The risk of metabolic derangements is higher in children and adolescents with overweight or obesity born small for gestational age

Background and aimsBirth 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 results710 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.ConclusionsBW 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.     

Serum Ferritin level,microalbuminuria and non-alcoholic fatty liver disease in type 2 diabetic patients

BackgroundNon-alcoholic fatty liver disease (NAFLD) was considered one of the most common causes of chronic liver disease and is considered the hepatic manifestation of type 2 diabetes mellitus (T2DM). The factors that lead to marked fibrosis and liver cell injury in NAFLD are still remaining undiscovered.Patients and methodsThis study included (40) type 2 diabetic patients with NAFLD and (40) diabetic patients without NAFLD beside 15 healthy persons as a control group. All of them were subjected to full history taking, thorough clinical examination with especial stress on body weight (BW), height, body mass index (BMI), waist-hip ratio, blood pressure. Laboratory tests included serum total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) and high-density lipoprotein (HDL), fasting blood glucose (FBG) and 2-h postprandial blood glucose (PBG), serum Ferritin and urine microalbuminuria (MAU).ResultsDuration of diabetes, BW, BMI and blood pressure were significantly higher in NAFLD group (P = 0.001). FBG, PBG, TC, TG, LDL, serum Ferritin and MAU were significantly increased in NAFLD group with significant difference between two studied groups as regard HDL. There was a highly significant correlation between serum Ferritin with BW, BMI, duration of diabetes, TC, TG, LDL and MAU. There was a significant correlation between serum Ferritin with age, waist hip ratio, duration of diabetes, SBP, FBG, PBG and HDL. There was a significant correlation between MAU and age, weight, BMI, waist hip ratio, duration of diabetes, DBP, FBG TC, TG, LDL and HDL.ConclusionNAFLD is a common liver disorder in diabetic patients. NAFLD is significantly associated with microalbuminuria and elevated serum Ferritin.     

Cardiometabolic determinants of mortality in a geriatric population: Is there a “reverse metabolic syndrome”?

AimsDiabetes or insulin resistance, overweight, arterial hypertension, and dyslipidaemia are recognized risk factors for cardiovascular (CV) disease. However, their predictive value and hierarchy in elderly subjects remain uncertain.MethodsWe investigated the impact of cardiometabolic risk factors on mortality in a prospective cohort study of 331 elderly high-risk subjects (mean age ± SD: 85 ± 7 years).ResultsTwo-year total mortality was predicted by age, diabetes, low BMI, low diastolic blood pressure (DBP), low total and HDL cholesterol, and previous CV events. The effect of diabetes was explained by previous CV events. In non-diabetic subjects, mortality was predicted by high insulin sensitivity, determined by HOMA-IR and QUICKI indices. In multivariate analyses, the strongest mortality predictors were low BMI, low HDL cholesterol and previous myocardial infarction. Albumin, a marker of malnutrition, was associated with blood pressure, total and HDL cholesterol, and HOMA-IR. The inflammation marker CRP was associated with low total and HDL cholesterol, and high HOMA-IR.ConclusionIn very old patients, low BMI, low DBP, low total and HDL cholesterol, and high insulin sensitivity predict total mortality, indicating a “reverse metabolic syndrome” that is probably attributable to malnutrition and/or chronic disorders. These inverse associations limit the relevance of conventional risk factors. Previous CV events and HDL cholesterol remain strong predictors of mortality. Future studies should determine if and when the prevention and treatment of malnutrition in the elderly should be incorporated into conventional CV prevention.     

