Association between school children's overweight and maternal obesity and perception of their children's weight status

AIM: To determine the association between overweight children and a) other components of the mothers' metabolic syndrome, such as body mass index (BMI), waist circumference (WC), HDL-cholesterol, triglycerides, glucose, HOMA-IR, blood pressure (BP), and age; and b) the mothers' perception of their children's overweight. METHODS: Six hundred and twenty children (297 M) aged 9 +/- 2 years and their mothers aged 37.7 +/- 7 years were examined between April and August 2006. BMI, BP, fasting glucose and lipids and children's Tanner stage were determined. Questionnaires were filled in about the mothers' perceptions of their children's eating habits and of their children's shape. RESULTS: Ninety-five (17.4%) of the children were obese (> 95th percentile), 108 (15.3%) overweight (> 85th percentile) and 418 (67.3%) normal. One hundred and twelve (18%) of the mothers were obese and 183 (29.5%) overweight. Mean values for measures in mothers differed between normal vs overweight/obese children: z-BMI (-0.19 vs 0.42), triglycerides (84 vs 105 mg/dl), cholesterol (147 vs 157 mg/dl), glucose (78 vs 82 mg/dl) and insulin resistance (HOMA-IR 1.34 vs 1.72). There were significant differences in the proportion with distorted perception of shape (2.2% vs 47.5%) and eating habits (11.2% vs 37%) between mothers of normal versus overweight/ obese children. Logistic regression analysis using BMI > or = 85th percentile as the dependent variable showed that the mothers' perceptions of their children's shape (OR: 18.84; 95% CI: 5.0-69.6), eating habits (OR: 3.82; 95% CI: 1.5-9.5) and mothers' BMI (OR: 2.1; 95% CI: 1.3-3.4) were associated with children's overweight. CONCLUSIONS: There was an association between mothers' distorted perception of their children's shape and eating habits and mothers' obesity and their children's overweight. This observation provides clues for obesity prevention programs.     

Fatty liver in obese children: prevalence and correlation with anthropometric measurements and hyperlipidemia

The aim of this study was to evaluate the correlation of ultrasonography-proven fatty liver with liver functions, serum lipid levels and anthropometric measurements in children with exogenous obesity. Three hundred and twenty-two patients (183 girls, 56.8%) with a mean age of 11.4+/-3.2 years (4-18 years) who presented with the complaint of obesity were enrolled. In 38 (11.8%) patients, increased liver echogenicity resembling fatty liver was found (Group 1). The body mass index percentages of group 1 patients were significantly higher than of those without fatty liver (Group 2) (157.7+/-18.0 vs 151.3+/-17.8, p=0.038). Alanine and aspartate aminotransferase levels of group 1 patients were significantly higher than of group 2 (p=0.002 vs p=0.028, respectively). Triglyceride levels were significantly higher in group 1 patients (120.8+/-88.8 vs 100.5+/-58.5 mg/dl, p=0.044). In conclusion, ultrasonography is an easy and noninvasive method for the diagnosis of fatty liver in children with obesity. Body mass index and serum lipids were higher in group 1 patients. The diagnosis and early treatment of obesity in childhood is important for the prevention and better treatment of related complications. Thus, ultrasonography should be a part of the early evaluation of obese children.     

Postprandial hyperlipidemia after a fat loading test in minority adolescents with type 2 diabetes mellitus and obesity

