Pediatric Obesity Clinic Research Articles

Healthy Lifestyle Management of Pediatric Obesity with a Hybrid System of Customized Mobile Technology: The PediaFit Pilot Project.

Pediatric obesity management strategies suffer from a high rate of dropout and persistence of weight excess, despite the use of new tools, such as automated mobile technology (MT). We aimed to compare the efficacy of two 6-month personalized MT protocols in terms of better engagement, adherence to follow-up visits and improved anthropometric and lifestyle parameters. MT contacts consisted of three personalized/not automated What’s App® self-monitoring or challenge messages per week. Messages, sent by a dedicated coach were inserted between three-monthly in-presence regular visits with (PediaFit 1.2) or without (PediaFit 1.1) monthly free-of charge short recall visits carried out by a specialized pediatric team. The sample included 103 children (mean age 10 years, range 6–14) recruited in the Pediatric Obesity Clinic between January 2017 and February 2019, randomized into Intervention group (IG) (n = 24 PediaFit 1.1; n = 30 PediaFit 1.2) and Control group (CG) (total n = 49). Controls received standard treatment only (indications for healthy nutrition and physical activity, and three months in presence regular visits). Overall, both IGs achieved significantly better results than the CGs for all considered parameters. Comparison of the two IGs at the sixth month in particular showed an IG 1.2 statistically significantly lower drop-out rate (10% vs. 62%, p = 0.00009), along with significantly improved BMI (p = 0.003), Screen Time (p = 0.04) and fruit and vegetables consumption (p = 0.02). The study suggests that the hybrid association of messaging through personalized/not automated MT plus monthly free-of charge recall visits may improve the prefixed outcomes of MT weight loss intervention programs.

Effect of individual- versus collective-based nutritional-lifestyle intervention on the atherogenic index of plasma in children with obesity: a randomized trial

BackgroundThe Atherogenic Index of Plasma is a predictive biomarker of atherosclerosis in adults but there is a lack of studies in paediatric population aimed at evaluating the longitudinal changes of the AIP and of the cardiometabolic blood profile related to nutritional interventions. The aim of this study was to compare the effect of individual- versus collective-based nutritional-lifestyle intervention on the Atherogenic Index of Plasma in schoolchildren with obesity.MethodsOne-hundred sixty-four children aged 6–12 years with Body Mass Index z-score > 2 referred to the Paediatric Obesity Clinic, San Paolo Hospital, Milan, Italy, were consecutively enrolled and randomized to undergo to either an individual- (n = 82) or a collective- (n = 82) based intervention promoting a balanced normo-caloric diet and physical activity. In addition, the individual intervention included a tailored personalized nutritional advice and education based on the revised Coventry, Aberdeen, and London-Refined taxonomy. Both at baseline and after 12 months of intervention, dietary habits and anthropometric measures were assessed, a fasting blood sample were taken for biochemistry analysis.ResultsThe participation rate at 12 months was 93.3% (n = 153 patients), 76 children in the individual-intervention and 77 children in the collective intervention. At univariate analysis, mean longitudinal change in Atherogenic Index of Plasma was greater in the individual than collective intervention (− 0.12 vs. − 0.05), as well as change in triglyceride-glucose index (− 0.22 vs. − 0.08) and Body Mass Index z-score (− 0.59 vs. − 0.37). At multiple analysis, only change in Body Mass Index z-score remained independently associated with intervention (odds ratio 3.37).ConclusionIn children with obesity, an individual-based nutritional and lifestyle intervention, including techniques from the CALO-RE taxonomy, could have an additional beneficial effect over a collective-based intervention, although the actual size of the effect remains to be clarified.Trial Registration Clinical Trials NCT03728621

Metabolically healthy overweight adolescents: definition and components.

