatores de Risco Cardiometabólico , Criança , Pré-Escolar , Terapia Combinada/métodos , Terapia por Exercício , Comportamento Alimentar , Feminino , Seguimentos , Humanos , Masculino , Sobrepeso/sangue , Sobrepeso/complicações , Sobrepeso/terapia , Obesidade Pediátrica/sangue , Obesidade Pediátrica/complicações , Obesidade Pediátrica/terapia , Medição de Risco/métodos , Resultado do Tratamento , Perda de Peso
11.
Nutrients ; 13(3)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652678

RESUMO

Obesity represents one of the most challenging public health problems of our century. It accounts for approximately 5% of deaths worldwide, mostly owing to cardiovascular disease and its associated complications. Cardiovascular noninvasive imaging may provide early accurate information about hypertrophy and ischemia/fibrosis in obese subjects. Echocardiography and nuclear cardiology have serious limitations in obese subjects owing to poor acoustic window and attenuation artifacts, respectively. Coronary computed tomography angiography can provide information about obstructive coronary disease; however, the use of radiation is a serious disadvantage. Finally, cardiac magnetic resonance (CMR) holds the promise of an "all in one" examination by combining evaluation of function, wall motion/thickness, stress rest/perfusion, replacement and diffuse fibrosis without radiation. Future studies are required to document the cost/benefit ratio of the CMR in the evaluation of cardiovascular risk in overweight/obese children and adolescents.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Doenças Cardiovasculares/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Obesidade Pediátrica/diagnóstico por imagem , Adolescente , Adulto , Doenças Cardiovasculares/etiologia , Criança , Angiografia Coronária/métodos , Ecocardiografia/métodos , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade Pediátrica/complicações , Medição de Risco/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
12.
Nutrients ; 13(2)2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33546219

RESUMO

Obesity is often associated with cognitive and mood disorders. Recent evidence suggests that obesity may cause hypothalamic inflammation. Our aim was to investigate the hypothesis that there is a causal link between obesity-induced hypothalamic inflammation and cognitive and mood disorders. Inflammation may influence hypothalamic inter-connections with regions important for cognition and mood, while it may cause dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis and influence monoaminergic systems. Exercise, healthy diet, and glucagon-like peptide receptor agonists, which can reduce hypothalamic inflammation in obese models, could improve the deleterious effects on cognition and mood.


Assuntos
Transtornos Cognitivos/etiologia , Dieta/efeitos adversos , Doenças Hipotalâmicas/complicações , Inflamação/complicações , Transtornos do Humor/etiologia , Obesidade/complicações , Animais , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/prevenção & controle , Dieta Saudável , Exercício Físico , Receptores de Peptídeos Semelhantes ao Glucagon/agonistas , Humanos , Doenças Hipotalâmicas/terapia , Sistema Hipotálamo-Hipofisário/fisiopatologia , Inflamação/terapia , Transtornos do Humor/fisiopatologia , Transtornos do Humor/prevenção & controle , Obesidade/etiologia , Sistema Hipófise-Suprarrenal/fisiopatologia
13.
Endocrine ; 71(3): 653-662, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33512658

RESUMO

This article aims to provide guidance on prevention and treatment of COVID-19 in patients with genetic obesity. Key principals of the management of patients with genetic obesity during COVID-19 pandemic for patients that have contracted COVID-19 are to be aware of: possible adrenal insufficiency (e.g., POMC deficiency, PWS); a more severe course in patients with concomitant immunodeficiency (e.g., LEP and LEPR deficiency), although defective leptin signalling could also be protective against the pro-inflammatory phenotype of COVID-19; disease severity being masked by insufficient awareness of symptoms in syndromic obesity patients with intellectual deficit (in particular PWS); to adjust medication dose to increased body size, preferably use dosing in m2; the high risk of malnutrition in patients with Sars-Cov2 infection, even in case of obesity. Key principals of the obesity management during the pandemic are to strive for optimal obesity management and a healthy lifestyle within the possibilities of the regulations to prevent weight (re)gain and to address anxiety within consultations, since prevalence of anxiety for COVID-19 is underestimated.


Assuntos
COVID-19 , Gerenciamento Clínico , Obesidade/terapia , Pandemias , Ansiedade , Estilo de Vida Saudável , Humanos , Obesidade/epidemiologia , Obesidade/genética
14.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5296-5299, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019179

RESUMO

Obesity is currently affecting very large portions of the global population. Effective prevention and treatment starts at the early age and requires objective knowledge of population-level behavior on the region/neighborhood scale. To this end, we present a system for extracting and collecting behavioral information on the individual-level objectively and automatically. The behavioral information is related to physical activity, types of visited places, and transportation mode used between them. The system employs indicator-extraction algorithms from the literature which we evaluate on publicly available datasets. The system has been developed and integrated in the context of the EU-funded BigO project that aims at preventing obesity in young populations.