Early life factors and their relevance for markers of cardiometabolic risk in early adulthood

Background and aimsEarly life exposures could be pertinent risk factors of cardiometabolic diseases in adulthood. We assessed the prospective associations of early life factors with markers of cardiometabolic risk among healthy German adults.Methods and resultsWe examined 348 term-born DONALD Study participants with measurement of fasting blood at the age of 18–24 years to assess metabolic indices: fatty liver index (FLI), hepatic steatosis index (HSI), pro-inflammatory score and insulin sensitivity (HOMA2-%S).Early life factors (maternal weight in early pregnancy, maternal early pregnancy BMI, gestational weight gain (GWG), maternal age, birth weight and full breastfeeding (>17 weeks)) were assessed at enrolment of the offspring into the study. Multivariable linear regression models were used to analyze associations between early life factors and markers of cardiometabolic risk in early adulthood with adjustment for potential confounders.A higher early pregnancy BMI was related to notably higher levels of offspring FLI, HSI, pro-inflammatory score and a lower HOMA2-%S (all p < 0.0001). Similarly, a higher gestational weight gain was associated with a higher FLI (p = 0.044), HSI (p = 0.016), pro-inflammatory score (p = 0.032) and a lower HOMA2-%S among females (p = 0.034). Full breastfeeding was associated with a lower adult FLI (p = 0.037). A casual mediation analysis showed that these associations were mediated by offspring adult waist circumference (WC).ConclusionThis study suggests that early pregnancy BMI, gestational weight gain, and full breastfeeding are relevant for offspring markers of cardiometabolic risk which seems to be mediated by body composition in young adulthood.     

“Leaner and less fit” children have a better cardiometabolic profile than their “heavier and more fit” peers: The Healthy Growth Study

Background and aimsTo examine differences in cardiometabolic risk factors between children of different BMI and fitness levels.Methods and resultsFrom a representative sample of 1222 boys and 1188 girls, aged 9–13 years, anthropometric, body composition, physical activity, cardiorespiratory fitness, biochemical and blood pressure data was collected. The prevalence of overweight and obesity was 29.9% and 11.8% respectively. In both genders, plasma HDL cholesterol concentration was higher in the ‘leaner and less fit’ group (lowest quartile of BMI and lowest quartile of fitness) compared to the ‘heavier and more fit’ (highest quartile of BMI and highest quartile of fitness) and intermediate (all other children) groups (p < 0.05). Furthermore, the ‘leaner and less fit’ groups in both genders had lower triacylglycerol concentration, total-to-HDL cholesterol ratio, HOMA-IR, insulin and systolic blood pressure levels compared to the ‘heavier and more fit’ and/or intermediate groups. Similar trends were observed for hypertension in boys and insulin resistance for both genders. Finally, the effect size of being ‘leaner and less fit’ on serum levels of cardiometabolic risk indices was mainly small to medium (i.e. Cohen's d 0.2–0.5).ConclusionLeaner and less fit boys and girls had better cardiometabolic risk profiles than their heavier and more fit peers, probably suggesting a higher importance of leanness over fitness in children from a cardiometabolic health benefit perspective.     

School performance and weight status of children and young adolescents in a transitional society in Thailand

OBJECTIVE: To study the association between current or previous weight status and school performance among children and young adolescents of Hat Yai municipality, southern Thailand. DESIGN: Cross-sectional and longitudinal study. SETTING: Primary and secondary schools of Hat Yai municipality, southern Thailand. SUBJECTS: 1207 grades 3-6 and 587 grades 7-9 students. MEASUREMENTS: Body mass index (BMI, kg/m2) calculated from weight and height measurement of subjects in 1992 and 1994; parental education level and occupation, and monthly income, by questionnaire performed in 1992; grade-point-average (GPA) and grades of mathematics and Thai language from the school records of final examinations in 1994. RESULTS: Overweight subjects (BMI value > 85th percentile of the NHANES-I data for age and gender) in grades 7-9 had a mean GPA 0.20 point (95% confidence internal (CI) = 0.04, 0.37) lower than that of the normal weight children after controlling for gender, age, school and grade. They were twice more likely to have low grades (lower than 2 on the scales of 0-4) of mathematics and Thai language than normal weight children. There were no associations between GPA or individual subject grades and previous BMI status in 1992. Children in grades 7-9 who became overweight over the two years, had a mean GPA of 0.48 point lower than those who did not become overweight (95% CI = 0.12, 0.84). In grades 3-6 subjects, however, becoming overweight had no effect on GPA and individual subject scores. CONCLUSIONS: Our study showed that being overweight and becoming overweight during adolescence (grades 7-9) was associated with poor school performance, whereas such an association did not exist in children (grades 3-6).     

