Complications Of Childhood Obesity Research Articles

Is routine pre-operative cardiac evaluation necessary in obese children undergoing adenotonsillectomy for OSA?

BackgroundAdenotonsillectomy (T&A) is a common surgery performed for obstructive sleep apnea (OSA) in children. Obese children are at increased risk for OSA, but are also at increased risk for cardiovascular changes that might heighten their risk of undergoing a general anesthetic. There is currently no standard of care recommendation for cardiac workup prior to T&A. PurposeTo ascertain whether a preoperative cardiac workup is predictive of postoperative complications in obese children undergoing T&A for OSA. DesignRetrospective cohort review. Material and Methods241 children with BMI ≥ 25 kg/m2 underwent T&A for OSA. This cohort was divided into three groups — those who had no preoperative cardiac evaluation, those who had a preoperative cardiac evaluation but no significant findings and those who had a preoperative cardiac evaluation with at least one significant finding. Postoperative cardiac-related complications were compared between the three groups. ResultsThere were significantly more postoperative complications in Group 3, the group with findings on preoperative cardiac evaluation. However, these were heavily weighted toward “hospital stay > 24 hours” without clear cardiac sequelae. Notably there were no incidents of pulmonary edema, re-intubation postoperatively or death. ConclusionIn obese children undergoing T&A at a tertiary care center, a preoperative cardiac workup was not shown to be beneficial in predicting postoperative complications.

High-fat diet causes bone loss in young mice by promoting osteoclastogenesis through alteration of the bone marrow environment.

Obesity is a severe health problem in children, afflicting several organ systems including bone. However, the role of obesity on bone homeostasis and bone cell function in children has not been studied in detail. Here we used young mice fed a high-fat diet (HFD) to model childhood obesity and investigate the effect of HFD on the phenotype of cells within the bone marrow environment. Five-week-old male mice were fed a HFD for 3, 6, and 12weeks. Decreased bone volume was detected after 3weeks of HFD treatment. After 6 and 12weeks, HFD-exposed mice had less bone mass and increased osteoclast numbers. Bone marrow cells, but not spleen cells, from HFD-fed mice had increased osteoclast precursor frequency, elevated osteoclast formation, and bone resorption activity, as well as increased expression of osteoclastogenic regulators including RANKL, TNF, and PPAR-gamma. Bone formation rate and osteoblast and adipocyte numbers were also increased in HFD-fed mice. Isolated bone marrow cells also had a corresponding elevation in the expression of positive regulators of osteoblast and adipocyte differentiation. Our findings indicate that in juvenile mice, HFD-induced bone loss is mainly due to increased osteoclast bone resorption by affecting the bone marrow microenvironment. Thus, targeting osteoclast formation may present a new therapeutic approach for bone complications in obese children.

Obesidade infantil: o olhar dos enfermeiros inseridos na atenção básica

This is an exploratory, descriptive, qualitative approach, attempts to understand the perception of nurses inserted in primary care on childhood obesity a city in western Santa Catarina. Data were collected through interviews with ten nurses semiestrururadas inserted in Primary Care from January to March 2013. The collected data were subjected to content analysis Minayo. Categories “Change in nutritional status of the child population”, “Causes of childhood overweight and obesity”, “Complications of childhood obesity”, “Preventing Childhood Obesity” and “Actions undertaken within primary care’ were identified. It was possible to identify the perception of nurses regarding the growth of the risk factors for the development of childhood obesity. Moreover, it is necessary to intensify municipal actions with regard to physical space for physical activities and changes in eating habits.

