OB Children Research Articles

A tendency to worse course of multisystem inflammatory syndrome in children with obesity: MultiOrgan Inflammatory Syndromes COVID-19 related study.

BackgroundA new disease entity called multisystem inflammatory syndrome in children (MIS-C) is a rare consequence of COVID-19 infection. The pathophysiology and risk factors of MIS-C are still unclear, and the clinical manifestation ranges from milder forms to cases needing intensive care unit treatment. Based on available data, obesity is linked to pro-inflammatory stimulation. Moreover, several studies showed that obesity could play a role in COVID-19 severity and its comorbidities among the adult and children’s populations. This study aimed to investigate the influence of overweightedness/obesity in childhood for the course of MIS-C in Poland.MethodsThis study presented data from the national MultiOrgan Inflammatory Syndromes COVID-19 Related Study (MOIS-CoR) collected between 4 March 2020 and 20 February 2021. Of the 371 patients that met the Polish MIS-C criteria, 306 were included for further analysis.ResultsChildren who are obese (OB with body mass index (BMI) ≥95th percentile) and overweight (OV with BMI ≥85th percentile but <95th percentile) (28 and 49 patients, respectively) represented 25.1% (n=77) of all recruited patients. Complete recovery at the time of discharge presented in 93% of normal body weight (NW) participants and 90% of OV children (p>0.05). Among OB children, 76% recovered fully, which differed from the NW group (p=0.01). Calculated odds ratio (OR) of incomplete recovery for OB children was 4.2. Irrespective of body weight, there were no differences (p>0.05) in the length of hospitalization and the duration of symptoms (for OB, 13 and 16.5 days; for OV and NW, 10 and 14 days, respectively), as well as in the frequency of cardiovascular abnormalities, necessity of oxygen therapy (OB, 26.9%; OV, 23.9%; and NW, 20.7%), and intravenous immunoglobulin and glucocorticosteroid (GCS) treatment.ConclusionThe higher risk of incomplete recovery and observed tendency toward a worsening course of MIS-C in patients with obesity suggest the need for further studies to confirm and understand our findings.

Obesity Is Associated with Attenuated Tissue Immunity in COVID-19.

Rationale: Obesity affects 40% of U.S. adults, is associated with a proinflammatory state, and presents a significant risk factor for the development of severe coronavirus disease (COVID-19). To date, there is limited information on how obesity might affect immune cell responses in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objectives: To determine the impact of obesity on respiratory tract immunity in COVID-19 across the human lifespan. Methods: We analyzed single-cell transcriptomes from BAL in three ventilated adult cohorts with (n = 24) or without (n = 9) COVID-19 from nasal immune cells in children with (n = 14) or without (n = 19) COVID-19, and from peripheral blood mononuclear cells in an independent adult COVID-19 cohort (n = 42), comparing obese and nonobese subjects. Measurements and Main Results: Surprisingly, we found that obese adult subjects had attenuated lung immune or inflammatory responses in SARS-CoV-2 infection, with decreased expression of IFN-α, IFN-γ, and TNF-α (tumor necrosis factor α) response gene signatures in almost all lung epithelial and immune cell subsets, and lower expression of IFNG and TNF in specific lung immune cells. Peripheral blood immune cells in an independent adult cohort showed a similar but less marked reduction in type-I IFN and IFNγ response genes, as well as decreased serum IFNα, in obese patients with SARS-CoV-2. Nasal immune cells from obese children with COVID-19 also showed reduced enrichment of IFN-α and IFN-γ response genes. Conclusions: These findings show blunted tissue immune responses in obese patients with COVID-19, with implications for treatment stratification, supporting the specific application of inhaled recombinant type-I IFNs in this vulnerable subset.

Forearm Fractures in Overweight-Obese Children and Adolescents: A Matter of Bone Density, Bone Geometry or Body Composition?

Forearm fractures in children and adolescents are associated with increased body mass index (BMI). This bone site is non-weight-bearing and therefore is appropriate to explore the effect of BMI on bone mineral density (BMD) and bone geometry, avoiding the confounding effect of increased weight-associated mechanical loading. The aim of this review was to summarize available evidence on bone indices and body composition assessed by peripheral quantitative computed tomography (pQCT) or dual X-ray absorptiometry (DXA) at the forearm level in overweight (Ow) or obese (Ob) subjects. We conducted a review of the literature according to the PICOS model. A total of 46 studies were identified following the literature search. A final number of 12 studies were included in this review. pQCT studies evidenced that Ow and Ob children typically have normal or increased volumetric BMD (vBMD), total bone area and cortical area, with normal or reduced cortical thickness at the forearm. Outcomes from DXA evaluations are less conclusive. In almost all the studies fat mass and lean mass area at the forearm are increased. A higher fat-to-lean mass ratio has been observed in few studies. Bone strength was reported as normal or increased compared to normal weight peers. In Ow or Ob children-adolescents, vBMD, bone size and bone strength are not reduced compared to normal weight peers. The local higher fat-to-lean mass ratio may give a mismatch between bone strength and the load experienced by the distal forearm during a fall, resulting in increased risk of forearm fractures.