Higher vegetable consumption is related to a lower risk of cardiometabolic risk cluster among children and adolescents: A national cross-sectional study in China

Background and aimsEvidence about the association between vegetable consumption and cardiometabolic risk factors (CMRFs) cluster among children and adolescents was inconsistent. We aimed to investigate the prevalence of CMRFs and CMRFs cluster, and to evaluate their associations with vegetable consumption.Methods and resultsA total of 14,061 participants aged 6–19 years were recruited from 7 provinces of China. A standard physical examination, including height, weight and blood pressure, was conducted. Information regarding CMRFs was obtained through anthropometric measurements and blood sample testing, while weekly frequency and daily servings of vegetable consumption data collected by questionnaires. Logistic regression models were used to analyze the odds ratios (OR) for associations between CMRFs, CMRFs cluster and vegetable consumption. The prevalence of no CMRFs cluster among children and adolescents was 26.4%. Participants whose daily vegetable consumption was 0.75–1.5 and ≥1.5 servings showed a lower risk of high blood pressure (HBP), high total cholesterol (TC), high triglyceride (TG), and high low-density lipoprotein cholesterol (LDL-C) compared to those with daily vegetable consumption of <0.75 servings. Besides, higher average daily vegetable consumption was strongly associated with lower risks of CMRFs cluster. Stratified analyses showed that the protective effects of more vegetable intake on CMRFs cluster were profounder in boys and young adolescents.ConclusionMore vegetable intake was associated with lower risks of CMRFs cluster in Chinese children and adolescents aged 6–19 years, which further highlighted the significance of vegetable consumption to improve the cardiometabolic risk status.     

Competing impact of excess weight versus cardiorespiratory fitness on cardiovascular risk

Obesity is a risk factor for cardiovascular disease, whereas high cardiorespiratory fitness (CRF) is cardioprotective. This study evaluated the competing effect of weight and fitness on biomarkers of cardiovascular risk in a nationally representative sample of 2,112 adults (20 to 49 years of age; body mass index [BMI] > or =18.5 kg/m(2)) without previously diagnosed cardiovascular disease from the National Health and Nutrition Examination Survey 1999 to 2002. CRF levels were assigned using age- and gender-specific reference points of estimated maximal oxygen consumption calculated from submaximal graded exercise treadmill testing. CRF was also categorized by sample-specific tertiles of maximal oxygen consumption. Weight was categorized using BMI. Fasting insulin level >12.2 mU/L, C-reactive protein level > or =3.0 mg/L, and total cholesterol/high-density lipoprotein ratio (TC/HDL) >5 characterized increased cardiovascular risk. CRF and BMI were independently associated with increased fasting insulin and C-reactive protein (p <0.05). When patients with low, moderate, and high CRF were further stratified as normal, overweight, or obese, weight remained significantly associated with increased fasting insulin, C-reactive protein, and TC/HDL (p <0.001), but CRF did not. Logistic regressions evaluating increased fasting insulin, C-reactive protein, and TC/HDL demonstrated no significant differences in overweight/obese patients by CRF level after adjustment for other factors. Significant differences were present between normal-weight and overweight or obese patients regardless of fitness level. Analyses using tertiles of CRF yielded similar results. In conclusion, patients who are "fat but fit" require weight-loss interventions to improve their cardiovascular risk profiles. Future interventions should emphasize weight control, even for those with high CRF.     