The continuing increase in the incidence of type 2 diabetes mellitus (DM2) and obesity in children and adolescents is attributable to excessive caloric intake. Abnormal lipid metabolism in the postprandial state leads to long exposure of the vasculature to hyperlipidemia. Most children and adolescents with DM2 are obese, and many have fasting hypertriglyceridemia. Clustering of hyperlipidemia, DM2 and obesity increases the risk for cardiovascular disease. We therefore studied lipids, insulin, C-peptide, and glucose in response to an oral fat load simulating the fat content of a high-fat, fast-food meal in 12 type 2 diabetic obese, 15 non-diabetic obese, and 12 non-diabetic non-obese (control) adolescents (aged 10-19 yr; 87% African-Americans). All three groups were age-, sex-, and sexual maturation-matched. Mean body mass indices were similar in the diabetes and obese groups (32.7 +/- 1.1 vs 35.8 +/- 1.6 kg/m2). All patients with DM2 had fasting C-peptide > 0.2 nmol/l (0.7 ng/ml) and negative diabetes-associated autoantibodies. Serum total cholesterol, triglyceride, high- and low-density lipoprotein cholesterol, insulin, C-peptide, and plasma glucose levels were measured at 0, 2, 4, and 6 h after the fat load. The area under the curve (AUC) was calculated by trapezoidal estimation. Triglyceride AUC was significantly greater in the diabetes group than in the other two groups (15.7 +/- 2.9 vs 9.2 +/- 0.7 and 7.5 +/- 0.7 mmol x h/l [1389 +/- 258 vs 819 +/- 60 and 663 +/- 62 mg x h/dl]; p < 0.02 and <0.004, respectively), as were insulin, C-peptide, and glucose AUCs. Incremental triglyceride response (delta triglyceride = peak - fasting) in the diabetes group was significantly higher than that in the control group (2.1 +/- 0.7 vs 0.8 +/- 0.1 mmol/l 189.7 +/- 58.4 vs 71.2 +/- 11.1 mg/dl]; p < 0.04). Insulin resistance was estimated using the homeostasis model assessment (HOMA), which was greater in the diabetes group than in the obese and control groups (14.4 +/- 2.8 vs 5.2 +/- 0.8 and 3.2 +/- 0.4; p < 0.001 and < 0.0001, respectively). The diabetes group was divided into subgroups of high and normal fasting triglycerides on the basis of triglyceride levels above and below the 95th percentile. The delta triglyceride in the subgroup with high fasting triglycerides was substantially greater than in the subgroup with normal fasting triglycerides (3.4 +/- 1.1 vs 0.8 +/- 0.2 mmol/l [305.2 +/- 96.8 vs 74.2 +/- 18.0 mg/dl]; p < 0.001). Total cholesterol and triglyceride AUCs were much greater in the high vs normal fasting triglycerides subgroup (33.0 +/- 2.9 vs 24.2 +/- 1.9 and 23.6 +/- 3.5 vs 7.8 +/- 0.6 mmol x h/l [1274 +/- 113 vs 934 +/- 72 and 2085 +/- 309 vs 692 +/- 49 mg x h/dl]; p < 0.02 and <0.0001, respectively), as were insulin and C-peptide AUCs. HOMA was greater in the high vs normal fasting triglycerides subgroup (20.8 +/- 4.0 vs 8.0 +/- 1.6; p < 0.0001). In addition to elevated plasma glucose levels, there were no significant differences in either insulin or lipid parameters among the diabetes subgroup with normal fasting triglycerides, the obese group, and controls. Our data suggest that postprandial hyperlipidemia in response to a fat loading test is present in adolescents with DM2 who already have fasting hypertriglyceridemia. The degree of insulin resistance as an underlying abnormality--not DM per se--determines the degree of postprandial lipemia.     

单纯性肥胖儿童外周血单核细胞载脂蛋白E基因的表达

目的　探讨单纯性肥胖儿童外周血单核细胞载脂蛋白E基因表达及其与血脂、脂蛋白、载脂蛋白的相关关系。方法　采用竞争性逆转录 聚合酶链式反应方法分析 3 2例单纯性肥胖儿童和 3 2例正常健康儿童外周血单核细胞的载脂蛋白E基因表达。结果　载脂蛋白E基因能在儿童外周血单核细胞表达 ,与健康儿童比较 ,单纯性肥胖儿童外周血单核细胞载脂蛋白E基因表达水平显著下调 (P <0 0 1) ,重度肥胖儿童尤其明显 ,载脂蛋白E基因表达水平与肥胖度呈负相关 (P <0 0 5)。肥胖儿童存在明显的血脂代谢紊乱 ,载脂蛋白E基因表达水平与低密度脂蛋白 胆固醇呈负相关 ,与血载脂蛋白E浓度呈正相关 (P <0 0 5) ,与血总胆固醇、甘油三酯、高密度脂蛋白 胆固醇、脂蛋白 (a)、载脂蛋白AⅠ水平无明显相关 (P >0 0 5)。结论　单纯性肥胖儿童外周血单核细胞载脂蛋白E基因表达水平明显下调 ,并与肥胖程度及血脂代谢异常相关联 ,提示载脂蛋白E基因表达变化可能与肥胖的发生发展及肥胖的心血管病变相关联     

