Weight Reduction In Obese Children Research Articles

Effects of alpha lipoic acid as a supplement in obese children and adolescents

ObjectivesObesity is significantly associated with inflammatory process and oxidative stress. Alpha lipoic acid (ALA) is a potent antioxidant that has been reported for reducing weight in animals and obese adults in several studies but no data are available in pediatrics. We investigated the possible beneficial role of ALA in obese children. Patients and methodsEighty obese children and adolescents were randomized into two groups; the treatment group (n = 40) who received 300 mg of ALA twice daily for 3 months and the control group (n = 40) who received placebo for 3 months. Measurements of weight, body mass index (BMI), lipid profile, fasting blood glucose (FBG), malondialdhyde (MDA), tumor necrosis factor alpha (TNF-α), leptin and adiponectin were carried out before and 3 months after the treatment. ResultsALA treatment group had a significant reduction of the weight, BMI, MDA, TNF-α, and leptin levels but a significant increase of adiponectin level (P < 0.05) compared to the control group. However, it had no effect on FBG or lipid profile (P > 0.05). ConclusionALA may be a promising supplement in the weight reduction in obese children and adolescents.

O 102 - How does load transfer with weight reduction in obese children: A 3-year follow-up study

This study aimed to explore load transference in weight reduced children after 3-year follow-up and to identify how plantar pressure redistribute in feet with the weight changes. Totally 147 children (82 boys and 65 girls) in Shandong, China, which were selected from a database of 836 Chinese children, completed a plantar pressure measurement, and were followed-up for 3 years. Data of pressure parameters were recorded by Footscan® plate system. An algorithm was designed to quantify the plantar force transference with the weight reduced. The results indicated that when overweight and obese children weight reduced back to normal, plantar load in the midfoot transferred to the heel or the metatarsal.

Human Gut Microbiota Associated with Obesity in Chinese Children and Adolescents.

Objective To investigate the gut microbiota differences of obese children compared with the control healthy cohort to result in further understanding of the mechanism of obesity development. Methods We evaluated the 16S rRNA gene, the enterotypes, and quantity of the gut microbiota among obese children and the control cohort and learned the differences of the gut microbiota during the process of weight reduction in obese children. Results In the present study, we learned that the gut microbiota composition was significantly different between obese children and the healthy cohort. Next we found that functional changes, including the phosphotransferase system, ATP-binding cassette transporters, flagellar assembly, and bacterial chemotaxis were overrepresented, while glycan biosynthesis and metabolism were underrepresented in case samples. Moreover, we learned that the amount of Bifidobacterium and Lactobacillus increased among the obese children during the process of weight reduction. Conclusion Our results might enrich the research between gut microbiota and obesity and further provide a clinical basis for therapy for obesity. We recommend that Bifidobacterium and Lactobacillus might be used as indicators of healthy conditions among obese children, as well as a kind of prebiotic and probiotic supplement in the diet to be an auxiliary treatment for obesity.

Effects of SLC22A1 Polymorphisms on Metformin-Induced Reductions in Adiposity and Metformin Pharmacokinetics in Obese Children With Insulin Resistance.

Steady-state population pharmacokinetics of a noncommercial immediate-release metformin (hydrochloride) drug product were characterized in 28 severely obese children with insulin resistance. The concentration-time profiles with double peaks were well described by a 1-compartment model with 2 absorption sites. Mean population apparent clearance (CL/F) was 68.1 L/h, and mean apparent volume of distribution (V/F) was 28.8 L. Body weight was a covariate of CL/F and V/F. Estimated glomerular filtration rate was a significant covariate of CL/F (P<.001). SLC22A1 genotype did not significantly affect metformin pharmacokinetics. The response to 6 months of metformin treatment (HbA1c , homeostasis model assessment for insulin resistance, fasting insulin, and glucose changes) did not differ between SLC22A1 wild-type subjects and carriers of presumably low-activity SLC22A1 alleles. However, SLC22A1 variant carriers had smaller reductions in percentage of total trunk fat after metformin therapy, although the percentage reduction in trunk fat was small. The median % change in trunk fat was -2.20% (-9.00% to 0.900%) and -1.20% (-2.40% to 7.30%) for the SLC22A1 wild-type subjects and variant carriers, respectively. Future study is needed to evaluate the effects of SLC22A1 polymorphisms on metformin-mediated weight reduction in obese children.

