Pediatric Obesity Clinic Research Articles

Increasing Patient Attendance in a Pediatric Obesity Clinic: A Quality Improvement Project

Research supports intensive lifestyle interventions (>25 contact hours/six months) to treat childhood obesity. Success requires retention in program. This quality improvement project's purpose was to increase attendance of follow-up patients in a childhood obesity clinic by 10%. A pretest posttest design was used. Three months of baseline data were collected, followed by 52 weeks of intervention data. Data were analyzed using descriptive statistics and Fisher's exact test. Follow-up patient attendance improved significantly from 69% to 81% (z=1.76, p=.039 (95% CI=0.2822, 1.0021)). Simple and inexpensive interventions can significantly increase attendance of obese children in follow-up.

The effect of body mass index on blood pressure varies by race among obese children.

Previous studies have shown that the effect of adiposity on blood pressure (BP) intensifies as children become increasingly obese. Black children tend to have greater body mass index (BMI) and higher BP than age-matched white children. It is unclear whether the BP effects of BMI are race-specific among black and white children, and data on obese Hispanic children are sparse. We compared the BP effect of BMI in obese white, black, and Hispanic children. We examined the medical records of children enrolled in a pediatric obesity clinic. Height, weight, BP, and fasting insulin were assessed as part of routine clinical care. The concurrent effects of age and BMI on BP percentile values were examined using semiparametric regression, which allows the accommodation of nonlinear effects. The study included 873 children (338 male; 354 black, 447 white, 72 Hispanic; 11.7±3.5 years, BMI 36.2±8.5 kg/m2). While BMI Z-scores were similar among the groups, systolic BP (SBP) was higher in black children and Hispanic children (white: 107 mm Hg; black: 112 mm Hg; Hispanic: 112 mm Hg; p=0.0001). Age, sex, and height-adjusted SBP percentiles were significantly different among the three groups (white: 50; black: 59; Hispanic: 59; p=0.0006). In children of the same age, BP was higher at any given BMI in black children and Hispanic children. Among children referred for treatment of obesity, black children and Hispanic children are at a greater risk for having elevated BP when compared to white children of similar age and BMI.

Lifestyle and treatment adherence among overweight adolescents.

This study evaluated the influence of overweight adolescents' lifestyle on the adherence to weight control, and identifies their predictors. Participants were 94 adolescents, aged 12-18 years, attending a Paediatric Obesity Clinic. Lifestyle was assessed using the "Adolescent Lifestyle Profile" and treatment adherence through the "Therapeutic Adherence to Weight Control Questionnaire." Adherence to weight control was associated with various lifestyle domains. Several predictors were identified for lifestyle and adherence to weight control among overweight adolescents. A broad array of inter-correlations and predictors were identified and should be taken into account when designing adolescent weight control interventions.

Moderators of quality of life among overweight adolescents. Influence of body mass index, sociodemographics, behavioral, motivational and clinical variables.

Overweight is an extra burden for adolescent development and triggers serious physical and psychosocial problems. Overweight in adolescence has been consistently associated with poorer psychosocial and emotional wellbeing. This study aims to evaluate moderators of quality of life in adolescents with excess weight. The sample consists of 94 adolescents who are attending a specialized Pediatric Obesity Clinic, 46 boys (48.94%), median age of 14.17 years (SD = 1.51). Weight-related quality of life was assessed with the 27-item measure, developed by Kolotkin et al. (IWQOL-K: Impact of Weight on Quality of Life-Kids). Statistical analysis was performed using nonparametric tests (Spearman correlation, Mann–Whitney U test and Kruskal–Wallis test). Body Mass Index (BMI) z -score correlated negatively with quality of life in terms of physical comfort, social life and overall quality of life index. Gender, weight loss motivation, perception of body image, presence of binge eating episodes and mother’s education level were found to work as quality of life moderators. These results underscore the importance of routinely assessing quality of life when treating overweight adolescents. Intervention programs should be designed not only to tailor the individual adolescent health needs but also take into account those moderators that have been identified.

Moderator variables of lifestyle and treatment adherence in overweight adolescents.