IV. The cognitive implications of obesity and nutrition in childhood.

The prevalence of childhood obesity in the United States has tripled since the 1980s and is strongly linked to the early onset of several metabolic diseases. Recent studies indicate that lower cognitive function may be another complication of childhood obesity. This review considers the research to date on the role of obesity and nutrition on childhood cognition and brain health. Although a handful of studies point to a maladaptive relationship between obesity and aspects of cognitive control, remarkably little is known regarding the impact of fat mass on brain development and cognitive function. Further, missing from the literature is the role of nutrition in the obesity-cognition interaction. Nutrition may directly or indirectly influence cognitive performance via several pathways including provision of key substrates for optimal brain health, modulation of gut microbiota, and alterations in systemic energy balance. However, in the absence of malnutrition, the functional benefits of specific nutrient intake on particular cognitive domains are not well characterized. Here, we examine the literature linking childhood obesity and cognition while considering the effects of nutritional intake. Possible mechanisms for these relationships are discussed and suggestions are made for future study topics. Although childhood obesity prevalence rates in some developed countries have recently stabilized, significant disparities remain among groups based on sex and socioeconomic status. Given that the elevated prevalence of pediatric overweight and obesity may persist for the foreseeable future, it is crucial to develop a comprehensive understanding of the influence of obesity and nutrition on cognition and brain health in the pediatric population.

Screening for metabolic and reproductive complications in obese children and adolescents.

Childhood obesity is associated with a number of metabolic comorbidities. These include glucose intolerance and type 2 diabetes mellitus, hyperlipidemia, fatty liver disease, and reproductive complications, such as polycystic ovary syndrome. The occurrence of these complications in a child or adolescent may result in progressive health decline at an early age. We, therefore, advocate screening and early diagnosis. This purpose of this review is to outline a rational, evidence-based approach to screening obese children and adolescents for metabolic and reproductive complications. In each section, the aim is to provide the primary care provider with a review of the literature supporting current screening practices. As such, this review is designed to assist the primary care provider in the selection and interpretation of screening tests and to make recommendations regarding the referral of patients for subspecialty care.

Variants of 11β-hydroxysteroid dehydrogenase (HSD11B) gene type 1 and 2 in Chinese obese adolescents.

To investigate the relationship between 11β-hydroxysteroid dehydrogenase (HSD11B) gene type 1 and 2 and obesity in Chinese children. A total of 400 obese and 200 healthy adolescents were enrolled as obese and control groups. Seven SNPs in HSD11B1 (rs4393158, rs2235543, rs10082248, rs10863782, rs2236903, rs2298930, rs4545339) and four variants in HSD11B2 gene (rs28934592, rs28934591, rs28934594 and rs28934593) were measured by automated platform MassArray. The rs28934592 in HSD11B2 and rs10863782 in HSD11B1 were excluded as false positive or HWE P < 0.05. Moreover, one allele type was found in the other three locations of HSD11B2. The minor allele frequency of rs2235543 and rs10082248 was higher in patients than that in controls (P = 0.045, P = 0.041, respectively). The rs10082248, rs2298930 and rs4545339 were associated with the risk of obesity in the recessive model (P < 0.05, respectively). Moreover, the total cholesterol in patients with GG or AG genotype was significantly higher than that in patients with AA genotype in rs10082248. The rs4393158 was associated with the hypertension in log-additive model test (P = 0.037), and glucose abnormal and hypercholesteremia in dominant model test (P < 0.05, respectively), while the rs2235543 was associated with hypercholesteremia in overdominant model test (P = 0.017). The polymorphism of HSD11B1 may be a cause of childhood obesity, or even associated with the complication of childhood obesity. However, variants of HSD11B2 may be not a cause of obesity.

Metabolic monitoring of obese children born small for gestational age

The "catch-up growth" phenomenon in children born small for gestational age (SGA) has been linked to early onset obesity with the subsequent emergence of metabolic syndrome (MetS) or its components. It has been postulated that the prevalence of MetS and its components increases strongly with age. A retrospective study was carried out over a 5 year period (2007-2011) to determine long-term metabolic complications in obese children born with normal weight for gestational age (appropriate for gestational age: AGA) and SGA. 517 patients were qualified into the study. According to birth weight and gestational age they were first divided into SGA (107 patients--20%) and AGA (410 patients--80%) and then by age into three subgroups: prepubertary group, pubertary group and adolescents. Blood pressure, lipids and glucose were measured. Oral glucose tolerance tests (oGTT) were performed in all subjects. Prepubertary patients showed no significant differences between SGA and AGA; 4.8% met the framing criteria (according to Weiss) for MetS. Pubertary patients showed a slightly increased prevalence of MetS among SGA patients 10.8%, compared to AGA patients 7.3%. MetS prevalence was significantly higher in obese adolescents born SGA 26.3% compared to AGA 15.7%. MetS or its components develop progressively with age. Increased prevalence of MetS in SGA patients indicates that being born SGA appears to be an additional risk factor in the development of MetS starting with puberty.

