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1.
J Biol Regul Homeost Agents ; 33(5 Suppl. 1): 79-85, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31630719

RESUMO

Obesity in children has been recognized as a major underlying factor of the pathogenesis of several diseases and a reduced life expectancy. This study aims to verify if clinical parameters, such as waist circumference and/or body mass index and biohumoral and inflammatory parameters can help predict cardiac structural and functional alterations, through an echocardiogram test in obese children and adolescents. Children were prospectively enrolled at the AUOC outpatients' department of Emergency Paediatrics, University Hospital, Messina, from June to December 2017. Clinical, metabolic parameters and an inflammation marker (HMGB1) were evaluated and a transthoracic echocardiogram was carried out. Twenty-two obese subjects were prospectively enrolled.HMGB1 values were 12.6 ± 2ng/ml, significantly higher compared to a previously studied healthy control group. A significant positive correlation was found both between total cholesterol levels and HMGB1 values (r=0.846, p=0.000) and between LDL cholesterol and HMBG1 values (r=0.663, p=0.001). No correlation was found between clinical, biohumoral and echocardiograph parameters. In obese children cardiac parameters obtained from echocardiogram tests may be in the normal range. However, other parameters may be altered in the early phase, showing that infantile obesity can compromise myocardial functions, even in the absence of comorbidities. Furthermore, the evaluation of concentrations of HMBG1 could explain how an initial inflammation can trigger the condition of meta-inflammation.


Assuntos
Cardiopatias/complicações , Obesidade Pediátrica/complicações , Adolescente , Índice de Massa Corporal , Criança , LDL-Colesterol/sangue , Proteína HMGB1/sangue , Humanos , Dados Preliminares , Estudos Prospectivos , Circunferência da Cintura
2.
Medicine (Baltimore) ; 98(38): e17274, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568007

RESUMO

BACKGROUND: Weight status and autism spectrum disorder (ASD) are rising public health concerns. An increasing number of reports indicate that individuals with ASD may have unhealthy weight status, but the evidence is mixed. To understand the weight status in individuals with ASD and provide strategies for prevention and intervention, we describe the protocol for a systematic review and meta-analysis aimed at assessing the prevalence of obesity, overweight, and underweight in ASD. METHODS: A broad range of key bibliographic databases including MEDLINE (PubMed), Embase, Cochrane, and ISI Web of Science will be searched to identify studies reporting the prevalence of obesity, overweight, and underweight in patients with ASD. Retrieved records will be independently screened by 2 authors and relevant estimates will be extracted from studies reporting data on obesity, overweight, and underweight prevalence among individuals with ASD. The assessment of study quality will be conducted primarily using the Newcastle-Ottawa scale and checklist proposed by the Joanna Briggs Institute. Prevalence estimates of obesity and overweight will be separately pooled using random-effects model. The pooled estimates will be summarized and presented by regional groupings. Subgroup analysis will be conducted for variables (such as study setting, participants' age, and geographical region) across studies, depending on data availability. Between-study heterogeneity will be assessed using the I statistic and explored through subgroup analyses. This systematic review and meta-analysis will be reported following the preferred reporting items for systematic reviews and meta-analyses checklist and the meta-analysis of observational studies in epidemiology statements guidelines for meta-analysis and systematic reviews of observational studies. RESULTS: In this study, we will outline details of the aims and methods on the meta-analysis of weight status of individuals with ASD. CONCLUSION: The results of this study will summarize the current data of weight status of individuals with ASD. REGISTRATION: PROSPERO-National Institute of Health Research (NIHR) Prospective Register of Systematic Reviews (CRD42019130790).