PurposeIn adolescents, the definition and clinical implications of metabolically healthy overweight (MHO) status have not been established. This study aimed to investigate the prevalence of MHO according to its most widespread definition, which is based on metabolic syndrome (MS), and to explore further metabolic indicators such as Homeostatic Model Assessment of Insulin Resistance, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, and C-reactive protein levels, together with metabolic health predictors in a sample of adolescents attending a pediatric obesity clinic.MethodsData from 487 adolescents categorized as overweight (52.6% females, 88.1% white), with a mean body mass index (BMI) z-score of 2.74 (±1.07 standard deviation [SD]), and a mean age of 14.4 years (±2.2 SD) were cross-sectionally analyzed. From this original sample, a subsample of 176 adolescents underwent a second assessment at 12 (±6 SD) months for longitudinal analysis.ResultsFrom the 487 adolescents originally analyzed, 200 (41.1%) were categorized as MHO, but only 93 (19.1%) had none of the metabolic indicators considered in this study. According to longitudinal analysis, 30 of the 68 adolescents (44%) categorized as MHO at baseline became non-MHO over time. BMI z-score was the best predictor of metabolic health both in cross-sectional and longitudinal analyses. Increased BMI z-score reduced the odds of being categorized as MHO (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.4–0.9; P=.008) and increased the odds of having hypertension (OR 2.1, 95% CI: 1.4–3.3, P=0.001), insulin resistance (OR, 2.4; 95% CI, 1.4–4.1, P=0.001), or a proinflammatory state (OR, 1.2; 95% CI, 1.1–1.3, P=0.002).ConclusionsDiagnosis of MHO should not be exclusively based on MS parameters, and other metabolic indicators should be considered. Adolescents categorized as overweight should participate in weight-management lifestyle interventions regardless of their metabolic health phenotype.

Randomized nutrient bar supplementation improves exercise-associated changes in plasma metabolome in adolescents and adult family members at cardiometabolic risk.

Poor diets contribute to metabolic complications of obesity, insulin resistance and dyslipidemia. Metabolomic biomarkers may serve as early nutrition-sensitive health indicators. This family-based lifestyle change program compared metabolic outcomes in an intervention group (INT) that consumed 2 nutrient bars daily for 2-months and a control group (CONT). Overweight, predominantly minority and female adolescent (Teen)/parent adult caretaker (PAC) family units were recruited from a pediatric obesity clinic. CONT (8 Teen, 8 PAC) and INT (10 Teen, 10 PAC) groups randomized to nutrient bar supplementation attended weekly classes that included group nutrition counseling and supervised exercise. Pre-post physical and behavioral parameters, fasting traditional biomarkers, plasma sphingolipids and amino acid metabolites were measured. In the full cohort, a baseline sphingolipid ceramide principal component composite score correlated with adiponectin, triglycerides, triglyceride-rich very low density lipoproteins, and atherogenic small low density lipoprotein (LDL) sublasses. Inverse associations were seen between a sphingomyelin composite score and C-reactive protein, a dihydroceramide composite score and diastolic blood pressure, and the final principal component that included glutathionone with fasting insulin and the homeostatic model of insulin resistance. In CONT, plasma ceramides, sphinganine, sphingosine and amino acid metabolites increased, presumably due to increased physical activity. Nutrient bar supplementation (INT) blunted this rise and significantly decreased ureagenic, aromatic and gluconeogenic amino acid metabolites. Metabolomic changes were positively correlated with improvements in clinical biomarkers of dyslipidemia. Nutrient bar supplementation with increased physical activity in obese Teens and PAC elicits favorable metabolomic changes that correlate with improved dyslipidemia. The trial from which the analyses reported upon herein was part of a series of nutrient bar clinical trials registered at clinicaltrials.gov as NCT02239198.

Evaluation of Serum Chemerin and Lipid accumulation product as Predictors of Non-Alcoholic Fatty Liver Disease in Simple Obese Egyptian Children

Background The increase in the prevalence of obesity worldwide has led to non-alcoholic fatty liver disease (NAFLD) becoming one of the most common causes of chronic liver disease. Chemerin is a novel adipokine which regulates adipogenesis which is also a marker of systemic and vascular inflammation. Lipid accumulation product (LAP) is associated with the presence and severity of nonalcoholic fatty liver disease (NAFLD) in adults. We aimed to evaluate the clinical usefulness of both serum chemerin and LAP as predictors of NAFLD in children with simple obesity. Materials and Methods: This was a prospective cross-sectional study including 65 obese children with age range of 6–18 years old from pediatric obesity and endocrine outpatient clinic, Children’s University Hospital, Minia University, Egypt, in addition to 30 healthy children, age and sex matched as control group. The included children were subjected to careful history taking, thorough clinical examination and laboratory investigations including liver enzymes, fasting blood glucose (FBG), fasting serum insulin, lipid profile and serum chemerin. Then LAP was calculated using waist circumference and serum triglyceride. Results: Serum chemerin and LAP were significantly higher in obese children (p- 41; while serum chemerin at a cut-off point of > 271.7 ng/dl showed an 85.4% sensitivity and 51.4%% specificity for prediction of liver steatosis in our obese participants. Conclusion Based on the results, serum chemerin may be considered as an acceptable indicator of NAFLD in obese children but LAP is a more available, easy and inexpensive tool to predict NAFLD in those children.

