Syndrome In Youth Research Articles

A New Insight Into Sudden Cardiac Death in Young People: A Systematic Review of Cases of Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy (TTC) causes sudden cardiac death and has garnered increased attention worldwide in recent years. However, few studies have clearly classified the risk factors for this disease, including gender, race and morbidity, as well as the physical and mental stressors that can exacerbate the disease, particularly in young patients. To better analyze the characteristics of young TTC patients, we performed a systematic review of reported cases involving young patients.A computer-assisted search was performed using prominent electronic medical information sources to identify literature published between January 1965 and December 2013. Relevant studies containing clinical data of young TTC patients were included.Ninety-six records that included information about 104 cases were ultimately selected for our review. Several of the following results were noted: First, physical stress was more likely to exacerbate TTC than was mental stress in young patients. Second, more female than male TTC patients were noted among both young patients and the general population. Third, ethnicity appears to play no role in the disease, as no significant differences were noted among individuals of different races with respect to clinical characteristics, morbidity or stressors. Fourth, the clinical manifestations of TTC were similar to those of other cardiac diseases, including coronary heart disease. However, TTC may be detected using the combination of echocardiography and ventriculography.Clinicians should consider TTC if young patients present with symptoms similar to those of coronary heart disease so that harmful treatments such as coronary artery stent placement may be avoided. Moreover, the answers to questions regarding the clinical diagnostic criteria, etiology, pathophysiology, and the management of this syndrome in youth remain unclear; therefore, further research is needed.

Sports Participation As A Protective Factor Of Metabolic Syndrome In Youth

Sports Participation As A Protective Factor Of Metabolic Syndrome In Youth

A double-blind, placebo-controlled intervention trial of 3 and 10 mg sublingual melatonin for post-concussion syndrome in youths (PLAYGAME): study protocol for a randomized controlled trial.

BackgroundBy the age of sixteen, one in five children will sustain a mild traumatic brain injury also known as concussion. Our research found that one in seven school children with mild traumatic brain injury suffer post-concussion syndrome symptoms for three months or longer. Post-concussion syndrome is associated with significant disability in the child and his/her family and yet there are no evidence-based medical treatments available. Melatonin has several potential mechanisms of action that could be useful following mild traumatic brain injury, including neuroprotective effects. The aim of this study is to determine if treatment with melatonin improves post-concussion syndrome in youths following mild traumatic brain injury. Our hypothesis is that treatment of post-concussion syndrome following mild traumatic brain injury with 3 or 10 mg of sublingual melatonin for 28 days will result in a decrease in post-concussion syndrome symptoms compared with placebo.Methods/DesignNinety-nine youths with mild traumatic brain injury, aged between 13 and 18 years, who are symptomatic at 30 days post-injury will be recruited. This study will be conducted as a randomized, double blind, placebo-controlled superiority trial of melatonin. Three parallel treatment groups will be examined with a 1:1:1 allocation: sublingual melatonin 3 mg, sublingual melatonin 10 mg, and sublingual placebo. Participants will receive treatment for 28 days. The primary outcome is a change on the Post-Concussion Symptom Inventory (Parent and Youth). The secondary outcomes will include neurobehavioral function, health-related quality of life and sleep. Neurophysiological and structural markers of change, using magnetic resonance imaging techniques and transcranial magnetic stimulation, will also be investigated.DiscussionMelatonin is a safe and well-tolerated agent that has many biological properties that may be useful following a traumatic brain injury. This study will determine whether it is a useful treatment for children with post-concussion syndrome. Recruitment commenced on 4 December 2014.Trial registrationThis trial was registered on 6 June 2013 at ClinicalTrials.gov. Registration number: NCT01874847.