Assuntos
Exercício Físico , Obesidade , Humanos , Obesidade/epidemiologia , Características de Residência
15.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5864-5867, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019308

RESUMO

Obesity is a complex disease and its prevalence depends on multiple factors related to the local socioeconomic, cultural and urban context of individuals. Many obesity prevention strategies and policies, however, are horizontal measures that do not depend on context-specific evidence. In this paper we present an overview of BigO (http://bigoprogram.eu), a system designed to collect objective behavioral data from children and adolescent populations as well as their environment in order to support public health authorities in formulating effective, context-specific policies and interventions addressing childhood obesity. We present an overview of the data acquisition, indicator extraction, data exploration and analysis components of the BigO system, as well as an account of its preliminary pilot application in 33 schools and 2 clinics in four European countries, involving over 4,200 participants.


Assuntos
Obesidade Pediátrica , Saúde Pública , Adolescente , Criança , Europa (Continente) , Humanos , Obesidade Pediátrica/epidemiologia , Instituições Acadêmicas
16.
J Pediatr Endocrinol Metab ; 33(12): 1577-1588, 2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33035189

RESUMO

OBJECTIVES: Idiopathic short stature (ISS) is a recognized, albeit a controversial indication for treatment with recombinant human growth hormone (rhGH).The objective of the present study was to conduct a systematic review of the literature and meta-analyses of selected studies about the use of rhGH in children with ISS on linear growth and adult height (AH). METHODS: A systematic literature search was conducted to identify relevant studies published till February 28, 2017 in the following databases: Medline (PubMed), Scopus and Cochrane Central Registry of Controlled Trials. After exclusion of duplicate studies, 3,609 studies were initially identified. Of those, 3,497 studies were excluded during the process of assessing the title and/or the abstract. The remaining 112 studies were evaluated further by assessing the full text; 21 of them fulfilled all the criteria in order to be included in the current meta-analysis. RESULTS: Children who received rhGH had significantly higher height increment at the end of the first year, an effect that persisted in the second year of treatment and achieved significantly higher AH than the control group. The difference between the two groups was equal to 5.3 cm (95% CI: 3.4-7 cm) for male and 4.7 cm (95% CI: 3.1-6.3 cm) for female patients. CONCLUSION: In children with ISS, treatment with rhGH improves short-term linear growth and increases AH compared with control subjects. However, the final decision should be made on an individual basis, following detailed diagnostic evaluation and careful consideration of both risks and benefits of rhGH administration.

17.
Nutrients ; 12(9)2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32961973

RESUMO

Obesity in childhood and adolescence represents one of the most challenging public health problems of the 21st century owing to its epidemic proportions worldwide and the associated significant morbidity, mortality and public health costs. In Greece, the prevalence of overweight and obesity in childhood and adolescence exceeds 30-35%. To address the increasing prevalence of overweight and obesity in children and adolescents in our country, we developed the 'National e-Health Program for the Prevention and Management of Overweight and Obesity in Childhood and Adolescence', which provides specific and detailed guidance to all primary health care physicians about the personalized management of children and adolescents with overweight or obesity. In the present study we evaluated 2400 children and adolescents [mean age ± SEM: 10.10 ± 0.09 years.; Males: 1088, Females: 1312; Obesity (n = 1370, 57.1%), Overweight (n = 674, 28.1%), normal BMI (n = 356, 14.8%)], who followed the personalized multi-disciplinary management plan specified by the 'National e-Health Program for the Prevention and Management of Overweight and Obesity in Childhood and Adolescence', and were studied prospectively for 1 year. We demonstrated that at the end of the first year, the prevalence of obesity decreased by 32.1%, the prevalence of overweight decreased by 26.7%, and the cardiometabolic risk factors improved significantly. These findings indicate that our National e-Health Program is effective at reducing the prevalence of overweight and obesity in childhood and adolescence after one year of intervention in the largest sample size reported to date.