Effect of Gut Microbiota and PNPLA3 rs738409 Variant on Nonalcoholic Fatty Liver Disease (NAFLD) in Obese Youth.

ContextNonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease, affecting approximately 3 in 10 obese children worldwide.ObjectiveWe aimed to investigate the potential relationship between gut microbiota and NAFLD in obese youth, while considering the role of PNPLA3 rs738409, a strong genetic contributor to NAFLD.DesignIn this cross-sectional study, participants completed an abdominal magnetic resonance imaging to measure hepatic fat fraction (HFF), oral glucose tolerance test, and PNPLA3 rs738409 genotyping. Fecal samples were collected to analyze the V4 region of the 16S rRNA gene for intestinal bacteria characterization.SettingYale Pediatric Obesity Clinic.ParticipantsObese youth (body mass index >95th percentile) with NAFLD (HFF ≥5.5%; n = 44) and without NAFLD (HFF <5.5%; n = 29).Main Outcome MeasureShannon-Wiener diversity index values and proportional bacterial abundance by NAFLD status and PNPLA3 genotype.ResultsSubjects with NAFLD had decreased bacterial alpha-diversity compared with those without NAFLD (P = 0.013). Subjects with NAFLD showed a higher Firmicutes to Bacteroidetes (F/B) ratio (P = 0.019) and lower abundance of Bacteroidetes (P = 0.010), Prevotella (P = 0.019), Gemmiger (P = 0.003), and Oscillospira (P = 0.036). F/B ratio, Bacteroidetes, Gemmiger, and Oscillospira were associated with HFF when controlling for group variations. We also observed an additive effect on HFF by PNPLA3 rs738409 and Gemmiger, and PNPLA3 rs738409 and Oscillospira.ConclusionsObese youth with NAFLD have a different gut microbiota composition than those without NAFLD. These differences were still statistically significant when controlling for factors associated with NAFLD, including PNPLA3 rs738409.

The Role of Hyperinsulinemia in Slipped Capital Femoral Epiphysis.

Obesity in the prepuberal stage has been directly associated with slipped capital femoral epiphysis (SCFE). Serum insulin level increases in the prepuberal and adolescence stage, to a greater extent in the obese population. The main objective of this article was to analyze the relationship between insulin levels and SCFE. A case-control study was conducted between January 2018 and April 2019. The study group was formed with patients with SCFE and the control group with patients from the pediatric obesity clinic of our hospital selected during their initial evaluation. None were being treated for obesity. Anthropometric measurements of size, weight, waist circumference, and blood pressure were taken. Body mass index (BMI) and waist-height index of all patients were calculated. According to BMI for age, they were classified as normal, overweight, or obese. Serum determinations of glucose, insulin, glycated hemoglobin, lipid profile, and complete blood count were analyzed. Insulin resistance was diagnosed with Homeostatic Model Assessment (HOMA) >3. Insulin levels >13 U/mL for girls and >17 U/mL for boys were considered as hyperinsulinemia. We studied 14 patients with SCFE and 23 in the control group. The mean age and BMI in both groups were similar. The elevation of serum insulin was significantly higher in the SCFE group (P=0.001) as was HOMA (P=0.005). Triglycerides and very-low-density lipoprotein were higher in the SCFE group (P=0.037 and 0.009, respectively). Glycemia, glycated hemoglobin, total cholesterol, high-density lipoprotein, low-density lipoprotein, and neutrophils showed no significant difference. Patients with SCFE showed elevated levels of insulin, HOMA, triglycerides, and very-low-density lipoprotein, even higher than the control group. Our study demonstrates a significant association between abnormally high serum insulin levels and SCFE. The known effects of insulin on growth cartilage may explain the physeal mechanical insufficiency to support the abnormally high or repetitive loads in accelerated growth stages that lead to SCFE. Level III-case-control, prognostic study.

