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1.
BMC Health Serv Res ; 21(1): 611, 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34183008

RESUMO

BACKGROUND: The causes and consequences of childhood obesity are complex and multifaceted. Therefore, an integrated care approach is required to address weight-related issues and improve children's health, societal participation and quality of life. Conducting a psychosocial and lifestyle assessment is an essential part of an integrated care approach. The aim of this study was to explore the experiences, needs and wishes of healthcare professionals with respect to carrying out a psychosocial and lifestyle assessment of childhood obesity. METHODS: Fourteen semi-structured interviews were conducted with Dutch healthcare professionals, who are responsible for coordinating the support and care for children with obesity (coordinating professionals, 'CPs'). The following topics were addressed in our interviews with these professionals: CPs' experiences of both using childhood obesity assessment tools and their content, and CPs' needs and wishes related to content, circumstances and required competences. The interviews comprised open-ended questions and were recorded and transcribed verbatim. The data was analysed using template analyses and complemented with open coding in MAXQDA. RESULTS: Most CPs experienced both developing a trusting relationship with the children and their parents, as well as establishing the right tone when engaging in weight-related conversations as important. CPs indicated that visual materials were helpful in such conversations. All CPs used a supporting assessment tool to conduct the psychosocial and lifestyle assessment but they also indicated that a more optimal tool was desirable. They recognized the need for specific attributes that helped them to carry out these assessments, namely: sufficient knowledge about the complexity of obesity; having an affinity with obesity-related issues; their experience as a CP; using conversational techniques, such as solution-focused counselling and motivational interviewing; peer-to-peer coaching; and finally, maintaining an open-minded, non-stigmatizing stance and harmonizing their attitude with that of the child and their parents. CONCLUSIONS: Alongside the need for a suitable tool for conducting a psychosocial and lifestyle assessment, CPs expressed the need for requisite knowledge, skills and attitudes. Further developing a supporting assessment tool is necessary in order to facilitate CPs and thereby improve the support and care for children with obesity and their families.


Assuntos
Prestação Integrada de Cuidados de Saúde , Obesidade Pediátrica , Criança , Humanos , Estilo de Vida , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/terapia , Pesquisa Qualitativa , Qualidade de Vida
2.
Nutr Metab Cardiovasc Dis ; 31(7): 2181-2185, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-33994065

RESUMO

BACKGROUND AND AIM: Lockdown due to COVID-19 pandemic has forced a decrease in physical activity (PA), an increase in sedentary behavior (SB) and a possibly worsening of fat accumulation in already obese subjects. The aim of this study was to investigate how social restriction may have contributed to weight changes in adolescents with obesity. Secondary aim was to evaluate possible parameters influencing weight changes. METHODS AND RESULTS: Parameters of 51 obese adolescents were compared between two visits: within 2 months before 8 March, start of lockdown, and within 40 days after the end of it. RESULTS: Mean weight gain during lockdown was 2.8 ± 3.7 kg (p < 0.001). Weight increase was higher in males than in females (3.8 ± 3.4 kg vs 1.2 ± 3.7 kg, p = 0.02). The hours dedicated to SB increased (+2.9 ± 2.8 h/day; p < 0.001) while the hours of PA decreased (-1.0 ± 1.6 h/week; p < 0.001). Males spent more hours in SB than females (+3.8 ± 2.7 h/day vs +1.5 ± 2.5 h/day; p = 0.003). There were minor changes in diet during lockdown. The most significant variables influencing both delta BMI and waist/height ratio increase were hours devoted to SB during lockdown and differences in mild and moderate PA before and after lockdown. CONCLUSIONS: Obese adolescents showed a worsening of obesity during lockdown, with males mainly affected, mainly due to a reduced mild PA and increased hours spent in SB.


Assuntos
COVID-19/prevenção & controle , Obesidade Pediátrica/fisiopatologia , Distanciamento Físico , Ganho de Peso , Adolescente , Fatores Etários , COVID-19/transmissão , Criança , Dieta/efeitos adversos , Exercício Físico , Feminino , Humanos , Masculino , Obesidade Pediátrica/diagnóstico , Medição de Risco , Fatores de Risco , Comportamento Sedentário , Fatores Sexuais , Fatores de Tempo
3.
Nutr Metab Cardiovasc Dis ; 31(6): 1903-1910, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-33941428