Adherence to behavior changes and a healthier lifestyle is crucial for the treatment of overweight adolescents. This study aims to evaluate the moderators of lifestyle and treatment adherence, based on socio-demographics, anthropometric, behavioral/motivational and clinical data. The sample consists of 94 adolescents who are attending a Pediatric Obesity Clinic in Portugal, aged 12–18 years, 51.06% girls, average age 14.17 years (SD = 1.507). Lifestyle was assessed using the “Adolescent Lifestyle Profile” and treatment adherence through the “Therapeutic Adherence to Weight Control Questionnaire”. Statistical analysis was performed using nonparametric tests (Spearman correlation, Mann–Whitney U test and Kruskal–Wallis test). There was no significant relationship either between BMI Z-score and lifestyle or BMI Z-score and treatment adherence. However, adherence to weight control was positively influenced by various lifestyle domains (health responsibility, physical activity, nutrition, positive life perspective, stress management and spiritual health). The moderators influencing lifestyle that have been identified included gender, weekly physical activity and sedentary life. The moderators for adherence included waist circumference percentile, family support, treatment duration, previous attempts to lose weight and parental education. These results underline the importance of behavioral change and the adoption of a healthier lifestyle as pillars for adherence to weight control.

Abstract P279: A High Fiber Nutrient Dense Supplement Moves the Metabolome in Obese Parent[[Unable to Display Character: −]]Teen Dyads

Objective: To determine whether twice daily intake of a low-calorie (110 kcal), high-fiber, fruit and dark chocolate based nutrient-dense bar with supplemental vitamins/minerals, β-glucan, and docosahexaenoic acid might serve as an effective adjunct to lifestyle counseling for weight management in an inner city population. Methods: 18 overweight, predominantly female adolescent/parent guardian dyads and 2 triads (21 adults, 22 teens, randomized as 12 intervention (INT, with bars), 8 control (C) family units were recruited from a pediatric obesity clinic. The cohort was 48.7% Nonhispanic Black, 34.1% Hispanic, and 17.0% Caucasian. Two adults dropped out. The remaining 41 subjects participated in six identical weekly exercise and nutrition sessions by group. Full assessment of physical (BMI, blood pressure), behavioral (diet, activity), metabolic (cardiovascular and diabetes risk biomarkers), and metabolomic status was conducted at baseline and end-of-study. Results: There was excellent attendance in both INT and C groups with all family units participating in more than 80% of group sessions and 100% of baseline and follow-up assessment visits. Compliance with nutrition bar intake was 86 ± 11% and 87 ± 14% among INT group adults and teens respectively. There was considerable obesity, hypertension, dyslipidemia, inflammation, and insulin resistance in all subjects and baseline diets were universally poor. Self-report activity increased and dietary habits improved in both INT and C groups, adults and teens, most notably decreased saturated fat and total carbohydrates (especially added sugars). Weight was stable, even in the INT group despite the addition of 220 additional kcal in two daily nutrition bars. In paired analyses, systolic blood pressure (SBP) improved significantly in INT teens (-6.7 ± 9.2 mm Hg, p = 0.02), and worsened in C teens (+6.3 ± 7.7 mm Hg, p = 0.04); p = 0.002 for unpaired comparison by teen group. Plasma homocysteine levels and two amino acids, citrulline and sarcosine, implicated in the arginine-urea cycle pathway fell in both INT parents and teens, but not in controls. The drop in citrulline was more significant in INT teens ( p = 0.005) than in adults ( p = 0.047). In a diet-induced obesity mouse model, elevated plasma citrulline has been associated with cardiometabolic complications attributed to decreased systemic arginine bioavailability that may affect capacity to produce nitric oxide. The observed metabolomic changes are consistent with more efficient mitochondrial processing and may relate to the systolic BP improvement observed in teens. Conclusions: A nutritional supplement bar may be a valuable adjunct for weight management, resulting in early favorable metabolomic changes.

The Feasibility of a Physical Activity Referral Network for Pediatric Obesity

Pediatricians cite a lack of physical activity referral (PAR) opportunities as a major barrier to treating obesity. However, no literature exists on PARs for youth in the clinical setting. This study explores the feasibility of implementing PARs in a pediatric obesity clinic. Patients ages 6-18 years in an obesity clinic from July 2010 to October 2011 were referred to PARs in their community. Researchers confirmed enrollment and participation in activities by follow-up phone calls. Of 130 eligible youth, 102 (78%) agreed to be referred to a physical activity program; 45 (35%) enrolled and 35 (27%) reported actually participating in an activity, for an average of 1.4 hours per week. Youth participated in 9 of 69 available activity programs included in the PAR network. Patient characteristics at baseline did not predict participation in an activity. Youth referred to organizations that contacted interested families were 5 times as likely to enroll in activities as youth referred to organizations that did not contact families (p < 0.001). Although only 27% of eligible youth participated in an activity through the PAR network, exposing 1 in 4 obese youth to 1.4 hours of physical activity weekly could have a significant public health impact. These results suggest that PAR networks for overweight and obese youth should focus on organizations that have the infrastructure to contact youth and their families, and that a small number of physical activity programs could form the basis for launching PAR networks.

