Metabolic syndrome and leptin concentrations in obese children

Objective Obesity and its complications including metabolic syndrome has been increased in children and adolescents recently. Leptin is known to play an important role in the pathogenesis of obesity. Methods The objective of this study was to evaluate the relationship of leptin and metabolic syndrome in obese Iranian children. A cross sectional study was carried out in 65 primary schools in Tehran. The children with waist circumferences equal or above 90^th percentile for their height and age were chosen for further evaluations. 505 children aged 7–12 years participated in the study. Anthropometric variables measurements, blood pressure, fasting plasma glucose, triglyceride, high-density lipoprotein cholesterol and serum leptin were obtained from the study sample. Results Serum leptin levels were significantly higher in girls in comparison to the boys (with median 11.0 Vs 8.25 ng/dl; P value =0.007). Serum level of leptin were higher in children with metabolic syndrome (median 11.3 Vs 8.9 ng/dl; P value=0.045). However, after adjustment for sex, this association was removed. Conclusion Leptin did not appear to have a major role in metabolic syndrome, even though it was strongly associated with obesity parameters. More studies evaluating the relationship between leptin and metabolic syndrome in various ethnic groups are recommended.     

Prevalence and risk factors of metabolic syndrome in obese children and adolescents: the role of the severity of obesity

The present study was performed to determine the prevalence of metabolic syndrome (MS) and its risk factors in obese children and adolescents. The study included 352 obese children and adolescents (body mass index [BMI] ≥ 95th percentile) aged between 2 and 19 years. The diagnosis of MS was made according to the criteria adapted from the World Health Organization (WHO) and the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. BMI z-scores were calculated to assess the degree of obesity. The prevalence of MS and risk factors were determined. Determinants of MS were examined using regression analysis. The prevalence of MS was 41.8%. The age at onset of obesity, sedentary life-span, fasting blood levels of glucose, insulin, triglyceride, very-low-density lipoprotein (VLDL) cholesterol, and alanine aminotransferase (ALT) were higher, while levels of high-density lipoprotein (HDL) cholesterol and the number of actively spent hours were lower in cases with MS (p < 0.05). The most important determinant of MS was BMI z-score (r = 0.31, p < 0.0001). A one-point increase in BMI z-score yielded a 2-fold increase in the prevalence of MS. The prevalence of MS increased from 27.6% to 60.7% when the BMI z-score increased from 2.3 to 3.3. The risk of developing MS was 2.6-fold higher in cases with BMI z-score > 3 when compared to those with z-scores between 2 and 3. The results from this study indicate that, although the correlation between MS and the BMI z-score was weak, the BMI z-score may be an effective parameter in identifying obese children and adolescents at risk for MS. Screening the cases with BMI z-scores ≥ 2 for MS is important for establishing an early diagnosis.     

儿童代谢综合征尿酸变化及其与心血管危险因素的关系

目的 探讨肥胖代谢综合征儿童血清尿酸(SUA)水平与心血管疾病危险因素之间的相关性.方法 肥胖儿童157例,代谢综合征(MS)77例,非代谢综合征(非MS)80例.分析两组患儿人体测量参数、血尿酸、血脂、血糖及胰岛素等指标间差异,观察SUA与人体测量参数、血压、糖脂代谢紊乱的相关性,并对影响SUA水平的指标进行多元逐步回归分析.结果 MS组血尿酸、腰围、血压、三酰甘油(TG)均高于非MS组,高密度脂蛋白胆固醇(HDL-C)低于非MS组(P<0.05).Spearman相关分析提示SUA水平与体质指数、腰围、腰围身高比、舒张压、收缩压、空腹胰岛素水平、胰岛素抵抗指数(HOMA-IR)、TG及患儿已表现出的MS组分个数呈正相关(P<0.05);与HOMA-IS及HDL-C呈负相关(P<0.05).结论 MS儿童除血压、血脂、血糖异常,也伴有嘌呤代谢紊乱.腰围、TC、舒张压、HDL-C为SUA水平的重要影响指标.高尿酸血症与中心性肥胖、高血压、高血脂关系密切.SUA水平增高可能成为心血管疾病的一个重要的危险因素,参与心血管相关疾病的发生、发展过程.     