Evaluation of Existing Printed Nutrition Education Materials About Childhood Obesity

Printed educational material is the primary mode of communication in public health education. However, there is a scarcity of studies that evaluate the acceptance towards printed educational materials in Malaysia. Therefore, this study was conducted with the aim of evaluating existing printed nutrition educational materials regarding childhood obesity for use in nutrition education or health promotion programme. This study was conducted in two stages. Stage 1 involved a survey of existing printed nutrition educational materials related to childhood obesity and pilot testing on questionnaires that was developed. Whereas Stage 2 was the evaluation of the acceptance of subjects towards existing printed educational materials and changes in knowledge level after reading the materials. Likert scale from 1 (very not satisfactory) to 5 (very satisfactory) was used in the evaluation. Subjects in this study comprised 67 individuals who were educational and health professionals (n = 7), adults (n = 30) and children (n = 30). In this study, adults were given a booklet that focused on prevention and management of childhood obesity such as complications of childhood obesity and food preparation. Children received a booklet that focused on food pyramid, importance of breakfast, physical activity and so on and a poster that focused on healthy food choices. The professionals were given all three printed materials. This study found that the acceptance of subjects towards content, illustrations, tables and fi gures, colour, organization of picture, organization of content, language and font size of the three printed educational materials are variety, which ranged from not satisfactory to very satisfactory. Mean satisfaction score of booklet targeted at adult population was 3.9 ± 0.5 while mean satisfaction score of booklet targeted at children population was 4.3 ± 0.4 and poster was 3.9 ± 0.9. Knowledge score of the professionals increased from 88.6 ± 11.2% to 95.5 ± 3.2% after reading the educational materials. The knowledge score of adults also increased signi fi cantly (p < 0.001) from 67.7 ± 13.6% to 84.8 ± 15.9%; among children, knowledge score signi fi cantly increased (p < 0.001) from 65.3 ± 14.4% to 84.0 ± 11.4%. In conclusion, the existing printed educational materials were well-accepted and were able to increase the knowledge level of target population. Therefore, the printed educational materials are suitable to be used in any health education program related to childhood obesity.

Aspartate aminotransferase-platelet ratio index, adiponectin and body mass index in children with fatty liver

Obesity in children is becoming a global epidemic. Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent and potentially serious complication of childhood obesity. Adiponectin level was decreased on obese children. Adiponectin is a protective factor against non-alcoholic fatty liver disease on obesity. The early identification of fibrosis is important in children with NAFLD in order to prevent the development of liver disease in adulthood. One of non-invasive procedure to predict liver fibrosis is the aspartate aminotransferase (AST)-platelet ratio index (APRI). The purpose of our study was to assess a correlation between APRI, adiponectin and body mass index (BMI) in obese children with fatty liver. A cross-sectional study was conducted from August to September 2007. Subjects were obese children from one junior high school in Semarang, Indonesia. Complete blood count, transaminase enzyme measurement, adiponectin level and abdominal ultrasound (USG) were performed on each subject. Only subjects with bright liver on USG underwent APRI analysis. Spearman’s correlation was used for statistical analysis. Of 37 obese children, 19 children had bright liver on USG. The mean APRI was 0.16 (0.119). The mean Adiponectin was 4.04. Only one obese subject (5.0%) with bright liver had an APRI > 0.5. APRI was significantly correlated to alanine amino transferase (ALT) levels (r = 0.62), but not significantly correlated to BMI (r = 0.35) and adiponectin (r = 0.45). There was no correlation between BMI, ALT (r = 0.16), AST (r = 0.16), and adiponectin (r = 0.30). This study suggest that obese children with fatty liver might have high APRI levels indicating the presence of liver fibrosis. However, there is no correlation between APRI, adiponectin and BMI.