Family Systems Theory and Obesity Treatment: Applications for Clinicians.

Family-based approaches are recommended for the treatment of pediatric obesity, although most of the literature describes programs that only include the identified child and one parent in the treatment process. As a result, the clinical application of research protocols in nutrition settings may be inadequate; multiple representations of a "family" will be encountered in the clinical environment. Mental health professionals, particularly those who work with children, often engage families in psychotherapy. Developing an understanding of their methods may be beneficial to Dietitians and other clinicians who wish to follow a more family-based approach and may present new avenues for effective treatment. In our tertiary care pediatric obesity clinic, we routinely involve multiple family members throughout the treatment process. Here we discuss our experiences and introduce Bowen's Family Systems Theory as a model for translating family therapy principles into nutrition-focused treatment settings.

Metabolic syndrome and its components among obese (BMI ≥95th) Mexican adolescents

The aim of this study was to estimate the prevalence of metabolic syndrome (MS) and its components in obese Mexican adolescents and to compare the clinical, anthropometric, and biochemical characteristics between patients with and without MS by sex. We conducted a cross-sectional study with a sample of 110 obese adolescents (boys and girls) from 8 to 16 years old (BMI ≥95th percentile), who were recruited in the pediatric obesity clinic of a third-level care hospital. A frequency analysis was used to estimate the prevalence of MS and its components, and the assessments were compared between the sexes and between the groups with and without MS using the Kruskal–Wallis test. The prevalence of MS was 62%. In order of prevalence, the following components of MS were observed in the sample: abdominal obesity (88%), high triglycerides (TG) (85%), low HDL-C (60%), hypertension (35%), and hyperglycemia (5%). In the groups with MS, hypertension (P<0.001), waist circumference (P=0.003), and TG (P=0.012) were significantly higher, and HDL-C (P<0.001) was significantly lower. In conclusion the prevalence of MS and its components is high among obese Mexican-Hispanic children. These findings show the importance of preventing and treating obesity in the early stages of life in order to decrease the incidence rates of cardiovascular disease and type 2 diabetes mellitus.

Effect of the Go4it multidisciplinary group treatment for obese adolescents on health related quality of life: a randomised controlled trial

BackgroundWe developed a Dutch outpatient multidisciplinary group treatment (Go4it) for obese adolescents, including cognitive behavioural therapy and education on healthy dietary and physical activity behaviour. This study examined the effect of Go4it on Health Related Quality of Life (HRQoL).MethodsAt our outpatient paediatric obesity clinic, obese adolescents (n = 122, 11–18 years) were randomly assigned to 1) Go4it, 7 sessions with an interval of 2 weeks or 2) current regular care consisting of referral to a dietician in the home care setting (controls). Linear mixed model analysis was performed to evaluate the intervention effects on HRQoL at 6 and 18-month follow-ups. HRQoL indicators included the Child Health Questionnaire, the Paediatric Quality of Life Inventory™ Version 4.0 (PedsQL™4.0), and the Body Esteem Scale (BES).ResultsIn total, 95 adolescents (Go4it 57, controls 38) were included in the current analysis with a mean age of 14.5 ± 1.7 and mean BMI-SDS of 2.9 ± 0.5. At baseline, all participants experienced lower levels of physical and psychosocial well-being compared to a normal weight reference group. At the 18 month follow-up, we found small but beneficial intervention effects on all subscales of the PedsQL™4.0 and BES questionnaires. Two subscales improved significantly; i.e., physical health (between group difference 5.4; 95%CI: 0.3; 10.6), and school functioning (between group difference 7.4; 95%CI: 1.6; 13.2).ConclusionObese adolescents experienced lower HRQoL than their healthy peers. The Go4it intervention had small beneficial effects on HRQoL compared to the current regular care practices for obese adolescents.Trial registrationNetherlands Trial Register: ISRCTN27626398, METC number: 05.134 (WMO, monocenter).