Psoriasis and metabolic and cardiovascular comorbidities in children: A systematic review

Introduction

Psoriasis is associated with a higher risk of cardiovascular and/or metabolic comorbidity in adults, but discordant data have been reported in children.

Urinary sodium excretion: Association with hyperinsulinaemia,hypertension and sympathetic nervous system activity in obese and control children

The aim of the present study was to evaluate the association between 24 h urinary excretion of sodium and blood pressure, fasting plasma insulin, renin, aldosterone and serum norepinephrine concentrations in 45 obese and 15 control children. Urinary sodium excretion was significantly lower in obese subjects (1.3 ± 0.6 mmol/kg/24 h, P < 0.01) than in controls (2.8 ± 1.3 mmol/kg/24 h). Hyperinsulinaemia did not affect sodium excretion of obese children. Plasma renin and aldosterone levels did not correlate with sodium excretion and were significantly higher in overweight children. Serum norepinephrine levels were also significantly higher in the obese group (0.66 ± 0.89 μg/100 ml) as compared to the controls (0.11 ± 0.03 μg/100 ml, P < 0.01) and showed significant negative correlation with urinary sodium excretion (r = 0.43, P < 0.05). Conclusion Hyperinsulinaemia and the consequently increased sympathetic nervous system activity might be involved in the development of high blood pressure in obese children by decreasing urinary sodium excretion. Received: 17 January 1995 Accepted: 28 March 1996     

Prevalence of the metabolic syndrome in secondary school adolescents in Beijing, China

AIM: To estimate the prevalence and distribution of the metabolic syndrome and to determine the risk factors associated with the metabolic syndrome in secondary school adolescents. METHODS: In 2006, we conducted a school-based survey in Beijing, China. Questionnaire data, anthropometric, blood pressure, and biochemical measurements were available for 2020 adolescents aged 14-16 years. The metabolic syndrome was assessed using the National Cholesterol Education Program's (NCEP) Adult Treatment Panel (ATP) criteria modified for age. RESULTS: The overall prevalence of the metabolic syndrome among adolescents was 3.3%. In Beijing, 4.2% of boys and 2.5% of girls were affected (p<0.05). The syndrome was present in 28.1% of obese adolescents compared with 6.0% of overweight and 0.2% of normal status (p<0.001). Abdominal obesity and elevated blood pressure were the most common components of the metabolic syndrome in boys, and elevated triglyceride (TG) and abdominal obesity were the most common in girls. The prevalence of the metabolic syndrome was influenced by body mass index (BMI) status, father's educational degree and pubertal development. CONCLUSION: The metabolic syndrome and its components are frequent in overweight and obese adolescents in Beijing. Early identification and treatment of these risk factors may help target intervention to improve future cardiovascular health.     

儿童癌症远期生存与代谢综合征

随着全球医疗技术的快速发展,儿童癌症的临床诊治及研究取得了长足进步。儿童癌症生存率大幅提高,儿童癌症幸存者的生活质量开始受到重视。大量研究报道儿童癌症幸存者远期代谢综合征发病率高,特别是经颅照射腹部照射或者全身照射的患儿发生代谢综合征的风险更高。代谢综合征是多种代谢异常同时聚集在同一个体的病理状态,显著增加心血管疾病风险。儿童癌症幸存者远期代谢综合征的发病机制尚未阐明,但已明确与抗癌治疗后激素缺乏、药物或放射治疗损害、内皮功能紊乱等因素密切相关。因此,重视儿童癌症幸存者代谢综合征的早期诊断、早期防治,鼓励癌症幸存者改善饮食习惯和增加运动达到理想的体重,以降低代谢综合征、心血管疾病的发病率具有重要的临床意义。     

Prevalence of the metabolic syndrome in elementary school children

AIM: To determine the prevalence of the metabolic syndrome (MS) and its related components in elementary-aged school children. METHODS: Three hundred and seventy-five 7-9-y-old boys (n=182) and girls (n=193) in the eastern Kansas area served as participants. Criteria for the MS were the presence of three or more of the following components: 1) central obesity (waist circumference>or=90th percentile in males and females); 2) elevated triglyceride concentrations (>or=1.13 mmol/l); 3) low HDL-C concentrations (or=90th percentile, age and gender specific); or 5) elevated fasting glucose levels (>or=6.10 mmol/l). RESULTS: The prevalence of the MS in this sample was 5%, and was similar across gender and race. Fifty percent of the children had no components and 15% had at least two components, with elevated blood pressure the most common component (37%). CONCLUSION: The MS is prevalent even in young children at rates similarly reported in adolescents.     