Calciferol and health: much more than bones

The discovery of “vitamin” D began with the study of childhood rickets. Over the past few decades, however, the nonskeletal effects of this hormone are becoming increasingly recognized, albeit mainly in adults. Categories of disease such as malignancy, autoimmunity, and cardiovascular disorders have been added to the skeletal complications associated with low calciferol status. Although the mechanisms underlying the bone mineral effects of calciferol deficiency are fairly clear, we are in the very early stages of understanding its nonskeletal effects. An early step in this direction is reported in this issue of The Journal by Codoñer-Franch et al from Spain. Studying a group of obese children, the authors found (not unexpectedly) that the group had evidence of vitamin D deficiency, as assessed by low 25-hydroxy-cholecalciferol 25(OH)D levels and elevated parathyroid hormone levels. The authors then looked at a variety of biomarkers of inflammation, oxidative stress, and endothelial activation. Many of these markers were elevated in the obese children, and in some cases, there was an intriguing correlation with 2(OH)D levels. Obviously, this is very preliminary work. Yet it does hint at the complexity of the relationship between the levels of what was once thought to be a simple nutrient involved in bone development and a host of adult diseases. Article page 848▶ Vitamin D Status is Linked to Biomarkers of Oxidative Stress, Inflammation, and Endothelial Activation in Obese ChildrenThe Journal of PediatricsVol. 161Issue 5PreviewTo examine vitamin D, parathyroid hormone, and serum calcium-phosphorus levels relationships to biomarkers of oxidative/nitrosative stress, inflammation, and endothelial activation, potential contributors for vascular complications in obese children. Full-Text PDF

Association between anthropometric parameters and cardio-metabolic disease risk factors among obese children and adolescents

Background: Childhood obesity increases risk for developing cardio-metabolic diseases. Objectives: to investigate the relation of some anthropometric parameters with cardio-metabolic disease risk factors in obese children and adolescents. Subjects and Methods: Cross sectional study, comprised of 139 obese pupils; aged 8 to 16 years (classified to 3 age groups). Each pupil underwent complete physical examination, anthropometric and laboratory assessment (fasting blood sugar and lipid profile). Results: Boys had significantly higher values of abdominal skin fold thickness in the age groups II and III and in central adiposity, waist circumference, waist/hip ratio and sub scapular skin fold thickness in adolescents. For boys, fasting blood sugar correlated with most of the anthropometric measurements in young age, and with skinfold thickness in the three age groups. While lipid profile correlated with skinfold thickness particularly at subscapular area in the age groups I and II. For girls, none of the parameters under study showed any significant correlation except subscapular skinfold thickness which had significant correlations with lipid profile in age groups I and II. Conclusion: Skin fold thickness particularly subscapular; is important indicator for cardio-metabolic complications in obese children of both sexes. Obese boys are more liable to cardio-metabolic complications.

Aspartate aminotransferase-platelet ratio index and body mass index in children with fatty liver

Background Obesity in children is becoming a global epidemic.Non􀀷alcoholic fatty liver disease (NAFLD) is a highly prevalentand potentially serious complication of childhood obesity. Theearly identification of fibrosis is important in children v.ith NAFLDin order to prevent the development of liver disease in adulthood.One non􀀷invasive procedure to predict liver fibrosis is the aspartateaminotransferase (AST)􀀷platelet ratio index (APRI).Objective The purpose of our study was to assess a correlationbetween APRI and body mass index (BMI) in obese childrenwith fatty liver.Methods A cross􀀷sectional study was conducted from August toSeptember 2007. Subjects were obese children from one juniorhigh school in Semarang. Complete blood count, transaminaseenzyme measurement, and abdominal ultrasound (USG) wereperformed on each subject. Only subjects with bright liver onUSG underwent APRI analysis. Spearman's correlation was usedfor statistical analysis.Results Of 3 7 obese children, 19 children had bright liver on USG.Their mean APRI was 0.16 (SD 0.119). Only one obese subject(1137) with bright liver had an APRI &gt; 0.5. APRI was significantlycorrelated to alanine amino transferase (ALT) levels (r = 0.62),but not significantly correlated to weight and BMI.Conclusion There was no correlation between APRI and BMI.Only lout of 37 obese children with fatty liver had APRI levelsindicating the presence of liver fibrosis. [Paediatr Indones.2012;52:181-4].

Battling the rising prevalence of gestational diabetes in India: Are clinicians on the right track?