Assuntos
Transtorno do Espectro Autista/complicações , Peso Corporal , Criança , Humanos , Obesidade/complicações , Obesidade/psicologia , Sobrepeso/complicações , Sobrepeso/psicologia , Obesidade Pediátrica/complicações , Obesidade Pediátrica/psicologia , Magreza/complicações , Magreza/psicologia
3.
Nutr. hosp ; 36(5): 1055-1060, sept.-oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184626

RESUMO

Introducción: el sobrepeso y la obesidad alcanzan una alta prevalencia desde la infancia en España. Objetivo: describir el efecto del sobrepeso y la obesidad en niños escolares de once años de edad, en pruebas que valoran la fuerza, tanto de las extremidades inferiores como de las superiores, así como la velocidad. Método: participaron en el estudio 423 escolares de once años de edad. Se obtuvieron características básicas antropométricas y desarrollaron diversos test de la batería EUROFIT. Resultados: los niños y niñas que se encuentran en normopeso poseen mejores puntuaciones en las pruebas de condición física en general. De este modo, los saltos verticales y horizontales, suspensión en barra y abdominales son superiores en los participantes con normopeso (p < 0,05). Además, recorren en menos tiempo un circuito de velocidad en ambos sexos (p < 0,001); sin embargo, en la fuerza isométrica manual, en el grupo de niñas poseen mejores resultados aquellas que se encuentran en sobrepeso u obesidad (p < 0,01). Conclusiones: los niños de once años con sobrepeso y obesidad muestran una menor prestación muscular, salvo en el caso de la fuerza isométrica manual. También se han determinado diversas ecuaciones de predicción de resultados de las pruebas físicas llevadas a cabo, como saltos, dinamometría y velocidad, a través del sexo e índice de masa corporal (IMC)


Introduction: overweight and obesity reach a high prevalence since childhood in Spain. Objective: to describe the effect of overweight and obesity, in schoolchildren of eleven years of age, in tests that assess the strength of both the lower and upper extremities, as well as speed. Method: four hundred and twenty-three schoolchildren of eleven years of age participated in the study. Basic anthropometric characteristics were obtained and several tests of the EUROFIT battery were developed. Results: normal-weight boys and girls had better scores in physical condition tests in general. Therefore, the vertical and horizontal jumps, bar suspension and abdominals were higher in the participants with normal-weight (p < 0.05). In addition, they performed in less time a speed circuit in both sexes (p < 0.001); however, in relation to the manual isometric strength, in the group of girls those who are overweight or obese have better results (p < 0.01). Conclusions: overweight and obese children of eleven year-olds showed a lower muscular performance, except in the case of manual isometric strength. Several equations haven been also determined for predicting the results of physical tests carried out such as jumps, dynamometry and speed, through sex and body mass index (BMI)


Assuntos
Humanos , Masculino , Feminino , Criança , Obesidade Pediátrica/epidemiologia , Sobrepeso/epidemiologia , Força Muscular/fisiologia , Dinamômetro de Força Muscular , Obesidade Pediátrica/complicações , Sobrepeso/complicações , Índice de Massa Corporal , Análise de Classes Latentes
5.
J Laparoendosc Adv Surg Tech A ; 29(10): 1285-1291, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31464567

RESUMO

Background: Operative maneuvers to increase mesenteric length during ileal pouch-anal anastomosis (IPAA) are frequently utilized in adults, but limited data exist on the need for their use in children. Materials and Methods: A retrospective chart review of children (age <18) considered for IPAA creation at two affiliated tertiary referral centers from 2007 to 2017 was conducted, and patient factors, operative details, and 30-day postoperative complications were abstracted. Body mass index (BMI) was normalized to BMI percentile-for-age-and-sex and classified as underweight (BMI <5th percentile), healthy weight (5th ≤ BMI percentile <85th), or overweight/obese (BMI ≥85th percentile). Maneuvers were identified from operative notes. Univariate analysis and multivariable logistic regression were performed to determine independent factors associated with the use of maneuvers. Results: A total of 94 patients underwent attempt at IPAA creation, which was successful in 91 (97%). Fourteen (15%) of 91 patients were classified as overweight or obese. The 3 failures occurred secondary to inability to reach in 3 patients, with specific mention of patients' obesity in 2 and pouch ischemia in 1. Sixty (66%) patients required maneuvers to lengthen the mesentery. Overweight/obese patients required maneuvers more often than nonoverweight/obese patients (93% versus 61%, P = .03). There were no differences in 30-day maximum Clavien-Dindo scores between patients with and without maneuvers performed (P = .83). Being overweight/obese was an independent risk factor for requiring maneuvers (odds ratio: 9.3, 95% confidence interval: 1.1-82.8) after adjusting for age, sex, height, operative stage, and surgeon. Conclusion: Surgeons should be prepared to perform mesenteric lengthening maneuvers when operating on pediatric patients to ensure minimal tension on the IPAA, and more so when operating on obese children. Whether these maneuvers have an impact on long-term pouch function is undetermined.