肥胖儿童代谢综合征代谢紊乱与血清高敏C反应蛋白关系探讨

目的研究对肥胖儿童人群中代谢综合征(MS)与血清高敏C-反应蛋白(hs-CRP)之间的关系,探讨hs-CRP在MS发病机制中的作用及在MS诊断、评价中的可能。方法选取2006年6月至2008年3月在天津医科大学总医院儿科门诊确诊的肥胖儿童109例,根据腰围、血压、血脂及糖耐量指标将患儿分为MS组非MS组,进行人体参数测量并收集临床基本资料,测定hs-CRP、血脂,进行口服糖耐量试验和胰岛素释放试验。对上述资料进行统计学分析。结果血清hs-CRP水平MS组高于非MS组(P<0.05);Sperman相关分析提示hs-CRP水平与体重指数(BMI)、腰围、腰围/身高比值(WHtR)、非酒精性脂肪肝情况、胰岛素抵抗指数(HOMA-IR)及MS组分数呈正相关(P<0.05),与血浆HDL-C水平呈负相关(P<0.05)。回归分析表明WHtR(OR=2.708,P<0.05)、BMI(OR=1.169,P<0.05)及腰围(OR=1.145,P<0.05)为hs-CRP水平的显著影响因素。结论提示慢性炎症反应和胰岛素抵抗可能共同参与MS的发病及进展过程,血清hs-CRP水平可作为预计和评价儿童MS的有效指标之一。     

Medical care of obese children and adolescents

So far in Europe, no studies have been published on the structuring of medical care for obese children and adolescents. Besides anthropometric parameters, evaluations of the cardiovascular risk factors hypertension, dyslipidaemia, impaired glucose metabolism and treatment modalities were documented in a standardised multicentre evaluation survey (APV) of 18 primarily outpatient and nine rehabilitation institutions. In total, 3837 children (aged 2–20 years) took part in the years 2000 up to March 2003, of whom 1985 were treated in outpatient institutions and 1852 in rehabilitation institutions. Of these children, 10% were overweight, 37% obese, 49% extremely obese and 4% of normal weight at initial presentation. The frequencies of diagnostic procedures performed and documented were low (measurement of blood pressure 43%, lipids 40%, glucose metabolism 21%). In the subgroup of obese children who were screened for cardiovascular risk factors, 23% suffered from hypertension, 11% displayed increased cholesterol, 9% increased low-density lipoprotein-cholesterol, 29% increased triglycerides, 11% decreased high-density lipoprotein-cholesterol and 6% had impaired glucose metabolism. Conclusion: despite the high prevalence of cardiovascular risk factors in obese children and adolescents confirmed in this report, diagnostic procedures failed in a considerable percentage even in specialised treatment centres for obese children and adolescents. In future, the feedback based on standardised evaluation of diagnostic and treatment procedures should aim to improve the quality of medical care.Abbreviations BMI body mass index - HDL high-density lipoprotein - LDL low-density lipoprotein - SDS standard deviation scoreOn behalf of the APV Study Group, Department of Paediatrics, University of Ulm, Germany     

The metabolic syndrome in children and adolescents

The metabolic syndrome is a constellation of metabolic abnormalities that result in an increased risk for type 2 diabetes mellitus and cardiovascular disease in adults. It emerges when a person’s predisposition for insulin resistance is worsened by increasing central obesity and is largely confined to the overweight population. The United States National Cholesterol Education Program’s Adult Treatment Panel III report proposed a set of criteria for the clinical diagnosis of metabolic syndrome in the adult population. A uniform definition for the paediatric population is lacking. Despite this, several studies have demonstrated that features of the syndrome develop in childhood and that the syndrome is present in up to 30% of obese children (body mass index at or above the 95th percentile). Ninety per cent of obese children meet at least one of the five criteria. The degree of abnormality is related to the body mass index, waist circumference and fasting insulin levels. There appears to be a genetic predisposition to the development of the syndrome and certain ethnic groups are at increased risk. The intrauterine environment also appears to play a role. Insulin resistance should be targeted for treatment through exercise and dietary intervention. The role of pharmacotherapeutic agents remains unclear. A uniform definition of the metabolic syndrome for paediatric patients needs to be created. Early intervention should be instituted because many of the features of the syndrome track from childhood into adulthood.     