Can we modulate physical activity in children?

Intuition tells us that physical activity is central to weight reduction in obese children. Evidence, on the other hand, suggests that increases in physical activity are difficult to achieve in the short term, and may not be possible in the long term. One explanation could be an 'activitystat', a feedback loop in the child's brain that controls physical activity according to a set point. This brief article, which argues that it may not be possible to modulate the activity of children, reviews the principles of feedback control as they apply to physical activity, discusses evidence for its central control, and demonstrates how a physical activity control loop might operate to defend the set point. Studies restricted to objective measurement suggest that the physical activity of children varies in a systematic, rather than random manner. It varies little from environment to environment, from year to year or from place to place. Where children undertake more activity at one time of day, they appear to compensate at another. Systematic variation of this kind implies control, and the control of physical activity appears to lie with the child, not with his environment. Perturbation (temporary change in response to disturbance) during short-term physical activity interventions may be mistaken for modulation (permanent change in set point), a fundamentally different response. Perturbation lasts no longer than the disturbance that causes it, and there is little evidence that interventions raise activity long term, if at all.

Decrease of Lp(a) during weight reduction in obese children is modified by the apo(a) kringle-IV copy number variation

Lipoprotein(a) [Lp(a)] is considered an independent risk factor for cardiovascular disease. Its concentration is mainly determined by the kringle-IV repeat copy number variation (CNV) at the apolipoprotein(a) [apo(a)] locus. We aimed to investigate the immediate effect of weight reduction on plasma Lp(a) levels and its dependency on the apo(a) CNV in obese children. We performed a prospective longitudinal intervention study of a low-fat hypocaloric diet conducted in a 3-week dietary camp for obese children. In all, 140 obese participants (54 boys and 86 girls) with a mean age of 12.5+/-1.6 years and a mean relative body mass index (BMI) before treatment of 165.6+/-24.7% were included. Body weight and plasma levels of Lp(a), lipids, apolipoproteins A-I and B, insulin, and C-reactive protein were determined before the onset and after the end of the intervention. In addition, the number of apo(a) kringle-IV repeats were determined using sodium dodecyl sulfate agarose gel electrophoresis. The mean loss of body weight was 5.0+/-1.3 kg (-6.6%), resulting in a mean decrease of the relative BMI of 6.6%. Blood chemistry revealed significant changes in all parameters, especially in Lp(a), with a decrease from 24.4+/-30.6 to 17.9+/-22.6 mg per 100 ml or -19% (P<0.001). The decrease of Lp(a) levels was higher in the group with low compared with high molecular weight apo(a) phenotypes (-23.9 vs -16.6%). Weight reduction in obese children is associated with significant changes in Lp(a) levels, especially in subjects with high pre-treatment Lp(a) concentrations. This effect is markedly influenced by the molecular phenotype at the copy-number variable apo(a) locus.

Severity of Myocardial Infarction

Cardiovascular disease constitutes a burden of epidemic proportion,1 and understanding its determinants is essential to designing effective interventions. Doing so requires the ability to track disease burden at the population level. In the United States, without national registries, community surveillance is the method of choice.2 Community surveillance studies are mostly retrospective by design, rely on diagnostic codes for case finding, and require a defined population in which events can be consistently and reliably captured and validated with standardized approaches. Applied to cardiovascular disease, community surveillance measures its burden in communities by tracking the incidence of events, their severity, and their mortality, thereby enabling the appraisal of the components of cardiovascular diseases in a given population.2 Because of the aforementioned methodological requirements, few surveillance studies exist in the United States. They include the Atherosclerosis Risk in Communities (ARIC) Study,3 the Minnesota Heart Survey,4 the Olmsted County Study,5 and the Worcester Heart Attack Study.6 The data from these studies indicate that, although deaths from coronary disease have declined, the incidence of myocardial infarction in the United States has remained mostly stable. Thus, the decline in mortality can be envisioned as reflecting an improvement in survival, which may be mediated by a declining severity of myocardial infarction. Article p 503 The article by Myerson et al7 in this issue of Circulation specifically addresses this important and understudied issue in ARIC between 1987 and 2002. They examined a large, multiracial population and relied on several indicators, including the composite Predicting Risk of Death in Cardiac Disease Tool (PREDICT) score to conclude that the severity of infarction declined over time. Indeed, the proportion of infarctions with major ECG abnormalities, ST-segment elevation, and Q waves decreased, as did biomarker values and the proportion of persons presenting with shock. …