Assuntos
Polipose Adenomatosa do Colo/cirurgia , Colite/cirurgia , Mesentério/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Proctocolectomia Restauradora/métodos , Polipose Adenomatosa do Colo/complicações , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Colite/complicações , Feminino , Florida , Humanos , Lactente , Modelos Logísticos , Masculino , Minnesota , Obesidade Pediátrica/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
7.
J Pediatr Orthop ; 39(7): 347-352, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31305377

RESUMO

BACKGROUND: Obesity as a cause of lower extremity deformity in children has been well established. This deformity is most often seen as tibia vara, however, at our institution we have observed more obese children and adolescents over age 7 years with excessive or progressive idiopathic genu valgum. Our hypothesis is that children with idiopathic genu valgum have high rates of obesity which impact the severity of their disease. METHODS: Retrospective review of existing data was performed on 66 consecutive children/112 limbs over age 7 years with idiopathic genu valgum, seen from 2010 to 2013. Children with known metabolic or skeletal disease were excluded. Genu valgum was defined as mechanical axis in zone II or III and mechanical tibiofemoral angle ≥4 degrees on standing anteroposterior radiograph of the lower extremities. Body mass index (BMI) was calculated and classified by Center for Disease Control percentiles. Skeletal maturation was rated by closure of pelvic and peri-genu physes. Severity of genu valgum was also assessed by femoral and tibial mechanical axes and the mechanical axis deviation. RESULTS: Mean patient age was 12.2±2.2 years. 47% of patients had BMI≥30 and 71% were categorized as obese (>95th percentile). No sex differences were identified. Skeletal maturation explained 25% of the variance in the mechanical axis deviation and 22% of the mechanical tibiofemoral angle. BMI predicted 9.8% of the tibial valgus. Because of its skewed distribution, BMI percentile was a less useful parameter for assessment. CONCLUSIONS: The 71% obesity rate found in our children with idiopathic genu valgum is significantly higher than the normal population. Higher BMI is associated with more tibial valgum but skeletal maturation was the main predictor of overall valgus severity. This suggests that obesity may play a role in the etiology of idiopathic genu valgum which progresses with skeletal maturation, thereby increasing the risk of osteoarthritis in adulthood. LEVEL OF EVIDENCE: Level III.


Assuntos
Geno Valgo/etiologia , Obesidade Pediátrica/complicações , Adolescente , Índice de Massa Corporal , Doenças do Desenvolvimento Ósseo , Criança , Feminino , Fêmur , Geno Valgo/diagnóstico por imagem , Lâmina de Crescimento , Humanos , Joelho , Articulação do Joelho , Extremidade Inferior/diagnóstico por imagem , Masculino , Osteocondrose/congênito , Radiografia , Estudos Retrospectivos , Tíbia
8.
Int J Pediatr Otorhinolaryngol ; 125: 66-70, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31260810

RESUMO

OBJECTIVES: Research has shown improvement in apnea-hypopnea index in children with mild obstructive sleep apnea treated with anti-inflammatory medications. Data on quality of life outcomes in children receiving these medications is lacking. We aim to assess quality of life in children with mild obstructive sleep apnea treated with montelukast and fluticasone. METHODS: Children between 3 and 16 years old with mild sleep apnea (apnea-hypopnea index > 1 and ≤ 5) presenting to a pediatric otolaryngology clinic were recruited prospectively and treated with 4 months of montelukast and fluticasone. Subjects' caregivers completed the OSA-18, a validated quality of life survey, at baseline and 4 months. Children with ongoing obstruction at follow-up underwent adenotonsillectomy. RESULTS: Thirty-one patients were included. Mean (SD) age was 6.8 (3.9) years. Most subjects (54.8%) were black and 48% were obese. Mean (SD) apnea-hypopnea index of the subjects was 2.8 (1.0). The mean (SD) baseline OSA-18 score was 60.2 (18.5), indicating a moderate impact of sleep disturbance on quality of life. Following treatment, there was significant improvement (p < 0.005) in mean OSA-18 score. Four children discontinued montelukast due to behavioral side effects. Seven children (22%) underwent adenotonsillectomy after failing medical therapy. Demographic factors such as obesity [OR 0.63 (0.11, 3.49)] and apnea hypopnea index [OR 1.38 (0.59, 3.66)] failed to predict which children would respond to anti-inflammatory medications. CONCLUSIONS: Children with mild obstructive sleep apnea treated with montelukast and fluticasone experience significant improvements in quality of life. Further research is needed to determine optimal duration of therapy.