The triglyceride/HDL-cholesterol ratio as a marker of cardiovascular risk in obese children; association with traditional and emergent risk factors

Objectives: To determine the presence of traditional and emergent cardiovascular risk factors and to evaluate the triglyceride/high‐density lipoprotein cholesterol (Tg/HDL‐C) ratio as a marker for cardiovascular disease and metabolic syndrome (MS) in obese children. Material and methods: Sixty‐seven prepubertal children of both sexes, between the ages of 6 and 12 yr, 20 normal‐weight children, 18 overweight, and 29 obese subjects, were studied. Anthropometric measures, blood pressure, body mass index (BMI), and fat mass (FM), were measured. Plasma glucose, serum insulin, lipid profile, C‐reactive protein (CRP), and leptin concentrations were quantified. Glucose and insulin concentrations 2 h post‐glucose load were determined. The Tg/HDL‐C ratio, homeostasis model assessment index (HOMA), and quantitative insulin sensitivity check index (QUICKI) were calculated. Results: Systolic, diastolic, and mean blood pressures (MBP), low‐density lipoprotein cholesterol (LDL‐C), Tg/HDL‐C, total cholesterol/HDL‐C, LDL‐C/HDL‐C ratios, basal and 2 h postload insulin, CRP, and leptin were significantly higher and the QUICKI index were lower in the obese group. MBP, Tg/HDL‐C ratio, HOMA, CRP, and leptin levels showed a positive and significant correlation and QUICKI a negative correlation with abdominal circumference, BMI, and FM. The Tg/HDL‐C ratio correlated positively with MBP. The frequency of MS in the obese group was 69%. While Tg/HDL‐C ratio, CRP, and leptin were higher and the values of QUICKI were lower in subjects with MS, it was the Tg/HDL‐C ratio and the BMI that significantly explained the MS. Conclusions: Obesity increases the cardiovascular risk in childhood. The Tg/HDL‐C ratio could be a useful index in identifying children at risk for dyslipidemia, hypertension, and MS.     

血脂紊乱在儿童青少年代谢综合征中的意义

代谢综合征是一种涉及多种代谢异常、与心血管疾病紧密联系的疾病状态.我国和美国儿科学会新定义的儿童青少年代谢综合征血脂紊乱主要为高甘油三酯、高非高密度脂蛋白胆固醇和低高密度脂蛋白胆固醇血症.研究证实,儿童期血脂紊乱在成年期疾病如动脉粥样硬化、高血压的发生发展中起重要作用,与代谢综合征、胰岛素抵抗和高血糖的发生亦密切相关.该文就血脂紊乱在儿童青少年代谢综合征中的地位及作用的进展作一综述.     

肥胖儿童非酒精性脂肪肝病及代谢综合征发病情况分析

目的 研究肥胖儿童中非酒精性脂肪肝病(NAFLD)与代谢综合征(MS)的发生情况,并探索两者之间的关系.方法 对308例在本院内分泌科住院的9～14岁肥胖儿童进行腰围、体块指数、血脂、肝功能、肝脏B超、糖耐量试验及胰岛素释放试验等各项检查,根据诊断标准分别计算发生NAFLD[包括单纯性非酒精性脂肪肝(SNAFL)、非酒精性脂肪肝炎(NASH)]和MS的患病率,并将308例肥胖患儿分为无肝脏损害的肥胖儿童组(OCWLD组),SNAFL组和NASH组,比较各组胰岛素、胰岛素抵抗(IR)指标及MS的发病率和MS组成成分的发病率.结果 (1)308例中发生NAFLD的达到203例(65.9%),其中发生SNAFL者140例(45.5%),发生NASH者63例(20.5%).(2)308例中发生MS 76例(24.7%),这76例中合并有NAFLD的64例(84.2%).NAFLD组中MS 64例(31.5%),高于OCWLD组的12例(11.4%),差异有统计学意义,但SNAFL组中MS 41例(29.3%),与NASH组的23例(36.5%)比较差异无统计学意义.(3)就单个MS的组成成分来说,OCWLD组与SNALF组比较仅在高血压的发病率上差异有统计学意义,而OCWLD组与NASH组比较在高血压、高血脂、高血糖的发病率上差异均有统计学意义;SNALF组与NASH组比较在高血脂的发病率上差异有统计学意义.随OCWLD向SNAFL和NASH发展,空腹胰岛素水平逐渐上升,IR也越加明显.但NAFLD患儿与MS患儿比较各IR指标差异无统计学意义.结论 肥胖儿童中NAFLD和MS的发生率均已相当高,MS患儿合并NAFLD的比例很高,IR是NAFLD和MS共同的发病基础,且随着NAFLD患儿病情的进展,MS成分指标越来越严重,IR也越来越严重.     