Sleep Duration, Physical Activity, and Metabolic Syndrome for Adolescents

I read the article by Countryman et al. with interest [1]. They analyzed the relationship among metabolic syndrome, sleep, and inflammation in combination with physical activity and aerobic fitness for pediatrics. They used two models to elucidate the relationship among several key factors. They set the average value of sleep duration and physical activity as predictors of metabolic syndrome and systemic inflammation, and peak VO2 was used as a mediator on the relationship in a structural equation model. They selected adolescents in cohorts 2 and 3, who had some elevated blood pressure and waist circumferences were also high from the data in their Table 1. They selected the majority of the sample from ethnic minorities, and the target adolescents had already suffered from cardiovascular risk. I fundamentally agree with their speculation that undesirable lifestyle and behavioral factors have a risk of metabolic syndrome in youth. But before accepting their conclusion, I have a query as follows. Their conclusion is difficult to accept because standardized coefficients were insignificant between sleep and metabolic syndrome or inflammation. Insignificant relationships were also observed between physical activity and both metabolic syndrome and inflammation. In addition, aerobic fitness as a mediator from sleep and physical activity, which was measured by peak VO2, showed significant, but not high standardized coefficients with sleep and physical activity. Significant and high standardized coefficients of aerobic fitness for metabolic syndrome or inflammation were observed in their study, and a strong correlation between metabolic syndrome and inflammation showed that sleep and physical activity were not core predictors of metabolic syndrome or inflammation. I understand that lifestyle factors such as sleep and physical activity associate with pathophysiology of metabolic components, including inflammation, but their conclusion should be verified by more epidemiological evidences. Bornhorst et al. conducted a cross-sectional study and concluded the existence of an inverse relationship between sleep duration and body mass index (BMI) [2], and the serum insulin significantly attenuated the association between sleep duration and BMI. Sung et al. reported that there was no significant association between sleep duration and homeostatic model assessment of insulin resistance in obese adolescents [3]. These reports also recommend further study if insulin resistance becomes a mediator of the association between sleep and obesity. I previously conducted a 3-year follow-up study on the effect of habitual exercise on the metabolic syndrome [4], presenting insignificant odds ratio (95 % confidence interval) of 0.90 (0.66–1.2). I also conducted a cross-sectional study on the association between metabolic syndrome and lifestyle factors [5]. In this study for male adult workers, odds ratio of sleep duration ≥7 h against <6 h was 0.615 (95 % CI 0.415–0.911, p=0.015), although causality could not be determined. Countryman et al. did not describe their definition of metabolic syndrome, which is indispensable to allow comparison with other studies. Currently, further studies with adolescents are needed to better understand the link between sleep duration, metabolic syndrome, and inflammation.

Metabolic Syndrome in Youth: Current Insights and Novel Serum Biomarkers

Paralleling the worldwide epidemic in childhood obesity, in the last decade we have observed a rise in the prevalence of metabolic syndrome (MetS) in pediatrics. The MetS comprises a cluster of cardiovascular risk factors. Multiple definitions have been proposed for the syndrome in the pediatric age group, but they are very difficult to test and validate. Thus, in this paper we will discuss the current knowledge in pediatric MetS and the potential role of novel biomarkers in the pathogenesis and diagnosis of MetS.

A Diagnosis of the Metabolic Syndrome in Youth That Resolves by Adult Life Is Associated With a Normalization of High Carotid Intima-Media Thickness and Type 2 Diabetes Mellitus Risk: The Bogalusa Heart and Cardiovascular Risk in Young Finns Studies

The aim of this study was to examine the effect of resolution from metabolic syndrome (MetS) between youth and adulthood on carotid artery intima-media thickness (IMT) and type 2 diabetes mellitus (T2DM). Published findings demonstrate that youth with MetS are at increased risk of cardio-metabolic outcomes in adulthood. It is not known whether this risk is attenuated in those who resolve their MetS status. Participants (n = 1,757) from 2 prospective cohort studies were examined as youth (when 9 to 18 years of age) and re-examined 14 to 27 years later. The presence of any 3 components (low high-density lipoprotein cholesterol, high triglycerides, high glucose, high blood pressure, or high body mass index) previously shown to predict adult outcomes defined youth MetS; the harmonized MetS criteria defined adulthood MetS. Participants were classified according to their MetS status at baseline and follow-up and examined for risk of high IMT and T2DM. Those with MetS in youth and adulthood were at 3.4 times the risk (95% confidence interval: 2.4 to 4.9) of high IMT and 12.2 times the risk (95% confidence interval: 6.3 to 23.9) of T2DM in adulthood compared with those that did not have MetS at either time-point, whereas those that had resolved their youth MetS status by adulthood showed similar risk to those that did not have MetS at either time-point (p > 0.20 for all comparisons). Although youth with MetS are at increased risk of adult high IMT and T2DM, these data indicate that the resolution of youth MetS by adulthood can go some way to normalize this risk to levels seen in those who have never had MetS.

Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder

Chronic tic disorders (TD) are consistently found to have high rates of comorbidity with obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). The purpose of this study is to compare the severity of TD only to TD with comorbid OCD or ADHD based on severity of tics, measures of psychopathology and additional comorbid diagnoses. Baseline data from 158 youth with a chronic TD who participated in two longitudinal studies were examined. Fifty-three percent (N = 85) of the youth also met criteria for a diagnosis of OCD, 38.6 % (n = 61) met criteria for ADHD and 24.1 % (N = 38) met criteria for both. Measures of interest addressed severity of tics, symptoms of anxiety, depression, ADHD, psychosocial stress, global functioning and the presence of comorbid diagnoses. Youth with comorbid TD and OCD were characterized by more severe tics, increased levels of depressive and anxious symptoms, heightened psychosocial stress and poorer global functioning. Youth with comorbid TD and ADHD did not differ from those with TD alone on measures of tic severity, but experienced greater psychosocial stress and poorer global functioning. Subjects with comorbid TD and OCD had more internalizing disorders than those without OCD, while those with comorbid ADHD were more likely to meet criteria for oppositional defiant disorder. TD with OCD is a more severe subtype of TD than TD without OCD. TD with ADHD is associated with higher psychosocial stress and more externalizing behaviors. Further research is needed into the underlying relationships between these closely associated conditions.

Measurement site of visceral adipose tissue and prediction of metabolic syndrome in youth

It is unknown whether measurement site of visceral adipose tissue (VAT) influences the relationship between VAT and associated health risk in youth and if so, whether ethnic differences exist in this relationship. We examined the influence of the measurement site of VAT on the relationships between VAT and metabolic syndrome (MetS) in African-American (AA) and American-White (AW) youth. Healthy AA (n = 54) and AW (n = 54) children and adolescents (age: 8-18 yr; BMI: 15.3-42.5 kg/m(2)). VAT mass was derived using a series of five transverse images measured by magnetic resonance imaging, extending from 5 cm below to 15 cm above L4-L5. MetS was defined using a modified IDF criteria. In AA, VAT measure at 5 cm above L4-L5 (R(2) = 0.93) was most strongly (p < 0.05) correlated with VAT mass and was a significantly (p < 0.05) stronger correlate as compared to L4-L5 (R(2) = 0.84). In AW, VAT measures at 5 cm (R(2) = 0.93) and 10 cm (R(2) = 0.93) above L4-L5 were most strongly (p < 0.05) correlated with VAT mass; however, these were not stronger correlates as compared to L4-L5 (R(2) = 0.91). In AW, all VAT measures were significantly (p < 0.05) associated with an increased odds ratio (OR) for prevalent MetS, wherein the VAT mass [OR = 5.32(1.9-15.0)] and VAT at L4-L5[OR = 5.99(1.9-18.4)] were most strongly associated with MetS. In contrast, only VAT at 10 cm above L4-L5 [OR = 4.39 (1.1-18.1)] was significantly (p < 0.05) associated with MetS in AA. In AA and AW youth, the measurement site for VAT has impact on the estimation of total VAT and the magnitude of the association with obesity-related health risks.

A three-country study on the components of the metabolic syndrome in youths: The BIG Study

