Non-obese Adolescents Research Articles

Case-Control Study: Evaluation of the Correlation between Obesity and Hypertension in South Jakarta Adolescents

Introduction: The prevalence of hypertension in adolescents has increased in recent years. Initially, hypertension was rare in adolescents, but now hypertension is showing a trend of prevalence at a younger. Hypertension in adolescents is multifactorial, and there is no single cause. However, some studies suggest that high blood pressure or hypertension is more common in overweight or obese adolescents. Objective: To determine the correlation between obesity and hypertension in adolescents in South Jakarta in 2023. Method: This research is an analytical study with a case-control design, using secondary data from the Non-Communicable Disease Information System (SIPTM) of DKI Jakarta Provincial Health Office in 2023. The sample size used the Lemeshow formula, hypothesis tests for two proportions (two-sided test), with 1124 respondents divided by 562 cases and 562 controls, by purposive sampling technique. Statistical tests included univariate, stratification, and multivariate analysis (logistic regression causal model).. Result: The obesity proportion was 29.8%, primarily female, at 58.45%, with the highest being 16 years (25.8%). After evaluating confounding, found a significant correlation between obesity and hypertension in adolescents, namely aOR 3,6 (95% CI 2.72 - 4.73), which means that obese adolescents are statistically proven to have a 3,6 times greater risk of developing hypertension than non-obese adolescents. Conclusion: This finding indicates a prevalence increase of hypertension in the future if there is no obesity control in adolescents. Need screening or early detection in adolescents, especially in obese adolescents. Hypertension screening in adolescents to involve parents so that they get enough attention in the screening routine. In addition, there will be collaborative efforts between schools and healthcare providers to provide education and health promotion for school children, especially adolescents, to control hypertension and other non-communicable diseases.

Relationship between body mass index and fat mass percentage among adolescents from Constantine (Algeria)

Several references based on body mass index (BMI) have been used in Algeria to define adolescent obesity. No studies have been published to assess the diagnostic accuracy of these references. This study aimed to evaluate the sensitivity and specificity of the International Obesity Task Force (IOTF) and Algerian national data based on BMI to detect excess fat in adolescents. A cross sectional study of 257 adolescents aged 16-19 was conducted in Constantine, Algeria. The BMI was calculated from weight and height measurements. The body fat percentage (BF%) was estimated by impedancemetry (BIA). The IOTF and Algerian national data were evaluated for their sensitivity and specificity to detect excess body fat. The BF% thresholds used to define true positives were 25% for boys and 30% for girls. Body mass index was significantly associated with BF% in the whole population (r=0.759). Obesity is more common in girls (p<0.01), regardless of the reference used. The percentage of obesity among adolescents according to the IOTF, Algerian data and BF% was 5.84%, 5.45% and 20.62%, respectively. The obesity rate estimated by BF% was significantly higher (p<0.00001). Sensitivity of the evaluated criteria, IOTF and Algerian data, was high for males (83.3% and 100%, respectively) and low for females (19.2% for both IOTF and Algerian data). Specificity of the two criteria was high for both sexes (100%). Specificity was higher than sensitivity; therefore, the ability of BMI to detect non-obese adolescents was higher than its ability to identify obese adolescents. As BMI is an index of body weight rather than body fat, it can be a source of error. Local data and international references gave the same percentages of obesity. Body mass index is a very specific but less sensitive method to assess increased body adiposity in adolescents. It fails to identify excessive adiposity in a significant percentage of female teenagers. It seems necessary to measure body fat in addition to BMI in adolescent girls. Therefore, it is important to consider body fat mass when determining obesity in order to predict the consequences of obesity, which are mainly due to an increase in fat mass in the body. Key words: Adolescent, Obesity, BMI, Fat mass rate, IOTF, Impedancemetry, Algeria

Stress level and emotional eating in obese and non-obese adolescents

The association between stress factors and emotional eating can contribute to the development of obesity. Boredom, stress, anxiety, and depression can lead to emotional eating, which involves the consumption of food to cope with negative emotions. Emotional eating often involves the consumption of high-calorie, comfortable foods that can contribute to weight gain. This study aimed to analyze the differences in stress levels and emotional eating between obese and non-obese adolescents. This research was conducted in May 2023 using an observational case-control study comparing obese and non-obese adolescents in a special region of Yogyakarta. A total of 139 respondents who attended this study were selected using multistage random sampling. Stress levels were measured using the Perceived Stress Scale-10 (PSS-10) questionnaire and emotional eating was assessed using the Emotional Eater Questionnaire (EEQ). Data were collected and analyzed using the Mann-Whitney test. Results: Most respondents had high stress levels (49,6%) and low emotional eaters (43,9%). There were differences in stress levels (p=0,004) and emotional eating (p=0,000) between the obese and non-obese adolescents. Conclusions, stress levels and emotional eating were different in obese and non-obese adolescents.

