Complications Of Obesity In Children Research Articles

Современный взгляд на метаболические особенности детского ожирения и его осложнения

INTRODUCTION: Over the past several decades, the problem of pediatric exogenous constitutional obesity has acquired the status of a non-infectious pandemic of the 21st century. Statistics shows that both the prevalence of overweight and obese children and the incidence of morbid obesity, its complications and metabolic syndrome are increasing, which most is alarming for healthcare workers. This tendency requires specialists to understand the metabolic bases of formation of obesity, to search for new ways to treat and prevent the disease, as well as to prevent the development of complications. CONCLUSION: The given review considers the main features of metabolic alterations in the formation of childhood obesity, which can be an additional risk factor for both the development of the disease itself, and of its complications, the main ones being physiological insulin resistance of adolescents and a significant secretion of insulin-like growth factor-1 in children in the period of active growth. Understanding of metabolic features of the development of obesity at the pathophysiological and biochemical levels can become the basis for development of the ways to influence these processes. Of attention is the fact of a high prevalence of obesity complications and metabolic syndrome in childhood, with a continuing tendency to growth proportional to increase in the prevalence of obesity itself. A key point is the current absence of ways to predict obesity complications in children. Taking into account very limited possibilities of treatment of childhood obesity and its complications, the existence of prognostic markers may contribute to prevention or earlier, timely diagnosis of the main obesity complications, with a further decline of disability and mortality at a young age, as well as a considerable improvement of the quality of life of obese patients. The presented data require an in-depth analysis of mechanisms of development of childhood obesity — one of the most common problems in the world, and permit to reconceive the problems of treatment and prevention, to open up new prospects for creation of new approaches to diagnosis and control of this disease and its complications.

Beyond the Metabolic Syndrome: Non-Obvious Complications of Obesity in Children.

Obesity is currently one of the most significant public health challenges worldwide due to the continuous increase in obesity rates among children, especially younger children. Complications related to obesity, including serious ones, are increasingly being diagnosed in younger children. A search was performed from January 2023 to September 2023 using the PubMed, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases. The focus was on English-language meta-analyses, systematic reviews, randomized clinical trials, and observational studies worldwide. Four main topics were defined as follows: disorders of glucose metabolism; liver disease associated with childhood obesity; the relationship between respiratory disorders and obesity in children; and the effects of obesity on the hypothalamic-pituitary-gonadal axis and puberty. Understanding potential complications and their underlying mechanisms can expedite the diagnostic process and enhance the effectiveness of treatment. We aspire that this study will bring insight into the often-overlooked complications associated with obesity.

Характеристика коморбидной патологии при саркопеническом ожирении у детей

Objective. To study the frequency and structure of comorbid pathology in children with sarcopenic obesity. Patients and methods. This retrospective study included 726 children aged 10 to 17 (13 [12; 15]) years, among whom 54.9% were girls. Anthropometric, laboratory and instrumental examinations were performed to diagnose non-alcoholic fatty liver disease (NAFLD), arterial hypertension (AH), and metabolic syndrome (MS). Body fat mass and skeletal muscle mass were determined by bioelectrical impedance analysis. Sarcopenic obesity was diagnosed when the muscle-to-fat ratio (MFR) fell below the reference range. Results. The frequency of sarcopenic obesity in the total group of children was 83.3%, 71.2% in girls and 98.2% in boys. MFR was negatively correlated with the body mass index standard deviation score (BMI SDS) (R = -0.66, p < 0.05). Sarcopenic obesity was associated with an increase in the frequency of comorbidities: in children with decreased MFR, NAFLD was detected in 74.7%, AH in 35.9%, and MS in 29.6%; with normal MFR values, the frequency of comorbidities was 52.9%, 14.0%, and 14.9%, respectively (p < 0.001). Median MFR in children with uncomplicated obesity (0.78 [0.67; 0.92]) was significantly higher than in patients with NAFLD (0.67 [0.58; 0.82]), AH (0.66 [0.52; 0.78]), and MS (0.68 [0.56; 0.83]), p < 0.001. Absolute values of skeletal muscle mass in most of the children remained within or exceeded the reference range. Conclusion. Most children with exogenous constitutional obesity were diagnosed with sarcopenic obesity. Sarcopenic obesity in children was accompanied by an increase in the frequency of non-alcoholic fatty liver disease, arterial hypertension, and metabolic syndrome. MFR can be used to assess the risk of obesity complications in children. Key words: obesity, skeletal muscle mass, sarcopenic obesity, children, metabolic syndrome, non-alcoholic fatty liver disease