Characterizing attendance patterns at a multidisciplinary pediatric obesity clinic

ABSTRACTParticipants (N = 1050; ages 1–19) were from a multidisciplinary pediatric obesity clinic. There were no significant associations between patient characteristics and attrition from the initial visit to the first follow-up. Multiple linear regressions revealed race and the approximate distance traveled to the clinic was associated with the number of days elapsed between the initial visit and first follow-up, with a small effect size (such that Black/African American children and youth returned to the clinic later; individuals living farther away returned sooner). Days elapsed between the initial visit and first follow-up were associated with the rate of later clinic visits, with moderate effect size.

Abstract P292: THE LACK OF FASTING INSULIN MEASUREMENT DELAYS THE MANAGEMENT OF PREDIABETES IN OBESE ADOLESCENTS.

Background: Insulin resistance is a medical complication associated with obesity and metabolic syndrome in youth. Data have shown that pediatric obesity can stop or even decrease by an adequate clinical management of the insulin resistance-associated syndrome. Despite those new evidences, measurement of insulin resistance in youth remains quite low. Objective: The objective was to review and evaluate the proportion of pediatric obese patients referred to a 2nd line pediatric multidisciplinary obesity clinic among whom insulin resistance was screened or not. Material &amp; Method: We have looked, retrospectively, at the initial blood tests among 133 obese patients (body mass index above 97th percentile with respect for age and sex) above 10 years of age, between July 2017 and April 2019. Sixty percent (60%) of our urban cohort is represented by 1st and 2nd generation immigrants. Hyperinsulinemia was defined as a value above 100 pmol/L. Pediatric obese patients were referred by general practitionniers or community pediatricians. Results: Among the 133 medical files revised, 91 patients shown hyperinsulinemia (68%). Of those 91 patients, 64 were not initially screened for hyperinsulinemia (70%). Interestingly, in the hyperinsulinemia pediatric group, mean HDL-cholesterol was lower, mean triglycérides were higher, as well as the mean alanine transaminase (ALT) compared to the normal insulin group (p smaller than 0.05). In the hyperinsulinemia group, 71,8% of our pediatric cohort was started on metformin therapy in addition to a multidisciplinary intensive educational family interventions as recommended by WHO. Conclusions: Fasting insulin can be variable among puberty stages and general guidelines for the use of metformin in the pediatric population are still to come. However, measurement of elevated fasting insulin among pre- and post-pubertal patients was previously associated with markers of cardiovascular and hepatic complications in obese young patients. Fasting insulin is a simple, cheap, easily accessible measure in all clinical settings. Multidisciplinary health care for pediatric obesity is still embryonic and difficult to access. Appropriate and complete initial clinical investigations, including fasting insulin measurement, should be performed in order not to delay its medical intensive multidisciplinary management both in 1st and 2nd lines practitioners.

Predictors of non-alcoholic fatty liver disease (NAFLD) among children with obesity.

Background The prevalence of childhood obesity and its related comorbidities in Malaysia are alarming. Malaysia ranked second in childhood obesity among South-east Asian countries with a prevalence of 12.7%. This study was conducted to investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) among obese children and to ascertain the predictors associated with NAFLD. Methods NAFLD was diagnosed via ultrasonographic evidence of fatty liver in obese and overweight children who presented to the Paediatric Obesity Clinic of University Malaya Medical Centre (UMMC), Malaysia. Demographic, anthropometric, clinical and biochemical parameters were analysed and compared between the NAFLD and non-NAFLD groups. Statistical analyses were carried out. Results Twenty-one out of 33 obese and overweight children (63.6%) were found to have NAFLD. We found that 62% of our study population in the NAFLD group had metabolic syndrome based on the definition by the International Diabetes Federation (IDF). Mean body mass index (BMI), waist circumference (WC), triglyceride (TG) and alanine aminotransferase (ALT) were found to be significantly greater in the NAFLD group compared to the non-NAFLD group (35.2 [6.1] vs. 29.3 [4.7] kg/m2 [p-value 0.007]; 104.1 [11.4] vs. 94.1 [12] cm [p-value 0.034]; 1.5 [0.9] vs. 0.9 [0.3] mmol/L [p-value 0.002]; 60.7 [53.8] vs. 27.3 [13] U/L [p-value 0.007]). Multivariate regression analysis revealed TG as the independent predictor for NAFLD, with an odds ratio of 41.7 (95% confidence interval [CI] 0.001, 0.819) (p-value 0.04). Conclusions Prevalence of NAFLD among children who are obese and overweight is alarming with 62% having metabolic syndrome. TG was found to be a strong predictor for NAFLD.

