Haemorheologic and fibrinolytic evaluation in obese children and adolescents

The haemorheologic condition was evaluated in 43 obese children and 35 controls. In 18 of the obese children and in 21 controls the euglobulin lysis time (ELT) was also studied. Blood viscosity at 94.5 and at 0.204 s^-1 shear rates, plasma viscosity, fibrinogen and erythrocyte filtration time were significantly higher in obese than in control children. No significant differences were observed in haematocrit levels. Triglycerides, non-esterified fatty acids (NEFA), pre--lipoprotein and insulin rates were all significantly higher in obese than in control children. There were no significant differences in glycaemia and in haemoglobin A1 values. ELT, both basal and after stimulation with 1-deamino-8-d-arginine-vasopressin (DDAVP), was significantly higher in the obese than in control children. The haemorheologic disturbances together with alterations of the haemostatic balance and fibrinolysis may be an important risk factor for the development of vascular changes at paediatric age.Abbreviations Htc haematocrit - BV blood viscosity - BV94 blood viscosity at 94.5 s^-1 shear rates - BV0.2 blood viscosity - PV plasma viscosity - RV relative viscosity - EFT erythrocyte filtration time test - ELT euglobulin lysis time - NEFA non-esterified fatty acids - HbA1 glycosilated haemoglobin - DDAVP 1-deamino-8-d-arginine-vasopressin - HDL high density lipoprotein - MCV mean corpuscular volume This study was supported by Consiglio Nazionale delle Ricerche, Grant no. 85.00477.56 and no. 86.01698.56     

Expressions of discomfort in adolescents. Clinical reflections resulting from an exploratory study of a group of students

AIM: The aim of this study was to explore some fundamental dimensions of adolescent discomfort relating to food, the body, sexuality, relationships in general and health care. METHODS: We recruited 206 students (66 males, 140 females; average age=19.4+/-2) and we administered 4 questionnaires: the first two to examine their relationship with food, the third to explore adolescents' attitudes to their social context, sexuality and first sexual experiences; the fourth to measure their ability to look after their health. RESULTS: The results show the different role that sexual styles have in the expression of juvenile discomfort. Girls tend to live the discomfort by mentalizing it in relationships and sexuality and contextualizing it in their bodies; boys direct their discomfort towards occasional drug taking or drug addiction, or alcohol abuse, the excitement of speed, or dangerous driving. CONCLUSIONS: In clinical work with adolescents it seems appropriate to refer to the relational gradient of risk behaviours, that is their linking function within their peer group. Behaviours with a high relational gradient, which develop within the group or are related to the group, in most cases are normal modalities for facing the important challenges of adolescence. These behaviours are symptoms of the normal process of adolescent development. We should pay particular attention to behaviours with a low relational gradient because they indicate a possible interruption in their development.     

Metabolic,inflammatory, endothelial and haemostatic markers in a group of Italian obese children and adolescents

Childhood obesity and its related comorbidities are increasingly recognised in children, predisposing them to early cardiovascular disease and metabolic syndrome. The objective of the study was to investigate markers of metabolism, inflammation and haemostasis in a group of Italian obese children and adolescents. Fifty-nine obese and 40 non-obese subjects were recruited. Fasting glucose and insulin, total cholesterol, HDL and LDL cholesterol, triglycerides, high-sensitivity C-reactive protein (hsCRP), tumour necrosis factor alpha (TNF-α), and adiponectin were measured. Hypercoagulability was assessed by measuring the circulating levels of thrombin-antithrombin complex (TAT), D-dimer, fibrinogen, plasminogen activator inhibitor 1 (PAI-1) and von Willebrand Factor (vWF). A significant degree of insulin resistance was present in obese subjects compared with controls (p < 0.0001). The obese showed higher levels of total cholesterol, LDL cholesterol and triglycerides, and lower levels of HDL cholesterol than controls (p < 0.0001). Circulating levels of hsCRP and TNF-α were significantly higher in obese than in controls while serum adiponectin levels were significantly lower in obese than non-obese subjects (p < 0.001; p = 0.031; p < 0.0001, respectively). vWF, TAT, D-dimer, fibrinogen and PAI-1 levels were significant higher in obese subjects compared with control group (p = 0.02; p < 0.0001; p = 0.0037; p < 0.0001; p = 0.017, respectively). In conclusion, our results suggest that childhood obesity per se is associated with a proinflammatory and prothrombotic state.     