Evaluation of the Effect of Vitamin D Treatment on Cardiac Function in Non-Obese Female Adolescents with Vitamin D Deficiency in Türkiye: A Cross-Sectional Study.

Vitamin D deficiency may cause adverse effects on the cardiovascular system as well as many other systems. The risk of vitamin D deficiency increases during adolescence, when the growth rate is high, due to reasons such as limited sun exposure, inadequate dietary calcium, and vitamin D intake. To evaluate the effect of daily 2000 IU vitamin D supplementation for 12 weeks on cardiac function in non-obese adolescent girls with vitamin D deficiency. This cross-sectional study was carried out between September 2021 and June 2022. A total of 108 non-obese adolescent girls having 25-hydroxyvitamin D [25(OH)D] levels below 12 ng/mL were given daily 2000 IU vitamin D orally for 12 weeks. Serum levels of 25(OH)D, alkaline phosphatase, parathormone, calcium, phosphate, and cardiac function were determined before and after treatment. After treatment, the 25(OH)D levels were above 20 ng/mL in 90.8% of the adolescents. The parathormone and alkaline phosphatase levels decreased, while the phosphate levels increased. Echocardiographic tissue Doppler studies showed positive changes in some systolic and diastolic function indicators. In addition, the myocardial performance index decreased from 0.42 ± 0.03 to 0.40 ± 0.03 (P < 0.001) in the left ventricle, from 0.43 ± 0.03 to 0.38 ± 0.03 (P < 0.001) in the right ventricle, and from 0.41 ± 0.04 to 0.38 ± 0.02 (P < 0.001) in the interventricular septum after vitamin D treatment as compared to pretreatment. It was observed that administration of 2000 IU vitamin D treatment for a period of 12 weeks to non-obese adolescent girls with vitamin D deficiency contributed positively to cardiac systolic and diastolic function.

Reduced exercise capacity for muscle mass in adolescents living with obesity.

Adolescents living with obesity (AlwO) can have limited exercise capacity. Exercise capacity can be predicted by a 2-factor model comprising lung function and leg muscle function, but no study has looked at cycling leg muscle function and its contribution to cycling exercise capacity in AlwO. Twenty-two nonobese adolescents and 22 AlwO (BMI > 95 percentile) were studied. Anthropometry, body composition (dual-energy X-ray absorptiometry), spirometry, 30-s isokinetic work capacity, and maximal exercise (cycle ergometry) were measured. AlwO had greater total body mass, lean body mass, and lean leg mass (LLM). Lung function trended higher in AlwO. Leg 30-s work did not differ in absolute terms or per allometrically scaled LLM. Peak oxygen consumption did not differ between the groups in absolute terms or as percent predicted values (79.59 ± 14.6 vs. 82.3 ± 11.2% predicted control versus ALwO) but was lower in AlwO when expressed per kg body mass, kg lean body mass, scaled lean body mass, and LLM. Peak oxygen consumption related to both lung function and 30-s work, with no observed group effect. 30-s leg work related to the scaled LLM, with a small group effect. There was some correlation between leg work and time spent in moderate to vigorous physical activity in AlwO (rs = 0.39, p = .07). AlwO have larger LLM and preserved exercise capacity, when expressed as percentage of predicted, but not per allometrically scaled LLM. Increasing time spent in moderate to vigorous activity may benefit AlwO.