Background: Gestational diabetes (GDM) is associated with increased long term problems of type 2 diabetes in the mother. In the offspring, GDM can append an intrauterine environmental risk factor to the increased genetic risk for the development of childhood obesity and/or type two early adult onset diabetes. Given the high prevalence of GDM in India, there is a real threat of an epidemic of type 2 diabetes in INDIA. Objective: (a) To assess knowledge among obstetricians in India, regarding management of GDM with respect to strict glycemic monitoring to provide the right environment to the fetus and timely intervention. (b) To assess the attitudes and practices with respect to long term follow up of the mother. Materials and methods: A 25-question online survey (www.abcofobg.com) was developed to assess providers' knowledge, practices and attitudes related to the management of GDM. The final sample consisted of 584 respondents. Data were analyzed using SPSS version 16.0. Results: When patients were on insulin, 41% of the clinicians did not insist on daily home monitoring using a glucometer.They resorted to estimation of post breakfast blood glucose at two-week intervals. Only 60% had access to endocrinologists for advice regarding insulin dosage adjustments. Only 35.71% of the clinicians said to wait for spontaneous labor. 64.29% of doctors said they would intervene and deliver at 38 weeks. Out of 584 respondents, 70.24% were aware of long term complication of childhood obesity and adult onset diabetes. Majority of doctors (92.86%) knew that T2DM was the long-term complication in GDM mother and 67.86% were aware of possibility of GDM in next pregnancy. Only 17% of clinicians offered WHO 75 gm testing for sugar estimation at the six weeks postpartum visit and 70% of the practitioners advised regarding exercises and diet. Conclusions: This study raises the challenge of how to translate the evidence from well-resourced research studies into initiatives that are affordable and feasible, whether in richer or poorer parts of the world. Also, the study results reveal the urgent need to improve the quality of diabetes treatment and care: accessible, community-based, multi-disciplinary teams, and patient-centered approach.

Increased plasma isoprostane is associated with visceral fat, high molecular weight adiponectin, and metabolic complications in obese children

Oxidative stress is considered to be increased in obese subjects. However, the association of oxidative stress with visceral adiposity and adiponectin level is not fully understood in children. Forty-four obese Japanese children and adolescents, 28 boys and 16 girls, with median age of 9.9 years [5.2-13.8 years], and the 28 age-matched non-obese healthy controls, 15 boys and 13 girls, were enrolled in this study. The median BMI Z scores were +2.21 [1.31-4.38] for the obese subjects and -0.72 [-2.11-1.31] for the control. Plasma concentrations of 8-epi-prostaglandin F₂α (isoprostane), a marker of oxidative stress, and adiponectin fractions were assayed using ELISA. 8-epi-PGF₂α levels were significantly higher in the obese group (37.1 [4.7-112.7], median and the range) than in the control (11.5 [4.5-27.3]). In a univariate analysis, concentrations of 8-epi-PGF₂α positively correlated with visceral adipose tissue area measured by computed tomography, waist circumference, serum triglycerides, alanine aminotransferase, insulin levels, and the homeostasis of minimal assessment of insulin resistance and inversely correlated with high-density-lipoprotein cholesterol and high-molecular weight (HMW) adiponectin. Total-, medium-, or low-molecular weight adiponectin fraction did not show a significant correlation with 8-epi-PGF₂α Forty of 44 obese children had one or more metabolic complications. The 8-epi-PGF[Formula: see text] levels also elevated with increasing numbers of obesity-related complications. These results suggest that oxidative stress is enhanced in relation to visceral fat accumulation and decreasing HMW adiponectin level in childhood obesity. Oxidative stress may be associated with the development of obesity-related complications.

Management of obesity, insulin resistance and type 2 diabetes in children: consensus and controversy

Childhood obesity has become a national and international epidemic. The prevalence and incidence of type 2 diabetes in youth have been increasing, and type 2 diabetes is one of the most challenging complications of obesity in childhood. Comprehensive lifestyle interventions that include attention to dietary change, increased physical activity and behavior change appear to be required for the successful treatment of pediatric obesity. In particular, aspects of behavioral interventions that have been identified as contributing to effectiveness have included intensity, parent/family participation, addressing healthy dietary change, promoting physical activity, and involving behavioral management principles such as goal setting. A multidisciplinary team approach is required for successful management of type 2 diabetes in youth as well. As with many therapies in pediatrics, clinical trials and support for treatments of obesity and type 2 diabetes in youth lag behind adult data. Pediatric recommendations may be extrapolated from adult data and are often based on consensus guidelines. Type 2 diabetes in children is most commonly managed with lifestyle modification and medications, metformin and/or insulin, the only medications currently approved for use in children. However, many opportunities exist for ongoing research to clarify optimal management for obesity and type 2 diabetes in youth.