Assuntos
Acetatos/uso terapêutico , Fluticasona/uso terapêutico , Quinolinas/uso terapêutico , Síndromes da Apneia do Sono/tratamento farmacológico , Adenoidectomia , Adolescente , Antiasmáticos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Obesidade Pediátrica/complicações , Estudos Prospectivos , Qualidade de Vida , Síndromes da Apneia do Sono/cirurgia , Tonsilectomia
9.
J Pediatr Endocrinol Metab ; 32(8): 811-819, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31271554

RESUMO

Background The beneficial effects of treating hypertriglyceridemic adults with omega-3 fatty acids have been reported. However, information regarding omega-3 treatment of pediatric patients is limited. To evaluate the efficacy and safety of administering omega-3 fatty acids (3 g/day for 12 weeks) to children/adolescents with obesity and hypertriglyceridemia. Methods A randomized, double-blind, placebo-controlled, parallel study involving pediatric patients (10-16 years old) with obesity and hypertriglyceridemia was conducted. The National Center for Health Statistics (CDC) defines obesity as a body mass index (BMI) ≥95th percentile. Subjects with triglyceride concentrations ranging from 150 to 1000 mg/dL were randomized into two groups: those receiving omega-3 fatty acids (eicosapentaenoic and docosahexaenoic acids) (n = 65) and those receiving a placebo (n = 65) for 12 weeks. Serum triglyceride concentrations were always measured from 8 to 9 am after a 12-h fast. Results By the end of treatment, triglyceride concentrations had decreased by 39.1% in the omega-3 group and 14.6% in the placebo group (p < 0.01). The incidence of adverse gastrointestinal events (e.g. flatulence, belching) was 41.2% and 6.2% in the omega-3 and placebo groups, respectively (p < 0.01). There were no serious drug-related adverse events. Conclusions Supplementation with 3 g/day of omega-3 fatty acids is a safe and effective option for treating hypertriglyceridemia in children and adolescents with obesity.


Assuntos
Biomarcadores/sangue , Suplementos Nutricionais , Ácidos Graxos Ômega-3/administração & dosagem , Hipertrigliceridemia/tratamento farmacológico , Obesidade Pediátrica/tratamento farmacológico , Adolescente , Criança , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Hipertrigliceridemia/sangue , Hipertrigliceridemia/etiologia , Masculino , Obesidade Pediátrica/complicações , Resultado do Tratamento , Triglicerídeos/sangue
10.
J Pediatr Endocrinol Metab ; 32(7): 749-758, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31216264

RESUMO

Background The objective of this study was to investigate the association of polymorphisms in four genes, tumor necrosis factor-α (TNFA), patatin-like phospholipase domain containing 3 (PNPLA3), adiponectin (ADIPOQ) and apolipoprotein C3 (APOC3), with obesity and non-alcoholic fatty liver disease (NAFLD) in Asian Indian adolescents. Methods In this case-control study, 218 Asian Indian adolescents with overweight/obesity and 86 lean healthy adults without fatty liver were enrolled. Hepatic steatosis was assessed and graded by ultrasonography (USG). Serum insulin, lipids, alanine aminotransferase (ALT), aspartate aminotransferase (AST), TNF-α, adiponectin and apolipoprotein C3 were measured and genotyping was done. Frequencies of variant and wild genotypes in all adolescents and in the subgroups without steatosis, with grade 1 steatosis and with grade 2 or 3 steatosis were compared to those in the controls. The frequencies were also compared in the overweight adolescents with grade 2 or 3 steatosis and without steatosis. Results Variant genotypes of polymorphisms -863 C > A and -1031 T > C of the TNFA gene, 455 T > C of the APOC3 gene and the wild type of +276 G > T of the ADIPOQ gene were associated with obesity with odds ratios (OR, 95% confidence interval [CI]) of 2.5 (1.5-4.4), 2.5 (1.5-4.2), 2.0 (1.1-3.6) and 2.5 (1.4-5.0), respectively. Polymorphisms 455 T > C of APOC3 and rs738409 C > G of PNPLA3 were associated with NAFLD. Fasting insulin and triglycerides (TG) were higher in the adolescents with homozygous variant polymorphisms -1031 T > C of TNFA and 455 T > C of APOC3 genes, respectively. Conclusions Several polymorphisms were noted to have a significant association with obesity and NAFLD in Asian Indian adolescents.