Associação entre padrões alimentares e fenótipos corporais em adolescentes brasileiros

Abstract Objectives: to investigate the association between dietary patterns, physical activity, and body phenotypes in adolescents. Methods: this school-based cross-sectional study involved 1,022 adolescents aged ten to 19 years. Dietary patterns and body phenotypes were defined using a principal component analysis. Body phenotype was defined using anthropometry, body composition, biochemistry, sexual maturation, and dietary patterns from 19 food groups, using a food frequency questionnaire. The association between the dietary patterns and body phenotypes was assessed using a linear regression model. Results: five body phenotypes (BP1adiposity, BP2puberty, BP3biochemical, BP4muscular, BP5lipids_biochemical) and five dietary patterns (DP1ultraprocessed_foods, DP2fresh_foods, DP3bread_rice_beans, DP4culinary_preparations, DP5cakes_rice_beans) were identified. There were higher BP_adiposity scores for obese adolescents, but energy expenditure was similar for obese and non-obese adolescents. Physical activity was positively associated with BMI, BP_adiposity, and BP_puberty. We observed a negative association between DP_ultraprocessed_foods and BMI, and a positive association between DP_fresh_food. DP_fresh_foods was positively associated with BP_adiposity; DP_ultraprocessed_foods and DP_culinary_preparations were negatively associated with this phenotype. BP_biochemical was negatively associated with DP_fresh_foods. Conclusion: we identified a negative association between a dietary pattern composed mainly of ultra-processed foods, fresh foods, and BP_adiposity. These associations need to be better explored, especially in adolescents, as both dietary patterns and phenotypes were defined using multivariate analysis.

A case of type A insulin resistance syndrome in a 14-year-old adolescent girl without common clinical features.

Type A insulin resistance syndrome is a rare congenital disorder caused by insulin receptor dysfunction arising from heterozygous mutations in the insulin receptor (INSR) gene. It is usually diagnosed in non-obese female adolescents with insulin resistance, acanthosis nigricans, or ovarian hyperandrogenism. We present the case of a 14-year-old adolescent girl with non-obesity diabetes and insulin resistance; however, she had no acanthosis nigricans, or menstrual abnormalities. The laboratory results were as follows: fasting plasma glucose 179 mg/dL; C-peptide 1.8 ng/mL; insulin 34.8 lU/mL; HbA1c 10.6%. Islet cell autoantibodies, insulin autoantibodies, and glutamic acid decarboxylase antibodies were negative. We performed a next-generation sequencing-based targeted gene panel for the known maturity-onset diabetes of the young and found a heterozygous mutation in the INSR gene c.3602G>A (p.Arg1201Gln). Her mother carried the same mutation as her and also did not present with acanthosis nigricans or menstruation abnormalities. Type A insulin resistance syndrome has diverse clinical phenotypes even with the same type of mutation at the same site in the INSR gene. Clinicians should consider genetic testing for early detection and adequate treatment approaches.

FRI426 Raised Thyroid Stimulating Hormone In Girls With Polycystic Ovary SyndromeEffects Of Randomized Interventions

Abstract Disclosure: L. Ibanez: None. C. Garcia-Beltran: None. J. Bassols: None. G. Carreras-Badosa: None. A. Lopez-Bermejo: None. F.E. de Zegher: None. Introduction: Polycystic ovary syndrome (PCOS) in women associates with raised levels of circulating thyroid stimulating hormone (TSH) and with high rates of gestational complications. A low range of preconception TSH is followed by low rates of gestational complications. It is unknown whether TSH levels are elevated in adolescents with PCOS and, if so, whether traditional or exploratory treatments can lower them into safe preconception range. We investigated TSH in non-obese adolescents with PCOS, including the effects of randomized interventions. Methods: Morning TSH was a safety marker in randomized pilot studies comparing the effects of an oral contraceptive (OC) versus those of a low-dose combination of spironolactone-pioglitazone-metformin (SPIOMET, aiming at a reduction of ectopic fat without necessarily lowering body weight) in non-obese adolescents with PCOS. A post-hoc analysis compared: TSH levels in PCOS (N= 62) vs controls; TSH changes on treatment (1 year); TSH levels post treatment (1 year). Results: Mean TSH levels were higher in PCOS patients than in control girls (P&amp;lt;0.01). On-treatment TSH levels diverged (P&amp;lt;0.001), remaining elevated on OC, and descending swiftly on SPIOMET, well into safe preconception range. Post-treatment TSH levels were stable in both subgroups. On-treatment changes of circulating TSH associated to those of liver fat (R= 0.307, P= 0.017). Conclusion: The endocrine signature of early PCOS is herewith extended to include modestly raised levels of circulating TSH; the normalizing effects of SPIOMET intervention in non-obese adolescents with PCOS are herewith extended to include on- and post-treatment TSH. Presentation: Friday, June 16, 2023

Blood Lipid Disorders in Post-Operative Craniopharyngioma Children and Adolescents and the Improvement with Recombinant Human Growth Hormone Replacement.