RESUMO

BACKGROUND AND AIMS: Birth weight (BW) has been associated with the risk of obesity and metabolic derangements in children and adults. The aims of this study were: i. to evaluate the distribution of BW in a sample of overweight and obese children and adolescents compared with the general reference population; ii. to explore the relationship between the BW and insulin resistance and other cardiometabolic derangements in a population of children and adolescents with overweight and obesity. METHODS AND RESULTS: 710 overweight and obese children and adolescents were recruited and categorized into small (SGA), appropriate (AGA), and large (LGA) for gestational age, according to the BW percentile. Arterial blood pressure, lipid profile, glucose metabolism and hepatic steatosis were evaluated to assess cardiometabolic obesity-related derangements. The distribution of BW categories in our population was significantly different compared with the general population (SGA 6.9% vs. 8.6%, AGA 74.6% vs. 81.4%, LGA 18.5% vs. 10%; p < 0.0001). We found a higher frequency of prediabetes conditions (21.7% vs 8.9%, OR 2.97, 95% CI 1.38-6.38, p = 0.005) and borderline/high low-density lipoprotein cholesterol (31.8% vs 18.6%, OR 2.13, 95% CI 1.09-4.18, p = 0.033) in overweight and obese children born SGA compared to those born non-SGA, independently of age, sex, and BMI. CONCLUSIONS: BW is a risk factor of cardiometabolic derangements in a population of children and adolescents with overweight and obesity. Therefore, adequate obesity prevention strategies should be planned for children born SGA to minimize their risk to become obese and to reduce their short- and long-term cardiometabolic risks.


Assuntos
Peso ao Nascer , Metabolismo Energético , Recém-Nascido Pequeno para a Idade Gestacional , Resistência à Insulina , Obesidade Pediátrica/metabolismo , Adolescente , Fatores Etários , Biomarcadores/sangue , Fatores de Risco Cardiometabólico , Estudos de Casos e Controles , Criança , Pré-Escolar , Idade Gestacional , Humanos , Itália , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/fisiopatologia , Prognóstico , Medição de Risco , Fatores de Tempo
4.
Eur J Pediatr ; 180(8): 2549-2561, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33987685

RESUMO

The aim of this study was to develop and examine the predictive accuracy of an index that estimates obesity risk in childhood based on perinatal factors and maternal sociodemographic characteristics. Analysis was conducted by using cross-sectional and retrospective data collected from a European cohort of 2775 schoolchildren and their families participating in the Feel4Diabetes-study. The cohort was randomly divided by using two-thirds of the sample for the development of the index and the remaining one third for assessing its predictive accuracy. Logistic regression analyses determined a prediction model for childhood obesity. The area under the receiver operating characteristic curve (AUC-ROC), sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated. Cut-off analysis was applied to identify the optimal value of the index score that predicts obesity with the highest possible sensitivity and specificity. Eight factors were found to be significantly associated with obesity and were included as components in the European "Childhood Obesity Risk Evaluation" (CORE) index: region of residence, maternal education, maternal pre-pregnancy weight status, gestational weight gain, maternal smoking during pregnancy, birth weight for gestational age, infant growth velocity, and exclusive breastfeeding during the first 6 months. Risk score ranged from 0 to 22 corresponding to a risk from 0.9 to 54.6%. The AUC-ROC was 0.725 with optimal cut-off ≥9 (sensitivity = 74.1%, specificity = 61.0%, PPV = 11.3%, NPV = 97.2%).Conclusion: The European CORE index can be used as a screening tool for the identification of infants at high-risk for becoming obese at 6-9 years. This tool could assist healthcare professionals in initiating preventive measures from the early life.Trial registration: The Feel4Diabetes-intervention is registered at https://clinicaltrials.gov/ ; number, CT02393872; date, March 20, 2015. What is Known: • As prevention of obesity should start early in life, there is a compelling rationale for the early identification of high-risk children to facilitate targeted intervention. What is New: • This study developed and assessed the predictive accuracy of an index for the Childhood Obesity Risk Evaluation (CORE), combining certain perinatal factors and maternal sociodemographic characteristics in a large European cohort. • The European CORE index can be used as a screening tool for identifying infants at high-risk for becoming obese at 6-9 years and assist health professionals in initiating early prevention strategies.


Assuntos
Ganho de Peso na Gestação , Obesidade Pediátrica , Índice de Massa Corporal , Criança , Estudos Transversais , Feminino , Humanos , Lactente , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
5.
BMJ Open ; 11(3): e044624, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789852

RESUMO

INTRODUCTION: Mid-upper arm circumference (MUAC) has been suggested as an alternative screening tool to identify overweight and obesity in children and adolescents. Several studies have examined the diagnostic performance of MUAC to identify overweight and obesity in children and adolescents. However, the existing literature shows a considerable variability in measures of diagnostic performance and hence makes it difficult to direct clinical and public health practice. Therefore, this systematic review and meta-analysis aimed to synthesise evidence on the performance of MUAC to identify overweight and obesity in children and adolescents. METHODS AND ANALYSIS: A systematic search of databases including PubMed, EMBASE, SCOPUS, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Web of Science, CINAHL and PsycINFO will be conducted. The search will cover all studies until 1 April 2021. Grey literature will also be retrieved from Google Scholar. Titles and abstracts will be screened by two independent reviewers. The Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used to assess the risk of bias and clinical applicability of each study. To assess possible publication bias, we will use Deeks' funnel plot. We will investigate the sources of heterogeneity by visual inspection of the paired forest plots and summary receiver operating characteristic plots. The pooled summary statistics for the area under the curve, sensitivities, specificities, likelihood ratios and diagnostic ORs with 95% CI will be reported. ETHICS AND DISSEMINATION: The underlying study is based on published articles thus does not require ethical approval. The findings of the systematic review and meta-analysis will be published in a peer-reviewed journal and disseminated in different scientific conferences and seminars. PROSPERO REGISTRATION NUMBER: CRD42020183148.