北京市超重和肥胖学龄儿童中代谢综合征的流行特征

目的了解北京市6—18岁超重、肥胖儿童青少年中代谢综合征（MS）的流行现状和临床表型特征;比较美国国家胆固醇教育计划和国际糖尿病联盟定义的标准诊断儿童青少年MS的差异。方法以2004年北京儿童青少年MS调查中筛查出的超重和肥胖儿童为研究对象,并选取一组正常体重儿童为对照组,检测空腹血浆葡萄糖和胰岛素、血清甘油三酯和高密度脂蛋白胆固醇水平,采用稳态模式评估法计算胰岛素抵抗指数。符合以下5项指标中3项及以上者为MS：腹型肥胖（腰围≥P90）、高血压（≥P90）、低高密度脂蛋白胆固醇[〈1．03mmol／L（40mg／dl）]、高甘油三酯[≥1．24mmol／L（110mg／dl）]和空腹血糖升高[≥5．6mmol／L（100mg／dl）]。结果（1）采用美国国家胆固醇教育计划定义,MS检出率分别为,对照组0．9％,超重组7．6％,肥胖组29．8％,高于国际糖尿病联盟定义的检出率（0．1％,5．2％,28．6％）;两定义标准诊断的MS检出率均呈现随体重指数升高而增加的趋势（趋势检验,P〈0．001）;（2）肥胖儿童中MS单项异常检出率依次为：腹型肥胖81．6％,高血压47．7％,高甘油三酯35．6％,低高密度脂蛋白胆固醇16．9％,高空腹血糖13．4％;超过四分之一的超重儿童具有高血压（29．8％）、腹型肥胖（27．4％）和高甘油三酯（26．0％）;随体重指数增加,MS指标多项异常者和胰岛素抵抗者呈增加趋势（P〈0．001）。结论北京市肥胖儿童青少年中MS已呈现严重流行趋势;腹型肥胖、高血压、高甘油三酯是超重肥胖儿童最常见的代谢异常。采用美国国家胆固醇教育计划定义的儿童MS检出率高于国际糖尿病联盟定义的检出率。     

A cross-sectional study of dietary habits and lipid profiles. The Rivas-Vaciamadrid study

The relations between dietary habits and serum lipids have been firmly established in adults. In children, this relation has been less extensively studied. We have assessed the relations between dietary components, including the different types of fatty acids (saturated, polyunsaturated and monounsaturated) and serum lipids and apolipoproteins in a group of 673 6-year-old children of the town of Rivas-Vaciamadrid, Spain. Children in the highest tertile of total fat consumption, when compared with children in the lowest tertile, had higher mean levels of total cholesterol (188.3 mg/dl vs. 146.8 mg/dl), triglycerides (56.7 mg/dl vs. 51.3 mg/dl), LDL cholesterol (120.7 mg/dl vs. 92.6 mg/dl), HDL cholesterol (56.2 mg/dl vs. 54.5 mg/dl) and apolipoprotein B (86.8 mg/dl vs. 62.9 mg/dl). When compared with children in the lowest tertile, children in the highest tertile of saturated fat consumption had significantly higher mean levels of total cholesterol (206.3 mg/dl vs. 151.8 mg/dl), LDL cholesterol (140.6 mg/dl vs. 95.1 mg/dl) and apolipoprotein B (99.2 mg/dl vs. 64.3 mg/dl) and lower mean levels of HDL cholesterol (53.5 mg/dl vs. 57.5 mg/dl), whereas children in the highest tertile of monounsaturated fat consumption had significantly higher mean levels of HDL cholesterol (56.5 mg/dl vs. 51.8 mg/dl) and lower levels of total cholesterol (133.2 mg/dl vs. 201.6 mg/dl), LDL cholesterol (93.1 mg/dl vs. 137.5 mg/dl) and apolipoprotein B (68.6 mg/dl vs. 94.9 mg/dl) than children in the lowest tertile. No statistically significant relation between polyunsaturated fat and lipid levels was found. We have found a strong association between diet composition and lipid and apolipoprotein levels in 6-year-old children. Our findings strengthen the role of monounsaturated fatty acid consumption as a part of a healthy diet in childhood.     

单纯性肥胖儿童血脂类、内皮素、糖耐量变化的意义

目的研究不同程度单纯性肥胖儿童血总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、内皮素(ET)及糖耐量变化。方法选择单纯性肥胖儿童436例,其中轻度单纯肥胖242例、中度单纯肥胖138例、重度单纯肥胖56例。对照组儿童80例。检测各组儿童血TC、TG、LDL、ET、糖耐量。结果单纯肥胖患儿血TC、TG、LDL、ET明显高于对照组,各项之间均有显著性差异,且增高程度与体质量呈正相关;重度单纯肥胖患儿中4例糖耐量异常,对照组无异常。结论单纯性肥胖儿童血脂类和ET表达水平均有增高,个别重度肥胖患儿有糖耐量下降情况,应对单纯性肥胖儿童进行早期干预。     