2006-P: Association between High Birth Weight and Later Higher BMI and Blood Pressure in 9-Year-Old Schoolchildren

Background: Studies have suggested that high birth weight (BW) is associated with later higher BMI but its association with higher blood pressure (BP) should be further explored. Objective: To determine the association between high BW with later higher BMI and BP in 9-year-old overweight/obese (OW/OB) schoolchildren. Methods: Schoolchildren (n = 2567, 1157M) aged 8.7±2.1 years from 10 elementary schools in five states of Argentina were examined between April 2017 and September 2019. Mothers submitted children’s BW information. Body mass index (BMI) and BP were assessed by pediatricians. Results: 1095 (42.7%) of the children were OW/OB. The prevalence of low (&amp;lt;2500grams), and high BW (&amp;gt;4000grams) was 6.6% (n=169) and 7.4% (n=190), respectively. There was a significant difference in mean BMI z-score in 9-year-old children between low BW, normal BW, and high BW (0.44, 0.73, and 1.05, respectively). OW/OB 9-year-old children with high BW had higher z-BMI (1.70 vs. 1.89, respectively) and higher systolic BP (97 vs. 100 mm Hg, respectively) than OW/OB 9-year-old children with normal or low BW. However, normal-weight 9-year-old children with high BW had similar BP than 9-year-old children with normal or low BW. Multiple linear regression analyses showed that systolic BP was significantly associated with age in 9-year-old normal-weight children (R2=0.07). However, systolic BP was positively associated with age and BW in 9-year-old-OW/OB children (R2=0.11). When systolic BP was replaced by diastolic BP similar results were obtained. Conclusion: This study suggests that systolic BP was significantly associated with high BW in OW/OB 9-year-old children but not in 9-year-old normal-weight children. Children with high BW should be followed closely to prevent future cardiovascular disease. Disclosure V. Hirschler: None. C. Molinari: None. C. Garcia: None. S. Lapertosa: None.

Relationship between body mass index and physical fitness in Italian prepubertal schoolchildren.

The objective of this study was to investigate the association between physical fitness and body mass index categories (obesity, OB; overweight, OW; normal-weight, NW; and underweight, UW) in prepubertal children. Anthropometric and physical fitness characteristics were collected from a convenience sample of 30472 Italian schoolchildren (6–11 years old). Six field-based tests were used: Léger, agility shuttle, long jump, frontal throw of the basketball, Sit & Reach and standing balance. Significant differences were found in the anthropometric characteristics, physical fitness and weight status prevalence between girls and boys (p<0.05) and, except for flexibility, by age class (p<0.05). Obese children performed worse than their NW counterparts in aerobic capacity (p<0.001), agility (p<0.001), muscular power of the lower limb (p<0.001) and balance (p<0.001). Conversely, children with obesity showed greater upper limb power than NW children (p<0.001). The discrepancy in physical fitness between OB and NW children increased in older girls (flexibility, p = 0.002; muscular power of the lower and upper limb, p = 0.002 and p = 0.005) and boys (aerobic capacity, p = 0.009; agility, p = 0.006; standing balance, p = 0.019; muscular power of the lower and upper limb, p<0.001 and p = 0.011) compared to their younger counterparts. On the other hand, UW children performed worse than NW children mainly in terms of muscular power of the arms (p<0.001). Additionally, there was an increasing disparity in the frontal throw test scores of UW and NW girls (p = 0.003) and boys (p = 0.011) in older children compared to younger children. In conclusion, the effect of body mass index on children’s physical fitness intensifies with age. OB and OW negatively affect aerobic capacity, agility, lower limb power and balance but positively affect upper limb power. UW negatively affects upper limb power. This study underscores the importance of preventing childhood OW, OB, and UW in early life to promote children’s health and proper fitness development.