Ethnicity and comorbidities in an overweight and obese multiethnic childhood cohort in Berlin

Aim: This study aims to analyse the association between ethnicity, elevated metabolic parameters and metabolic syndrome (MS) in a multiethnic cohort of overweight to obese children and adolescents. Methods: For 1053 patients, standard deviation of body mass index (BMI‐SDS) was calculated and metabolic parameters (fasting blood glucose, fasting insulin, homeostasis model assessment‐IR, lipids, blood pressure) were measured. MS was defined by WHO criteria. Bivariate and multivariate analyses were performed. Adjusted differences in BMI‐SDS and metabolic parameters between different migration groups were assessed with linear regression models. The risk for MS was calculated with multiple logistic regression models. Results: Forty‐eight per cent of the children were German, 25% Turkish and 27% had another ethnicity. Concerning weight status, 23% are overweight, 31% obese and 46% extremely obese with higher rates among the immigrant population. Multivariable models indicate significant associations between elevated metabolic parameters and higher BMI‐SDS values. Overall prevalence of MS was 32.3%. MS was detected significantly more often among Turkish patients (40.4%) compared to Germans (27.3%; p = 0.02). Logistic regression analysis showed a greater risk for MS with older age (OR = 1.09; p = 0.003) and Turkish ethnicity (OR = 1.62; p = 0.02). Conclusion: Nearly all patients had symptoms of MS, and 40% had MS showing that this highly health‐threatening condition is quite common. Therefore, effective therapy and prevention efforts must be developed for this high risk group. More migration‐specific research regarding insulin resistance, MS and Type 2 DM is needed.     

Early cerebrovascular disease in a 2-year-old with extreme obesity and complete metabolic syndrome due to feeding of excessively high amounts of energy

A 2-year-old morbidly obese boy presented with early manifestation of vascular disease associated with several obesity-related features of the metabolic syndrome due to massive overfeeding. Ultrasound of the carotid arteries showed significant thickening of the intima media, perfusion magnetic resonance spectroscopy indicated cerebral microcirculation disturbance, and echocardiography revealed left ventricular hypertrophy. Thorough assessment of morbidly obese children seems to be of importance from early childhood on. Studies evaluating the prevalence of obesity-related metabolic and vascular comorbidities in very young morbidly obese children are warranted.     

Obesity and associated cardiovascular risk factors in Iranian children: A cross-sectional study

BACKGROUND: Obesity is a growing public health problem in developing countries considering its association with cardiovascular risk factors. Relationship between childhood obesity and these risk factors has not been attested in the Iranian population before. The aim of the present study was to investigate frequency of cardiovascular risk factors and their association with severity of obesity in a sample of Iranian obese children. METHODS: A total of 13 086 children aged 7-12 years were screened and those with waist circumference = 90th percentile of their age were invited for further evaluations. Participants were divided into two groups of overweight or obese according to International Obesity Task Force criteria. Cardiovascular risk factors were defined as high fasting total cholesterol, high low density lipoprotein, low high density lipoprotein, high triglycerides, and systolic or diastolic hypertension. These factors were compared between obese and overweight children and their correlations with body mass index and other measures of obesity were tested. RESULTS: Of 532 children (274 boys, mean age 9.5 +/- 1.3) enrolled in the study, 194 were overweight and 338 were obese. Mean levels of triglyceride and Apo-lipoprotein B in obese children were significantly higher than overweight participants. A total of 81.9% of obese children and 75.4% of overweight children had at least one cardiovascular risk factor. There were significant correlations between body mass index and systolic blood pressure, diastolic blood pressure, serum triglyceride, and Apo-lipoprotein B levels (P values <0.01). CONCLUSION: The high prevalence of cardiovascular risk factors in overweight and obese children and positive correlation of these factors with severity of obesity emphasizes the need for prevention and control of childhood obesity from early stages.     