瘦素/脂联素值与肥胖儿童体质量指数及糖脂代谢的关系

目的 探讨瘦素/脂联素(L/A)值与单纯性肥胖儿童体质量指数(BMI)、糖脂代谢及肥胖症发病的关系.方法 单纯性肥胖60例和57例健康儿童,采用放射免疫分析(RIA)法测定其血清瘦素水平;ELISA法测定其血清脂联素、空腹胰岛素(FINS)水平;免疫比浊法测定其血脂各成分.分析并比较血清瘦素、脂联素及L/A值与肥胖儿童BMI、糖脂代谢的相关性.结果 1.肥胖儿童血清瘦素、FINS和三酰甘油(TG)水平与健康对照组相比明显增加;脂联素水平降低,差异均有显著性(Pa＜0.05,0.01).2.单纯性肥胖儿童瘦素与BMI、FINS、TG水平均呈显著正相关(r=0.408,0.301,0.301 Pa＜0.05,＜0.01);脂联素水平与BMI、FINS、TG均呈显著负相关(r=-0.360,-0.413,-0.258 Pa＜0.01,＜0.05).3.L/A值与BMI、FINS、TG呈显著正相关(r=0.780,0.764,0.601 Pa＜0.001).结论 血清瘦素和脂联素与肥胖儿童的发病有关,可作为儿童肥胖的监控指标;L/A值较单独瘦素、脂联素更能反映肥胖症儿童的代谢状况,可为肥胖症儿童糖脂代谢提供更为有效的监测指标.     

瘦素抵抗及其受体基因变异对单纯性肥胖患儿脂代谢的影响

目的探讨瘦素受体(LEPR)基因外显子突变与瘦素抵抗对单纯性肥胖患儿脂代谢的影响。方法选取6～14岁单纯性肥胖患儿102例(肥胖组)及非肥胖儿童83例(对照组)为研究对象,空腹12 h后抽取2组儿童外周静脉血,常规抽提基因DNA,用PCR限制性片断长度多态性及聚丙烯酰胺凝胶电泳法对2组儿童LEPR基因的第20外显子基因变异频率进行分析,采用放射性免疫分析法测定其血清瘦素水平及血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平及2组儿童身高和体质量。结果共检出3种LEPR基因第20外显子的基因型:AA型、AG型、GG型;与对照组儿童比较,单纯性肥胖患儿LEPR基因第3 057位核苷酸G→A突变率增高。AA基因型的肥胖患儿血清TC、TG、LDL-C水平均明显高于GG型者,而HDL-C水平低于后者。与对照组比较,肥胖组患儿存在血脂代谢紊乱,血清瘦素水平增高,79%存在瘦素抵抗。瘦素抵抗组患儿血清TC、TG、LDL-C显著高于瘦素敏感组,HDL-C低于瘦素敏感组。基因型为AA的瘦素抵抗者与基因型为GG的瘦素抵抗者比较,血清TG、LDL-C水平升高,HDL-C水平降低(Pa<0.05)。结论单纯性肥胖患儿存在瘦素抵抗及LEPR基因第20外显子基因突变,二者可影响儿童脂质代谢,且有一定的协同作用。临床表现为LEPR基因第20外显子AA基因型的瘦素抵抗个体更易发生血脂代谢紊乱。     

Serum Lipid and Lipoproteins Concentrations in Obese Children as Atherogenic Risk Factors

Nine hundred and ninety-eight obese children aged 6 to 15 years participated in the present study. Fasting serum lipid and lipoprotein cholesterol values were measured and the relationship between obesity and abnormalities of serum lipids and lipoproteins was assessed. The results were as follows: 1. Obese children were more likely than non-obese children to have elevated serum total cholesterol (TC), triglyceride (TG) and LDL-C(low density lipoprotein cholesterol) levels and reduced HDL-C (high density lipoprotein cholestrol) levels. 2. The more the relative body weight index increased, the worse the abnormalities of serum lipids and lipoproteins became. This tendency was marked in junior high-school boys. 3. Hypercholesterolemia in obese children was mostly accounted for by LDL-C only and elevated HDL-C could not be detected.     