Distinct causal effects of body fat distribution on cardiometabolic traits among children: Findings from the BCAMS study

Background and aimsObservational studies reveal that different body fat measures are associated with cardiometabolic disease with different effects. However, causality is not reflected by such observations. To explore and compare the causal relationships of general obesity (measured by body mass index (BMI)), adipose obesity (measured by fat mass percentage (FMP)) and central obesity (measured by waist-to-height ratio (WHtR)) with cardiometabolic traits among children.Methods and resultsWe conducted one sample Mendelian randomization (MR) analysis in 3266 children from Beijing Children and Adolescents Metabolic Syndrome Study. Genetic instruments based on 28 SNPs were performed to explore and compare the causal associations of genetically BMI, FMP and WHtR with cardiometabolic traits. The genetic instruments were robustly correlated with observed BMI, FMP and WHtR. Each genetically 1-SD increment in BMI, FMP and WHtR were causally associated with increment in systolic blood pressure (SBP), diastolic blood pressure (DBP), log-transformed fasting plasma glucose (FPG), log-transformed HOMA-β, and decrease in log-transformed high-density lipoprotein cholesterol (HDL), respectively (all P < 0.05 after Bonferroni correction). The receiver operating characteristic curve indicated that BMI and FMP showed stronger effects on SBP, DBP, HOMA-β and HDL than WHtR (all P < 0.05). We also observed causal associations of BMI and FMP with log-transformed fasting insulin and HOMA-IR.ConclusionsThe MR analysis based on population-based cohort indicated a causal relationship of adiposity and body fat distribution with cardiometabolic traits. When compared with central obesity, general obesity and adipose obesity might own stronger effects on blood pressure and blood lipids among children.     

Association of abdominal fat distribution and cardiometabolic risk factors among obese Korean adolescents

The association between abdominal fat distribution and cardiometabolic risk factors using direct measures of abdominal fat in adolescents has not been extensively researched. This study was designed to investigate the association between visceral and subcutaneous fat and cardiometabolic risk factors, in obese Korean adolescents. The study enrolled 175 adolescents (72 boys, 103 girls), from ages nine to 19 years, who were referred to the Obesity Clinic of Asan Medical Center. Body mass index (BMI) and waist circumference (WC) were measured for each study participant. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were calculated by computed tomography. Blood pressure, fasting plasma glucose, total cholesterol, triglycerides, HDL cholesterol, insulin and homeostasis model assessment (HOMA) score were measured. Systolic blood pressure, HDL cholesterol, fasting insulin and the HOMA score were significantly correlated with BMI, WC, VAT and SAT. In addition, VAT was significantly correlated with diastolic blood pressure and triglyceride levels. On multiple regression analysis, VAT was independently correlated with blood pressure, triglycerides, HDL cholesterol, fasting insulin and the HOMA score, while SAT was independently correlated with systolic blood pressure, fasting insulin and the HOMA score. This study determined that cardiovascular risk factors are closely associated with VAT, while insulin resistance is closely associated with both VAT and SAT among obese Korean adolescents.     

Body-mass index and cardiometabolic disease: a Mendelian randomisation study of UK Biobank participants