Life-stage factors associated with overweight severity in adolescents.

Investigating life-stage factors associated with overweight may be useful in the prevention of excessive BMI increase. The main aim of this study was to investigate the influence of the route of delivery, birth weight and overweight onset on overweight severity in a sample of overweight adolescents followed at a Pediatric Obesity Clinic. Clinical data from 412 adolescents with overweight (BMI ≥ p85), aged 10-18 were retrospectively collected and analyzed. Adolescents born by cesarean section (CS) showed a lower age of overweight onset, compared to other methods of delivery (d= 0.33, p= .009). Birth weight was positively associated with BMI z-score (r=.164, p= 002) and waist circumference (WC) (r=.191, p=.001). The overweight onset was negatively associated with BMI z-score (r= -.277, p < .001), WC (r= -.270, p < .001) and body fat mass (r= -.199, p=.001). Overweight duration was the best predictor of BMI z-score, explaining in 75% its variation (F=1,317)=26.94, p < .001), which increased to 99% when birth weight was included in the model (F(2,316)=18.47, p < .001). This study suggests that lifestyle may interrupt the burden of CS on BMI z-score throughout growth. Moreover, increased birth weight may anticipate overweight onset, and consequently overweight duration in the presence of inadequate lifestyle behaviors.

A Nomogram for Predicting Non-Alcoholic Fatty Liver Disease in Obese Children.

PurposeNon-alcoholic fatty liver disease (NAFLD) ranges in severity from simple steatosis to steatohepatitis. Early detection of NAFLD is important for preventing the disease from progressing to become an irreversible end-stage liver disease. We developed a nomogram that allows for non-invasive screening for NAFLD in obese children.MethodsAnthropometric and laboratory data of 180 patients from our pediatric obesity clinic were collected. Diagnoses of NAFLD were based on abdominal ultrasonographic findings. The nomogram was constructed using predictors from a multivariate analysis of NAFLD risk factors.ResultsThe subjects were divided into non-NAFLD (n=67) and NAFLD groups (n=113). Factors, including sex, body mass index, abdominal circumference, blood pressure, insulin resistance, and levels of aspartate aminotransferase, alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γGT), uric acid, triglycerides, and insulin, were significantly different between the two groups (all p<0.05) as determined using homeostatis model assessment of insulin resistance (HOMA-IR). In our multivariate logistic regression analysis, elevated serum ALT, γGT, and triglyceride levels were significantly related to NAFLD development. The nomogram was established using γGT, uric acid, triglycerides, HOMA-IR, and ALT as predictors of NAFLD probability.ConclusionThe newly developed nomogram may help predict NAFLD risk in obese children. The nomogram may also allow for early NAFLD diagnosis without the need for invasive liver biopsy or expensive liver imaging, and may also allow clinicians to intervene early to prevent the progression of NAFLD to become a more advanced liver disease.

Influence of Exercise on Body Composition and Patient Outcomes in a Multidisciplinary Pediatric Obesity Clinic

Background: Childhood obesity has become a global epidemic, with approximately 34% of American children affected. This study describes outcomes seen in patients of a Multidisciplinary Pediatric Obesity Clinic (MPOC) who are compliant with individualized exercise regimens conducted by a Clinical Exercise Physiologist (CEP). The goal of this study is to track body composition, physical fitness measures, laboratory results, dietary and behavioral changes over the course of the program. Methods: Prospective cohort study design was implemented. There were 8-week exercise sessions conducted. Participants were evaluated by the CEP before, after the 8-week session using a standardized physical fitness evaluation, measurement of body composition and circumferences. Results: Statistical significance was observed with the increase in height (p<0.001), weight (p=0.014), Total Lean Mass (p=0.015). Increase in percent lean mass for all ethnicities in the study group i.e. black (male and female), hispanic (male and female) and white (male). An increase in the number of push-ups (p=0.012) was also observed. Conclusion: We can conclude that the use of an MPOC, CEP, and an exercise program early in childhood can potentially prevent the complications of obesity later in life.