Assuntos
Obesidade Pediátrica , Adolescente , Braço , Criança , Humanos , Programas de Rastreamento , Metanálise como Assunto , Sobrepeso/diagnóstico , Obesidade Pediátrica/diagnóstico , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
6.
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
7.
Nutr Metab Cardiovasc Dis ; 31(5): 1586-1593, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33810960

RESUMO

BACKGROUND AND AIMS: Epidemiological studies show that obese adolescents are candidates to suffer cardiovascular pathologies in adulthood. In order to detect subfractions with a diagnostic value for future cardiovascular disorders, we analyzed the complete lipoprotein profile of severely obese adolescents. METHODS AND RESULTS: Twenty-eight obese adolescents free from comorbidities were admitted into a weight reduction program. Anthropometric parameters were monitored. The circulating lipoproteins and glycemia were measured at the beginning and at the end of the study by conventional blood analysis as well as by using lipoprotein electrophoresis. Twenty-one puberty-matched normal-weight adolescents were recruited as controls. After 4 months, participants improved anthropometric parameters. Blood analysis indicated that circulating lipoproteins were in the healthy range during intervention. Nevertheless, results obtained from lipoprotein electrophoresis showed a significant increase in the large high-density lipoprotein subfraction in the obese population at the end of intervention, but significantly lower than normal-weight counterparts. In addition, intermediate- and low-density lipoprotein subfractions were in the healthy range in controls and in obese adolescents during intervention. CONCLUSIONS: Altogether, it seems that the obese adolescents with no comorbidities do not develop a clear dyslipidemia. However, low values of large high-density lipoprotein subfractions could be considered as candidate predictors to develop cardiovascular disease in the future. For this reason, diet and exercise are key tools to fight against this pathology. REGISTRATION NUMBER FOR CLINICAL TRIALS: ISRCTN99414527.


Assuntos
Restrição Calórica , Dislipidemias/sangue , Terapia por Exercício , Lipoproteínas HDL/sangue , Obesidade Pediátrica/dietoterapia , Perda de Peso , Adolescente , Biomarcadores/sangue , Estudos de Casos e Controles , Colesterol/sangue , Dislipidemias/diagnóstico , Feminino , Humanos , Lipoproteínas/sangue , Estudos Longitudinais , Masculino , Obesidade Pediátrica/sangue , Obesidade Pediátrica/diagnóstico , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
8.
Nutr Metab Cardiovasc Dis ; 31(5): 1548-1555, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33810963

RESUMO

BACKGROUND AND AIM: The association between non-alcoholic fatty liver (NAFL) and the variant rs641738 within the membrane bound O-acyltransferase domain-containing 7 (MBOAT7) gene is currently uncertain, especially in the paediatric population. We examined whether there is an association between this genetic variant and NAFL in a large multicentre, hospital-based cohort of Italian overweight/obese children. METHODS AND RESULTS: We studied 1760 overweight or obese children [mean age (SD): 11.1(2.9) years, z-body mass index (zBMI) 3.2(0.9)], who underwent ultrasonography for the diagnosis of NAFL. A subgroup of these children (n = 182) also underwent liver biopsy. Genotyping of the MBOAT7 rs641738 polymorphism was performed by TaqMan-Based RT-PCR system in each subject. Overall, 1131 (64.3%) children had ultrasound-detected NAFL; 528 (30%) had rs641738 CC genotype, 849 (48.2%) had rs641738 CT genotype, and 383 (21.8%) had rs641738 TT genotype, respectively. In the whole cohort, the interaction of MBOAT7 genotypes with zBMI was not associated with NAFL after adjustment for age, sex, serum triglycerides, serum alanine aminotransferase levels and patatin-like phospholipase domain-containing protein-3 (PNPLA3) genotype (adjusted-odds ratio 1.02 [95% CI 0.98-1.06]). Similarly, no association was found between MBOAT7 genotypes and NAFL after stratification by obesity status. MBOAT7 genotypes were not associated with the presence of non-alcoholic steatohepatitis or the stage of liver fibrosis in a subgroup of 182 children with biopsy-proven NAFLD. CONCLUSIONS: The results of this study did not show any significant contribution of MBOAT7 rs641738 polymorphism to the risk of having either NAFL on ultrasonography or NASH on histology in a large hospital-based cohort of Italian overweight/obese children.