Metabolic syndrome in obese children born large for gestational age

Objective This study was to compare the prevalence of metabolic syndrome (MS) and insulin release in Chinese obese children born large-for-gestational age (LGA) with those born appropriate-for-gestational age (AGA). Methods Obese children were divided into LGA group (n = 60) and AGA group (n = 312); clinical and metabolic characteristics were collected. An oral glucose tolerance test was performed to detect glucose and insulin concentration at 0, 30, 60, 90, and 120 min. Differences between parameters were compared in the two groups and MS was determined. Results The age of adiposity rebound (AR) was earlier and the period from AR to hospitalization was longer in LGA group than AGA group (4.58 ± 3.35 years vs 5.64 ± 3.08 yr, p=0.016 and 5.87 ± 2.85 yr, vs 4.98 ± 2.7 yr, p=0.02). There were no differences in β-cell function, insulin resistance, insulin sensitivity and Disposition index between the two groups. Fasting insulin (FINS) and area under curve of insulin (AUCI) showed differences between two groups. The prevalence of MS was 65% for LGA group, which was significantly higher than AGA group (42.3%). LGA status increased the risk of MS with hazard ratios of 2.53 [95% confidence intervals (CI): 1.42–4.51]. Timing of AR showed significant negative correlation with hypertriglyceridemia (r = −0.497, P = 0.01). Multiple logistic regression analysis identified age at AR as an independent factor associated with blood triglyceride level. The prevalence of hypertension and hypertriglyceridemia was independently associated with LGA [adjusted odds ratios (95% CI) 2.41 (1.39–4.36), P = 0.003; 2.18(1.21–3.72), P = 0.016]. Conclusions There was a younger trend in age of AR in obese children born LGA. The prevalence of MS was particularly higher in obese pediatric populations born LGA. Hypertension and hypertriglyceridemia were better components for diagnosis of MS in obese children.     

Metabolic disturbances and cardiovascular risk factors in obese children with vitamin D deficiency

ObjectivesThe prevalence of obesity among children and adolescents has been rapidly increasing in recent years. Obese individuals are at risk of vitamin D deficiency. The aim of this study was to investigate the relationship between vitamin D deficiency and anthropometric measurements, cardiovascular risk factors, and glucose homeostasis in obese children.MethodsBetween June 2011 and January 2012, 40 obese and 30 non-obese children (between 7 and 14 years of age) were evaluated at Tepecik Training and Research Hospital. The following characteristics were recorded: height; weight; body mass index (BMI); total body fat content; fasting glucose, insulin, and lipid levels; basic biochemical parameters; complete blood count; bilateral carotid intima media thickness; liver ultrasound results; and left ventricular wall thickness were recorded. 25-hydroxy (OH) vitamin D levels were measured from serum.ResultsThe serum 25(OH) vitamin D level was low in 45 children (64.3%). The 24-h ambulatory blood pressure measurements, carotid intima-media thickness, and the prevalence of 25(OH) vitamin D deficiency were different between obese and non-obese children (P < 0.05). The incidence of dyslipidemia was not statistically different between obese and non-obese children (P > 0.05). Plasma 25(OH) vitamin D concentrations were negatively correlated with age, BMI, total body fat content, 24-h ambulatory blood pressure, and carotid intima-media thickness (P < 0.05). Plasma 25(OH) vitamin D levels were not correlated with fasting plasma glucose, HOMA-IR, triglycerides, total cholesterol, low-density cholesterol, and high-density cholesterol (P > 0.05).ConclusionVitamin D deficiency is more prevalent in obese children. Serum 25(OH)vitamin D was significantly associated with several cardiometabolic risk factors. There was no relationship between abnormal glucose homeostasis and dyslipidemia with vitamin D deficiency in obese children.