Alexithymia in obese adolescents is associated with severe obesity and binge eating behavior

ObjectiveTo study the occurrence of alexithymia in obese adolescents.MethodsCross-sectional study with 102 obese adolescents. Sociodemographic, clinical, and psychometric data (alexithymia and binge eating) were analyzed The Brazilian version of the Toronto Alexithymia Scale and Binge Eating Scale were used for psychometric data collection. Statistical analysis was performed using the Kolmogorov-Smirnov test, Student's t-test, ANOVA, chi-square, linear regression, and logistic regression. The study was approved by Research Ethics Committee.ResultsA 22% occurrence of alexithymia was observed. Considering the category “possible alexithymia”, half of the participants presented some alexithymic behavior. Adolescents with alexithymia had higher binge eating scores (alexithymia 16,2 versus possible alexithymia 11,7 versus no alexithymia 8,5; ANOVA p < 0,0005) and three times more binge eating behavior than adolescents with no alexithymia or possible alexithymia (alexithymia 36.4% versus 17.2% possible alexithymia versus 11.8% no alexithymia; chi-square = 6,2, p = 0.04). In simple linear regression, alexithymia scores were positively associated with binge eating scores (r² = 0,4; p = 0,002). Binary logistic regression showed a three times higher probability of an adolescent with severe obesity to meet the criteria for alexithymia.ConclusionsThere was a 22% occurrence of alexithymia in obese adolescents. It was positively associated with obesity severity and higher binge eating scores, suggesting a relationship between severe obesity, alexithymia, and binge eating behavior.     

Effects of a lifestyle modification trial among phenotypically obese metabolically normal and phenotypically obese metabolically abnormal adolescents in comparison with phenotypically normal metabolically obese adolescents

This study aimed to assess the effects of a 2-month lifestyle modification trial on cardio-metabolic abnormalities and C-reactive protein (CRP) among obese adolescents with metabolic syndrome [phenotypically obese metabolically abnormal (POMA)] and obese adolescents without a cardio-metabolic disorder [phenotypically obese metabolically normal (POMN)], as well as in normal-weight adolescents with at least one cardio-metabolic disorder [phenotypically normal metabolically obese (PNMO)]. The study comprised 360 adolescents assigned in three groups of equal number of POMN, POMA and PNMO. They were enrolled in a trial consisting of aerobic activity classes, diet and behaviour modification, and were recalled after 6 months. Overall, 94.7% of participants completed the 2-month trial, and 87.3% of them returned after 6 months. The mean CRP was not significantly different between the POMA and PNMO groups, but was higher than in the POMN group. After the trial, body mass index (BMI) and waist circumference (WC) decreased in obese participants, and the mean body fat mass decreased in all groups. At 2 months, the mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and CRP decreased in the POMA and PNMO groups. After 2 and 6 months, the decrease in mean TC, LDL-C, TG, CRP and systolic blood pressure was greater in the POMA than in the POMN group. The magnitude of decrease in CRP correlated with that of BMI, WC, fat mass, TG, TC and LDL-C. Lifestyle modification programmes for primordial/primary prevention of chronic diseases would be beneficial at the population level and should not be limited to obese children.     

Evidence of mitochondrial dysfunction in obese adolescents

Aim: Although obesity and weight gain generally are anticipated to be caused by an imbalance between energy intake and energy expenditure, the significance of thyroid hormones (TH) remains unclear. Examination of mitochondrial function may reflect intracellular thyroid hormone effect and elucidate whether a lower metabolic rate is present. Methods: In a group of 34 obese adolescents (age <16 years and body mass index above the age‐related 95th percentile), and an age‐ and gender‐matched group of 32 lean adolescent, thyroid stimulating hormone (TSH) and basal oxygen consumption were measured and mitochondrial function in peripheral blood monocytes was determined by flow cytometry. Results: Significant increase in TSH (3.06 ± 1.56 mU/L vs. 2.33 ± 0.91 mU/L, p < 0.05) and a decrease in VO₂ (129 ± 16 mL O₂/m²*min vs. 146 ± 15 mL O₂/m²*min, p < 0.05) were observed in obese adolescents compared with lean adolescents. Flow cytometry analysis demonstrated a lower mitochondrial mass (6385 ± 1962 a.u. vs. 7608 ± 2328 a.u., p < 0.05) and mitochondrial membrane potential (11426 ± 3861 a.u. vs. 14017 ± 5536 a.u., p < 0.05) in obese adolescents compared with lean adolescents. These results are even more pronounced in adolescents with obese mothers. Conclusion: In obese adolescents, the increased TSH and lowered VO₂ propose a lowered basal metabolic rate and the impaired mitochondrial function suggests a decreased thyroid hormone stimulation of mitochondrial energy production. The maternal in‐heritage is suggestive of a basal metabolic defect or mitochondrial resistance for TH.     