Treatment of childhood obesity in obese families

BACKGROUND: Parental obesity reduces the likelihood of a multidisciplinary childhood obesity program to succeed, suggesting that special family-based interventions should be constructed for obese children from obese families. AIM: To examine the effects of an intense combined 3-month familial dietary-behavioral-physical activity intervention for a subgroup of obese children (BMI >95th percentile) from obese families (parental BMI >27 kg/m2) compared to a control group of obese children and obese parents who did not participate in the combined intervention. CHILDREN: Twenty-two obese children were randomly assigned to the intervention (n = 11) or control (n = 11) group. Anthropometric measurements, body composition, dietary and activity habits and fitness levels were measured before and at the end of a 3-month intervention. RESULTS: The intervention led to a significant difference in change in body weight (-0.2 +/- 0.3 vs 1.7 +/- 0.6 kg; p <0.05), BMI percentiles (-1.4 +/- 0.5 vs -0.1 +/- 0.2%; p <0.05), and to a decrease in screen (television and computer) time (-2.2 +/- 0.6 vs 0.1 +/- 0.3 h/day; p <0.05) in the intervention group compared to the controls. In addition, the intervention led to a significant improvement in fitness level determined by endurance time (181 +/- 30 vs 26 +/- 63 seconds in the intervention vs control group, respectively; p <0.05). CONCLUSION: Obese children from obese families pose a therapeutic challenge to health care providers. Intense family-oriented multidisciplinary weight management intervention should be designed for treatment in this unique population.     

Cardiac mass and function, carotid artery intima-media thickness and lipoprotein (a) levels in children and adolescents with type 1 diabetes mellitus of short duration

OBJECTIVE: To evaluate cardiac mass and function, carotid intima-media thickness, and serum lipid and lipoprotein (a) (Lpa) levels in children and adolescents with type 1 diabetes mellitus (DM) of short duration. BACKGROUND: Diabetes mellitus has been found to be an important risk factor for macrovascular disease in adults. Increased serum lipids and Lpa levels have been reported in adolescents with type 1 DM; atherosclerotic vascular lesions involving a combination of fatty degeneration and vessel stiffening of the arterial wall and myocardial involvement impairing diastolic function may be present in adolescents and young adults with type 1 DM. DESIGN/METHODS: Twenty children and adolescents (10 males, 10 females) diagnosed with type 1 DM before 3.4 +/- 3.3 years with a mean age of 11.9 +/- 3.6 years were studied; their HbA1c levels were 8.0 +/- 1.9%. Twenty healthy non-diabetic controls, 10 males and 10 females, aged 12.1 +/- 3.4 years, matched for height and weight, participated in the study. Fasting blood samples were obtained for lipid and Lpa analysis. Patients underwent transthoracic M-mode and two-dimensional echocardiographic evaluation for measurement of left atrial and ventricular dimensions and left ventricular (LV) wall thickness and mass. Stroke volume and cardiac output were measured using pulsed Doppler echocardiography; carotid intima-media thickness was measured using high-resolution mode B ultrasound. RESULTS: Interventricular septal thickness (7.1 +/- 1.8 vs 7.0 +/- 1.5 mm), LV posterior wall thickness (7.1 +/- 1.4 vs 7.5 +/- 2.0 mm) and LV mass after correction for body surface area (70.6 +/- 27.4 vs 70.7 +/- 18.0 g/m2) were similar in patients and controls. Similarly, the LV ejection fraction at rest was similar in patients and controls (69.9 +/- 2.3 vs 70.0 +/- 0.6%), as were pulmonary venous flow velocities (0.56 +/- 0.09 vs 0.55 +/- 0.10 m/s for diastolic peak velocity, 0.54 +/- 0.08 vs 0.50 +/- 0.09 m/s for systolic peak velocity and 0.17 +/- 0.07 vs 0.19 +/- 0.05 m/s for atrial reversal filling). Carotid intima-media thickness (0.60 +/- 0.02 and 0.59 +/- 0.02 mm for the right and left carotid artery) was similar to that of controls (0.60 +/- 0.03 and 0.61 +/- 0.02 mm for the right and left carotid artery). Low density lipoprotein cholesterol and Lpa levels were increased in patients compared to controls (113.2 +/- 26.0 mg/dl and 20.1 +/- 11.7 mg/dl in patients vs 90.4 +/- 14.3 mg/dl and 9.8 +/- 2.9 mg/dl in controls; p <0.01), while total cholesterol, HDL cholesterol and serum triglyceride concentrations were similar to those in controls. CONCLUSIONS: Although children and adolescents with type 1 DM seem not to show alterations in cardiac mass and function or early atherosclerotic changes in the first few years after diagnosis, their cardiovascular risk is increased as they present with dyslipidemia at an early stage of the disease.     