BackgroundHigher body-mass index (BMI) is a risk factor for cardiometabolic disease, although the underlying causal associations remain unclear. The conflicting evidence with respect to the magnitude of association between BMI and cardiometabolic diseases lends support to adopting a Mendelian randomisation approach: we aimed to contribute a fairly large amount of data with detailed covariate information to this question.MethodsThe UK Biobank is a prospective general cohort study of adults aged 40–70 years at baseline (between 2006 and 2010). We examined 119 859 UK Biobank participants with complete cross-sectional phenotypic and genetic data, using a polygenic risk score consisting of 93 single nucleotide polymorphisms associated with BMI from previous genome-wide association studies. We used the polygenic risk score to derive causal estimates using a Mendelian randomisation approach. Cardiometabolic outcomes were based on self-report of clinical diagnosis for each of hypertension, coronary heart disease, type 2 diabetes, and blood pressure. This study was conducted under generic approval from the NHS National Research Ethics Service (ref 11/NW/0382).FindingsMendelian randomisation analysis showed significant positive associations (all p values <0·0001) between genetically instrumented higher BMI and risk of hypertension (odds ratio per 1 SD increase in BMI 1·64, 95% CI 1·48–1·83), coronary heart disease (1·35, 1·09–1·69), type 2 diabetes (2·53, 2·04–3·13), diastolic blood pressure (difference per 1 SD increase in BMI [β] 1·65 mmHg, 0·78–2·52) and systolic blood pressure (1·37, 0·88–1·85). These associations were independent of age, sex, Townsend deprivation scores, alcohol intake, and smoking history.InterpretationThe results of this study add to the evidence of a causal association between higher BMI and increased risk of cardiometabolic diseases. This finding has relevance for public health policies in countries struggling with increasing obesity levels. BMI is a modifiable risk factor for ameliorating risk of cardiometabolic disease. This report advances the field by including a fairly large sample size including detailed covariates; by using a 93-locus polygenic risk score; and by conducting Mendelian randomisation of BMI on a range of cardiometabolic disease outcomes.FundingNone.     

Birth weight, current body mass index, and insulin sensitivity and secretion in young adults in two Latin American populations

Background and aimsAlthough studies have shown association of birth weight (BW) and adult body mass index (BMI) with insulin sensitivity in adults, there is limited evidence that BW is associated with insulin secretion. We assessed the associations between BW and current BMI with insulin sensitivity and secretion in young Latin American adults.Methods and resultsTwo birth cohorts, one from Ribeirao Preto, Brazil, based on 1984 participants aged 23–25 years, and another from Limache, Chile, based on 965 participants aged 22–28 years were studied. Weight and height at birth, and current fasting plasma glucose and insulin levels were measured. Insulin sensitivity (HOMA%S) and secretion (HOMA%β) were estimated using the Homeostatic Model Assessment (HOMA2). Multiple linear regression analyses were carried out to test the associations between BW and adult BMI z-scores on log HOMA%S and log HOMA%β. BW z-score was associated with HOMA%S in the two populations and HOMA%β in Ribeirao Preto when adult BMI z-score was included in the model. BW z-score was associated with decreasing insulin secretion even without adjusting for adult BMI, but only in Ribeirao Preto. BMI z-score was associated with low HOMA%S and high HOMA%β. No interactions between BW and BMI z-scores on insulin sensitivity were shown.ConclusionsThis study supports the finding that BW may affect insulin sensitivity and secretion in young adults. The effect size of BW on insulin status is small in comparison to current BMI.     

Blood Pressure in Adolescence,Adipokines and Inflammation in Young Adults. The Rio de Janeiro Study

Background

The impact of blood pressure (BP) during adolescence on other cardiovascular risk factors in young adults is important for the primary prevention.

Objective

To evaluate BP, anthropometric indexes, metabolic and inflammatory profiles in young individuals stratified by their BP behavior recorded for 18 years.

Methods

A total of 116 individuals, of whom 63 were males, from the Rio de Janeiro study (follow-up of 17.76 ± 1.63 years), were assessed at two moments: A1 (12.40 ± 1.49 years) and A2 (30.09 ± 2.01 years). The 116 individuals were divided into two groups: GN (n = 71), of participants with normal BP at A1; and GH (n = 45), of those with abnormal BP at A1. BP, weight, height and body mass index (BMI) were measured at A1 and A2. At A2, abdominal circumference (AC) and laboratory, metabolic and inflammatory variables were included.