Internet‐based intervention programme for obese adolescents and their families (Next.Step): research protocol of a controlled trial

This paper describes the design and rationale of a controlled trial that aims to determine the effectiveness of an intervention programme in which the internet is used. Adolescent obesity is a major health problem, there being urgency to find effective interventions that induce behavioural change. The inclusion of the internet in the intervention may improve adolescents' adherence to the weight management programme and lead to adoption of healthier lifestyles. A clinical trial with a control group (non-randomized). Participants are adolescents with appointments at a paediatric obesity clinic (Portugal). Sample size was calculated according to the power analysis. The experimental group will follow the standard treatment protocol and receive free access to the e-therapeutic platform. The control group will follow the standard treatment protocol and join a waiting list. Intervention length will be 36weeks (24weeks of direct intervention with a follow-up for 12weeks). This study was approved by the Ethical Committee for Health (Lisbon, Portugal) in January 2012 and funded by the Foundation for Science and Technology (Portugal) in December 2012. The results of this research will promote reflection on new approaches directed to treat adolescent obesity and on the promotion of healthy behaviours. We expect to gather empirical evidence of the intervention programme effectiveness. The expectations lie on the population health gains, empowerment in decision-making and adoption of healthier lifestyles.

The Prevalence of Abnormal Metabolic Parameters in Obese and Overweight Children

This retrospective study aimed to determine the prevalence of abnormal metabolic parameters in obese children and its correlation to the degree of obesity determined by body mass index (BMI). In total, 101 children seen at the Pediatric Gastroenterology Obesity Clinic at Stony Brook Children's University Hospital were enrolled in the study. The degree of obesity was characterized according to the following formula: (patient's BMI/BMI at 95th percentile) × 100%, with class I obesity >100%-120%, class II obesity >120%-140%, and class III obesity >140%. A set of metabolic parameters was evaluated in these patients. Frequency distributions of all study variables were examined using the χ(2) test of independence. Mean differences among the obesity classes and continuous measures were examined using 1-way analysis of variance. Within our study population, we found that 80% of our obese children had a low high-density lipoprotein (HDL) cholesterol level, 58% had elevated fasting insulin levels, and 32% had an elevated alanine aminotransferase (ALT) level. Class II obese children had a 2-fold higher ALT value when compared with class I children (P = .036). Fasting insulin, ALT, HDL cholesterol, and triglyceride levels trended with class of obesity. Obese children in classes II and III are at higher risk for developing abnormal laboratory values. We recommend obese children be further classified to reflect the severity of the obesity since this has predictive significance for comorbidities. Obesity classes I, II, and III could help serve as a screening tool to help communicate risk assessment.

Decreased circulating 25-(OH) Vitamin D concentrations in obese female children and adolescents: Positive associations with Retinol Binding Protein-4 and Neutrophil Gelatinase-associated Lipocalin

Hypovitaminosis D has been associated with adult as well as childhood obesity. Retinol-binding-protein-4 (RBP-4) and Neutrophil Gelatinase-associated Lipocalin (NGAL) are altered in obese individuals. The aim of this study was to examine circulating 25-(OH) Vitamin D (25-(OH) D) concentrations according to BMI and its associations with RBP-4 and NGAL in female children and adolescents. Seventy-nine (79) children, aged 8-16 years, were studied and divided into four groups: 19 control (BMI z-score range -2.15 - 1.24), 20 overweight (1.34 - 2.49), 20 obese (2.50 - 2.87) and 20 ultra-obese (3 - 4.37). Patients were derived from a Pediatric Obesity Clinic. Plasma 25-(OH) D, RBP-4 and NGAL concentrations were measured with specific assays. Plasma 25-(OH) D concentrations were decreased significantly in the ultra-obese (p=0.005) and marginally in the obese group (p=0.05) compared to the control group. In the entire BMI range, Spearman correlations revealed strong positive associations between 25-(OH) D and RBP-4 (r=0.349, p=0.002) and between 25-(OH) D and NGAL (r=0.338, p=0.003). 25-(OH) D is deficient in a clinical population of obese female children and adolescents, whereas in the entire BMI range 25-(OH) D is associated with RBP4 and NGAL concentrations. Longitudinal studies are needed to reveal the role of these associations in metabolic alterations related to childhood and adolescent obesity and associated metabolic morbidities.