This study aimed to assess the prevalence of components of the metabolic syndrome (MetS) among representative samples of children and adolescents from Brazil, Iran and Germany (BIG study). We report the data of a total number of 4 473 children (mean age 7.7 years; 2 218 boys,) and 6 800 adolescents (mean age 12.6 years; 3 409 boys) who participated in three large national studies. Anthropometric measures, blood pressure (BP) and lipid profile were assessed, fasting plasma glucose was determined in German and Iranian participants. With few exceptions, the mean of the components of the metabolic syndrome was higher in boys than in girls. The main ethnic differences were the high prevalence of low HDL-C levels in Iranian and Brazilian youths compared with German youths (34% vs.7%, respectively, p<0.05) and of increased triglycerides (10% vs. 1%, respectively, p<0.05). Furthermore the prevalence of high BP was lowest (<1%) in Iranian than in Brazilian and German children (6%). Both in children and adolescents, the prevalence of the MetS was significantly higher in Iranian than in German children (1% vs.0.1%, respectively, p<0.05) and adolescents (2% vs.0.5%, respectively, p<0.05). TG to HDL-C ratio had significant correlations with waist circumference and body mass index in Iranian and German children of both genders; these correlations were significant among both genders of adolescents in the three ethnic groups. While the prevalence of abdominal adiposity was nearly similar, Iranian and Brazilian youths had considerably higher prevalence of dyslipidemia than German youths. Future longitudinal studies should seek the clinical importance of these ethnic differences.

Childhood obesity and adult morbidities

The prevalence and severity of obesity have increased in recent years, likely the result of complex interactions between genes, dietary intake, physical activity, and the environment. The expression of genes favoring the storage of excess calories as fat, which have been selected for over many millennia and are relatively static, has become maladaptive in a rapidly changing environment that minimizes opportunities for energy expenditure and maximizes opportunities for energy intake. The consequences of childhood and adolescent obesity include earlier puberty and menarche in girls, type 2 diabetes and increased incidence of the metabolic syndrome in youth and adults, and obesity in adulthood. These changes are associated with cardiovascular disease as well as with several cancers in adults, likely through insulin resistance and production of inflammatory cytokines. Although concerns have arisen regarding environmental exposures, there have been no formal expert recommendations. Currently, the most important factors underlying the obesity epidemic are the current opportunities for energy intake coupled with limited energy expenditure.

The Influence of Exercise on Metabolic Syndrome in Youth: A Review

The metabolic syndrome (MetS) is a clustering of dyslipidemia, hypertension, glucose intolerance, and central obesity or waist circumference that places individuals at high risk for developing cardiovascular or heart disease. Although first characterized in adults, it has been found in children, but the definition of MetS in children is still controversial. Although MetS is most closely associated with obesity in children, 2 factors believed to affect MetS are physical activity (PA) and aerobic power or fitness. Studies using accelerometry to estimate PA of children have shown that low levels are associated with increased risk of developing MetS. Conversely, high levels of PA at moderate to vigorous intensities reduce the risk. Similarly, low levels of aerobic fitness increase the likelihood of developing MetS. These effects appear to be independent of obesity. Studies have also shown that interventions that increase PA levels and improve aerobic fitness cause a reduction in MetS risk; however, an exact prescription for exercise cannot be presently provided. This review provides an in-depth analysis of what is presently known about the relationship between MetS and PA and aerobic fitness in children. In addition, information is presented regarding potential mechanisms for exercise to affect the major markers of MetS.

Understanding the Nature of Metabolic Syndrome Components in Children and What They Can and Cannot Do to Predict Adult Disease

Understanding the Nature of Metabolic Syndrome Components in Children and What They Can and Cannot Do to Predict Adult Disease

Retraction: Update to “C‐reactive Protein and Metabolic Syndrome in Youth: A Strong Relationship?”