Complications of obesity in children and adolescents during covid-19 pandemic: A narrative review

Background: Obesity in children and adolescents has increased exponentially around the world. Furthermore, the COVID-19 pandemic has led to a higher pediatric obesity rate. The excess adipose tissue generates a dysregulation of adiponectin, ghrelin, and leptin, among others. Metabolic alterations can develop cardiovascular disease, dyslipidemias, arterial hypertension, type 2 diabetes mellitus, nonalcoholic fatty liver disease, sleep disorders, and higher risk of COVID-19 severity. Obesity has different therapeutic approaches such as behavioral weight loss programs, pharmacologic treatments, and surgical procedures. Therefore, timely diagnosis and treatment are important to decrease the mortality in obesity among pediatric population.

Impairment of carbohydrate metabolism in children and adolescents with obesity

Obesity is one of the socially significant diseases of our time and is a generally recognized risk factor for the development of carbohydrate metabolism disorders, including type 2 diabetes mellitus (DM), the prevalence of which in the pediatric population is rapidly increasing.Aim of the study. To demonstrate the most frequent types of carbohydrate metabolism disorders in children and adolescents with obesity.Materials and methods. 123 obese patients under 18 years old were examined and the structure of obesity complications was analyzed.Results. Carbohydrate metabolism disorders were identified in 24 patients (19%): impaired fasting glycemia (IFG) (8 girls, 6 boys (11%)), type 2 DM (6 girls, 3 boys (7%)), and type 1 DM (1 boy (1%)). Descriptions of 4 clinical cases are given: 1) patient, 17 years old, with constitutional-exogenous obesity of 3rd degree, arterial hypertension (AH), dyslipidemia and nonalcoholic fatty liver disease (NAFLD) and a history of transient IFG; 2) patient, 16 years old, with morbid obesity, NAFLD, AH, polycystic ovarian syndrome (PCOS), type 2 DM, compensated on metformin therapy; 3) patient, 17 years old, with constitutional-exogenous obesity of the 3rd degree, AH, dyslipidemia, NAFLD, type 2 DM (on insulin pump therapy), complicated by diabetic nephropathy and diabetic polyneuropathy; 4) patient, 12 years old, with type 1 DM, manifested against the background of obesity.Conclusion. When screening for obesity complications in children and adolescents, carbohydrate metabolism disorders may be detected in one in five patients. Prediabetes in childhood can be transient. When a child with obesity is identified, differential diagnosis of type 1 and type 2 DM should be made. It is necessary to teach patients with type 2 DM the skills of self-monitoring on a par with patients with type 1 DM and motivate them to control glycemia regularly at home.

Escalating Risk of Metabolic Syndrome Imparted by Salivary Biomarker in Obese Children