Assuntos
Aciltransferases/genética , Cirrose Hepática/genética , Proteínas de Membrana/genética , Hepatopatia Gordurosa não Alcoólica/genética , Obesidade Pediátrica/epidemiologia , Polimorfismo de Nucleotídeo Único , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Itália/epidemiologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/epidemiologia , Masculino , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade Pediátrica/diagnóstico , Fenótipo , Prevalência , Medição de Risco , Fatores de Risco
9.
Nutr Metab Cardiovasc Dis ; 31(5): 1604-1612, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33812731

RESUMO

BACKGROUND AND AIMS: Overweight is associated with increased cardiovascular disease in general populations. However, a similar relationship among Kawasaki Disease (KD) patients was unclear. The study aimed to investigate the relation between weight-for-height and coronary artery lesions (CAL) among KD patients, and whether laboratory indices modified this relation. METHODS AND RESULTS: All consecutive KD patients from January 2009 to December 2014 in a city in China were reviewed, and classified into overweight/obese and control groups. All patients were followed to assess the occurrence of CAL by echocardiography for two months from disease onset. The independent effect of overweight/obesity on CAL was evaluated after adjustment for confounders. The interaction effect between overweight and laboratory indices was examined. The prevalence of overweight/obesity among KD patients was 18.5% (95%CI: 16.0%, 21.0%). The proportion of male patients and the proportion of non-standard IVIG treatment were significantly higher in overweight/obese children in comparison with their counterparts. Overweight/obesity was associated with increased odds of total CAL (aOR = 1.69, 95%CI: 1.16, 2.45) and also increased odds of CAL after treatment (aOR = 1.96, 95%CI: 1.09, 3.51); after adjustment for age, gender, KD type, change of medical departments, number of days before admission, treatment regimen and laboratory index. Similar results were found using stratification analysis. In addition, patients at risk of overweight were also associated with significantly increased risk of CAL. There was interaction between weight-for-height and platelet, WBC, and albumin. CONCLUSIONS: Overweight/obesity may be an independent risk factor for CAL among KD patients. Some laboratory indicators may modify this association.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Obesidade Pediátrica/epidemiologia , Biomarcadores/sangue , Estatura , Peso Corporal , Pré-Escolar , China/epidemiologia , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Incidência , Lactente , Contagem de Leucócitos , Masculino , Síndrome de Linfonodos Mucocutâneos/sangue , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Obesidade Pediátrica/sangue , Obesidade Pediátrica/diagnóstico , Contagem de Plaquetas , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Albumina Sérica Humana/análise
10.
Sci Rep ; 11(1): 5494, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33750841

RESUMO

It is important to pay attention to the indirect effects of the social distancing implemented to prevent the spread of coronavirus disease 2019 (COVID-19) pandemic on children and adolescent health. The aim of the present study was to explore impacts of a reduction in physical activity caused by COVID-19 outbreak in pediatric patients diagnosed with obesity. This study conducted between pre-school closing and school closing period and 90 patients aged between 6- and 18-year-old were included. Comparing the variables between pre-school closing period and school closing period in patients suffering from obesity revealed significant differences in variables related to metabolism such as body weight z-score, body mass index z-score, liver enzymes and lipid profile. We further evaluated the metabolic factors related to obesity. When comparing patients with or without nonalcoholic fatty liver disease (NAFLD), only hemoglobin A1c (HbA1c) was the only difference between the two time points (p < 0.05). We found that reduced physical activity due to school closing during COVID-19 pandemic exacerbated obesity among children and adolescents and negatively affects the HbA1C increase in NAFLD patients compared to non-NAFLD patients.


Assuntos
COVID-19/patologia , Intolerância à Glucose/diagnóstico , Obesidade Pediátrica/diagnóstico , Adolescente , Alanina Transaminase/análise , Aspartato Aminotransferases/análise , Índice de Massa Corporal , Peso Corporal , COVID-19/virologia , Criança , Exercício Físico , Feminino , Intolerância à Glucose/complicações , Hemoglobina A Glicada/análise , Humanos , Lipídeos/análise , Fígado/enzimologia , Masculino , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Obesidade Pediátrica/complicações , Quarentena , SARS-CoV-2/isolamento & purificação
11.
Nutr Metab Cardiovasc Dis ; 31(5): 1613-1621, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33741212

RESUMO

BACKGROUND AND AIMS: Recently, it has been hypothesized that Tri-Ponderal Mass Index (TMI) may be a valid alternative to Body Mass Index (BMI) when measuring body fat in adolescents. We aimed to verify whether TMI has better accuracy than BMI in discriminating central obesity and hypertension in adolescents with overweight. METHODS AND RESULTS: This monocentric and retrospective cross-sectional study included 3749 pupils, 1889 males and 1860 females, aged 12-13. BMI (kg/m2) was calculated and expressed as percentiles and as z-scores. TMI (kg/m3) was calculated, and we used pre-defined cut-off previously proposed by Peterson et al.. For central obesity we adopted the Waist-to-Height Ratio (WHtR) discriminatory value of 0.5. Hypertension was defined as blood pressure ≥95th percentile of age- sex-, and height-specific references recommended by NHBPEP Working Group. The discriminant ability of TMI, BMI and BMI z-score, with respect to central obesity and hypertension, was investigated using non-parametric receiver operating characteristic analysis. The overall misclassification rate for central obesity was 8.88% for TMI vs 14.10% for BMI percentiles and vs 14.92% for BMI z-scores (P < 0.001). The overall misclassification rate for hypertension was 7.50% for TMI vs 22.03% for BMI percentiles and vs 25.19% for BMI z-scores (P < 0.001). CONCLUSION: TMI is a superior body fat index and it could discriminate body fat distribution more accurately than BMI. This supports the use of TMI, in association with WHtR, to characterize adolescents with overweight and high cardio-metabolic risk. Our analysis needs to be extended to other ethnic groups and replicated in a wider age range and in longitudinal studies.