Relationship between fat distribution and lipid and apolipoprotein profiles in young teenagers

The influence of obesity and fat distribution on serum levels of lipoprotein and apolipoprotein was investigated in 294 Japanese junior high school children (12-13 years of age). Serum levels of low-density lipoprotein cholesterol (LDLC) (P= 0.013), triglycerides (TG) (P= 0.0006), and apolipoprotein B (apoB) (P= 0.003), and the apoB/A-I ratio (P= 0.005) were significantly higher and serum levels of high-density lipoprotein cholesterol (HDLC) (P= 0.00003) and apoA-1(P = 0.003) were significantly lower in obese boys than in non-obese boys. The serum levels of TG (P = 0.013) and the apoB/A-1 ratio (P= 0.011) were significantly higher and the serum levels of HDLC (P= 0.004) was significantly lower in obese girls than in non-obese girls. The LDLC/apoB ratio was lower in obese girls than in non-obese girls (P= 0.03). Obesity ( 20% of ideal weight) was strongly correlated with the serum levels of lipids and apolipoproteins in boys; this relationship was less clear in girls. The degree of obesity and the body mass index (BMI) were more strongly correlated with serum levels of lipids and apolipoproteins in boys than in girls. In boys, atherogenic-lipoproteins and apolipoproteins, such as LDLC and apoB, showed a stronger correlation with the thickness of the triceps skinfold, while in girls the anti-atherogenic lipoproteins and apolipoproteins, such as HDLC and apoA-1, showed a stronger correlation with both the triceps and the subscapular skinfold thicknesses. In girls the relationships between the BMI and the degree of obesity and the thickness of the subscapular skinfold (S) thickness were similar to the relationships between those parameters and the triceps skinfold (T) thickness. In boys, these parameters showed a stronger correlation with the subscapular skinfold thickness than with the triceps skinfold thickness. The correlation coefficients for the relationships between skinfold thickness and lipid and apolipoprotein levels were similar to the coefficients for the relationships between skinfold thicknesses and the severity of obesity and the BMI. The distribution of central-type fat accumulation, which is indicated by the thickness of the subscapular skinfold, the S/T ratio and S-T value, was inversely correlated with the HDLC level in both boys and girls. The degree of obesity was strongly correlated with the atherogenic lipoprotein profile in boys, in part because the subscapular skinfold thickness was strongly correlated with the degree of obesity and the BMI. In girls, the correlations between indices of central-type obesity and atherogenic lipid and apolipoprotein profiles were stronger than in boys. These data suggest that childhood obesity may be an early cardiovascular risk factor.     

Serum leptin level in prepubertal children with simple obesity. Part II

The aim of the study was to determinate the serum leptin level, glucose concentration, lipids (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride) and thyroid hormones level (triiodothyronine, thyroid stimulating hormone and free thyroxine) in a group of prepubertal children with simple obesity. Fourfold higher leptin concentration in obese (23.3 +/- 11.8 ng/mL) in comparison to a group of slim children (6.8 +/- 2.7 ng/mL), (p<0.0001) was shown. There was no significant difference in serum glucose level (87.3 +/- 9.7 mg/dL) between both studied groups. In obese subjects we showed higher triglyceride, insignificantly lower HDL-C concentrations and invariable other lipid fractions. Mean values of triiodothyronine (T3) were 3.0 +/- 0.7 nmol/L in obese children and 2.8 +/- 0.8 nmol/L in slim children. On the contrary, mean values of thyroid stimulating hormone (TSH) were 2.5 +/- 1.7 mIU/L and 2.8 +/- 0.7 mIU/L in the group of obese and normal children respectively. Free thyroxine (FT4) concentrations in our obese children were lower (11.5 +/- 2.9 pmol/L) than in slim subjects (14.6 +/- 3.1 pmol/L) but were within the reference range. The results obtained indicate that in children with simple obesity there was no dyslipidemia connected with leptin and thyroid hormones levels. However, higher triglyceride and lower HDL-C concentrations suggest a necessity of monitoring the body mass index and lipid profile in these patients.     