Assuntos
Biomarcadores/análise , Hepatopatia Gordurosa não Alcoólica/genética , Obesidade Pediátrica/genética , Polimorfismo de Nucleotídeo Único , Adiponectina/genética , Adolescente , Adulto , Apolipoproteína C-III/genética , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Humanos , Lipase/genética , Masculino , Proteínas de Membrana/genética , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/patologia , Obesidade Pediátrica/complicações , Obesidade Pediátrica/patologia , Prognóstico , Fator de Necrose Tumoral alfa/genética
12.
Compr Child Adolesc Nurs ; 42(sup1): 226-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31192711

RESUMO

This study aims to explore mothers' experiences in caring for overweight children under five years of age. This study used a descriptive phenomenology approach, with in-depth interviews with ten mothers who had overweight children under five years of age (2-5 years) selected by purposive sampling. The data was then analyzed using thematic analysis based on Collaizi's approach. This study produced eight themes illustrating that mothers were not only unaware of the children's overweight condition, but even felt more pleased to have overweight kids. This caused mothers not to give the optimum effort in limiting their children's food intake. The low awareness mothers had towards their children's overweight condition indicated the need for an intervention program that focuses on overweight children under five years of age to empower the family and increase family awareness in managing obesity early.


Assuntos
Relações Mãe-Filho , Mães/psicologia , Obesidade Pediátrica/complicações , Adulto , Índice de Massa Corporal , Pré-Escolar , Empatia , Feminino , Humanos , Indonésia , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Obesidade Pediátrica/psicologia , Pesquisa Qualitativa
13.
J Pediatr Endocrinol Metab ; 32(7): 667-674, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31150357

RESUMO

Background Obesity with developmental disability/intellectual disability (DD/ID) is the most common association in syndromic obesity. Genomic analysis studies have allowed the decipherment of disease aetiology, both in cases of syndromic obesity as well as in cases of isolated or syndromic DD/ID. However, more data are needed to further elucidate the link between the two. The aim of this pangenomic study was to use single nucleotide polymorphism (SNP) array technology to determine the copy number variant (CNV) type and frequency associated with both obesity and DD/ID. Methods Thirty-six patients were recruited from the Clinical Emergency Hospital for Children, in Cluj-Napoca, Romania during the period 2015-2017. The main inclusion criterion was a diagnosis that included both obesity and DD/ID. Genomic analysis via SNP array technology was performed. Results Out of the 36 patients, 12 (33%) presented CNVs with a higher degree of pathogenicity (A group) and 24 (66%) presented benign CNVs (B group). The SNP array results for the A group were as follows: pathogenic CNVs in 8/12 patients (67%); variants of unknown significance (VOUS) in 2/12 patients (16%); and uniparental disomy (UPD) in 2/12 patients (16%). Conclusions Some of these CNVs have already been observed in patients with both obesity and DD/ID, but the others were noticed only in DD/ID patients and have not been described until now in association with obesity.


Assuntos
Biomarcadores/análise , Aberrações Cromossômicas , Deficiências do Desenvolvimento/genética , Genômica/métodos , Deficiência Intelectual/genética , Obesidade Pediátrica/genética , Polimorfismo de Nucleotídeo Único , Adolescente , Criança , Pré-Escolar , Variações do Número de Cópias de DNA , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/patologia , Feminino , Seguimentos , Testes Genéticos , Humanos , Lactente , Deficiência Intelectual/complicações , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/patologia , Masculino , Análise em Microsséries , Obesidade Pediátrica/complicações , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/patologia , Prognóstico , Romênia/epidemiologia
14.
Int Braz J Urol ; 45(4): 790-797, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31184451

