Sedentary behaviour as an emerging risk factor for cardiometabolic diseases in children and youth.

Purpose of reviewThe alarming increase in the prevalence of pediatric obesity has led to a rise in associated metabolic complications in worldwide pediatric populations. This review summarizes recent literature on detection, pathophysiology, and potential intervention strategies for the metabolic de

Metabolic complications of obesity in childhood and adolescence: more than just diabetes.

https://www.journal-of-hepatology.eu/article/S0168-8278(07)00176-6/pdf

Pediatric Nonalcoholic Fatty Liver Disease (NAFLD): A "Growing" Problem?

Summary
Objective Childhood obesity is increasingly common and is associated with health problems; in particular, obesity plays a central role in the metabolic syndrome (MS). We estimated the prevalence of MS in Caucasian children and adolescents with varying degrees of obesity.

Patients and methods  We studied 191 obese [body mass index (BMI) > 97th percentile] children and adolescents. Obesity was stratified on the basis of a threshold BMI z-score and subjects were classified as moderately (z-score 2–2·5) or severely obese (z-score > 2·5). Seventy-six, nonobese subjects were recruited into a comparison group. Thirty-one of them were of normal weight (BMI < 75th percentile) and 45 overweight (BMI 75th–97th percentile).

Patients were classified as having MS if they met three or more of the following criteria for age and sex: BMI > 97th percentile, triglyceride levels > 95th percentile, high density lipoprotein (HDL) cholesterol level  95th percentile and impaired glucose tolerance (blood glucose level: 7·8–11·1 mmol/l at 2 h). Insulin resistance was calculated using the homeostasis model assessment for insulin resistance (HOMA-IR) and impaired insulin sensitivity was defined as a HOMA-IR ≥ 2·5 in prepubertal patients and HOMA-IR > 4 in pubertal subjects.

Results  The overall prevalence of MS was 13·9% and was present in 12·0% of moderately obese and 31·1% of severely obese subjects; no overweight or normal weight subjects met the criteria for MS. The rate of the MS increased progressively with increasing BMI categories (P < 0·001). Severely obese patients had a threefold increased risk with respect to moderately obese patients.

Conclusions  The prevalence of the MS is higher in obese as opposed to nonobese subjects and increases with severity of obesity.

Prevalence of metabolic syndrome (MS) in children and adolescents with varying degrees of obesity

Background
Obesity is a one of the most common nutritional disorder worldwide, clearly associated with the metabolic syndrome, condition with implications for the development of many chronic diseases.

In the poorest countries of Latin America, malnourishment is still the most prevalent nutritional problem, but obesity is emerging in alarming rates over the last 10 years without a predictable association with metabolic syndrome.

The objective of our study was to determine the association between insulin-resistance and components of the metabolic syndrome in a group of Bolivian obese children and adolescents. The second objective was determining the relation of acanthosis nigricans and insulin-resistance.

/pdf/prevalence-of-insulin-resistance-and-its-association-with-4vm1jc6n8m.pdf

Prevalence of insulin resistance and its association with metabolic syndrome criteria among Bolivian children and adolescents with obesity.

Summary
Objective To estimate the frequency of the metabolic syndrome (MS) and of the insulin resistance syndrome (IRS) in overweight or obese French children and to determine the risk factors.

Design, patients and methods  A total of 308 overweight and obese children [166 girls, 142 boys, aged 7–17 years; median body mass index (BMI) 4·7 standard deviation (SD) (Q1–Q3: 3·9–5·8) adjusted for age and sex] were included. The frequency of the MS was assessed with the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria and the frequency of the IRS with World Health Organization (WHO) criteria.

Results  The overall frequency of MS and IRS was 15·9% and 42·5%, respectively. The most common component, after abdominal obesity (95·8%) and IR (71·8%), was elevated systolic blood pressure (28·6%). The frequency of glucose tolerance disorders was low (3·6%). The frequency of MS was independently influenced by homeostatic model assessment (HOMA) (P = 0·06) and waist-to-hip ratio (P = 0·09), whereas the frequency of IRS was influenced by adiposity (degree of obesity: P = 0·02; waist-to-hip ratio: P = 0·05), puberty (P = 0·05) and mother's BMI (P = 0·01). Ethnicity had no effect on either MS or IRS.

Conclusions  Metabolic complications and IR are frequent in overweight and obese children whereas the frequency of glucose tolerance disorders is very low. IRS is more prevalent than MS, indicating a major role of IR, which could precede the other metabolic complications in obese children. IRS is a relevant marker for the risk of type 2 diabetes (T2D) and cardiovascular complications in obese European children.

Insulin resistance and the metabolic syndrome in obese French children.

In many parts of the world, overweight and obesity have become increasingly prevalent in children in the past 2 decades. These states are associated with cardiovascular risk factors, and the risk increases with the development of complications such as impaired glucose tolerance, insulin resistance (IR), dyslipidemia, and hypertension. This study was planed to estimate the frequency of the IR syndrome (IRS) and metabolic syndrome (MS) in 65 overweight and 243 obese children and adolescents 7 to 17 years of age. MS was diagnosed using the National Cholesterol Education Program Adult Treatment Panel III criteria and IRS using the World Health Organization criteria. MS was diagnosed in 15.9% of the study group and IRS in 42.5%. More than half the children studied, 54.2%, did not have either IRS or MS. All but 3.6% of children with MS also presented with IRS. Body mass index (BMI) was a significant factor in MS after adjusting for age and gender. Other risk factors for MS included the homeostatic model assessment (HOMA) index and acanthosis nigricans. Children with IRS had significantly higher BMI values, and IRS became more frequent as the waist-to-hip ratio increased. Pubertal children were approximately 1.7-fold more likely than those who were prepubertal to develop IRS. The mother's BMI, but not the father's, significantly influenced the frequency of IRS. On multiple regression analysis, both the HOMA index and waist-to-hip ratio were significant and independent risk factors for MS. Both adiposity (personal and maternal) and puberty correlated positively and significantly with IRS. These findings show that metabolic abnormalities and insulin resistance are frequent in overweight and obese children and adolescents. In this study of obese European children, IRS appeared to be a relevant marker for cardiovascular complications.

Insulin Resistance and the Metabolic Syndrome in Obese French Children

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Insulin resistance and the metabolic syndrome in obese French children.

Insulin Resistance and the Metabolic Syndrome in Obese French Children