An update on childhood snoring

Habitual snoring or daily snoring is a symptom of sleep-disordered breathing (SDB) in children and it is reported in about 10% of children. SDB includes primary snoring, upper airway resistance syndrome (UARS), obstructive hypoventilation syndrome and obstructive sleep apnea syndrome (OSAS). Classification of SDB in a particular snoring child requires an overnight polysomnography (PSG). Manual scoring of PSG is mandatory in children. Risk factors for SDB include allergic rhinitis, passive smoking, obesity, dysmorphic syndromes and neuromuscular disorders. Treatment includes general measures like treatment of allergic rhinitis, weight reduction in obese children, and avoidance of sleep deprivation. Specific measures include removal of adenoid and tonsils. Complications of SDB include neurocognitive impairment, hypertension and failure to thrive.

Leptin levels in obese children: effects of gender, weight reduction, and androgens.

Obesity in children is accompanied by increased circulating leptin concentrations. Girls have higher leptin concentrations than boys. The aim of our study was to compare serum leptin levels before and after a five-week weight reduction program and to study the relationship of leptin levels, serum total cholesterol, and androgens (testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulphate) in 33 obese boys (age: 12.7+/-1.97 years, BMI: 30.46+/-4.54) and 66 obese girls (age: 12.7+/-2.51 years, BMI: 29.31+/-4.62). We found that serum leptin concentrations in obese children were significantly decreased after a weight reduction program (before 20.79+/-9.61 ng/ml, after 13.50+/-8.65 ng/ml in girls; before 12.25+/-10.09 ng/ml and after 5.18+/-3.56 ng/ml in boys, p&lt;0.0001 in both genders). Leptin levels correlated positively with the body mass index before and after weight reduction. There was a positive association in obese boys and a negative one in obese girls between leptin levels and the WHR (waist to hip circumference ratio). Serum leptin also shows a strong relationship to fat distribution (p=0.02 in boys, p&lt;0.0001 in girls). No significant correlation was found between leptin concentrations and total cholesterol or androgens. We confirmed that leptin is a sensitive parameter of body composition and weight reduction in obese children.

Weight loss and growth velocity in obese children after very low calorie diet, exercise, and behavior modification

The prevalence of obesity in American youth is increasing and treatment of the condition is difficult. We have developed a multi‐disciplinary weight reduction program that extends over 1 y and includes a very low‐calorie diet (VLCD) followed by a hypocaloric diet, exercise, and behavior modification. Based on data collected at baseline, at the end of the acute intervention phase (10–20 wk), and at 1‐y evaluation, we assessed the efficacy of this outpatient weight reduction program in treating obese children and adolescents in a follow‐up of a series of cases. Furthermore, we examined the impact of the approach on growth velocity and maintenance of weight loss at 1 y. Fifty‐six overweight children (aged 7–17 y) were recruited during a period of 18 mo to participate in the weight management program; 52 (93%) completed the acute phase of treatment and 35 (62.5%) successfully completed the I‐y program. There was a significant decrease in body weight and body fat, as assessed by weight determinations and skinfold measurements 0, &lt; 0.0001; results not corrected for age). The body mass index for the 35 individuals who completed the 1‐y program decreased significantly from 32.7 on entry to 28.72 at 1 y (p &lt; 0.0001; results not corrected for age). Conclusion: We conclude that a multidisciplinary weight reduction program that combines a VLCD, followed by a balanced hypocaloric diet, with a moderate‐intensity progressive exercise program and behavior modification is an effective means for weight reduction in obese children and adolescents.