Autonomic Activity in Overweight-Obese Children During the Morning Transition in Cardiac Circadian Regulation (P21-065-19)

ObjectivesRegulation of the autonomic nervous system is disturbed in obese children and adults. This dysregulation—which includes sympathetic nervous system (SNS) over activity and disruption of cardiac circadian rhythms—is of interest because of the negative impact of these effects on cognition, regulation of energy homeostasis, cardiovascular health, and metabolic functions. The present study evaluated heart rate (HR) measures during the first hours following awakening from sleep when circadian cardiac control transitions from an emphasis on parasympathetic nervous system activity (PNS) during sleep to an emphasis on SNS activity during wakefulness. MethodsResting HR recordings (5 min) were obtained from healthy normal weight (NW: BMI < 85th %ile; n = 47; 25 boys) and overweight-obese (OB: BMI > 95th %ile; n = 48; 24 boys) 10 yr olds enrolled in the ACNC’s Brain Food study. The first of two recording sessions (T1) took place 2 hrs after awakening (1 hr after a standardized breakfast), and the second (T2) 1 hr later. Recordings were processed for measures of sympathetic [low frequency (LF)] and parasympathetic [high frequency (HF); vagal tone (VT); root mean square of intervals between adjacent heart beats (RMSSD)] activities. ResultsSeparate ANOVAs (recording session by group by sex) were conducted for each measure. Previous reports of higher HR in girls than boys and in OB than NW groups were confirmed (both P ≤ 0.001) HR slowed significantly from T1 to T2 for OB (P = 0.021), but not NW. These effects were associated with T1 to T2 increases in SNS LF activity for both groups (both P ≤ 0.003), but significant increases in PNS measures (HF, RMSSD, VT; all P < 0.05) for only OB children. Increases in PNS activity across recording sessions for OB children attenuated group HR differences during T2 (T1: OB > NW, P = 0.008; T2: OB > NW, P = .051). Gender differences were consistent with faster HR in girls which was maintained across groups and recording sessions. ConclusionsThe results are the first to show that autonomic dysregulation in obese children modulates the shift in SNS-PNS balance characteristic of the transition from sleep to waking. These findings may inform the development of new early intervention strategies to attenuate obesity that consider the role played by circadian rhythms. Funding SourcesFunded by USDA-ARS Project 6026-51000-010-05S.

A Look Back at Healthy Lifestyle Behavioral Patterns among School-Age Children: Are We Neglecting Healthy Weight for Overweight Kids?

Objective: To describe prevalence of healthy lifestyle behaviors (HLBs) between two school-age cohorts of racial-ethnically diverse children. Methods: Using two Early Childhood Longitudinal Study cohorts (ECLS-K 1999 and 2010), we compared percentage change in HLBs (sleep, physical activity, screen time, and family meals) by child weight groups and within racial-ethnic groups. Weight groups of interest included healthy weight (HW; BMI 5th-84th percentile), overweight (OW; ≥ 85th-94th), obese (OB; ≥ 95th-99th percentile), and severely obese (SO; ≥ 99th percentile). Results: OW children within the 2010 cohort reported greater percentage change (range: 2.0%-15.1% increase) in HLBs, whereas HW children demonstrated lower percentage change (range: -6.2% to 8.7% increase). OB and SO children showed significant lower percentage change in reducing screen time (range: -11.0% and -12.7%, respectively). HW Latino children demonstrated the least favorable trends with overall declines noted for 4/5 HLBs. Screen time was noted to have the greatest degree of favorable change (2%-14%) across weight groups, whereas adequate sleep duration demonstrated the lowest favorable percentage change (2%-2.8%). Conclusion: Fewer HW and OB children were participating in recommended HLBs compared with OW children in 2010. Recent health campaigns may have helped providers prioritize the identification and counseling of OW children, yet our data suggest that we may be neglecting the role of HLB counseling in OB and HW children. Continued analysis on the social determinants that impact HLBs in school-age and HW/OB minority children should inform how we can best tailor counseling and messages in the coming decades.

Serum Branched Chain and Aromatic Amino Acids Are Associated to Overweight, Obesity and Metabolic Alterations in School‐Aged Children