The high prevalence of hypothalamic obesity (HO) and dyslipidemia in individuals with craniopharyngioma (CP) following surgery is a cause for increasing concern. However, few studies have explored the lipid profile in pediatric CP patients, with inconsistent findings. In addition, the role of recombinant human growth hormone (rhGH) replacement remains unclear in these patients. To compare the blood lipid profile among post-operative craniopharyngioma children and adolescents with that among healthy controls and to reveal the effects of rhGH replacement. Data of 79 post-operative craniopharyngioma children and adolescents in our center were retrospectively collected. Sixty patients underwent rhGH replacement during the follow-ups. We selected 36 patients who received rhGH replacement therapy, while 20 patients received rhGH replacement for at least 1 year and had complete lipid data before and after treatment and compared them with 19 patients who did not receive rhGH replacement therapy. Craniopharyngioma patients had higher total cholesterol (TC) (5.17 vs 3.77 mmol/L), triglyceride (TG) (1.51 vs 0.73 mmol/L), and low-density lipoprotein cholesterol (LDL-C) (3.14 vs 2.10 mmol/L), and lower high-density lipoprotein cholesterol (HDL-C) (1.06 vs 1.39 mmol/L) than controls (all p < 0.001). The lipid profile of obese and non-obese patients was not significantly different. After rhGH replacement, TC was 0.90 mmol/L lower (p = 0.002) and LDL-C was 0.73 mmol/L lower (p = 0.010) than baseline. Although the baseline LDL-C was higher, patients with rhGH replacement had lower LDL-C (-0.73 mmol/L adjusted for age and sex, p = 0.045) after the initiation of replacement compared with patients without rhGH replacement. The lipid profile of obese and non-obese children and adolescents with craniopharyngioma was unfavorable, and rhGH replacement could improve their lipid profile.

Factors associated with the adoption of extreme weight control behavior by non-obese adolescents: a secondary analysis

BackgroundMisperceptions about obesity is common among adolescents. Adolescents who overestimate their body size tend to indulge in extreme weight control behaviors. However, little is known about the factors involved in the adoption of extreme weight control behavior (EWCB) by non-obese adolescents who are mistaken for being overweight. This study identified factors associated with unhealthy behaviors among normal/underweight high school students who overestimate their body image and attempt to lose weight.DesignA secondary analysis of nationally representative data from the Korea Youth Risk Behavior Survey focused on adolescents who attended vocational and academically oriented high schools.MethodsThe analysis included data from 4,286 non-obese respondents (15–18 years) who overestimated their body weight. Of them, 2,887 were girls (66.5%), while 1,399 were boys (33.5%). Multiple logistic regression was used to investigate risk factors for EWCB by sex. A statistical analysis reflecting strata, clusters, and weights of the complex sampling design was adopted.ResultsOf the respondents, 674 (23.3%) girls and 162 (11.5%) boys reported EWCB. For both sexes, vocational high school attendance and depression were significantly influenced by EWCB. EWCB was linked to perceived stress in girls and living in a big city in boys.ConclusionsThe findings suggest the importance of providing quality health education, including that for non-obese adolescents, in school obesity prevention programs along with the expansion of tailored intervention programs based on sex, following a consideration of the characteristics of high schools as well as individuals.

Low-Density Lipoprotein Cholesterol Is Associated with Atopic Dermatitis in Korean Adolescents