瘦素受体基因20外显子突变对儿童脂质代谢影响的临床研究(英文)

目的：探讨瘦素受体基因(LEPR)第20外显子突变对脂质代谢的影响及肥胖儿童基因型与血脂的关系。方法：用聚合酶链反应限制性片段长度多态性(PCRRFLP)方法及聚丙烯酰胺凝胶电泳分析20外显子的基因突变频率,并测定单纯型肥胖儿童(102例)和健康儿童(81例)血清中甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)和低密度脂蛋白(LDL)水平。两组分别测量身高、体重,计算体重指数(BMI)及脂肪百分比。结果：肥胖儿童瘦素受体基因的20外显子经PCRRFLP及聚丙烯酰胺凝胶电泳分析,检测出3种基因型G/G,G/A和A/A型。肥胖儿童20外显子3057位G→A突变频率较健康儿童增高(P<0.05)。A/A基因型的肥胖儿童其血清TG(1.8±0.5mmol/Lvs1.0±0.4mmol/L,P<0.01)、BMI(33±5kg/m2vs25±4kg/m2,P<0.05)水平和脂肪百分比(30±8vs20±3,P<0.01)均明显高于G/G基因型者,而血清HDL水平则低于后者(1.08±0.23mmol/Lvs1.38±0.22mmol/L,P<0.01)。G/A型肥胖儿童,除其血清TG浓度高于G/G基因型者外(1.6±0.4mmol/Lvs1.0±0.4mmol/L,P<0.05),余各项指标均与另外两种基因型无明显差别。心电图检查显示部分A/A型血脂增高儿童有ST段和T波改变。结论：单纯型肥胖儿童瘦素受体基因第20外显子存在基因多态性,且该多态性明显影响肥胖儿童的脂质代谢及体脂分布。该研究为临床上开展对肥胖儿童的早期干预提供了理论依据。     

Association of a mutation in the β3-adrenergic receptor gene with obesity and response to dietary intervention in Chinese children

This study aimed to determine whether the Trp64Arg mutation in the beta3-adrenergic receptor beta3-adr) gene is related to childhood obesity and the response to dietary intervention for obesity. The study included 311 healthy children aged 8-11 y selected at random from 4 primary schools in Beijing. Fasting insulin and lipids were measured and anthropometry was carried out for all samples. The mutation of the beta3-adr gene was determined by polymerase chain reaction-restriction fragment length polymorphism analysis. Forty-seven obese children were selected and divided into two groups. One group received dietary intervention (36 subjects); the other served as the control group (11 subjects). After 3 mo of dietary intervention, anthropometry was carried out again in 47 obese children. The frequency of the mutated allele was similar in 73 overweight and 238 normal-weight children (0.18 and 0.17, respectively). Adjusted for age and sex. there was no significant difference in body mass index (BMI) and the levels of fasting lipids and insulin between those with and without the mutation of the 311 children. However, after 3 mo of dietary intervention. increases in weight and BMI were significantly lower in obese children without the mutation than in the control group (2.41 +/- 0.56 vs 4.43 +/- 0.70. p < 0.05: 0.48 +/- 0.24 vs 1.55 +/- 0.35, p < 0.05. respectively), but the changes in weight and BMI in obese children with the mutation were similar to the results in the controls (4.32 +/- 0.69 vs 4.43 +/- 0.70; 1.47 +/- 0.32 vs 1.55 +/- 0.35). CONCLUSION: The Trp64Arg mutation of the beta3-adr gene may predict the result of dietary intervention in obese children to some extent, but it was not a major factor affecting weight in Chinese children.     

Hypoadiponectinemia, dyslipidemia, and impaired growth in children with HIV-associated facial lipoatrophy

OBJECTIVE: To compare growth, lipids and adipocytokines in HIV-positive children with and without lipoatrophy. PATIENTS: Eleven HIV-positive children with facial lipoatrophy, and 22 age- and sex-matched HIV-positive controls without signs of fat abnormality. METHODS: Clinical data including height, physical examination findings, medications, markers of viral control, cholesterol, and triglycerides were retrieved from the medical charts. Serum samples were analyzed for adiponectin, inflammatory markers, and high density lipoprotein cholesterol (HDL). RESULTS: Lipoatrophy was associated with higher triglycerides (330 vs 133 mg/dl, p = 0.0003), lower HDL (33 vs 48 mg/dl, p = 0.02), and a greater frequency of hypercholesterolemia (total cholesterol > 200 mg/dl; 64% vs 23%, p < 0.03). Adiponectin was 53% lower in patients with lipodystrophy (6.9 microg/ml vs 14.8 microg/ml, p = 0.005), however there was no difference in the inflammatory markers soluble TNFa receptor 2 or interleukin 6. Strikingly, despite similar BMI z-scores and virological control, lipoatrophic patients were shorter by 1 standard deviation score (p = 0.03). CONCLUSIONS: The presence of facial lipoatrophy in a child with HIV infection is a marker for significant metabolic derangements including dyslipidemia and hypoadiponectinemia, and suggests the need for careful growth evaluation.     