Assuntos
Adiposidade , Pressão Sanguínea , Índice de Massa Corporal , Hipertensão/diagnóstico , Obesidade Abdominal/diagnóstico , Obesidade Pediátrica/diagnóstico , Adolescente , Fatores Etários , Fatores de Risco Cardiometabólico , Criança , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Itália/epidemiologia , Masculino , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/fisiopatologia , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/fisiopatologia , Valor Preditivo dos Testes , Prevalência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Relação Cintura-Quadril
13.
Nutr Metab Cardiovasc Dis ; 31(4): 1317-1323, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33589322

RESUMO

BACKGROUND AND AIM: Childhood obesity is one of the most serious public health challenges of the 21st century. Body mass index (BMI), the most widely used marker of body fatness, has serious limitations, particularly in children, since it does not accurately discriminate between lean and fat mass. Aim of our study was to investigate if the estimate of fat mass, as derived by a new prediction model, was associated with carotid intima media thickness (IMT) and the cross-sectional area of the intima media complex (CSA-IMC) in overweight or obese children. METHODS AND RESULTS: As many as 375 overweight/obese Italian children, 54.7% males, aged 5-15 years, admitted to a tertiary care hospital, were consecutively enrolled in a study on cardiovascular markers of atherosclerosis. All children underwent an ultrasound carotid examination. Mean weight was 62.2 ± 20.8 Kg and fat-mass was 26.2 ± 10.7 Kg. Multiple regression analyses showed a significant association of fat mass with carotid IMT (ß 0.156, p 0.01) and CSA-IMC (ß 0.216, p < 0.001); these associations remained significant after controlling for the main cardiovascular risk factors (age, sex, blood pressure, HOMA-index, triglycerides, LDL-cholesterol, HDL-cholesterol, birth weight and high-sensitivity C-reactive protein). CONCLUSION: Fat mass calculated with the new formula is independently associated with subclinical atherosclerosis in overweight/obese children.


Assuntos
Adiposidade , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Modelos Biológicos , Obesidade Pediátrica/diagnóstico , Adolescente , Fatores Etários , Doenças das Artérias Carótidas/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Itália , Masculino , Obesidade Pediátrica/complicações , Obesidade Pediátrica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
14.
Nutr Metab Cardiovasc Dis ; 31(4): 1308-1316, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33618924

RESUMO

BACKGROUND AND AIMS: The relationship between insulin resistance (IR) and hepatic steatosis (fatty liver) is well known; however, the extent to which the satiety hormone leptin acts as a confounder or mediator in this relationship is uncertain. We examined whether the association between IR and hepatic steatosis is mediated by leptin in Colombian adolescents with excess adiposity. METHODS AND RESULTS: A total of 122 adolescents (mean age: 13.4 years; 68% girls) participated in the study. We assessed body composition, hepatic steatosis (as defined by the controlled attenuation parameter [CAP]), cardiometabolic risk factors (body mass index, waist circumference, body composition), biochemical variables (leptin, insulin, glucose, lipid profile, cardiometabolic Z-score, transaminases, etc.), and physical fitness (cardiorespiratory fitness and grip strength). Partial correlation, regression, and mediation analyses were conducted using the Barron and Kenny framework. RESULTS: Ninety-two youths (75.4%) had IR. Mediation analysis revealed a positive relationship between Homeostasis Model Assessment-IR (HOMA-IR) and CAP (ßdir = 3.414, 95% confidence interval [CI]: 1.012 to 5.816, p < 0.001), which was attenuated when leptin was included in the model, thus indicating that leptin mediates this relationship (ßind = 1.074, 95% CI: 0.349 to 2.686, p < 0.001). The percentage of the total effect mediated by leptin was 21%. Regarding sex, the mediation effect of leptin remains significant among boys (ßind = 0.962, 95% CI: 0.009 to 2.615, p < 0.001), but not in girls (ßind = 0.991, 95% CI: 1.263 to 5.483, p = 0.477). CONCLUSIONS: The findings are clinically relevant to consider leptin levels as a surrogate marker of insulin sensitivity when assessing youths with excess adiposity and/or suspected Nonalcoholic hepatic steatosis or nonalcoholic fatty liver disease (NAFLD).