BackgroundChildhood overweight and obesity are risk factors for metabolic alterations that could ultimately lead to pathological states. Metabolomics has emerged as a powerful tool to identify biomarkers for metabolic alterations. Multiple metabolomics studies have associated childhood obesity to serum amino acids and acylcarnitines, particularly to an increase in branched chain amino acids (BCAA). Despite these findings, so far there are no studies evaluating the serum amino acid profile in Mexican children. Therefore we aimed to identify amino acids associated to overweight, obesity and its metabolic alterations in Mexican school‐aged children.MethodologyAnthropometric and biochemical measurements were conducted in 845 children (6–12 years old) from a cross‐sectional study in Mexico City. Targeted metabolomics was performed by mass spectrometry. Children were classified according to their BMI percentile (BMIp) as low weight (LW; BMIp&lt;5th), normal weight (NW; 5th&lt;BMIp&lt;85th), overweight (OW; 85th&lt;BMIp&lt;95th) and obese (OB; 95th&lt;BMIp).ResultsOW and OB children had higher serum levels of BCAA and aromatic amino acids (AA) than NW and LW children (p&lt;0.001). BCAA and AA correlated with higher HOMA (r=0.11, p=0.002 and r=0.15, p&lt;0.001, respectively) and serum triglycerides (r=0.18, p&lt;0.001 and r=0.19, p&lt;0.001, respectively), after adjusting for age, sex and BMI percentile. Since insulin resistance (IR) and hypertriglyceridemia (hTG) are the most common metabolic alterations in Mexican children, those with both abnormalities were classified as Metabolically Compromised (MC), while those with none of these as Metabolically Healthy (MH). In NW, BCAA and AA were higher in MC than in MH children (p&lt;0.001), concomitant to an increase in adiposity, suggesting that the higher levels of amino acids could respond to the higher degree of adiposity. However in OW children, BCAA an AA were also higher in MC children than in MH children (p&lt;0.002), despite same percentage of adiposity between these two groups. Previous studies have suggested that a dysfunctional adipose tissue plays a role in the accumulation of these amino acids in serum and, in the development of metabolic complications. Thus we hypothesize that in OW children the adipose tissue functionality could be playing a role in the presence of metabolic complications, however the latter requires further research.ConclusionsBCAA and AA are associated to higher degree of overweight, likely related to a higher adiposity. However, their association with IR and hTG seems to be related to other factors besides adiposity. This highlights the importance of BCAA and AA in differentiating MH children from MC children.Support or Funding InformationThis work was supported by CONACYT grant 248765 to SM‐R

Radiographic cephalometry analysis of head posture and craniofacial morphology in oral breathing children

Background/Aim. Nasal breathing plays an important role in overall physical growth and mental development, as well as in the growth of the craniofacial complex. Oral breathing over a long period of time, can cause changes in position of the head relative to the cervical spine and jaw relationship. It can cause an open bite and the narrowness of the maxillary arch due to increased pressure of strained face. The aim of this study was to analyze the position of the head and craniofacial morphology in oral breathing children, and compare the values obtained compared with those of the same parameters in nasal brething children. Methods. We analyzed the profile cephalometric radiographs of 60 patients who had various orthodontic problems. In the first group there were 30 patients aged 8?14 years, in which oral breathing is confirmed by clinical examination. In the second group there were 30 patients of the same age who had orthodontic problems, but did not show clinical signs of oral breathing. The analyses covered the following: craniocervical angle (NS/OPT), the length of the anterior cranial base (NS), anterior facial height (N-Me), posterior facial height (S-Go), the angle of maxillary prognathism (SNA), angle of mandibular prognathism (SNB), difference between angles SNA and SNB (ANB angle), the angle of the basal planes of the jaws (SpP/MP), cranial base angle (NSB), and the angle of facial convexity (NA/Apg). Results. The average value of the craniocervical angle (NS/OPT) was significantly higher in OB children (p = 0.004). There were significantly different values of SNA (p &lt; 0.001), ANB (p &lt; 0.001), NA/APg (p &lt; 0.001) and length of the anterior cranial base (NS) (p = 0.024) between groups. Conclusion. Oral breathing children have pronounced retroflexion of the head in relation to the cervical spine compared to nasal breathing children, and the most prominent characteristics of the craniofacial morphology of skeletal jaw relationship of class II and increased facial convexity.

Reduced Deoxyhemoglobin Threshold In The Prefrontal Cortex In Obese vs. Healthy Children