Lipoprotein (a) in obese children with a family history of cardiovascular disease

OBJECTIVE: To analyze the influence of family history of cardiovascular disease (CVD) on lipoprotein (a) (Lpa) values in obese children. SUBJECTS AND METHODS: Lpa values were measured by a nephelometric technique in 837 prepubertal obese children (442 girls, 395 boys) aged 6-8 years. Lpa > 30 mg/dl were determined to be a risk factor for CVD after complete recording of dietary norms, family history of CVD and coronary risk in relatives aged less than 50 years old. RESULTS: The obese children's group with BMI > 30 and with family history of CVD presented higher values of Lpa (32.07 +/- 1.2 mg/dl) in comparison to the less obese group with family history of CVD (27.19 +/- 0.8 mg/dl) (p < 0.01), and both of these groups had significantly higher Lpa values than the groups with no family history of CVD. CONCLUSIONS: Childhood obesity with high BMI increases the risk of CVD when these children become adults in children with family risk factors for CVD.     

Oxidative stress in childhood obesity

OBJECTIVE: To measure products of free radical damage in childhood obesity. METHODS: Plasma free radicals were assayed in 24 children with exogenous obesity and 24 non-obese healthy controls. A new colorimetric method was used that measures the generation of peroxy radicals (D-Roms), first products of the reaction between free radicals and oxygen. RESULTS: D-Roms levels were higher in the obese children than in the non-obese group (33.3+/-10.1 mg% of H2O2 vs 22.8+/-2.8 mg% of H2O2; p <0.001). Moreover, D-Roms levels were higher in children with hyperlipidemia than in children with normolipidemia (49.6+/-3.1 mg% of H2O2 vs 27.8+/-3.2 mg% of H2O2; p <0.001). D-Roms level was positively correlated with waist-hip ratio, serum total cholesterol, serum triglycerides, serum low-density lipoprotein-cholesterol, systolic blood pressure, diastolic blood pressure and fasting blood glucose in obese children. In a multivariate regression model for obese children, the independent correlates for D-Roms level were systolic blood pressure (p <0.001) and serum total cholesterol (p <0.001), with the total variance explained being 82%. CONCLUSION: Our study demonstrates for the first time that there was increased D-Roms levels in obese children and adolescents and suggests that increased systolic blood pressure associated with hyperlipidemia may independently contribute to increased oxidative stress in childhood obesity.     

Childhood obesity-related cardiovascular risk factors and carotid intima-media thickness

The purpose of this study was to investigate the relationship between childhood obesity and carotid intima-media thickness (IMT). This is a cross-sectional study in obese children and non-obese control subjects. This study included 75 obese children and 40 non-obese control children. Systolic and diastolic blood pressure (SBP, DBP) values and waist and hip circumferences were measured. Fasting blood glucose and insulin concentrations, total cholesterol, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were assayed. The carotid IMT was measured by high resolution B-mode ultrasonography. Waist/hip ratios, SBP and DBP were significantly increased in the obese group compared to the non-obese children (all p < 0.001). The total cholesterol, LDL-C, HDL-C, and TG in the obese children were significantly different from values in the control subjects (all p < 0.001). Compared to the controls, the obese children demonstrated significant differences in a number of clinical risk factors including body weight, body mass index (BMI), BMI-standard deviation score (SDS), SBP/DBP, waist circumference, hip circumference, and waist/hip ratio (all p < 0.001). Compared to the controls, the obese children showed increased mean carotid IMT values [0.52 mm (95% confidence interval [CI], 0.40-0.64 mm) vs. 0.35 mm (95% CI, 0.24-0.38 mm), p < 0.001]. Univariate correlation analysis revealed that the carotid IMT was closely related to the BMI-SDS, SBP/DBP, waist and hip circumferences, serum TG, cholesterol, LDL-C, HDL-C, fasting serum insulin level, and insulin resistance indices including the homeostasis model assessment of insulin resistance (HOMA-IR), fasting glucose-to-insulin ratio (FGIR), and quantitative insulin-sensitivity check index (QUICKI). Multiple regression analysis showed that the BMI-SDS, TG and QUICKI were independent predictive risk factors for increased carotid IMT. Measurements of BMI-SDS, blood pressure, waist and hip circumferences, serum TG levels, the QUICKI insulin resistance index, and carotid IMT by ultrasonography are suitable in pediatric patients in a clinical setting and may be used for screening of obese children.