TO THE EDITOR: We are part of a research group on childhood obesity and made a cross-sectional study with a large sample of normal weight and overweight/obese children and adolescents that had never been studied before under these conditions. Based on the literature, C-reactive protein (CRP) and alanine aminotransferase (ALT) are defined as good markers for cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2), respectively, but separately. As obesity, CVD, and DM2 are increasing in this age group, one of our objectives was to find a reliable and readily available surrogate marker for both CVD and DM. In this way, we divided the population into four groups by BMI and these groups were further subdivided into four groups based on ALT and CRP median scores, trying to confirm our hypothesis that simultaneous measurements of ALT and CRP are better than the isolated measures as a screening test for metabolic disturbances and CVD. These conclusions we sent to a journal and after several contacts/corrections/improvements were accepted by the Journal of Pediatrics (date of submission 19 March 2007; date of decision: 6 July 2007). In the same period, we hypothesized that CRP is related to metabolic syndrome (MS). To confirm our hypothesis, we studied the same population based on the presence or absence of MS and the analyses were performed based on MS. Then, the population was divided according to CRP quartiles, in an attempt to confirm the importance of this marker in MS. As we believe that obesity is the basis of insulin resistance, and that this state is very important with regard to the development of MS, our aim was to carry out a statistical analysis of all MS components, in order to find the most important element that influences CRP levels. We concluded that obesity, in this population, never studied before, is probably the major determining factor for elevated CRP, an indication of a precocious proinflammatory state. These data were sent almost simultaneously to Journal of Pediatrics and then to Obesity and once again after much work the paper was accepted (date of submission: 24 May 2007; date of decision: 6 September 2007). These data were sent to different journals just because the focuses of the two papers are different. We realized that we had different ideas, objectives, and hypotheses, leading to different statistical analyses, results, and conclusions and we didn’t send copies of the papers to the journals (Journal of Pediatrics and Obesity) just because we didn’t know whether the data would be accepted and published. We are aware of the rules for publications and author guidelines, and would never intentionally publish the same data in two journals, for ethical reasons. If you still consider our arguments inconclusive, our team of researchers respectfully requests that you retract the publication of our article from Obesity.

High-normal fasting glucose levels are associated with increased prevalence of impaired glucose tolerance in obese children

The natural history of impaired glucose tolerance (IGT) and Type 2 diabetes among obese children is not clear. Although the cut-off for impaired fasting glucose (IFG) has recently been changed from 110 (6.1 mmol/l) to 100 mg/dl (5.6 mmol/l), it does not seem a reliable way to find all subjects with impaired glucose homeostasis. The aim of our study was to determine whether high-normal fasting glucose level could predict the occurrence of IGT and metabolic syndrome. Three hundred and twenty-three Italian obese children and adolescents were included in the study (176 females, mean age 11+/-2.9 yr; mean body mass index z-score: 3+/-0.6). Waist circumference, serum glucose, insulin, triglyceride, cholesterol HDL, blood pressure were evaluated and an oral glucose tolerance test (OGTT) was performed. The prevalence of IFG and IGT were respectively 1.5% (5 subjects) and 5% (18 patients); no diabetic patients were found. Metabolic syndrome was diagnosed in 20% of patients. Fasting glycemia values <100 mg/dl (5.6 mmol/l) have been divided in quintiles. Metabolic syndrome prevalence increased across quintiles, although not in a statistically significantly manner, but it could depend on the selected diagnostic criteria as no univocal definition exists for metabolic syndrome in youths. Interestingly high-normal fasting plasma glucose levels constitute an independent risk factor for IGT among obese children and adolescents; therefore, this very easy-to-use parameter may help to identify obese patients at increased risk of diabetes or at least could suggest in which subjects to perform an OGTT.

Physical activity, cardiorespiratory fitness, and the metabolic syndrome in youth.

The metabolic syndrome is defined as the coexistence of multiple cardiovascular and diabetes risk factors, the prevalence of which has increased dramatically in adult populations in the last decades. More recently, the same cluster of metabolic risk factors has also been recognized in children and adolescents. Epidemiological evidence suggests that high levels of cardiorespiratory fitness (CRF) and physical activity are associated with a favorable metabolic risk profile in adults. However, in youth the role of these factors is less clear. Therefore, the purpose of this mini-review is to examine the recent evidence between objectively measured habitual physical activity and CRF with clustered metabolic risk in youth. In general, it appears that both physical activity and CRF are separately and independently associated with metabolic risk factors in youth, possibly through different causal pathways. Further research is necessary to quantify how much physical activity is needed to prevent the metabolic syndrome and the diseases with which it is associated. Public health approaches that encourage increased physical activity and reduce sedentary behaviors may prove useful in reducing the population burden associated with metabolic risk.

Learning from children: the emergence of pediatric exercise science

which unique insights can be gained from the investigations of the physiology of the growing child? Are there pragmatic outcomes to research in children's exercise science that bear specific utility to this age group or to their future life? What importance do exercise responses in youth bear to our

RETRACTION: C‐reactive Protein and Metabolic Syndrome in Youth: A Strong Relationship?