Type 2 diabetes (T2D) is a chronic metabolic disorder characterized by a progressive loss of ß-cell function relative to insulin resistance. Once thought to be an adult disease, T2D has emerged as an increasingly prevalent health concern in obese youth, suggesting that early identification of those who are at high-risk for T2D is critical. Traditionally, either fasting glucose and/or 2-hr glucose concentrations during an oral glucose tolerance test has been used to identify prediabetes (i.e., intermediate stage of T2D). However, the fact that multiple blood collections are required during the test hinders necessary screening of high-risk youth with obesity and metabolic syndrome, primarily due to the invasive methods (i.e., fear of needles). For this reason, there is increasing interest in salivary biomarkers that can identify metabolic abnormalities. Goodson et al. provided critical evidence for future use of salivary samples for T2D risk detection as investigating saliva-based inflammatory biomarkers in an at-risk population of children. A total of 744 children (mean age 11 years) were divided into 4 groups based on their weight status using the age- and sex-standardized BMI z-score: underweight, normal healthy weight, overweight, and obese (n=186 for each group). Fasting saliva samples were collected from all participants to examine 20 biomarkers and the biomarkers were analyzed on a Luminex 200 platform (Luminex Corporation, Austin, TX, USA). Of the 20 biomarkers tested, 16 showed no significant differences between obese and normal weight subjects. However, 4 biomarkers did show significant differences between obese and normal weight subjects. Salivary C-reactive protein (CRP), a pro-inflammatory biomarker, was 6 times higher in obese youth compared with their normal weight peers (median 435 pg/ml vs. 76 pg/ml, P<0.0001) (Table 1). Salivary insulin and leptin showed a 3-fold increase in obese children compared with their normal weight counterparts. Salivary adiponectin (anti-inflammatory biomarker and indicator of insulin sensitivity) concentration was 30% lower in overweight (median 2,981 pg/mL) and obese (2,798 pg/mL) youth compared with normal weight (4,083 pg/ml, P<0.0001) (Table 1). Biomarkers provide essential information for understanding the etiology of diseases, treatment, and early intervention. Saliva sampling has been introduced into research as a potential indicator of T2D risk and correlations between serum and saliva samples have been identified. In this study, 4 biomarkers were identified that exhibit significant change with increasing body weight in a pediatric population (Goodson et al., 2014). This suggests that saliva could be a useful blood replacement for the study of metabolic complications of obesity in children. In the face of COVID-19, this study is especially important in bringing awareness to the possible use of salivary biomarkers in determining potential risk for T2D and metabolic syndrome. With the limited in-person human research available currently, a new non-invasive, cost-effective, time-saving method is of the utmost importance in addition to the fact that at-home saliva collection is feasible for the research purpose (https://salimetrics.com/how-do-i-collect-saliva/). Although Goodson et al. proved the utility of the saliva analysis for T2D risk, a lack of validation data against blood samples is considered significant obstacle for a solid conclusion from this study. The saliva samples need to be compared to their respective blood samples in order to validate its reliability as novel biomarker. Furthermore, it would be germane to see if salivary biomarkers can be used for testing effectiveness of any prevention and treatment of metabolic syndrome and T2D in youth populations.

Cardiometabolic and Cardiovascular Complications of Obesity in Children

The rise in obesity in both children and adults has made obesity one of the biggest public health problems of this century. Obesity along with other factors such as hypertension, insulin resistance, dyslipidemia and diabetes mellitus are risk factors for the development of cardiovascular diseases. Overweight and/or obesity during childhood and its maintenance until adult life has been associated with early stages of cardiovascular disease. For this reason, the aim of this study is to revise the state of the art of cardiometabolic and cardiovascular complications related with overweight and/or obesity in children and adolescents. The first consequence of weight gain is an increase in adipose tissue, with different distribution depending on the sex. The excess of fat mass entails dysfunction of adipose tissue with an altered secretion of adipokines and instauration of a proinflammatory environment, which may derive in metabolic syndrome condition. The increase of adipose tissue along with an increase in sympathetic nervous system, triggers an increased left ventricular mass and with a reduced diastolic function. Therefore, obesity should be prevented from the early stages of life, in order to avoid obesity itself and the metabolic disturbances that could undermine quality of life further on.

Relationship Between Body Mass Index, Fatty Liver, Lipids Profile, Carotid Intima-Media Thickness and Subcutaneous and Visceral Fat Determined by Ultrasound

Background: Childhood obesity is a risk factor for cardiovascular diseases, hypertension, diabetes and non-alcoholic fatty liver. Early diagnosis of obesity complications in children can be helpful for more effective treatment. Objectives: The present study aimed to evaluate the relationship of body mass index (BMI), fatty liver, lipids profile, carotid arteries intima-media thickness and thickness of subcutaneous visceral fat by using the ultrasound. Methods: Sixty one obese children (BMI > 95th) were enrolled in the study. The ultrasound was performed to evaluate the presence and degree of fatty liver in all cases and also for measuring the subcutaneous tissue which was measured in the middle regions of the abdomen and the right flank and visceral fat thickness along with carotid arteries intima-media thickness. The lipids profile (TG, Chol, LDL, HDL) was measured after 12-hour fasting in all cases. Results: A significant increase in the degree of fatty liver was observed with increasing subcutaneous and visceral fat thickness (P < 0.001), but these correlations were not considerable for carotid arteries intima-media thickness. A linear relationship with a positive trend was seen between the BMI and degree of liver steatosis. The visceral fat thickness showed a significant correlation with lipids profile. Conclusions: The present study revealed significant relationships between thickness of visceral and subcutaneous fat, grade of fatty liver, and lipids profile in children.

Elevation of circulating microRNA levels in obese children compared to healthy controls.