Results

1) No difference was observed between the groups as regards age and gender; 2) At A2, GH showed higher mean weight, BMI, BP, insulin, HOMA-IR (p < 0.001), leptin (p < 0.02), apolipoprotein B100 and A1 (p < 0.02), apolipoprotein B100 / apolipoprotein A1 ratio (p < 0.010); and higher prevalences of overweight/obesity (p < 0.001), of increased AC (p < 0.001) and of hypertension (p < 0.02); 3) No difference was observed between the groups as regards the inflammatory variables; 4) There was a positive correlation of BP at A1 with BP, BMI, insulin, leptin and HOMA-IR at A2 (p < 0.05).

Conclusion

BP in adolescence was associated with higher values of BP, and anthropometric and metabolic variables in young adulthood, but not with inflammatory variables.     

Serum sphingolipids and inflammatory mediators in adolescents at risk for metabolic syndrome

The purpose of this study was to determine low-grade inflammation associated with obesity that is mediated partially by TNF-α, an adipocytokine which stimulates sphingomyelinase activity in adipocytes. Circulating ceramide (Cer) and sphingosine 1-phosphate (S1P) are elevated in genetically obese (ob/ob) mice. We aimed to determine whether serum sphingolipid concentrations correlate with measures of obesity, insulin resistance, and lipid profiles in overweight versus lean adolescents. This cross-sectional study recruited 30 healthy overweight (body mass index, BMI?≥?85%) and 15 lean (BMI 10-84%) adolescents. Anthropometric measurements and fasting blood samples were collected at one clinic visit. Serum glucose, insulin, and fasting lipid profiles were measured. Serum adipocytokine concentrations were measured by ELISA or colorimetric assay and sphingolipids were measured by HPLC-mass spectrometry. Between group differences in serum sphingolipid concentrations were assessed. Correlations between sphingolipid concentrations and (i) body mass index, (ii) calculated homeostasis model assessment of insulin resistance (HOMA-IR), (iii) adipocytokines, and (iv) lipoproteins were determined. The results showed that significant differences in HOMA-IR (4.5?±?3.2 vs. 1.2?±?0.7), free fatty acids (0.8?±?0.3?mmol/l vs. 0.4?±?0.3?mmol/l), and adiponectin (6.4?±?3.8 vs. 12.6?±?9.9 μg/ml) were seen between groups (overweight vs. lean). There were significant correlations between Cer and TNF-α (r?=?0.429), S1P and TNF-α (r?=?0.288), Cer and adiponectin (r?=?0.321), Cer:S1P and adiponectin (r?=?0.324), Cer and HOMA-IR (r?=?0.307), and Cer:S1P and LDL cholesterol (r?=?0.453); these associations persisted after adjustment for BMI Z-score, sex, and Tanner stage. We concluded that elevated sphingolipid concentrations correlate with TNF-α, adiponectin, lipoprotein profiles, and HOMA-IR. Ceramide is associated with atherogenic lipid profiles and the development of insulin resistance in obese adolescents, similar to adults.     

Diagnostic accuracy of triglyceride/glucose and triglyceride/HDL index as predictors for insulin resistance in children with and without obesity