Persistent hyperaminotransferasemia resolving after weight reduction in obese children

Nine obese children were referred to our liver disease unit because of asymptomatic, long-standing (range, 4 to 49 months) hyperaminotransferasemia of unknown origin. Ultrasonography showed a "bright" liver in most patients. A hypocaloric diet was prescribed, and the hepatic abnormalities of the compliant patients showed a prompt and persistent improvement that paralleled the loss of excess weight. (J PEDIATR 1994;125:239-41)

Long-term effects of weight reduction on serum lipids and plasma insulin in obese children

The long-term metabolic effects of weight reduction on serum lipids and plasma insulin were evaluated in 32 obese children with a mean (+/- SD) relative weight of 160.9 +/- 20.1% before and after active treatment for 1 y and after observation for another 4 y. The obese subjects had higher serum triglyceride and plasma insulin concentrations initially but lower high-density-lipoprotein (HDL)-cholesterol concentrations and a lower ratio of HDL cholesterol to total cholesterol (TC) than 29 normal-weight children. There was a decrease of 15.8% in relative weight over the first year with a parallel decrease in serum triglyceride and plasma insulin, whereas HDL cholesterol and the ratio of HDL cholesterol to TC increased (P < 0.001). These changes remained stable over the second year. At 5 y the obese subjects still had a reduced weight (12.8% lower than initially) and higher HDL cholesterol. These results indicate that weight reduction in obese children is associated with a change in serum lipids toward normal and reduced peripheral hyperinsulinemia.

No reduction of high density lipoprotein2 during weight reduction in obese children and adolescents.

The effects of a 3 week weight reduction regimen on lipids and lipoproteins, in particular high density lipoprotein (HDL)-subfractions in 61 grossly obese children and adolescents (37 females and 26 males) aged 11-15 years were studied. Dietary treatment resulted in a significant weight reduction of initial body weight of 9.6 +/- 2.1%, a highly significant decrease in cholesterol, low density lipoprotein cholesterol (LDL-C) and HDL-C (P less than 0.001), as well as a significant reduction in triglycerides, HDL3 and Apolipoprotein B concentrations (P less than 0.01). HDL2 concentrations remained almost constant. It is concluded that HDL reduction during a weight reducing regimen in adolescents does not result in a decrease of the antiatherogenic HDL2 subfraction.

Dispositional and situational correlates of long-term weight reduction in obese children

Two samples of obese children were studied in order to investigate the extent to which four classes of variables were associated with weight reduction outcomes: (a) use of self-control techniques, (b) degree of social support, (c) attributional style, and (d) self-reinforcement style. One sample participated in a program in Wisconsin ( n = 22) 1–2 years before assessment, whereas the second sample completed a similar program in Pittsburgh ( n = 17) 3 months prior to assessment. Children and parents were individually interviewed using structured protocols, and children also completed a block design task. Children's self-reinforcement and attributional styles, motivation to change, problem-solving style, family environment, and intellectual skills were assessed. Regression analyses selected a subset of variables which were clearly associated with change in percent overweight and Feinstein indices, computed from pretreatment and from posttreatment to time of assessment. Substantial proportions of outcome variance were accounted for in the Wisconsin sample but not in the Pittsburgh sample. The results suggest that obese children who terminate ineffective problem-solving efforts quickly and who make more adaptive weight reduction attributions may be more likely to succeed in long-term weight reduction. The differential results in the two samples suggest that variables investigated in this study may play a greater role in maintenance than in initial behavior change.

Weight reduction in boys with muscular dystrophy.

Many children with muscular dystrophy are overweight, and although weight control is pursued in some centres it is unusual to encourage severe dietary restriction for fear that it might lead to accelerated loss of muscle. In this study, two overweight boys with muscular dystrophy were monitored by whole-body nitrogen balance, total body potassium, strength and functional measurements during calorie restriction. Both patients were found to have a transient loss of nitrogen on commencing the low calorie intake: thereafter, weight loss was not found to have any deleterious effect on muscle bulk or function in either patient. It is suggested that controlled weight-reduction in obese children with muscular dystrophy is a safe and practical way of losing excess fat, which can improve mobility and self-esteem, and may possibly effect longevity.

Physical development at 7 years of age in relation to velocity of weight gain in infancy with special reference to incidence of overweight.