As childhood obesity increases, it is becoming important to understand the complications of obesity in children and develop novel biomarkers. Evidence indicates that microRNAs (miRNA) are dys-regulated in obesity and may serve as sensitive and specific circulating biomarkers. Non-alcoholic fatty liver disease (NAFLD) is a complication of obesity that ultimately requires a liver biopsy to determine disease severity. While studies have been conducted in adults, no study to date has examined circulating miRNAs in children with obesity and NAFLD. The goal of this study was to evaluate a panel of selected circulating miRNAs in obese children compared to healthy controls. We present here an analysis of a pre-selected panel of 20 candidate miRNAs in obese children compared to healthy controls. The miRNAs were chosen based on having been previously reported to be involved in NAFLD. We found that 16 out of 20 miRNAs tested were elevated at least twofold in children with obesity compared to controls. miR-122 and miR-199a showed the greatest increase in children with obesity versus controls. Both also had a high area under the curve when receiver-operator curves were plotted. Several circulating miRNAs correlated with body mass index (BMI) or serum transaminases. This study provides initial evidence that circulating miRNAs can be measured in the paediatric population and provides several diagnostic candidates increased in children with obesity that may be relevant to NAFLD.

DEPTOR promoter genetic variants and insulin resistance in obese children and adolescents.

Insulin resistance (IR) is one of the major metabolic complications of obesity in children and adolescents. DEP domain-containing mammalian target of rapamycin interacting protein (DEPTOR) is involved in downstream insulin signaling and DEPTOR's effects are regulated by its level of expression. To analyze promoter region of DEPTOR for genetic variants associated with altered IR in obese children and adolescents. IR was determined in 322 normoglycemic obese subjects [173 females, 149 males; mean age 13.3 ± 3.5 yr, mean BMI-SDS 2.85 ± 0.83, HbA1C 5.2 ± 0.2% (33 ± 2.5 mmol/mol)] using homeostatic model assessment-insulin resistance [HOMA-IR (>2 prepubertal and >3 pubertal)] and whole body insulin sensitivity index [WBISI (<6.5 prepubertal and <4.5 pubertal)]. Genetic variants, determined by high resolution melting analysis, were confirmed by Sanger sequencing, whereas population allele distribution was determined by TaqMan genotyping probes. Genetic variant c.-143T>C (rs7840156) was associated with a significant 2-fold decreased risk to present with IR, determined by HOMA-IR [odds ratio (OR) = 0.614, 95% confidence interval (CI) = 0.435-0.867, p = 0.0057) and WBISI (OR = 0.582, 95% CI = 0.414-0.817, p = 0.0018). The CC genotype had lower mean HOMA-IR value (2.47 ± 0.44 vs. 3.04 ± 0.14, p = 0.0177) and higher mean WBISI value (7.00 ± 0.71 vs. 5.27 ± 0.33, p = 0.0235) than TT genotype. Variant c.-143T>C was located in evolutionary highly conserved region in DEPTOR promoter region. Presented results on association between insulin sensitivity and genetic variants in DEPTOR gene suggest DEPTOR and mammalian target of rapamycin signaling pathway to be potential target for future research and pharmacological interventions.

Relation of fetuin A levels with cardiac, subcutaneous lipid accumulation and insulin resistance parameters in Turkish obese children.

Fetuin A is an inhibitor of insulin action and have been found to be related with subcutaneous lipid accumulation and insulin resistance. The relation of cardiac lipid accumulation, fetuin A and insulin resistance parameters in obese children is not well-known. The aim of the study was to evaluate the relation of serum fetuin A levels with subcutaneous and cardiac lipid accumulation, and insulin resistance parameters in Turkish obese children. Serum fetuin A levels, cardiac and subcutaneous lipid accumulation parameters of 42 obese (10.9±2.3 years, 19 female) and 40 control group subjects (11.2±2.7) were compared. Cardiac lipid accumulation measured by subepicardial adipose tissue thickness. Insulin resistance was assessed using homeostasis model assessment (HOMA-IR) index. There were significant correlations serum fetuin A levels with BMI-SDS, circumferences of waist, hip and midarm, SATT and HOMA-IR (r=0.362, p=0.018, r=0.728, p=0.001, r=0.662, p=0.0001, r=0.713, p=0.0001, r=0.477, p=0.001, and r=0.330, p=0.038 as, respectively). Fetuin A was correlated well with cardiac and subcutaneous lipid accumulation, insulin resistance parameters, which may be related with early pathogenetic mechanisms of metabolic obesity complications in children.