Long-term effect of the Go4it group treatment for obese adolescents: A randomised controlled trial

Few studies evaluating treatment of adolescent obesity have been published. Therefore, long-term effects of the Go4it group treatment for obese adolescents were examined. Obese adolescents (11-18 years) visiting an outpatient paediatric obesity clinic were randomly assigned to 1) intervention group (Go4it) or 2) current regular care i.e. referral to a dietician in the home care setting (controls). Linear mixed models analysis was performed to evaluate intervention effects. Effect modification by sex, age and ethnicity was checked. Outcome measures included body mass index standard deviation score (BMIsds), body composition and metabolic components at 6 and 18 months follow-up. 122 adolescents, 71 Go4it and 51 controls, with a mean BMIsds of 2.9±0.5 were randomised. At 18 months a modest significant reduction in BMIsds (between group difference:-0.16; 95%CI:-0.30,-0.02; p=.028) was observed. None of the other body composition or metabolic components showed significant treatment effects. Ethnicity was a significant effect modifier. Posthoc analysis showed a large significant reduction on BMIsds (between group difference:-0.35; 95%CI:-0.64,-0.07) at 18 months for obese adolescents from western descent, while no effect was observed for adolescents from non-western descent. Significant treatment effects were also observed for systolic and diastolic blood pressure, as well as HDL cholesterol level, but only for obese adolescents from western descent. Go4it showed promising long-term effects on BMIsds compared with regular care in obese adolescents. Larger benefits were achieved for adolescents of western ethnicity. This trial was registered at www.trialregister.nl with the Netherlands Trial Register as ISRCTN27626398.

Targeted Hepatic Sonography During Clinic Visits for Detection of Fatty Liver in Overweight Children

The purpose of this study was to assess the feasibility and utility of targeted hepatic sonography to evaluate for hepatic steatosis during a subspecialty clinic visit. In this pilot study, we performed targeted hepatic sonography on 25 overweight children aged 7 to 17 years consecutively seen in a pediatric obesity clinic. Long-axis images of the right lobe of the liver and a split-screen image of liver and spleen were taken. Images were interpreted in real time by the radiologist and shown to the family. Demographics, clinical measurements, and laboratory parameters were also collected from the specialty clinic visit on the same day. Sonography required a median of 4 minutes during the visit (interquartile range, 3-5 minutes). All consented patients completed the study. The median alanine aminotransferase (ALT) level was 23 U/L in those with no steatosis (n = 14), 26 U/L with mild steatosis (n = 6), and 41 U/L with moderate/marked steatosis (n = 5). Children with ALT levels of 25 to 50 U/L had very variable sonographic measures of hepatic steatosis. When the participants were categorized by the overall degree of fatty liver, hepatic steatosis was significantly associated with the aspartate aminotransferase level (P = .028), ALT level (P = .003), and diastolic blood pressure (P = .05) but did not correlate with age, sex, Latino race, or insulin resistance. Targeted hepatic sonography added information not apparent from routine ALT screening and provided immediate feedback to clinicians and families about the effect of obesity on end organs. This examination could be a feasible, informative addition to screening for children at high risk for nonalcoholic fatty liver disease who are seen in clinics that specialize in obesity.

Child and Caregiver Reports of Weight Control Behaviors in Pediatric Obesity

This study examined agreement and disagreement between child and caregiver reports of healthy, unhealthy, and extreme weight control behaviors (WCBs) in overweight and obese children. Participants were 93 youth 10-17 years old [M = 12.9; standard deviation (SD) = 2.1] attending an outpatient pediatric obesity clinic and their caregivers. Children and caregivers completed a measure examining child use of healthy, unhealthy, and extreme WCBs. Caregivers also completed a demographic questionnaire. Significant differences between child and caregiver reports were found for child engagement in healthy, t(88) = 2.13, p < 0.05, and unhealthy WCBs, t(91) = 2.19, p < 0.05. Children endorsed using more WCBs to lose or maintain weight within the past year compared to caregiver report. No differences were found for extreme WCBs t(92) = 1.72, p = 0.09. Agreement between child and caregiver reports of WCBs ranged from slight to moderate (Cohen kappa = 0.11 to 0.43) for healthy WCBs, fair to moderate (0.25 to 0.44) for unhealthy WCBs, and fair to substantial (0.36 to 0.66) for extreme WCBs. Comparing child and caregiver reports of different WCBs used by children is important due to the differences and ranges of agreement found. Agreement between child and caregiver reports of WCBs in this sample was higher than in previous research. These findings highlight the importance of including both child and caregiver reports of healthy, unhealthy, and extreme WCBs in future research.