Community engagement and pediatric obesity: Incorporating social determinants of health into treatment.

Childhood obesity is a complex and multi-faceted problem, with contributors ranging from individual health behaviors to public policy. For clinicians who treat pediatric obesity, environmental factors that impact this condition in a child or family can be difficult to address in a clinical setting. Community-clinic partnerships are one method to address places and policies that influence a person's weight and health; however, such partnerships are typically geared toward community-located health behavior change rather than the deeper social determinants of health (SDH), limiting effective behavioral change. Community-engaged research offers a framework for developing community-clinic partnerships to address SDH germane to obesity treatment. In this paper, we discuss the relationship between SDH and pediatric obesity treatment, use of community-clinic partnerships to address SDH in obesity treatment, and how community engagement can be a framework for creating and harnessing these partnerships. We present examples of programs begun by one pediatric obesity clinic using community-engagement principles to address obesity.

Increased Prevalence of Severe Obesity and Related Comorbidities among Patients Referred to a Pediatric Obesity Clinic during the Last Decade

Background: Childhood obesity is a major health concern worldwide. This study examined prevalence trends in severe obesity and related comorbidities among patients referred to a tertiary pediatric obesity clinic in Israel. Methods: The medical files of patients aged 2–18 years with BMI >95th percentile at initial referral to our obesity clinic in 2008–2017 were reviewed for demographic, anthropometric, and cardiometabolic data. Findings were compared between patients with 2.3 > BMI-SDS ≥1.645 and BMI-SDS ≥2.33 (severe obesity), and yearly rates of severe obesity were calculated. Results: The cohort included 1,027 children (median age 10.8 years, 41.8% male) of whom 55% were severely obese. The rate of severe obesity among referrals increased from 54% in 2008 to 69% in 2017, but it seemed to plateau during the last 3 years. In between-group comparison, the severe obesity group had a significantly greater predominance of males (p = 0.002), younger age at obesity onset in males (p <0.001), higher rate of a family history of obesity (overall and in males; p = 0.002 and p = 0.01, respectively), and higher rates of obesity-related comorbidities (systolic hypertension, dyslipidemia, obstructive sleep apnea, and nonalcoholic fatty liver disease; p < 0.001). Conclusions: Our data show an increased prevalence of severe obesity over the last decade among Israeli children and adolescents referred to an obesity clinic. This finding may reflect the trend in the general pediatric population or a change in the policy of referral to obesity clinics of pediatricians. The high rate of obesity-related comorbidities emphasizes the importance of early intervention to prevent their devastating consequences, especially in patients with severe obesity.

Metabolic Syndrome Is Associated With Advanced Liver Fibrosis Among Pediatric Patients With Non-alcoholic Fatty Liver Disease.

Background: Non-alcoholic fatty liver disease (NAFLD) among children is a growing concern with potential significant outcome. This study aims to investigate the relationship between hepatic steatosis, metabolic syndrome, and liver fibrosis among children with obesity and diabetes mellitus.Methodology: Children aged 6–18 years old were recruited from pediatric obesity and diabetes clinic in University Malaya Medical Center (UMMC) between year 2016 and 2019. Data on basic demographics, anthropometric measurements and clinical components of metabolic syndrome were collected. Transient elastography was performed with hepatic steatosis and liver fibrosis assessed by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) respectively. Mild, moderate and severe steatosis were defined as >248, >268, and >280 dB/m respectively, and LSM above 7.0 kPa for fibrosis stage F ≥ 2, 8.7 kPa for F ≥ 3, and 10.3 kPa for F4 (cirrhosis).Results: A total of 57 children (60% male) with median age of 13 years old were recruited. Fifty (87.7%) of the children are obese and 27 (54%) out of 50 are morbidly obese. Among 44 (77.2%) patients with steatosis, 40 (70.2%) had severe steatosis and 18 (40.9%) had developed liver fibrosis of stage 2 and above. Advanced fibrosis or cirrhosis was detected in 8 (18.2%) children with presence of steatosis. Twenty-three out of 57 (40.4%) was diagnosed with metabolic syndrome. Fibrosis is three times more likely to occur in the presence of metabolic syndrome (OR = 3.545, 95% CI: 1.135–11.075, p = 0.026). Waist circumference is a significant predictor of fibrosis after multiple regression analysis.Conclusion: Obese children with metabolic syndrome are more likely to have advanced liver fibrosis compared to those without metabolic syndrome. Waist circumference predicts development of liver fibrosis.