Complications of obesity in children

With the growth of people's living standard, the prevalence of childhood obesity is increasing year by year. Meanwhile, the adverse effect caused by obesity occurred more frequently as well. Therefore, obesity in childhood has become a critical issue in public health area. Complications of obesity may lead to enormous implications on children, including their endocrine, cardiovascular, digestive system, etc., which will have an impact on the body growth in the adolescence. Obesity not only has a huge threat to children's physical and psychological health, but also has a long-term effect on body health condition in the future. Consequently, it is significant to diagnose the occurrences of complications of children, and implement the guiding and curing at an early stage. Key words: Obesity; Complication; Child

Ratio of lipid parameters to coenzyme Q10 could be used as biomarker of the development of early complications of obesity in children

Chronic obesity is associated with reduced levels of antioxidants, increased free oxygen radicals, and oxidative stress. Child obesity may lead to the development of complications, such as changes in metabolism, metabolic syndrome, neurological, cardiological, respiratory, renal, gastrointestinal, endocrinological, and musculoskeletal conditions. The aim of the present study is to establish whether there is a correlation between basal CoQ10 plasma concentration and the ratio of lipid parameters to CoQ10 in obese children. The study included 101 obese children and 20 non-obese children, aged 10-18 years. Antioxidants - CoQ10-OX, α-tocopherol, β-carotene - in plasma were measured by HPLC method with UV detector, and plasma malondialdehyde spectrophotometrically. High correlation was found between plasma concentration of CoQ10 and the ratio of total Chol/CoQ10-OX as well as between CoQ10-OX and the ratio of HDL Chol/CoQ10 in plasma of obese children. The lowest correlation was between plasma concentration of CoQ10-OX and the ratio of LDL Chol/CoQ10 , as well as between CoQ10-OX and the ratio of TAG/CoQ10 in obese children. An increase of the ratios of lipid parameters to CoQ10 is associated with child obesity and could be used as biomarkers of early complications in the development of obesity in children (Tab. 3, Fig. 5, Ref. 22).

Medical versus surgical interventions for the metabolic complications of obesity in children

The global epidemic of obesity has not spared children. Although prevention of obesity is commendable, we cannot hide from the pressing need to identify, assess, and actively manage children seriously afflicted by obesity and its associated conditions. Sustained weight loss (or, for children, lowering of body mass index standard deviation score) delivers major health benefit, but in children has been difficult to achieve. In adults, the success of the diabetes prevention programs using practical lifestyle interventions is indisputable. Medical therapy, although currently limited in it scope, provides some promise for older children. There is now accumulating evidence, generally of poor quality that surgical interventions (laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass) provide excellent sustained weight loss and improvement in comorbidity and quality of life in selected older children. Their benefits in adults are well demonstrated. Surgery comes with risk, both immediate and in the future, as does severe obesity. Carefully weighing risk and benefit is challenging for the individual and for health service providers. Careful health outcomes research with registries and well-conducted trials will provide better direction in the future. In the meantime, we should move forward ethically and cautiously in providing more intensive obesity management in children.

Complications of obesity in children and adolescents

The increasing prevalence and severity of obesity in children and adolescents has provided greater emphasis on the wide variety of comorbid conditions and complications that can be experienced as a consequence of obesity. These complications can occur both in the short term and in the long term. Some complications, earlier thought to be long-term issues, which would only occur in adulthood, have now been shown to occur in children and adolescents. These findings have raised concerns about the overall health experience of those who develop obesity early in life and have even raised questions about whether the obesity epidemic might shorten the life span of the current generation of children. In this paper, I will examine current knowledge regarding the different organ systems that may be impacted by childhood obesity.

Relation between visceral fat and disease risk in children and adolescents

This review examines whether the relations and metabolic parameters necessary for the development of syndrome X are present in children and whether the metabolic complications of obesity in children are explained by excess intraabdominal adipose tissue (IAAT), or visceral fat. Despite the limited use of imaging techniques in research studies, an increasing number of studies reported on IAAT and its relation to disease risk in children and adolescents. For this article we reviewed studies that documented the early accumulation of IAAT in children and adolescents and the factors that contribute to variation in the degree of IAAT accumulation. We also reviewed studies that showed the clinical relevance of IAAT in children and adolescents through significant relations with adverse health effects including dyslipidemia and glucose intolerance in obese and nonobese children and adolescents of different ethnic groups.