Assuntos
Obesidade Pediátrica/prevenção & controle , Telemedicina , Adolescente , Índice de Massa Corporal , Peso Corporal , Criança , Pré-Escolar , Feminino , Humanos , Masculino
18.
Horm Res Paediatr ; 93(2): 94-107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32580197

RESUMO

BACKGROUND: Obesity in childhood and adolescence represents a major health problem of our century. In Greece, 30-35% of children and adolescents are overweight or obese. Objective and Hypotheses: To investigate the effectiveness of a comprehensive multidisciplinary personalized management plan at reducing the prevalence of overweight and obesity in childhood and adolescence. PATIENTS AND METHODS: One thousand (n = 1,000) children and adolescents aged 2-18 years (mean age ± SD: 10.09 ± 2.86 years; 520 females, 480 males) were studied prospectively. Subjects were classified as obese (n = 579, 57.9%), overweight (n = 295, 29.5%) or having a normal body mass index (BMI) (n = 126, 12.6%) according to the International Obesity Task Force cutoff points. All subjects were evaluated by a multidisciplinary team at frequent intervals, received personalized advice on diet and exercise and were studied prospectively for 1 year. Detailed clinical evaluation and laboratory investigations were performed at the beginning and at the end of the study. RESULTS: At initial evaluation, 57.9% of subjects were obese, 29.5% overweight and 12.6% of normal BMI. Indices of cardiometabolic disease were higher in obese than in overweight and normal-BMI subjects. Following 1 year of multidisciplinary management interventions, the prevalence of obesity decreased by 16.8%, the prevalence of normal BMI increased by 8.2%, and all cardiometabolic indices improved significantly. CONCLUSIONS: A personalized multidisciplinary management plan is effective at reducing the prevalence of obesity in childhood and adolescence.

19.
Nutrients ; 12(5)2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32408523

RESUMO

Obesity in childhood and adolescence represents a major health problem. Novel e-Health technologies have been developed in order to provide a comprehensive and personalized plan of action for the prevention and management of overweight and obesity in childhood and adolescence. We used information and communication technologies to develop a "National Registry for the Prevention and Management of Overweight and Obesity" in order to register online children and adolescents nationwide, and to guide pediatricians and general practitioners regarding the management of overweight or obese subjects. Furthermore, intelligent multi-level information systems and specialized artificial intelligence algorithms are being developed with a view to offering precision and personalized medical management to obese or overweight subjects. Moreover, the Big Data against Childhood Obesity platform records behavioral data objectively by using inertial sensors and Global Positioning System (GPS) and combines them with data of the environment, in order to assess the full contextual framework that is associated with increased body mass index (BMI). Finally, a computerized decision-support tool was developed to assist pediatric health care professionals in delivering personalized nutrition and lifestyle optimization advice to overweight or obese children and their families. These e-Health applications are expected to play an important role in the management of overweight and obesity in childhood and adolescence.


Assuntos
Técnicas de Apoio para a Decisão , Aplicativos Móveis , Obesidade Pediátrica , Medicina de Precisão/métodos , Telemedicina/métodos , Adolescente , Fatores de Risco Cardiometabólico , Criança , Feminino , Medicina Geral/métodos , Grécia , Humanos , Masculino , Pediatria/métodos
20.
Horm Res Paediatr ; 92(4): 229-236, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851969

RESUMO

INTRODUCTION: Obesity in childhood and adolescence is associated with complications that resemble those seen in hypercortisolism. Hair cortisol concentration (HCC) in children is a reliable marker of long-term endogenous cortisol concentrations. We determined HCC in overweight and obese children and adolescents, and examined the relation between HCC and other cardiometabolic parameters. METHODS: Three hundred children and adolescents aged 4-18 years (mean age ± standard error of the mean [SEM]: 10.49 ± 0.15 years; 140 [46.7%] obese, 94 [31.3%] overweight, 66 [22%] of normal BMI; 76 males, 224 females) were studied prospectively. Blood samples for determination of hematological, biochemical, and endocrinologic parameters were obtained. Systolic (SBP) and diastolic blood pressure (DBP) was determined. Scalp hair samples were collected from the posterior vertex, and HCC was measured using an electrochemiluminescence immunoassay. RESULTS: Obese subjects had significantly higher SBP, DBP, waist and hip circumferences, waist-to-hip ratio, waist-to-height ratio, ALT, γ-GT, triglycerides, apolipoprotein-B, insulin, and HbA1C concentrations than overweight and normal-BMI subjects. HCC did not differ significantly among the three groups of subjects (mean ± SEM: 8.74 ± 0.43 vs. 8.88 ± 0.52 vs. 9.33 ± 0.72, all p > 0.05). No significant association was noted between HCC and cardiometabolic or body composition parameters. HCC was significantly higher in prepubertal girls than prepubertal boys (9.45 ± 0.38 vs. 7.35 ± 0.39, p = 0.007). CONCLUSION: In our study, overweight and obesity was not associated with elevated HCC. Furthermore, no association was found between HCC with cardiometabolic parameters and fat mass. Further studies are required to delineate the association between overweight/obesity and HCC.


Assuntos
Cabelo/química , Hidrocortisona/análise , Sobrepeso/fisiopatologia , Obesidade Pediátrica/fisiopatologia , Adolescente , Pressão Sanguínea/fisiologia , Composição Corporal/fisiologia , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Humanos , Masculino
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