Assuntos
Adiposidade , Resistência à Insulina , Leptina/sangue , Hepatopatia Gordurosa não Alcoólica/etiologia , Obesidade Pediátrica/sangue , Adolescente , Fatores Etários , Biomarcadores/sangue , Criança , Colômbia , Estudos Transversais , Feminino , Humanos , Masculino , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Obesidade Pediátrica/complicações , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/fisiopatologia , Medição de Risco , Fatores de Risco
15.
Nutr. hosp ; 38(1): 85-93, ene.-feb. 2021. tab
Artigo em Inglês | IBECS | ID: ibc-198844

RESUMO

INTRODUCTION: early detection of childhood obesity plays a crucial role in the prevention of diseases during adulthood. At present, the most commonly used screening tool for detecting overweight/obesity in children is the percentile for age of body mass index, although this rate is unable to provide information about fat distribution. An emerging marker of abdominal fat distribution is waist circumference (WC). OBJECTIVE: the aim of this study was to evaluate the differences between the different diagnostic criteria available to define overweight and obesity in order to establish the optimal WC cut-off values for the Spanish children population. METHODS: a cross-sectional study was carried out in 8,241 schoolchildren aged 3 to 12 years from Villanueva de la Cañada (Madrid, Spain). WC (cm), weight (kg) and height (cm) were measured according to the recommendations of the Society for the Advancement of Kineanthropometry (ISAK). The values obtained for the diagnostic criteria (Spanish Orbegozo Foundation (OF), the International Obesity Task Force (IOTF), and the World Health Organization (WHO) were compared using McNemar's test for paired proportions. The kappa coefficient (κ) was used to assess the degree of agreement of the three classifications. We analyzed the validity of body mass index (BMI) and WC using the receiver operating characteristic (ROC) curve analysis. The Youden index was used to determine cut-off values for WC that identify childhood obesity RESULTS: overweight and obesity prevalences were calculated according to the OF, IOTF, and WHO criteria. There was a "substantial" agreement for the overweight and obesity categories between the Spanish criteria and IOTF (κ = 0.636), while agreement was "slight" between the Spanish criteria and those of WHO (κ = 0.198). The estimated cut-off WC criteria ranged from 54.5 to 88.0, varying according to sex and age. CONCLUSION: the proposed WC cut-off values, stated for the first time in a young Spanish population, are a simple and valid alternative as diagnostic criteria of abdominal obesity


INTRODUCCIÓN: la detección temprana de la obesidad durante la infancia es de vital importancia para la prevención de patologías durante la edad adulta. En la actualidad, la evaluación de la obesidad infantil se realiza principalmente utilizando el índice de masa corporal por edad percentilado, aunque este no aporta información sobre la distribución del tejido adiposo. Un marcador emergente de distribución de la grasa abdominal es la circunferencia de la cintura (CC). OBJETIVO: el objetivo de este trabajo fue evaluar las diferencias entre diferentes criterios diagnósticos para definir el sobrepeso y la obesidad con el fin de establecer el punto de corte óptimo de la CC en los niños españoles. MÉTODO: se llevó a cabo un estudio observacional transversal de 8241 niños/as (3-12 años) en Villanueva de la Cañada (Madrid, España). Se determinaron el peso, la talla y el perímetro de la cintura atendiendo a los criterios de la Sociedad Internacional para el Avance de la Cineantropometría (ISAK). Los valores obtenidos para los criterios diagnósticos (Fundación Orbegozo (OF), el Grupo Internacional de Obesidad (IOTF) y la Organización Mundial de la Salud (OMS)) se compararon utilizando la prueba de McNemar para proporciones emparejadas. El coeficiente kappa (κ) se utilizó para evaluar el grado de acuerdo de las tres clasificaciones. Analizamos la validez del índice de masa corporal (IMC) y el perímetro de la cintura (CC) utilizando el análisis de la curva característica operativa del receptor (ROC). El índice de Youden se utilizó para determinar los valores de corte de la CC que identifican la obesidad infantil. RESULTADOS: se calcularon las prevalencias del sobrepeso y la obesidad de acuerdo con criterios internacionales (IOTF, OMS) y nacionales (FO). Se observó un acuerdo "substancial" para el sobrepeso y la obesidad entre el criterio diagnóstico español y el IOTF (κ = 0,636), mientras que el acuerdo fue "ligero" entre el criterio español y el de la OMS (κ = 0,198). Los puntos de corte de la CC estimados variaron de 54,5 a 88,0 cm, modificándose en función de la edad y el sexo. CONCLUSIONES: los puntos de corte de la CC propuestos, establecidos por primera vez para niños españoles, son una alternativa simple y válida como criterio diagnóstico de obesidad abdominal


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Circunferência da Cintura/fisiologia , Prognóstico , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Espanha/epidemiologia , Gordura Abdominal/fisiopatologia , Antropometria
16.
J Pediatr Gastroenterol Nutr ; 73(1): 103-109, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33633075