Consequences of Childhood Obesity

The incidence of childhood obesity is rising across the globe, and obesity related co-morbidities are increasing concomitantly in the paediatric population. PubMed search for research and review papers on complications of childhood obesity was performed. The consequences of childhood obesity can be broadly classified into medical and psychosocial consequences. Medical consequences include metabolic complications such as diabetes mellitus, hypertension, dyslipidaemia and non-alcoholic fatty liver disease, and mechanical problems such as obstructive sleep apnoea syndrome and orthopaedic disorders. Psychological and social consequences are prevalent but often overlooked. Local data on these complications were also discussed. Childhood obesity is associated with significant morbidities, which not only have immediate impact on the health of the obese children, but also significantly increase the risk of morbidities in adulthood.

Determining Origins and Causes of Childhood Obesity via Mendelian Randomization Analysis

Childhood obesity has become a serious public health problem worldwide. The United States Centers for Disease Control and Prevention estimates that one in three children and adolescents are currently overweight/obese [1]. The adverse complications of childhood obesity on physical health and psychosocial development are tremendous [2]. Moreover, pediatric obesity may substantially increase future burden of cardiovascular disease and other morbidities in adulthood [3,4].

Metabolic complications of obesity in childhood and adolescence: more than just diabetes

The alarming increase in the prevalence of pediatric obesity has led to a rise in associated metabolic complications in worldwide pediatric populations. This review summarizes recent literature on detection, pathophysiology, and potential intervention strategies for the metabolic derangements encountered in the overweight pediatric population. Development of metabolic complications associated with obesity during childhood track into adulthood and increase the risk for type 2 diabetes and early cardiovascular disease. Clustering of these metabolic abnormalities, which include insulin resistance, hypertension and dyslipidemia, constitutes the metabolic syndrome, which may affect up to 50% of overweight adolescents. Other serious disorders associated with obesity and insulin resistance include polycystic ovary disease and fatty liver. Family and school-based programs focusing on lifestyle modifications, as well as pharmacotherapy, have shown preliminary promise in reversing some of these derangements. As the trend in pediatric obesity continues to rise, providers must effectively identify children at risk for metabolic disturbances and implement long-lasting, successful treatment regimens. Continued research into the predecessors of cardiovascular disease that begin during childhood and how they can be altered is crucial to the future health of our pediatric population.

Non-alcoholic fatty liver disease and childhood obesity

Obesity has emerged as a significant global health problem in the pediatric population. Pediatric liver disease is a serious complication of childhood obesity. Non-alcoholic steatohepatitis (NASH) is an entity in the spectrum of non-alcoholic fatty liver disease (NAFLD) ranges from fat in the liver--simple steatosis, NASH/ steatohepatitis--fat with in.ammation and/or fibrosis to advanced fibrosis and cirrhosis when fat may no longer be present. NASH is associated with obesity, diabetes, insulin resistance (IR), and hypertriglyceridemia. Children get NAFLD, and the incidence of this pediatric liver disease is rising as childhood obesity becomes increasingly prevalent. Although much remains to be learned about pediatric NAFLD, it is already evident that children with NASH risk progressive liver damage, including cirrhosis. Liver biopsy is required for definitive diagnosis, and other causes of fatty liver in childhood must be excluded. Gradual weight loss through increased regular exercise and a low-fat, low-refined carbohydrate diet appears to be effective. Drug treatments are being developed. The important message is that childhood obesity poses important health problems, including but not limited to potentially severe chronic liver disease. Early diagnosis of children who are only overweight is a worthy goal so that strategies to limit obesity can be instituted as early as possible. Identification of genetic risks is important, but management will invariably require changes in environmental factors. In addition to individual treatment, a multifaceted, societal initiative is required for solving the childhood obesity epidemic.

Complications of Obesity in Childhood

Complications of Obesity in Childhood