A growing body of evidence suggests that a neural component influences exercise tolerance. During exhaustive exercise, the prefrontal cortex (PFC) has been shown to switch from a steady state of deoxygenated blood levels (HbR) to a state of rapidly increasing HbR preceding exercise termination. We report alterations to the threshold at which HbR changes within obese (Ob) relative to normal-weight (Nw) children. PURPOSE: To compare, in Ob vs Nw children, PFC HbR thresholds in response to incremental exercise, as measured non-invasively with Diffuse Optical Spectroscopy (DOS). METHODS: A DOS probe was placed on the left forehead of 7 Ob children (13 ± 0.3 yrs, 97 ± 0.6 BMI%, 3F) and 12 Nw children (13 ± 0.2 yrs, 44 ± 8.7 BMI%, 10F). DOS measurements of HbR were obtained via a continuous wave near-infrared spectroscopy system (pocket NIRS, Hamamatsu) as the children underwent an incremental exercise test until exhaustion. HbR thresholds were calculated via linear segmented regression. Comparisons were made using one-tailed, independent Student’s t-tests. RESULTS: The HbR threshold occurred in Ob not only at a lower absolute work-rate (watts, W) (82 ± 9 vs.106 ± 8W, p<0.05) as could be expected by a lower aerobic capacity (27 ± 2 vs. 38 ± 2 ml O2/kg/min, p<0.05), but also at a lower % of peak work rate (60 ± 3 vs. 70 ± 3%, p<0.05), suggesting an additional, obesity-related component to this reduction. CONCLUSION: Our cohort of Ob children experienced earlier HbR thresholds in incremental exercise relative to Nw children. Our findings are consistent with the concept that alterations in HbR threshold are related to exercise tolerance, highlighting the PFC’s potential role in the volitional control of exercise termination.NIH NICHD P01HD048721 & UL1 TR000153

Comparison of Endothelial Function in Pre‐ and Post‐exercise States between Obese and Normal‐weight Children

Background and RationaleMicroangiopathy is a common comorbidity associated with adult obesity. We hypothesize that microvascular function may be altered following an age‐specific pattern in pediatric obesity, occurring well before any clinical sign of vascular impairment. As exercise provides a strong, relatively homogeneous vasodilatory stimulus, these early alterations in endothelial function may be more easily detected in the post‐exercise state. We therefore designed the present study with the objective to detect differences between obese (Ob) and normal‐weight (Nw) children in endothelial function, via Laser Doppler Flowmetry (LDF), both at rest and following a standard incremental exercise test to exhaustion.MethodsThirteen Ob children (13 ± 2 yrs, 97 ± 0.8 BMI%, 6F) and 11 Nw children (14 ± 2 yrs, 61 ± 14 BMI%, 6F) participated in the study. An optical probe connected with a Periflux 5000 Laser Doppler system (Perimed, Sweden) was placed on the base of the middle finger, and LDF measurements of skin perfusion were obtained before, during, and after a 1‐min occlusion induced at the wrist with a blood pressure cuff inflated at 200 mmHg. Subjects then performed a standard incremental cycling exercise test to exhaustion, using a commercial metabolic cart/cycle ergometer system (Carefusion, San Diego, USA). The incremental phase of the test was tailored to last ~ 10 min after 2 min of unloaded pedaling. LDF measurements were then repeated 8 min after exercise cessation. Baseline pre‐occlusive perfusion (Plat1), post‐occlusive hyperemic peak (pMax), and the time from release of occlusion to reach pMax (PkT) were obtained from perfusion tracings. Comparisons were made using two‐tailed, independent Student's t‐tests.ResultsPerfusion variables (in arbitrary perfusion Units) were greater in Ob throughout the study (Plat1, pre‐exercise 76 ± 13 vs. 43 ± 12 in Nw, p = 0.068; post‐exercise, 86 ± 13 vs. 41 ± 6 in Nw, p&lt;0.05; pMax, pre‐exercise, 165 ± 16 vs. 99 ± 21, p&lt;0.05, post‐exercise, 164 ± 16 vs. 117 ± 13, p&lt;0.05). The magnitude of the hyperemic peak relative to baseline, while quantitatively larger in Nw in the pre‐exercise state, only reached significance in the post‐exercise state (pMax/Plat1, post‐exercise, 3.0 ± 0.3 vs. 2.1 ± 0.2, p&lt;0.05). In general, therefore, a similar pattern of differences was present in all studies, but significance was more clearly delineated in the post exercise state. PkT was similar across weight groups, and unchanged by prior exercise.ConclusionsOverall, our cohort of Ob children displayed characteristic perfusion alterations relative to Nw children, possibly including a state of chronic baseline vascular dilation, and reduced responsiveness to additional vasodilatory stimuli, such as physical exercise. Our findings are consistent with the concept that obesity, even in its very early stages in pediatric populations, is associated with microvascular dysfunction.Support or Funding InformationNIH NICHD P01HD048721 &amp; UL1 TR000153

White blood cell count may identify abnormal cardiometabolic phenotype and preclinical organ damage in overweight/obese children