RESUMO

OBJECTIVES: In recent years, a subgroup of individuals with obesity has been described as having a lower risk of metabolic and cardiovascular complications. These individuals have what is referred to as metabolically healthy obesity (MHO), which has a favorable metabolic profile and a lower probability of long-term complications. The definition of this subtype in children is not clear. The aim of the present study was to determine whether Homeostasis Model Assessment (HOMA) above a set threshold could be the marker of metabolically unhealthy obesity (MUO) in children, or a parameter that can be used in the overall assessment. It is intended to compare the International Diabetes Federation (IDF) criteria against HOMA in the diagnosis of MUO. METHODS: This observational, retrospective, cohort study included children with obesity and analyzed their metabolic state by means of blood testing and dual-energy X-ray absorptiometry. RESULTS: A total of 96 patients were included, 44.8% boys and 55.2% girls, ages 6-17 years. The patients with MHO according to the HOMA criterion were younger (P = 0.001), had a lower body mass index (BMI) z score (P = 0.006), waist-height index (P = 0.009), hip-height index (P = 0.010), blood glucose (P = 0.003), insulin (P < 0.001), and lower percentages of total fat (P = 0.002), trunk fat (P = 0.001), and android fat (P = 0.009) than those with MUO. The logistic regression analysis according to IDF criteria detected an area under the receiver operating characteristic (ROC) curve of 0.659 (95% CI 0.546-0.771; P = 0.009) versus the area under the ROC curve of 0.854 (95% CI 0.777-0.931; P < 0.001) for the HOMA definition. Therefore, the determination of the metabolic state according to HOMA has greater sensitivity and specificity than the IDF criteria. The multivariate analysis in children classified according to HOMA revealed that the percentage of total fat and gynoid fat distributions and triglyceride level could be markers of a healthy or unhealthy metabolic state in children with obesity (P < 0.001). CONCLUSIONS: The use of HOMA as a single criterion was demonstrated to be an effective and simple detector of adiposity, which predicts the metabolically healthy obesity in children.


Assuntos
Resistência à Insulina , Síndrome Metabólica , Obesidade Metabolicamente Benigna , Obesidade Pediátrica , Adolescente , Índice de Massa Corporal , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Obesidade Metabolicamente Benigna/diagnóstico , Obesidade Pediátrica/complicações , Obesidade Pediátrica/diagnóstico , Estudos Retrospectivos , Fatores de Risco
17.
Nutr Metab Cardiovasc Dis ; 31(3): 902-910, 2021 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-33549442

RESUMO

BACKGROUND AND AIMS: Neurotensin (NT) is an intestinal peptide released after fat ingestion, which regulates appetite and facilitates lipid absorption. Elevated plasma levels of its stable precursor pro-neurotensin (pro-NT) are associated with type 2 diabetes, obesity and cardiovascular mortality in adult populations; no data on pro-NT and metabolic disease are available in children. Aim of the study was to evaluate plasma pro-NT in relation to the presence of obesity in children, and to test if high pro-NT associates with the development of metabolic impairment later in life. METHODS AND RESULTS: For this longitudinal retrospective study, we studied 151 overweight/obese children undergoing metabolic evaluations at University of Cagliari, Italy. Pro-NT was also assessed in 46 normal-weight, age-, sex-comparable normal-weight children, selected as a reference group. At the baseline, pro-NT was comparable between overweight/obese and normal-weight children and correlated positively with age (p < 0.001), triglycerides (p < 0.001) and inversely with HDL levels (p = 0.008). Plasma pro-NT associated with high triglycerides with OR = 5.9 (95%CI: 1.24-28.1; p = 0.026) after adjustment for multiple confounders. At the 6.5-year follow-up, high basal pro-NT associated with impaired ß-cell function to compensate for insulin-resistance (disposition index: r = -0.19, p = 0.035) and predicted bodyweight increase, as indicated by percentage change of standard deviation score BMI (median(95%CI) = +20.8(+4.9-+27.5)% in the highest tertile), independently from age, sex, triglycerides and insulin-resistance (standardized ß = 0.24; p = 0.036). CONCLUSIONS: Elevated pro-NT levels in children are significantly associated with weight gain later in life and may represent a marker of susceptibility to metabolic impairment in presence of obesity.


Assuntos
Metabolismo Energético , Doenças Metabólicas/sangue , Neurotensina/sangue , Obesidade Pediátrica/sangue , Precursores de Proteínas/sangue , Ganho de Peso , Fatores Etários , Biomarcadores/sangue , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/fisiopatologia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Regulação para Cima
18.
Trials ; 22(1): 78, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482883