Circadian cortisol profiles, anxiety and depressive symptomatology, and body mass index in a clinical population of obese children

Obesity is highly co-morbid with anxiety and/or depression in children, conditions that may further worsen the metabolic and cardiovascular risks for obese individuals. Dysregulation of the hypothalamic–pituitary–adrenal axis is involved in the pathophysiology of anxiety disorders, depression, and obesity, and diverse cortisol concentrations may be found in obese children, depending on their degree of psychological distress. The aim of this study was to examine cortisol profiles among obese children with or without symptoms of anxiety and depression. A group of 128 children (53% females; mean age ± SD: 11.2 ± 2.2 years) derived from a pediatric obesity clinic were studied. Anxiety and depressive symptomatology were assessed with appropriate instruments. Morning serum and five diurnal salivary cortisol concentrations were measured. Obese children were 3.1/2.3 times more likely to report state and trait anxiety, respectively, and 3.6 times more likely to report depressive symptoms than children of the same age group, from a contemporary Greek sample. Trait anxiety and noon salivary cortisol concentrations were significantly positively correlated (p = 0.002). Overall, salivary cortisol concentrations were increased in children with anxiety or depression symptomatology compared to obese children without any affective morbidity (p = 0.02) and to those with anxiety and depression co-morbidity (p = 0.02). In conclusion, in obese children, emotional distress expressed by symptoms of anxiety and/or depression is associated with circadian cortisol profiles reflecting a potential pathway for further morbidity. Longitudinal studies may reveal a role of cortisol in linking obesity, anxiety, and depression to the development of further psychological and physical morbidity.

Obesity Care Strategies in Primary Care Practices

We evaluated pediatric obesity clinics for internal referrals developed at 5 primary care offices. Clinics developed site-specific strategies: 1 group approach and 4 clinics providing individualized care only. Clinicians reported patient/family motivation as an important referral consideration and compliance as the greatest challenge and perceive clinics to have provided some help.

TeleFIT: Adapting a Multidisciplinary, Tertiary-Care Pediatric Obesity Clinic to Rural Populations

Pediatric obesity occurs most frequently in underserved communities where families have difficulty accessing healthcare. Disproportionate obesity rates in rural children denote significant disparities warranting innovative solutions. However, intensive, tertiary-care treatment options outlined in recent expert recommendations may not be available to families living in rural areas. Telemedicine may be useful for providing pediatric obesity treatment to rural families. The aim of this study was to assess the impact of a new outreach program (TeleFIT), which placed telemonitors in four rural satellite clinics to increase access to a pediatric obesity clinic (Brenner Families In Training [FIT]). Before TeleFIT began, of five patients from rural counties enrolled in treatment over a 1-year period, all dropped out by their third visit. Within the first year of TeleFIT, the number of rural patients increased nearly threefold (to 14) and increased again in the second year by an additional 16 new patients (n=35). Preliminary outcomes indicate comparable attrition rates and improvement in weight status compared with patients in conventional treatment. Telemedicine allows rural families to access intensive obesity treatment from local pediatric offices, eliminating geographic barriers. Systems delivering state-of-the-art care in rural areas have tremendous potential for reducing health disparities in rural populations. Further research is needed to test the efficacy of such interventions.

Impact of percent body fat on oral glucose tolerance testing: a cross-sectional study in 1512 obese children.

Although an association between insulin resistance (IR) and body adiposity has been reported in obese children, this relationship has not been studied as thoroughly as in adults. We evaluated the association between oral glucose tolerance testing (OGTT) and percent body fat (PBF) in a sample of 1512 obese children followed at a Pediatric Obesity Clinic. Six hundred and twenty-eight male and 884 female obese children aged 6 to 18 yr were consecutively enrolled into the study. OGTT was performed with administration of 1.75 g of glucose per kg of body weight (up to 75 g). PBF was estimated through bioelectrical impedance analysis (BIA) using a population- specific formula recently published by our group. Multivariable median regression was used to evaluate the association between 4 outcomes [glucose area under the curve (AUC), insulin AUC, insulin sensitivity index (ISI), and insulinogenic index (IGI)] and gender, age or pubertal status and PBF. Median PBF was 52% (range 26 to 70%). After correction for age and gender, a 10% increase of PBF was associated with a decrease of -0.50 [95% confidence interval (CI): -0.65 to -0.35] units of ISI and an increase of 0.15 units of IGI (95%CI 0.07 to 0.24). In obese children, PBF is inversely associated with IR and directly associated to β-cell response as detected by OGTT.