Introduction: Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. Several studies have investigated the relationship between obesity and AD prevalence, but the results have been conflicting. This study investigated the association between obesity and AD in Korean adolescents. Methods: We used nationally representative data regarding 1,617 Korean adolescents aged 12–18 years, which were obtained from the cross-sectional Korea National Health and Nutrition Examination Survey 2017–2019. Multiple logistic regression analysis (including age, sex, region of residence, number of household members, economic status, lipid profile, and stress level) was used to evaluate the relationships of obesity and abdominal obesity with doctor-diagnosed AD. Results: Although the results were not statistically significant, obese adolescents were diagnosed with AD (20.8%) more often than non-obese adolescents (20.8% vs. 14.5%, p = 0.055). This tendency was more prominent in male adolescents than in female adolescents, but the finding was not statistically significant. Body mass index and the prevalence of abdominal obesity did not differ between the AD and non-AD groups. Adolescents with AD had significantly higher total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels, compared with adolescents who did not have AD. In the adjusted model, an LDL-C level ≥130 mg/dL was a risk factor for AD (adjusted odds ratio, 1.03; 95% confidence interval, 1.01–1.05). Conclusions: A high LDL-C level may be a risk factor for AD. Proper management of dyslipidemia through lifestyle modification may aid in AD prevention and control. Further large-scale prospective studies are needed to assess the associations of AD with obesity and dyslipidemia.

Exploring Gut Microbiota and the Influence of Physical Activity Interventions on Overweight and Obese Children and Adolescents: A Systematic Review.

The recognition that the gut microbiota of obese children differs from lean children has grown, and some studies suggest that physical activity positively influences the gut microbiota. This systematic review explores the changes in the gut microbiota composition of obese and non-obese children and adolescents and provides an understanding of the effects of physical activity interventions in modulating their microbiota. The PRISMA protocol was used across PubMed, Scopus, and Web of Science. Overall, twenty-four research papers were included in accordance with the chosen inclusion and exclusion criteria, eighteen studies compared the gut microbiota of obese and normal-weight children and adolescents, and six studies explored the effect of physical activity interventions on the gut microbiota. The analysis indicated that obese gut microbiota is reduced in Bacteroidetes, Bifidobacterium and alpha diversity but enriched in Proteobacteria and Lactobacillus. Interventions with physical activity seem to improve the alpha diversity and beneficial bacteria linked to body weight loss in children and adolescents. The gut microbiota of obese children exhibited a remarkably individual variation. More interventions are needed to clearly and accurately explore the relationships between child obesity, gut microbiota, and physical activity and to develop approaches to decrease the incidence of paediatric obesity.

Comparison of Self-Esteem and Internet Addiction Levels in Obese and Non-Obese Adolescents

Comparison of Self-Esteem and Internet Addiction Levels in Obese and Non-Obese Adolescents

Lifestyle habits and obesity indices among male adolescents in Riyadh, Saudi Arabia

Obesity among adolescents is a global health apprehension which requires early prevention. The aim of this study was to determine the association between lifestyle habits including physical activity, sedentary behaviors and eating habits with obesity indices of body mass index (BMI) and waist-to-height ratio (WHtR) among male adolescents in Riyadh, Saudi Arabia. We randomly selected 471 secondary school male adolescents aged 14–18 years. A pre-validated self-reported questionnaire was used to record the data on physical activity level, sedentary behaviors, sleep duration and eating habits. The International Obesity Task Force (IOTF) cutoff values for adolescents under 18 years of age were used to define overweight and obesity. Total energy expenditure was calculated using metabolic equivalent-minutes per week. Anthropometry including weight, height, BMI, waist circumference, waist/height ratio (WHtR), were assessed. 53.7% and 48.4% of the adolescents were overweight/obese and had abdominal obesity; respectively. Those with overweight and obesity or above 50% of WHtR were much less active in terms of METs-min/week from vigorous-intensity sports, sum of all METs-min/week from all vigorous-intensity physical activity, total METs-min/week from all physical activity compared with non-obese adolescents and below 50% of WHtR. The present study identified the lifestyle habits that were associated with obesity and may represent valid targets for the prevention and management of obesity among Saudi adolescents. Knowledge of the factors that contribute to obesity could be used in preventive programs for the control of obesity among adolescents.

1153-P: Postprandial Increase in Inflammation Is Not Affected by Glycemic Index in Children and Adolescent with Type 1 Diabetes