A Pilot Study Evaluating a Binge-Eating Screener in Children: Development of the Children's Brief Binge-Eating Questionnaire in a Pediatric Obesity Clinic.

Children referred to pediatric obesity programs are at high risk of binge-eating disorder (BED) symptoms. Our goal was to develop and evaluate the Children's Brief Binge-Eating Questionnaire (CBBEQ) as a rapid screen of BED symptomatology. Seventy patients between the ages of 7 and 18 years (57% females) completed the CBBEQ and underwent the Eating Disorder Assessment for DSM-5 (EDA). Reliability and validity were assessed by examining results of the CBBEQ compared with the EDA, as well as measures of sleep, depression, and anxiety. Twenty-four of seventy (34%) children met full diagnostic interview criteria for BED and 12 (17%) met subclinical criteria. The CBBEQ demonstrated 100% specificity, 93% sensitivity, and a 100% negative predictive value for BED at a cutoff total score of 9. If confirmed in larger sample, this questionnaire could be a quick and accurate clinical tool for non-mental health providers to identify children at risk for BED.

Evaluation of TG-HDL Ratio Instead of HOMA Ratio as Insulin Resistance Marker in Overweight and Children with Obesity

Homeostasis model assessment for insulin resistance (HOMA-IR) is widely used as a marker of insulin resistance in adults and has also been validated in children and adolescents. Triglyceride (TG) and HDL-C on the other hand is a routine test and inexpensive compared to insulin. Previous studies reported conflicting findings on the usefulness of the triglyceride to HDL-C ratio (TG:HDL-C ratio) as predictor or marker of IR. The aim of this work was to investigate the usefulness of Triglyceride to HDL-C ratio (TG/HDL-C) as an Insulin Resistance (IR) marker in overweight and children with obesity. This study was a comparative cross sectional study which was conducted on ninety overweight and children with obesity attending National Nutrition Institute "Pediatric obesity clinic. They were classified into 2 groups as follows: group (1) included overweight and children with obesity with insulin resistance, group (2) included overweight and children with obesity with non-insulin resistance. All the subjects were subjected to history, clinical examination and laboratory investigations including total lipid profile, fasting glucose, insulin and TG:HDL-C ratio instead of HOMA ratio. Prevalence of IR among the studied sample was 42 (46.7%). Mean value of TG/ HDL-C ratio was greater among the insulin resistance group than non insulin resistance group (p value= < 0.001)value). TG/HDL ratio ≥1.36 had 85.7% sensitivity, 66.7% specificity. There was statistically significant positive correlation between TG/HDL ratio and HOMA-IR. TG:HDL ratio ≥1.36 is a significant early and sensitive predictor of insulin resistance in children instead of HOMA-IR.

Trajectories of changes in glucose tolerance in a multiethnic cohort of obese youths: an observational prospective analysis