Background and AimsSubclinical inflammation is a central component of cardiometabolic disease risk in obese subjects. The aim of the study was to evaluate whether the white blood cell count (WBCc) may help to identify an abnormal cardiometabolic phenotype in overweight (Ow) or obese (Ob) children. Methods and ResultsA cross-sectional sample of 2835 Ow/Ob children and adolescents (age 6–18 years) was recruited from 10 Italian centers for the care of obesity. Anthropometric and biochemical variables were assessed in the overall sample. Waist to height ratio (WhtR), alanine aminotransferase (ALT), lipids, 2 h post-load plasma glucose (2hPG), left ventricular (LV) geometry and carotid intima-media thickness (cIMT) were assessed in 2128, 2300, 1834, 535 and 315 children, respectively. Insulin resistance and whole body insulin sensitivity index (WBISI) were analyzed using homeostatic model assessment (HOMA-IR) and Matsuda's test. Groups divided in quartiles of WBCc significantly differed for body mass index, WhtR, 2hPG, HOMA-IR, WBISI, lipids, ALT, cIMT, LV mass and relative wall thickness. Children with high WBCc (≥8700 cell/mm3) showed a 1.3–2.5 fold increased probability of having high normal 2hPG, high ALT, high cIMT, or LV remodeling/concentric LV hypertrophy, after adjustment for age, gender, pubertal status, BMI and centers. ConclusionsThis study shows that WBCc is associated with early derangements of glucose metabolism and preclinical signs of liver, vascular and cardiac damage. The WBCc may be an effective and low-cost tool for identifying Ow and Ob children at the greatest risk of potential complications.

Relation between Candida spp in Dental Plaque and Nutritional Status in Kindergarten Children

Early childhood caries, an ecological disease, and obesity are related to dietary habits. We previously found an association among nutritional status (NS), prevalence of caries and microbiology composition of dental biofilm, that leads to a negative relationship between obesity and caries risk. Candida spp is a frequent commensal yeast of the oral microbiota; however, in the pediatric population is associated with presence of caries.The aim of the present study was to determine the association between NS, Candida spp, and caries in preschool children. Fifty one children aged 3 to 6 years were were classified in adequate (A), overweight (OW) or obese (Ob) with Anthro software. Presence/absence of caries lesions, and Candida spp in the dental plaque were determined. Dental plaque samples were collected and seeded in selective medium CHROMagar Candida®.ResultsNS showed 49% of A, 29.4% OW and 21.6% Ob. Candida spp strains were isolated from dental plaque of (% and CI95%): 52 (32‐72) of A, 33 (12‐62) OW and 0(0‐28) Ob children (Fisher's test, p=0.0107), regardless the presence of caries. Althoug 36% of Ob children presented caries, we did not isolated Candida spp in dental plaque.ConclusionColonization of dental plaque biofilm by Candida spp is related with nutritional status of preschoolers.UBACyT 20720130100017BA.

Impact of physical activity on energy balance, food intake and choice in normal weight and obese children in the setting of acute social stress: a randomized controlled trial.

BackgroundPsychological stress negatively influences food intake and food choices, thereby contributing to the development of childhood obesity. Physical activity can also moderate eating behavior and influence calorie intake. However, it is unknown if acute physical activity influences food intake and overall energy balance after acute stress exposure in children. We therefore investigated the impact of acute physical activity on overall energy balance (food intake minus energy expenditure), food intake, and choice in the setting of acute social stress in normal weight (NW) and overweight/obese (OW/OB) children as well as the impact of psychological risk factors.MethodAfter receiving written consent from their parents, 26 NW (BMI < 90th percentile) and 24 7-to 11-year-old OW (n = 5)/OB (n = 19, BMI ≥ 90th percentile) children were randomly allocated using computer-generated numbers (1:1, after stratification for weight status) to acute moderate physical or to sedentary activity for 30 min. Afterwards, all children were exposed to an acute social stressor. Children and their parents completed self-report questionnaires. At the end of the stressor, children were allowed to eat freely from a range of 12 different foods (6 sweet/6 salty; each of low/high caloric density). Energy balance, food intake/choice and obesity-related psychological risk factors were assessed.ResultsLower overall energy balance (p = 0.019) and a decreased choice of low density salty foods (p < 0.001) in NW children compared with OW/OB children was found after acute moderate physical activity but not sedentary activity. Independent of their allocation, OW/OB children ate more high density salty foods (104 kcal (34 to 173), p = 0.004) following stress. They scored higher on impulsive behavior (p = 0.005), restrained eating (p < 0.001) and parental corporal punishment (p = 0.03), but these psychological factors were not related to stress-induced food intake/choice. Positive parenting tended to be related to lower intake of sweet high density food (−132 kcal, −277 to 2, p = 0.054).ConclusionsIn the setting of stress, acute moderate physical activity can address energy balance in children, a benefit which is especially pronounced in the OW/OB. Positive parenting may act as a protective factor preventing stress-induced eating of comfort food.Trial registrationclinicaltrials.gov NCT01693926The study was a pilot study of a project funded by the Swiss National Science Foundation (CRSII3_147673).