Patients with type 1 diabetes (T1D) have lower life expectancy than individuals without diabetes. Most of this reduction is due to cardiovascular disease, the major cause of death in patients with T1D. Post-prandial inflammation after high glycemic index (GI) meals may cause cardiovascular disease in adults. Differences in postprandial inflammatory responses between high and low GI foods have not been studied in children and adolescents with T1D. Twelve non-obese children and adolescents, 10-18 years old, with type 1 diabetes were recruited from the Diabetes Clinic of Nationwide Children's Hospital. A randomized cross-over design for their two subsequent visits was used. Baseline blood sample were taken (plasma glucose, triglyceride, IL-6, CRP, and TNF-α), rapid acting insulin was given to cover meal carbohydrate without glucose correction, and blood samples were repeated (30, 60, 90, and 120 minutes) after an overnight fast. Visits 1 and 2 were identical except for the GI of the given meal. Visits were rescheduled if the fasting glucose was greater than 200 mg/dl. Glucose response were significantly greater following high GI meal (Δglucose: high 52±12 vs low 6±5 mg/dl, mean±SE, repeated measures ANOVA, p&amp;lt;0.001), as expected. TNF-α (High 0 min: 0.86±0.08, 30 min: 1.83±0.08; Low 0 min: 0.82±0.06, 30 min 1.81±0.06 ng/ml) and IL-6 (High 0 min: 0.38±0.06, 120 min: 0.68±0.25; Low 0 min: 0.49±0.11, 120 min 0.71±0.14 ng/ml) increased following both high and low GI meals (p &amp;lt;0.001 and p=0.008, respectively), but there were no statistically significant differences between the two groups. CRP did not increase with either type of meal. Children and adolescent with T1D have post prandial inflammation, as indicated by increased TNFα and IL-6 levels. The post-prandial inflammation is not different between high and low GI meals in spite of higher glucose levels with the former. Disclosure C.P.Damilano: None. R.P.Hoffman: None. Funding Abigail Wexner Research Institute; University of Ohio

Relationship between Body Image, Body Mass Index and Self Esteem among Obese and Non Obese Female Adolescents

Purpose of this research was to study the relationship between body mass index, body image dissatisfaction and self-esteem among obese and normal weight female adolescents in district Attock. This research also aimed to study differences among obese and non-obese female adolescents on self-esteem and body image. The population of study was female adolescents. Sampling technique used for selection of sampling was purposive sampling. Sample size of this research was 200 female adolescents. Survey method was used to collect data from sample. Statistical Package for Social Science (SPSS) software was used for obtaining results of this study. Finding of this study shows that there is significant positive correlation between body image dissatisfaction and body mass index. It indicates a significant negative correlation among body mass index, self-esteem and body image dissatisfaction. Results of this research indicate that obese female adolescents have more body image dissatisfaction and low self-esteem as compared to non-obese female adolescents.

Triglyceride level and soft drink consumption predict nonalcoholic fatty liver disease in nonobese male adolescents.

Differential metabolic risk factors of nonalcoholic fatty liver disease (NAFLD) in nonobese male adolescents were analyzed examining relationships between NAFLD and clinical parameters of metabolic syndrome, including exercise and soft drink consumption, in male adolescents. In total, 134 male university students (nonobese, n=78; obese, n=56) who underwent the first-year health checkup were divided into the NAFLD and non-NAFLD groups based on abdominal ultrasonography (AUS) findings. Relationships between NAFLD and metabolic parameters, including body mass index (BMI) and AUS score, were examined in nonobese students. Metabolic factors associated with hypertension, abdominal fat, liver damage, dyslipidemia, and impaired glucose tolerance were significantly less common in nonobese students than in obese students. The aforementioned factors and soft drinkconsumption were significantly more common in the NAFLD group than in the non-NAFLD group. The univariate and multivariate analyses of nonobese students showed that the triglyceride level (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01-1.10, p=0.001) was higher and soft drink consumption (OR, 36.8; 95% CI, 3.69-368, p<0.001) was more common in the NAFLD group than the non-NAFLD group. Triglyceride level and soft drink consumption could aid in the detection of NAFLD in nonobese male adolescents. Our findings could provide useful information related to NAFLD and metabolic syndrome in nonobese adolescents.

Appetite hormone dysregulation, body mass index, and emotional dysregulation in nonobese adolescents with first-episode schizophrenia, bipolar disorder, and major depressive disorder: a cross-sectional association study.