Type 2 diabetes is preceded by a prediabetic stage of impaired glucose tolerance that affects 10-23% of youth and is expected to double over the next decade. The natural history of impaired glucose tolerance and the determinants of β-cell dynamic response have never been investigated longitudinally in young people. We aimed to investigate the clinical and metabolic determinants of longitudinal glucose tolerance changes and β-cell function in a multiethnic cohort of obese youth. We followed up prospectively a multiethnic cohort of overweight and obese (body-mass index >85th percentile) adolescents with baseline normal glucose tolerance (plasma glucose <140 mg/dL) or impaired glucose tolerance (plasma glucose 140-199 mg/dL) at the Yale Pediatric Obesity Clinic (CT, USA). All participants underwent a 3-h oral glucose tolerance test at baseline and after 2 years to estimate insulin secretion (oral disposition index) in the context of body insulin sensitivity. As part of standard care at the clinic, all participants received dietary advice and underwent dietary assessment every 5-6 months. No structured lifestyle or pharmacological intervention was administered. Between January, 2010, and December, 2016, 526 adolescents (mean age 12·7 years, range 10·6-14·2) were enrolled to our study. At baseline, 364 had normal and 162 had impaired glucose tolerance. Median follow-up was 2·9 years (IQR 2·7-3·1). 105 (65%) of 162 with impaired glucose tolerance at baseline reverted to normal glucose tolerance at follow-up, 44 (27%) had persistent impaired glucose tolerance, and 13 (8%) progressed to type 2 diabetes. A feature of reversion to normal glucose tolerance was a roughly four-fold increase in the oral disposition index (from median 0·94 [IQR 0·68-1·35] at baseline to 3·90 [2·58-6·08] at follow-up; p<0·0001) and a significantly higher oral disposition index at follow-up compared with participants who maintained normal glucose tolerance across the study period (median 3·90 [IQR 2·58-6·08] vs 1·59 [1·12-2·23]; p<0·0001). By contrast, a decrease in insulin secretion was seen in participants who had persistent impaired glucose tolerance (median 1·31 [IQR 1·01-1·85]; p<0·0001) or who progressed to type 2 diabetes (0·20 [0·12-0·58]; p<0·0001), compared with participants who maintained normal glucose tolerance across the study period. Non-Hispanic white ethnic origin conferred five times the odds of reversion to normal glucose tolerance compared with non-Hispanic black ethnic origin (OR 5·06, 95% CI 1·86-13·76; p=0·001), with a two times greater annual increase in the oral disposition index (β 2·32, 95% CI 0·05-4·60; p=0·045). Impaired glucose tolerance is highly reversible in obese adolescents. Ethnic origin is the main clinical modifier of the dynamic β-cell response to prediabetic hyperglycaemia and, thus, determines the reversibility of impaired glucose tolerance, or its persistence. Therapeutic interventions for impaired glucose tolerance should target the specific mechanisms underpinning glucose tolerance changes in high-risk ethnic groups. National Institutes of Health (National Institute of Child Health and Human Development, National Center for Research Resources, and National Institute of Diabetes and Digestive and Kidney Diseases), American Diabetes Association, International Society for Pediatric and Adolescent Diabetes, Robert Leet Patterson and Clara Guthrie Patterson Trust, European Society for Pediatric Endocrinology, American Heart Association, and the Allen Foundation.

Which predictors differentiate between obese children and adolescents with cardiometabolic complications and those with metabolically healthy obesity?

Childhood obesity and associated metabolic comorbidities is a major global health concern. Metabolically healthy obesity (MHO) may represent a subgroup of individuals in which excessive body fat accumulation does not lead to adverse metabolic effects. We aimed to determine the prevalence of MHO among obese Israeli children and adolescents and to find predictors for metabolically unhealthy obesity (MUO). In a retrospective study, demographic, anthropometric, lifestyle, and cardiometabolic data were retrieved from medical records of patients with a body mass index (BMI) >95th percentile aged 6 to 17.6 years, attending a tertiary pediatric obesity clinic between 2008 and 2015, with at least 1 year of follow-up. Participants were dichotomized as either MHO or MUO based on cardiometabolic risk factor clustering (blood pressure, serum lipids, and glucose). Multivariable logistic regression was used to determine predictors of MUO. Of the 230 children (median age 9.9 years) fulfilling study criteria, 48 (20.9%) were classified as MHO. Occurrence of MUO was associated with male gender, Arabic ethnicity, higher BMI-SD score, higher tri-ponderal mass index (TMI), and higher insulin resistance (IR) (presence of acanthosis nigricans and a higher level of homeostasis model assessment-IR [HOMA-IR]). Male gender (odds ratio [OR] 2.27, P = .033), presence of acanthosis nigricans at baseline (OR 2.35, P = .035), and a greater increase in BMI-SDS during follow-up (OR 2.82, P = .05) were the best predictors of MUO. The MHO phenotype was present in only 20.9% of obese Israeli children. MUO was significantly associated with male gender, with presence of acanthosis nigricans, and with a greater increase in BMI-SDS during follow-up.