Patterns of habitual physical activity in youth with and without Prader-Willi Syndrome.

Children classified as overweight or obese and those with disabilities are at a greater risk of not meeting the minimum recommendation of 60 min a day of moderate to vigorous physical activity (PA). Youth with Prader-Willi Syndrome (PWS) appear to participate in less PA compared to nonsyndromal children, likely due to syndrome-related factors. However, description of PA patterns in youth with PWS is lacking. The purpose of this study was to characterize PA in youth with PWS and to compare it to PA in children with nonsyndromal obesity. Twenty-four youth with PWS (ages 8-16 years) and 40 obese children without PWS (OB) (ages 8-11 years) wore accelerometers for eight consecutive days. Data were screened for compliance and classified into PA intensities: sedentary behavior (SED), light (LPA), moderate (MPA), vigorous (VPA) and moderate plus vigorous (MVPA). Youth with PWS spent 19.4% less time in weekly LPA (p=0.007) and 29.8% less time in weekly VPA compared to OB controls (p=0.036). All other intensities were similar between groups. In addition, PWS participated in less LPA and VPA during the weekends compared to OB, and less LPA on weekdays when compared to OB. There was also a trend towards PWS participating in less MVPA during the weekends and less VPA during the weekends than OB controls. There was a trend towards PWS participating in less VPA on weekends compared to weekdays, while OB participated similarly in VPA on weekdays and weekend days. On average, neither PWS nor OB children met minimum MVPA recommendations. The results suggest there is a need to design exercise programs for PWS youth that focus on integrating vigorous intensity activities, especially during the weekends when structured PA may not be available.

Altered insulin response to an acute bout of exercise in pediatric obesity.

Pediatric obesity typically induces insulin resistance, often later evolving into type 2 diabetes. While exercise, enhancing insulin sensitivity, is broadly used to prevent this transition, it is unknown whether alterations in the exercise insulin response pattern occur in obese children. Therefore, we measured exercise insulin responses in 57 healthy weight (NW), 20 overweight (OW), and 56 obese (Ob) children. Blood samples were drawn before and after 30 min of intermittent (2 min on, 1 min off) cycling at ~80% VO2max. In a smaller group (14 NW, 6 OW, 15 Ob), a high-fat meal was ingested 45 min preexercise. Baseline glycemia was similar and increased slightly and similarly in all groups during exercise. Basal insulin (pmol/L) was significantly higher in Ob vs. other groups; postexercise, insulin increased in NW (+7± 3) and OW (+5 ± 8), but decreased in Ob (-15±5, p < .0167 vs. NW). This insulin drop in Ob was disproportionately more pronounced in the half of Ob children with higher basal insulin (Ob-H). In all groups, high-fat feeding caused a rapid rise in insulin, promptly corrected by exercise. In Ob, however, insulin rose again 30 min postexercise. Our data indicates a distinct pattern of exercise-induced insulin modulation in pediatric obesity, possibly modulated by basal insulin concentrations.

Resistance exercise heart rate recovery in youth with Prader‐Willi syndrome, nonsyndromal obese children and lean controls (881.13)

Prader‐Willi Syndrome (PWS) is a genetic disorder characterized by excess adiposity, low lean mass and hypotonia. Heart rate recovery (HRR), a determinant of all‐cause mortality, is slower in PWS in response to endurance exercise. This study examined how adiposity and PWS influence resistance exercise HRR. Eight PWS youth (age=11.5±3.5 y, body fat=44.1±3.9 %) and 16 nonsyndromal obese (OB: age=9.5±1.2 y, body fat=39.5±4.5 %) and 12 lean (LN: age=9.1±1.2 y, body fat=17.8±5.1 %) children completed six sets of a bench‐stepping protocol. Each set consisted of 10 steps per leg onto an adjustable platform (~20% of stature) while donning a weighted vest (~50% of lean body mass), followed by one minute of rest. HRR value (HRRV) was calculated as the difference between test termination HR and HR one minute after exercise. One‐way ANOVA showed PWS had a significantly lower HRRV (44±13 beats) compared to OB (63±20 beats; p=0.035) and LN (63±13 beats; p=0.044). Similar to previous research in submaximal endurance exercise, nonsyndromal OB and LN children recovered faster than PWS, suggesting adiposity alone did not affect resistance exercise HRR. The lower HRRV in PWS may be attributed to poor cardiovascular fitness and/or autonomic nervous system dysfunction inherent to the syndrome. Further, resistance exercise HRRVs appeared comparable to previously studied endurance exercise HRRVs in youth.Grant Funding Source: Supported by USAMRAA Award W81XWH‐08‐1‐0025