RESUMO

OBJECTIVE: The purpose of this study was to determine whether the presence of obesity was related with symptoms of nocturnal enuresis (NE) and the efficacy of behavioral intervention in the treatment of NE. MATERIALS AND METHODS: The patients diagnosed with primary monosymptomatic nocturnal enuresis (PMNE) were studied retrospectively. NE severity was classifi ed as mild, moderate, and severe according to the frequency of enuresis. The children were divided into three groups, namely normal weight (5th-84th percentile), overweight (85th-94th percentile), and obesity (≥95th percentile), according to their Body Mass Index (BMI) percentage. The relationship between obesity level and enuresis severity was analyzed. After three months of behavioral therapy, the effi cacy of treatment among normal, overweight, and obese groups were evaluated. Moreover, the predictive risk factors for treatment failure were investigated. RESULTS: The rates of severe enuresis in patients with normal weight, overweight, and obesity were 63.9%, 77.5%, and 78.6%, respectively. Obese children depicted higher odds of having severe enuresis compared with normal-weight children (OR: 1.571; 95% confi dence interval [CI]: 1.196-2.065; P=0.001). The odds of presenting with severe enuresis were 1.99 times higher in children who are obese or overweight compared to children with normal weight (OR: 1.994; 95% CI: 1.349-2.946; P=0.001). The complete response of the normal group was higher than those of the overweight and obese groups (26.8% vs. 14.0%, P=0.010; 26.8% vs. 0.0%, P=0.000). Overweight children showed higher complete response than obese ones (14.0% vs. 0.0%, P=0.009). Logistic regression analysis revealed that obesity level and enuresis frequency were significantly related to the treatment failure of behavioral intervention. CONCLUSIONS: Obesity is associated with severe enuresis and low effi cacy of behavioral therapy in children with nocturnal enuresis.


Assuntos
Terapia Comportamental/métodos , Enurese Noturna/etiologia , Enurese Noturna/terapia , Obesidade Pediátrica/complicações , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Humanos , Modelos Logísticos , Masculino , Sobrepeso/complicações , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Falha de Tratamento
15.
Pediatr Endocrinol Rev ; 16(4): 441-451, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31245939

RESUMO

Sleep disorders have been widely reported in obese individuals. Previous studies have shown that together with an increase in obesity prevalence, so does sleep duration in children and adolescents decrease. By contributing to energy imbalances, hormonal changes occurring with reduced sleep quality may cause weight gain and obesity. Current evidence shows that short sleep duration has effects on body weight and weight gain. Compared to individuals sleeping for a normal duration, insulin sensitivity is lower in those who sleep less. Lack of sleep increases the desire for food and has a direct effect on physical activity. Further studies are required to determine the contribution of sufficient sleep to obesity treatment.


Assuntos
Obesidade Pediátrica , Transtornos do Sono-Vigília , Adolescente , Índice de Massa Corporal , Peso Corporal , Criança , Exercício , Humanos , Obesidade Pediátrica/complicações , Transtornos do Sono-Vigília/etiologia , Ganho de Peso
16.
Eur J Pediatr ; 178(8): 1291-1295, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31214774

RESUMO

We evaluated the performance of a new simple formula (NSF) for the screening of hypertension by American Academy of Pediatrics Guidelines 2017 (AAPG2017) in children with overweight/obesity (OW/OB). The performance of the NSF and the modified blood pressure to height ratio (MBPHR3) thresholds against AAPG2017 was evaluated; both methods were also compared to assess the association with concentric left ventricular hypertrophy (cLVH). The study included 3259 OW/OB children (5-13 years). Two centers served as learning sample (LS) (n = 1428), four centers served as validation sample (VS) (n = 1831), and the echocardiographic evaluation was available in 409 children in VS. The NSF was [1.5 × systolic blood pressure (mmHg) + diastolic blood pressure (mmHg)] - [(26 × height (m)] - age (years). A cut-off of the NSF ≥ 193 mmHg showed sensitivity, specificity, positive, and negative predictive values of 0.92, 0.93, 0.83, and 0.97, respectively, versus the standard procedure. Against AAPG2017, the NSF showed higher specificity and positive predictive values than the MBPHR3 thresholds. Among hypertensive children defined by AAPG2017, NSF, or MBPHR3, the odds ratio (95%CI) for cLVH was respectively 1.73 (1.06-2.83), 1.69 (1.05-2.75), and 1.18 (0.75-1.85).Conclusions: The NSF shows a very high performance for the screening of OW/OB children at risk of hypertension and cLVH. What is Known: • The American Academy of Pediatrics released updated guidelines (AAPG 2017) to classify hypertension (HTN) in children. • The process needs categorization of height percentiles and comparison of blood pressure versus gender and age-adjusted values. What is New: • A user-friendly formula built on the AAPG 2017 was validated for the categorization of HTN in children with overweight/obesity. • The formula showed high performance in identifying children with HTN versus the standard procedure (sensitivity 0.92, specificity 0.93) and similar ability in identifying hypertensive children with concentric left ventricular hypertrophy versus the standard procedure (40% and 39% respectively).