As a result of a carefully controlled study on obese children, Borjeson (1962) concluded that obesity in childhood is not a problem of physical health, and that although it may be a major psychological problem for some children, in most cases there is no evidence of emotional conflict caused by obesity itself. Nevertheless, most physicians consider obesity in children to be a major health problem calling for preventive and therapeutic action. Besides a wide spread moral attitude towards overconsumption of food as the suspected cause of overweight, this concern gains support from the claim that obesity in adults implies a considerably increased risk of secondary disease and premature death (Kannel et al, 1967) and the fact that very often adult obesity starts in childhood (Mullins, 1958). In the view of physicians responsible for adult care, treatment of obesity should therefore start in childhood. Paedia tricians, however, have all experienced extreme difficulties in endeavours to achieve long-term weight reduction in obese children (Lloyd, Wolff, and Whelen, 1961; Spranger and Dorken, 1967; Lodi, 1970). Therefore the possibility of early preventive action, preferably in infancy, has to be considered seriously. This preventive attitude has been supported by the findings of Knittle and Hirsch (1968) that the number of fat cells in adipose tissue is significantly increased in rats overfed during the first 10 weeks of life. It is not yet known whether human infants behave in the same way as rats in this respect. It has been found in the human species as well as in the rat, however, that the total number of fat cells in adult life cannot be reduced (Bjorntorp and Sjostrom, 1971). In a study on obese children and adults published recently, Brook, Lloyd, and Wolff (1972) showed that the early onset of obesity is associated with an increased number of fat cells. In a longitudinal study in Sheffield, England, Eid (1970) found a significantly increased incidence of overweight and obesity in those children who had gained weight rapidly during the first six months of life, as compared with normally growing infants. However, these results may not be representative for a 'normal' population, since it was shown later by Taitz (1971) that no less than 60% of artificially fed infants from the same region gained weight above the 90th centile of generally accepted British standards. In Sweden the physical life conditions have for a long time been fairly similar for the great majority of infants; the frequency of breast-feeding is generally low, and artificial nutrition has been highly standardized during the last decades. The market for baby food is completely dominated by two manu facturers, whose products are similar and in accord ance with the recommendations of leading paedia tricians. The information about infant nutrition provided by child welfare centres and private paediatricians is uniform throughout the country, and the attendance rate at the well baby clinics approaches 100%. In case of deviations from normal weight development, substantial efforts are made to correct errors in nutrition which may have occurred. The present investigation was started with the aim of finding out how many of the obese children in a representative population of school children started as 'rapidly weight gaining' infants, and how many of such infants in a representative infant population will eventually be obese, if infant nutrition is fairly well controlled by a uniform programme.

COMMITTEE ON NUTRITION

Despite an imposing body of information derived from research, our ignorance concerning the etiology, pathogenesis, and treatment of obesity is remarkable. It is clear that when considering a given patient the terms "overweight" and "obese" are not necessarily synonymous. Evidence derived from various viewpoints suggests that obesity cannot be regarded as an etiologically unique metabolic disorder. It is likely that an excess of adipose tissue in man will ultimately prove to represent a clinical end-point common to a variety of hereditary and acquired disorders, as in the case of experimental animals, rather than a singular morbid condition with unique pathogenesis. The identification and evaluation of the inherited, acquired, metabolic, and psychogenic determinants of obesity still present an urgent challenge for future research. Mortality and morbidity rates for diabetes and cardiovascular disease are higher in obese adults than in those of average weight. These risks appear to be diminished by weight reduction. Because the majority of obese children do tend to remain obese as adults and because our society exerts considerable pressure towards relative leanness as a criterion for social acceptability, early treatment of obesity would seem to be a worthy objective. However, the fact is that no methods of treatment have as yet achieved more than minor success in significant sustained weight reduction. Since the natural history of childhood obesity remains ill-defined, the results of testimonials from inadequately controlled studies with short follow-up periods (less than 2 or 3 years) must be viewed with skepticism. Any attempts to achieve lasting weight reduction in obese children and adolescents should be tempered by a realization of the inherent difficulties of treatment and by sympathy for those children who, for reasons poorly understood by their physicians. lack the ability to regulate the delicate balance between physical activity and caloric intake. It appears that when treatment is directed at only a single element of the thermodynamic equilibrium, caloric intake, the chances of successful and lasting weight reduction are small. Prophylaxis may offer the most logical method for dealing with obesity. Prevention is necessary in high-risk families and should be undertaken by the family physician. The role of public health programs implemented by education may decrease the level of obesity in the remainder of the population. The efficacy of either approach remains to be determined. While there is knowledge of some of the metabolic derangements characteristic of the obese adult, little is known about these in childhood. In view of the apparent hazards of obesity in adult life, the patent failures characteristic of virtually all therapeutic approaches and the scientific void in knowledge of pathogenesis or pathophysiology make the study of obesity a compelling undertaking for the investigator.