ObjectiveTo investigate which of two indexes (TyG or TG/HDL) are the best predictors for insulin resistance (IR) and to evaluate the magnitude of each cardiometabolic risk factor in Mexican schoolchildren of 5–9 years with overweight-obesity and normal weight.Material and methodsWe realized a comparative cross-sectional prospective study in accordance of STARD guidelines. Setting was Family Medicine Unit (FMU) No. 80 of Mexican Institute of Social Security(IMSS) of Morelia, Michoacán, Mexico. Children between 5 and 9 years, both genders, 104 with normal weight(NW), 97 with Overweight-Obesity(OO Group) were included. Once the informed consent was signed we obtained the BMI, waist circumference, blood pressure(BP) and 5 mL of blood collected for glucose, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, uric acid and insulin. As main outcome measures TyG or TG/HDL, HOMA-IR, and Receiving Operating Curves(ROC), sensitivity, specificity by ROC were obtained.ResultsCutoff point TyG: 8.5 by ROC had an area under curve (AUC):0.802 IC95% 0.77to0.893, P = 0.0001; diagnostic accuracy of 73%. TG/HDL: 2.22; AUC:0.729 IC95% 0.622to0.837, P = 0.014; diagnostic accuracy of 52%. TyG can identify cardiometabolic alterations more than HOMA and TG/HDL. Cardiometabolic alterations in the OO group were hypertriglyceridemia:49.5%, low HDL:63.9%, IR:39.2% and in NW group were hypertriglyceridemia:30.8%, low HDL:60.6%, IR:9.6%.ConclusionsWe reported high frequency of hypertriglyceridemia and low HDL in Mexican children. TyG and TG/HDL are good predictors for IR. TyG has a better diagnostic accuracy. We need implementing TyG for identifying alterations and intervening in a timely manner to delay the onset of chronic diseases in children.     

Diminished insulin resistance with weight loss in severely overweight youth

Background: The influence of weight loss on insulin resistance was determined in severely overweight (BMI Z-score: 7.3 +/- 0.9 z-units) hyperinsulinemic (mean fasting serum insulin concentration: 33.0 +/- 6.7 muIU/mL) youth. Methods: Eight overweight youth and obese parents were studied at baseline and then at 6 and 12 months after behavioral weight loss therapy. Non-treated lean youth (n = 8) served as controls for normal interval growth. The groups were matched for sex, race, age (10.2 versus 10.1 years), and pubertal maturation, and evaluated for weight, height, blood pressure, and the homeostasis model of insulin resistance (HOMA-IR). Results: Overweight youth had reductions (p 相似文献   

Critical periods and growth patterns from fetal life onwards associated with childhood insulin levels

Aims/hypothesis

We aimed to identify critical periods and specific longitudinal growth patterns from fetal life onwards associated with childhood insulin and C-peptide levels.

Methods

In a prospective population-based cohort study of 4328 children, we repeatedly measured (femur) length and (estimated fetal) weight from the second trimester of fetal life until 6 years of age. BMI was calculated from 6 months onwards. Insulin and C-peptide levels were measured at 6 years of age.

Results

Preterm birth and small or large size for gestational age at birth were not associated with childhood insulin levels. Conditional growth modelling showed that, independent of growth in other time intervals, weight growth in each time interval from birth onwards, length growth from 6 months onwards and BMI growth from 12 months onwards were positively associated with childhood insulin levels. The strongest associations were present for weight and BMI growth between 48 and 72 months of age. Repeated measurement analyses showed that, compared with children in the lowest quartile of childhood insulin, those in the highest quartile had a higher length from birth onwards and a higher weight and BMI from 24 months onwards. These differences increased with age. No associations were observed for fetal growth characteristics. Similar results were observed for C-peptide levels.

Conclusions/interpretation

Our results suggest that rapid length, weight and BMI growth from birth onwards, but not during fetal life, is associated with higher insulin levels in childhood.

     

Anthropometric indices of fat distribution and cardiometabolic risk in Parkinson's disease

Background &; aimsTo investigate the association between anthropometric indices of body fat distribution and cardiometabolic risk factors in a population of Parkinson’s disease (PD) patients.Methods &; resultsOne hundred and fifty-seven PD patients (57.3% males) were studied measuring: waist circumference (WC), waist-hip ratio (WHR), waist-to-height ratio (WtHR), body fat percentage (BF%) by impedance, fasting glucose, serum lipids. Information was collected also on diabetes, hypertension and metabolic syndrome (MetS). Increased cardiometabolic risk was defined by ≥2 MetS component traits other than abdominal adiposity. In the whole population, prevalence of overweight and obesity were 35.0% and 19.2%, respectively. However, prevalence of MetS and elevated cardiometabolic risk were 14.6% and 18.5%, respectively. Prevalence was similar between genders, with one exception: adverse fat distribution according to WC and WHR was more common in females (P < 0.001). Using a multivariable model (adjustments: age, smoking status and disease duration), indices were highly correlated with BF% in both genders. WC and WtHR were associated with the number of MetS criteria and elevated risk. The only cardiometabolic parameters associated with anthropometric indices were HDL in men and triglycerides in women. After adjusting also for BMI all the associations found with anthropometric indices disappeared.ConclusionsDespite their correlation with BF%, anthropometric indices of body fat distribution appear to poorly account for the reduced cardiometabolic risk of the PD patient. This finding suggests a low metabolic activity within the adipose tissue. The implications of fat distribution on the cardiometabolic risk of PD patients clearly deserves further investigation.     