Assuntos
Determinação da Pressão Arterial/métodos , Hipertensão/diagnóstico , Programas de Rastreamento/métodos , Obesidade Pediátrica/complicações , Adolescente , Determinação da Pressão Arterial/normas , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Hipertensão/etiologia , Masculino , Programas de Rastreamento/normas , Pediatria/normas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Sociedades Médicas/normas
17.
J Pediatr Endocrinol Metab ; 32(7): 707-714, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31211688

RESUMO

Background Obesity is known to cause metabolic disturbances including insulin resistance, dyslipidemia and alters bone mineralization. The effects of obesity on fibroblast growth factor 23 (FGF-23), which is important in bone mineralization, have not yet been clarified. Our aim was to investigate the association between FGF-23 concentration and obesity-associated dysmetabolism. Methods Subjects comprised 46 obese children and adolescents. The same number of age-matched, healthy controls were recruited. Markers of bone mineralization and glucose metabolism were measured. Thyroid function and insulin resistance were investigated in both groups. In obese subjects; an oral glucose tolerance test (OGTT) was performed and hemoglobin A1c and lipid fractions were measured. Bone mineral density and hepatic steatosis were investigated. Results Serum FGF-23, α-klotho and 1,25(OH)2D3 concentrations were significantly lower while fasting insulin, fasting glucose, C-peptide and alkaline phosphatase (ALP) concentrations and homeostasis model assessment of insulin resistance (HOMA-IR) were significantly higher in the obese group compared to controls. A significant negative correlation was observed between free tri-iodothyronine (fT3) and both FGF-23 and α-klotho in the obese group. Significant negative correlation was found between FGF-23 and C-peptide and a positive correlation was found between FGF-23 and high density lipoprotein-cholesterol (HDL-c) in the obese subjects with impaired glucose tolerance (IGT). Significant negative correlations were found between FGF-23 and both fasting insulin levels and C-peptide levels in the obese subjects with hepatic steatosis. Conclusions In our study, insulin resistance-associated hyperinsulinism and/or lower 1,25(OH)2D3 levels, both present in obese children and adolescents, may lead to decreased serum FGF-23 concentrations in obese subjects.


Assuntos
Biomarcadores/sangue , Dislipidemias/sangue , Fatores de Crescimento de Fibroblastos/sangue , Resistência à Insulina , Obesidade Pediátrica/sangue , Estado Pré-Diabético/sangue , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Dislipidemias/etiologia , Feminino , Seguimentos , Humanos , Masculino , Obesidade Pediátrica/complicações , Estado Pré-Diabético/etiologia , Prognóstico
18.
J Pediatr Endocrinol Metab ; 32(5): 429-438, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31050656

RESUMO

Metabolic syndrome (MS) is common among children and adolescents. Age- and gender-specific references or age-, gender- and height-specific references were used in pediatric MS definitions. More recently, an increasing number of studies documented that the ratio of waist circumference (WC) to height (WHtR) and blood pressure to height (BPHR) were easy anthropometric indexes for detection of obesity and hypertension in children and adolescents. For these reasons, height-corrected MS definition was proposed. WHtR and BPHR were used as alternatives to WC and BP in the definition of MS. In the present review, we discuss the possibility of the height-corrected MS definition for identifying MS in children.