Evidence has suggested that emotional dysregulation is a transdiagnostic feature in schizophrenia and major affective disorders. However, the relationship between emotional dysregulation and appetite hormone disturbance remains unknown in nonobese adolescents with first-episode schizophrenia, bipolar disorder, and major depressive disorder. In total, 22 adolescents with schizophrenia; 31 with bipolar disorder; 33 with major depressive disorder; and 41 healthy age-, sex-, and body mass index (BMI)/BMI percentile-matched controls were enrolled for assessing levels of appetite hormones, namely leptin, ghrelin, insulin, and adiponectin. Emotional regulation symptoms were measured using the parent-reported Child Behavior Checklist-Dysregulation Profile. Adolescents with first-episode schizophrenia, bipolar disorder, and major depressive disorder exhibited greater emotional dysregulation symptoms than the control group (P=.037). Adolescents with bipolar disorder demonstrated higher log-transformed levels of insulin (P=.029) and lower log-transformed levels of leptin (P=.018) compared with the control group. BMI (P<.05) and log-transformed ghrelin levels (P=.028) were positively correlated with emotional dysregulation symptoms. Emotional dysregulation and appetite hormone disturbance may occur in the early stage of severe mental disorders. Further studies are required to clarify the unidirectional or bidirectional association of emotional dysregulation with BMI/BMI percentile and appetite hormones among patients with severe mental disorder.

Raised Thyroid-Stimulating Hormone in Girls with Polycystic Ovary Syndrome: Effects of Randomized Interventions

Introduction: Polycystic ovary syndrome (PCOS) in women associates with raised levels of circulating thyroid-stimulating hormone (TSH) and with high rates of gestational complications. A low range of preconception TSH is followed by low rates of gestational complications. It is unknown whether TSH levels are elevated in adolescents with PCOS and, if so, whether traditional or exploratory treatments can lower them into safe preconception range. We investigated TSH in nonobese adolescents with PCOS, including the effects of randomized interventions. Methods: Morning TSH was a safety marker in randomized pilot studies comparing the effects of an oral contraceptive (OC) versus those of a low-dose combination of spironolactone-pioglitazone-metformin (SPIOMET) in nonobese adolescents with PCOS. A post hoc analysis compared TSH levels in PCOS (N = 62) versus controls, TSH changes on treatment (for 1 year), and TSH levels posttreatment (for 1 year). Results: Mean TSH levels were higher in PCOS patients than in control girls (p < 0.01). On-treatment TSH levels diverged (p < 0.001), remaining elevated on OC, and descending swiftly on SPIOMET, well into safe preconception range. Posttreatment TSH levels were stable in both subgroups. On-treatment changes of circulating TSH associated to those of liver fat (R = 0.307, p = 0.017). Conclusion: The endocrine signature of early PCOS is herewith extended to include modestly raised levels of circulating TSH; the normalizing effects of SPIOMET intervention in nonobese adolescents with PCOS are herewith extended to include on- and posttreatment TSH.

Prediction equations for maximal heart rate in obese and nonobese children and adolescents: a systematic review and meta-analysis.

The aim of this study was to analyze which equation best estimates maximal heart rate (HRmax) for the pediatric population according to body mass. We performed a meta-analysis (PROSPERO No. CRD42020190196) of cross-sectional studies that aimed to validate or develop HRmax equations and that had children and adolescents as samples. The search was conducted in Scopus, Science Direct, Web of Science, PubMed, and Biblioteca Virtual em Saúde with the descriptors "prediction or equation," "maximal heart rate," "maximum heart rate," "determination of heart rate," children, and adolescent. The TRIPOD Statement tool was used to assess the methodological quality and the relevant data were extracted for analysis. The meta-analysis was conducted in the Comprehensive Meta-Analysis, adopting p<0.05 and a 95% confidence interval (CI). In total, 11 studies were selected, of which 3 developed predictive equations, 10 performed external validity of the preexisting models, and 1 incremented values related to equations already developed. The results of the methodological quality analysis showed a moderate rating in most studies. The 164 + (0.270 × HRres) - (0.155 × body mass) + (1.1 × METs) + (0.258 × body fat percent) (r=0.500, 95%CI 0.426-0.567, p<0.001) and 166.7+ (0.46 × HRres) + (1.16 × maturation) (r=0.540, 95%CI 0.313-0.708, p<0.001) equations presented stronger correlations with measured HRmax in nonobese adolescents. The predictive model developed by 208 - (0.7 × age) showed a greater accuracy among the possible models for analysis (SDM=-0.183, 95%CI -0.787 to -0.422, p=0.554). No specific predictive equation was found for obese adolescents. Future research should explore new possibilities for developing predictive equations for this population as a tool to control exercise intensity in the therapeutic management of childhood and adolescent obesity.