RESUMO

BACKGROUND: For prospective meta-analyses (PMAs), eligible studies are identified, and the PMA hypotheses, selection criteria, and analysis methods are pre-specified before the results of any of the studies are known. This reduces publication bias and selective outcome reporting and provides a unique opportunity for outcome standardisation/harmonisation. We conducted a world-first PMA of four trials investigating interventions to prevent early childhood obesity. The aims of this study were to quantitatively analyse the effects of prospective planning on variations across trials, outcome harmonisation, and the power to detect intervention effects, and to derive recommendations for future PMA. METHODS: We examined intervention design, participant characteristics, and outcomes collected across the four trials included in the EPOCH PMA using their registration records, protocol publications, and variable lists. The outcomes that trials planned to collect prior to inclusion in the PMA were compared to the outcomes that trials collected after PMA inclusion. We analysed the proportion of matching outcome definitions across trials, the number of outcomes per trial, and how collaboration increased the statistical power to detect intervention effects. RESULTS: The included trials varied in intervention design and participants, this improved external validity and the ability to perform subgroup analyses for the meta-analysis. While individual trials had limited power to detect the main intervention effect (BMI z-score), synthesising data substantially increased statistical power. Prospective planning led to an increase in the number of collected outcome categories (e.g. weight, child's diet, sleep), and greater outcome harmonisation. Prior to PMA inclusion, only 18% of outcome categories were included in all trials. After PMA inclusion, this increased to 91% of outcome categories. However, while trials mostly collected the same outcome categories after PMA inclusion, some inconsistencies in how the outcomes were measured remained (such as measuring physical activity by hours of outside play versus using an activity monitor). CONCLUSION: Prospective planning led to greater outcome harmonisation and greater power to detect intervention effects, while maintaining acceptable variation in trial designs and populations, which improved external validity. Recommendations for future PMA include more detailed harmonisation of outcome measures and careful pre-specification of analyses to avoid research waste by unnecessary over-collection of data.


Assuntos
Obesidade Pediátrica , Peso Corporal , Criança , Pré-Escolar , Dieta , Exercício Físico , Humanos , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/prevenção & controle , Estudos Prospectivos
19.
Am J Prev Med ; 60(3): 425-433, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33483154

RESUMO

INTRODUCTION: Childhood obesity continues to be a significant public health issue in the U.S. and is associated with short- and long-term adverse health outcomes. A number of states have implemented school-based BMI screening programs. However, these programs have been criticized for not being effective in improving students' BMI or reducing childhood obesity. One potential benefit, however, of screening programs is the identification of younger children at risk of obesity as they age. METHODS: This study used a unique panel data set from the BMI screening program for public school children in the state of Arkansas collected from 2003 to 2004 through the 2018-2019 academic years and analyzed in 2020. Machine learning algorithms were applied to understand the informational value of BMI screening. Specifically, this study evaluated the importance of BMI information during kindergarten to the accurate prediction of childhood obesity by the 4th grade. RESULTS: Kindergarten BMI z-score is the most important predictor of obesity by the 4th grade and is much more important to prediction than sociodemographic and socioeconomic variables that would otherwise be available to policymakers in the absence of the screening program. Including the kindergarten BMI z-score of students in the model meaningfully increases the accuracy of the prediction. CONCLUSIONS: Data from the Arkansas BMI screening program greatly improve the ability to identify children at greatest risk of future obesity to the extent that better prediction can be translated into more effective policy and better health outcomes. This is a heretofore unexamined benefit of school-based BMI screening.


Assuntos
Obesidade Pediátrica , Arkansas , Índice de Massa Corporal , Criança , Humanos , Aprendizado de Máquina , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Instituições Acadêmicas
20.
Nutr Metab Cardiovasc Dis ; 31(2): 363-371, 2021 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-33487495

RESUMO

BACKGROUND AND AIMS: Overweight and obesity in children have become a global public health problem. Epidemiological studies suggest that sleep duration may contribute to the incidence of overweight and obesity in all stages of life. China has an increasing prevalence of overweight and obesity, and sleep deprivation is common among Chinese children. The aim of this study was to assess the prospective relationship between short sleep duration and overweight or obesity in Chinese children and to gain an estimate of the risk. METHODS AND RESULTS: A systematic search was performed on 28/04/2020 by using Medline, PubMed and Web of Science. The exposure was the duration of sleep, and the outcome measure the incidence of overweight or obesity. The odds ratios (OR) and hazard ratios (HR) and 95% confidence intervals (C.I.) were extracted to calculate the pooled relative risk (RR) by a random effect model. Heterogeneity and publication bias of the studies were checked by sensitivity analysis. Seven studies fulfilled the criteria for a systematic review, and 5 studies for a meta-analysis. The total of 33,206 participants included boys and girls, aged 6-17 years old. In Chinese children the pooled RR for short sleep duration and overweight or obesity combined was 1.47 (95% C.I. 1.26, 1.71, p < 0.00001, n = 32,607), and for obesity alone 1.40 (95% C.I. 1.01, 1.95, p = 0.04, n = 17,038). There was no significant heterogeneity or publication bias between studies. CONCLUSION: Short sleep duration is associated with the development of overweight and obesity in Chinese children.


Assuntos
Obesidade Pediátrica/epidemiologia , Privação do Sono/epidemiologia , Adolescente , Fatores Etários , Grupo com Ancestrais do Continente Asiático , Criança , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/fisiopatologia , Medição de Risco , Fatores de Risco , Sono , Privação do Sono/diagnóstico , Privação do Sono/fisiopatologia , Fatores de Tempo
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