Differences in cognitive flexibility between healthy weight and obese children: an ERP study (629.6)

Obesity is associated with cognitive decline in later adulthood; however, the implication of obesity on childhood cognitive and brain health remains controversial. Accordingly, this study investigated the effect of weight status (healthy weight [HW] or obese [OB]) on behavioral and neuroelectric measures of cognitive control among 80 prepubertal children (8‐9‐years). HW (n=40) and OB (n=40) children completed a switch (cognitive flexibility) task while event‐related brain potentials were concurrently measured. Adiposity and aerobic fitness were assessed using DXA and VO2max, respectively. Groups were matched on key covariates including age, sex, IQ, SES, fat‐free VO2max, and ADHD. There were no differences in response accuracy or reaction time between groups on both the homogenous and heterogeneous trials. However, obese children exhibited greater global switch costs related to response accuracy. In addition, obese children displayed smaller central‐parietal P3 amplitude during heterogeneous trials, signifying decreased allocation of attentional resources. Given that global switch costs reflect efficiency of maintaining task sets in working memory as well as the selection of subsequent tasks, our findings indicate that obese children may exhibit lower cognitive flexibility when faced with greater executive function demands.Grant Funding Source: Supported by NIH HD055352

Evaluation of lipid and glucose metabolism and cortisol and thyroid hormone levels in obese appropriate for gestational age (AGA) born and non-obese small for gestational age (SGA) born prepubertal Slovak children

Obesity is the major determinant of metabolic syndrome. Being born small for gestational age (SGA) may be co-responsible. We aimed at evaluating the association between 1. obesity and 2. being born SGA and the presence of endocrine-metabolic abnormalities in prepubertal Slovak children. The study included 98 children, aged 3-10.9 years: 36 AGA-born obese children (OB), 31 SGA-born children (SGA) and 31 appropriate for gestational age born non-obese children (AGA). Fasting serum levels of glucose, total cholesterol, LDL, HDL, triglycerides, fT4, TSH, cortisol and insulin were determined. HOMA-IR was calculated. Personal data about birth weight and length and family history were collected. Actual anthropometric measurement was done. In every group, high prevalence of positive family history of metabolic disorder was found. In comparison with AGA children, OB children were taller (p<0.01) with higher body mass index (BMI) (p<0.001), and had increased insulin levels and homeostasis model assessment for insulin resistance (HOMA-IR) (p<0.001), decreased high-density lipoprotein (HDL) (p<0.001), and a trend to higher cortisol levels (p=0.069) was noted. SGA-born children were shorter (p<0.001), with BMI comparable to the AGA group. They had higher glucose levels (p<0.001), a trend to decreased HDL levels (p=0.085) and increased fT4 levels (p<0.001). A three-fold higher occurrence of metabolic abnormalities was present in obese children and twice more metabolic abnormalities were present in SGA-born children in comparison with AGA-born children. SGA-born children are more prone to developing endocrine-metabolic abnormalities than non-obese children born AGA, but they are at less risk than obese AGA-born children. We should provide specialized care for obese children already in prepubertal age and pay attention to SGA-born children.

Association between childhood obesity, cognitive development, physical fitness and social-emotional wellbeing in a transitional economy

Background: It has been suggested that obese children have lower cognitive function, demonstrate poorer physical performance and are more susceptible to social-emotional problems.Aims: To describe associations between human physical growth, cognitive development, physical fitness and social-emotional characteristics of obese and non-obese children and to verify the predictors of intellectual coefficient by socioeconomic status (SES).Subjects and methods: A sample of 107 non-obese (N-Ob) children [−1 z-score body mass index (BMI) ≤1 z-score] and 108 obese (Ob) children [2 z-score ≤BMI ≤5 z-score] from a larger cohort was evaluated. Intellectual coefficient (IQ), social-emotional wellbeing (SEW), 6-minute walk test (6MWT) and SES (mid-low, low and very low) were assessed.Results: Ob children were taller, heavier and present more height for age and BMI than N-Ob children (p < 0.001). A significant correlation between IQ and SEW (r = 0.14), 6MWT and BMI z-score (r = −0.18) and 6MWT and SEW (r = 0.15) was found. Multiple regression analysis revealed that BMI z-score had a negative impact on IQ in the mid-low SES sub-group and that SEW had a positive effect on IQ in the very-low SES sub-group.Conclusions: In Chilean pre-school children from low-income families cognitive ability varied according to SES.