Metabolic syndrome (MS) is on the rise in youth. As high-sensitivity C-reactive protein (hs-CRP) is associated with cardiovascular/metabolic disorders, we evaluated the association between MS and its components and hs-CRP in a sample of Brazilian overweight and obese youth. A total of 407 students (229 girls, 273 with excessive weight, 11.3+/-3.2 years) were evaluated. Measurement included BMI, waist circumference (WC), blood pressure, lipids, insulin, and hs-CRP. Excessive weight was defined using BMI z -score; MS by the modified National Cholesterol Education Program-Adult Treatment Panel III. Subjects were classified into two groups: with MS (n=72) and without (n=335). hs-CRP means and medians were higher in MS group (1.41 mg/l vs. 1.06 mg/l, P<0.001; 2.21 mg/l vs. 1.23 mg/l, P<0.001). Associations between hs-CRP quartiles and insulin resistance (IR) (P<0.001), MS (P<0.001), WC (P<0.000), BMI z-score (P<0.001), hypertension (P<0.001), hypertriglyceridemia (P<0.001), and low HDL-c (P=0.023) were significant; adjustment of hs-CRP for BMI z-score eliminated the previous association, except for the number of MS components (nMSc) (P<0.001). Adjusting for homeostasis model assessment method of IR (HOMA-IR) did not eliminate the relation between hs-CRP and MS components. Furthermore, increases in BMI z-score and nMSc were associated with an increased hs-CRP. Excessive weight (odds ratio (OR), 7.9; confidence interval (CI), 4.7-13.4; P=0.000), hypertension (OR, 2.3; CI, 1.3-4.2; P=0.003), and hypertriglyceridemia (OR, 2.3; CI, 1.5-3.7; P<0.001) were independently associated with hs-CRP. In youth, hs-CRP is strongly related with MS and its components, and is also determined by the body composition. This association indicates a precocious proinflammatory state.

Cardiovascular Reactivity, Physical Activity, And Metabolic Syndrome In Youth

Cardiovascular Reactivity, Physical Activity, And Metabolic Syndrome In Youth

Aerobic fitness, fatness and the metabolic syndrome in children and adolescents

The paediatric obesity epidemic is well documented. Recently, there has also been the emergence of type 2 diabetes and the metabolic syndrome (MetS) among children and adolescents. Although it is well known that obesity is linked to the metabolic syndrome in youth, the role of physical activity and fitness on the metabolic syndrome is unclear. The purpose of this review was to examine the concepts of and associations between fitness, fatness and the MetS in children and adolescents. In general, the association between fatness and the MetS (or components of the MetS) is stronger than those for fitness. Furthermore, the correlation between fatness and the MetS remains significant after controlling for fitness, whereas the correlation between fitness and MetS does not remain significant after controlling for fatness. When subjects are cross-tabulated into categories (fat-fit, etc.), there is good evidence that fitness attenuates the MetS score among fat children and adolescents. The reasons for these observations possibly involve genetics, adipocytokines and mitochondrial function. Further study is needed to understand the role of physical activity and other environmental factors on this phenomena. In addition, longitudinal studies of the fat-fit phenotype are required and should include measurements of the hormonal mileau, adipokines and the oxidative capacity of skeletal muscle during childhood and adolescence.

Metabolic syndrome in youth: a cross‐sectional school‐based survey

To assess the prevalence of metabolic syndrome (MetS) among students attending vocational secondary school (VSE). VSE provides practice-oriented education in which young people learn a specific occupation. Previously we reported VSE to be the type of education with the highest prevalence of overweight and obesity. All data were collected in a cross-sectional school-based survey. Subjects were recruited from a community sample of 869 adolescents in 14 secondary schools. In this total sample all components of the metabolic syndrome were assessed in a subgroup of 506 students. MetS was defined analogous to National Cholesterol Education Program: Adult Treatment Panel III criteria, with modifications for students under 19 years of age. In the subsample (n=506) 4.1% of the students had metabolic syndrome. There was a significant difference in the prevalence of metabolic syndrome among BMI categories (p<0.001). The prevalence of metabolic syndrome was higher in obese students (39.1%) than in overweight students (2.8%) and normal weight students (0.3%). Being overweight or obese substantially increases the risk for metabolic syndrome, even in an adolescent school population.