ApoC-III bound to apoB-containing lipoproteins increase with insulin resistance in Cherokee Indian youth

Because Native Americans are predisposed to obesity and type 2 diabetes associated with coronary artery disease, we assessed whether apoC-III bound to apoB-containing (LpB:C-III) and apoA-containing (LpA:C-III) lipoproteins, total apoC-III, apoB, and plasma lipids are associated with insulin resistance, body mass index (BMI), and waist circumference in Cherokee children and adolescents aged 5 to 19 years (n = 975). A cross-sectional analysis was done to determine associations of the lipoproteins with the homeostasis index (HOMA-IR) and BMI. When the data were grouped by quartiles for HOMA-IR and separated by three 5-year age groups (5-9, 10-14, and 15-19 years), the trend for LpB:C-III, triglyceride, and BMI z score to increase was significant for all age groups and both genders (P < .001). The trend to increase LpB:C-III with age was greater in boys (P < .0001) than in girls (P < .05) who tended to plateau after the age of 10 years. In contrast, the ratio of LpA:C-III to LpB:C-III decreased and the decrease was greater in boys (P < .0001) than girls (P < .01). Body mass index z score and waist circumference were correlated with LpB:C-III, triglyceride, apoB, and non-high-density lipoprotein cholesterol within each gender (P < .001). In multiple regression models, LpB:C-III, the dependent variable, was associated with HOMA-IR for both genders. We conclude that increases in LpB:C-III in childhood and adolescence are associated with insulin resistance and obesity supporting the need for prevention programs.     

Faster increase in body mass index between ages 8 and 13 is associated with risk factors for cardiovascular morbidity and mortality

Background and aimsExcess childhood weight is associated with cardiovascular disease (CVD) in adulthood. Whether this is mediated through adult body mass index (BMI) and associated risk factors such as metabolic derangements remains unclear. The aim was to examine whether childhood BMI velocity (Δkg m⁻² per year) was associated with adult CVD mortality and to examine how adult BMI and cardiometabolic risk factors contribute to the association.Methods and resultsSubjects were 1924 Icelanders born between 1921 and 1935 and living in Reykjavik when recruited into a longitudinal study from 1967 to 1991. From ages 8–13 years, BMI velocity was calculated to quantify the association between childhood growth and adult CVD mortality. Deaths from recruitment to 31 December 2009 were extracted from the national register. There were 202 CVD deaths among men and 90 CVD deaths among women (mean follow-up: 25.9 years). Faster BMI velocity from ages 8–13 years was associated with CVD mortality when comparing those in the highest versus lowest tertile with corresponding hazard ratio (HR) (95% confidence interval (CI)): 1.49 (1.03, 2.15) among men and 2.32 (1.32, 4.08) among women after adjustment for mid-life BMI and CVD risk factors. Faster childhood BMI velocity was associated with elevated CVD risk factors among men at mid-life but these associations were less pronounced among women.ConclusionFaster increase in BMI from ages 8–13 years was associated with an increased CVD mortality risk. Children with early growth spurts coupled with excess weight gain during this transition period from childhood into adolescence should be closely monitored to ensure better health in adulthood.