Assuntos
Estatura , Síndrome Metabólica/etiologia , Obesidade Pediátrica/complicações , Adolescente , Criança , Humanos , Prognóstico
19.
J Pediatr Endocrinol Metab ; 32(5): 471-478, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31042644

RESUMO

Background Thyroid dysfunction is the most common hormonal abnormality in obesity. It should actually be considered as an adaptation response to fat excess. However, little has been reported on the morphology of the thyroid gland, and no data regarding the relationship between thyroid gland changes and metabolic parameters are available in obese adolescents. Objective The study aimed to evaluate the frequency of non-autoimmune thyroiditis in obese adolescents and compare the metabolic status of patients with or without thyroiditis. Methods A total of 218 obese children and 49 age-matched control healthy children were included. Thyroid ultrasonography (USG) was performed in all participants, as well as thyroid hormone levels, thyroid antibodies (Abs), lipid profile, homeostasis model assessment of insulin resistance (HOMA-IR) and high-sensitivity C-reactive protein (HsCRP) were determined. Obese children were divided into three groups according to the presence of thyroid autoantibodies and USG findings of thyroiditis (Group-1: Abs [-], normal thyroid morphology/Group-2: Abs [+], abnormal thyroid morphology/Group-3: Abs [-], abnormal thyroid morphology). The relationship between body mass index, metabolic parameters and thyroid gland status was analyzed. Results Seventy-two of 218 obese patients (33%) had non-autoimmune thyroiditis (Group-3). The rate of insulin resistance was significantly higher in Group-3 than in Group-1 (p = 0.024). Similarly, the frequency of metabolic syndrome (MS) was higher in Group-3 (44.3%) than in Group-1 (27.1%) (p = 0.014). Conclusions Obese adolescents with non-autoimmune thyroiditis had a higher incidence of insulin resistance. This finding supported the hypothesis that insulin resistance may have an effect on thyroid morphology. Further randomized trials investigating this relationship are required.


Assuntos
Resistência à Insulina , Fígado/patologia , Obesidade Pediátrica/complicações , Glândula Tireoide/patologia , Tireoidite/etiologia , Adolescente , Biomarcadores/análise , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Humanos , Fígado/diagnóstico por imagem , Masculino , Prognóstico , Glândula Tireoide/diagnóstico por imagem , Tireoidite/diagnóstico por imagem , Tireoidite/patologia , Ultrassonografia
20.
Rev Gastroenterol Mex ; 84(2): 185-194, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31101468

RESUMO

AIM: To identify and discuss the efficacy of dietary interventions, antioxidant supplementation, physical activity, and nutritional and psychologic counseling in the treatment of children and adolescents with non alcoholic fatty liver disease associated with obesity. MATERIALS AND METHODS: A scoping review of studies on nutritional and educational interventions and physical activity in pediatric patients with non alcoholic fatty liver disease was conducted. A search for randomized clinical trials or quasi-experimental studies published up to December 2017 was carried out, utilizing seven databases (Medline, EBSCO, OVID, Science Direct, JSTOR, Wiley, and Biblioteca Digital UDG). RESULTS: From a total of 751 articles, 729 were excluded due to the criteria of age, design, language, diagnostic method, and outcome variables. The analysis included 22 articles. The most frequently used intervention variables were diet and physical activity. The interventions had different durations, but most were carried out for one year. Some authors employed ascorbic acid, vitamin E, or omega-3 fatty acid supplementation. There were varying degrees of improvement in the variables analyzed in the majority of the studies, such as a decrease in ALT levels, a reduced frequency of steatosis determined through imaging studies, and a decrease in body mass index. CONCLUSIONS: The dietary interventions, omega-3 fatty acid supplementation, physical activity, and nutritional and psychologic counseling were identified as efficacious measures in the treatment of non alcoholic fatty liver disease associated with obesity in children and adolescents, according to biochemical or imaging study indicators, within the time frame of the intervention.


Assuntos
Dieta , Exercício , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/terapia , Obesidade Pediátrica/complicações , Obesidade Pediátrica/terapia , Adolescente , Criança , Feminino , Humanos , Masculino , Hepatopatia Gordurosa não Alcoólica/dietoterapia , Educação de Pacientes como Assunto , Obesidade Pediátrica/dietoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto
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