Normative developmental behavior with implications for health and health promotion among adolescents: a Swedish cross-sectional survey

I describe behavior with impact on health in adolescents against the background of characteristics of the Swedish society and analyse possible areas for improvement. A total of 4500 adolescents, aged 13-18yr, in seven areas answered an anonymous questionnaire. Their socioeconomic back grounds reflected mainstream adolescents. The response rate was 80-85%. Questions concerned health habits, exploratory behaviors regarding sexuality, use of alcohol and tobacco, problem behaviors, such as getting drunk, and life quality. There was very little experimentation with regard to health habits learned in childhood. Rapid adaptation to adult life-styles occurred, which was similar in both sexes m the younger age groups, but there were significant differences among older students. Alcohol use is of considerable concern. Adolescent prediction of future behavior indicated that negative behaviors require intervention. Parental influence on adolescent behavior needs to be explored. Peer groups could be an additional area for intervention.     

Prevention of doping in sport in adolescents: evaluation of a health education based intervention]

BACKGROUND: The extent of sport doping and its potential risks for health is to be considered as a problem of public health. Until now, only a very few number of prevention programs have been shown to be efficient. The aim of this prospective study was to test the benefit of a specific educational intervention to reduce the intent of adolescent athletes to use drugs. PATIENTS AND METHODS: The participants were 476 adolescent athletes involved into high-level events, 238 were included in the experimental group and 238 as control group. The intervention was divided in four stages: information on epidemiology of doping in sport, discussions about nutritional supplement and other authorized products, a drug simulating role play, and information on self-medication. The program was evaluated by a self-administrated questionnaire before, just after the intervention, and three months later. RESULTS: A significant decrease in the intention to use doping drugs, and an increase in the perception of being able to refuse doping was found in the experimental group three months after the intervention. CONCLUSIONS: This work suggests that health education based interventions are effective in preventing drug use among adolescent athletes.     

Self-esteem in a clinical sample of morbidly obese children and adolescents

Aim: To study self-esteem in clinical sample of obese children and adolescents.
Methods: Obese children and adolescents aged 8–19 years (n = 107, mean age 13.2 years, mean BMI 32.5 [range 22.3–50.6], mean BMI z-score 3.22 [range 2.19–4.79]; 50 boys and 57 girls) were referred for treatment of primary obesity. Self-esteem was measured with a validated psychological test with five subscales: physical characteristics, talents and skills, psychological well-being, relations with the family and relations with others. A linear mixed effect model used the factors gender and adolescence group, and the continuous covariates: BMI z-scores, and BMI for the parents as fixed effects and subjects as random effects.
Results: Age and gender, but neither the child's BMI z-score nor the BMI of the parents were significant covariates. Self-esteem decreased (p < 0.01) with age on the global scale as well as on the subscales, and was below the normal level in higher ages in both genders. Girls had significantly lower self-esteem on the global scale (p = 0.04) and on the two subscales physical characteristics (p < 0.01) and psychological well-being (p < 0.01).
Conclusion: Self-esteem is lower in girls and decreases with age. In treatment settings special attention should be paid to adolescent girls.     

Mood disorder in a group of self-cutting adolescents.

This study describes the occurrence of mood disorder in a group of adolescent inpatients involved in self-cutting behavior. Although self-cutting is generally said to be associated with borderline personality disorder, a substantial number of patients who cut themselves in our study were clinically depressed. In addition, the self-cutting adolescents had a high prevalence of child abuse, past psychiatric history, and family psychiatric history. The incidents tended to spread by contagion and occur at times of change affecting the milieu. Clinical implications of these findings are discussed.     

Reproductive health problems and help seeking behavior among adolescents in urban India

Objective To assess their reproductive health problems and help seeking behaviour among urban school going adolescents. Method A sample of 300 urban school going adolescents between 11–14 years were chosen at random and assessed using four tools namely, self administered questionnaire: provision of adolescent friendly services; medical screening and focus group discussions. Results Seventy two percent girls and 56% boys reported health problems during survey with an average of 1.93 complaints per girl and 0.5 complaints per boy. However, only 43% girls and 35% boys reported to the clinic voluntarily to seek help and only one fifth the amount of problems were reported at the clinic in comparison to the quantum of problems reported in survey, which probably reflects a poor health seeking behaviour. A medical checkup with emphasis on assessment of reproductive health and nutritional status helped in detecting almost the same number of reproductive health problems as reported by them in survey. This intervention helped to increase the client attendance in subsequent period of next one year from 43% to 60% among girls and from 35% to 42% among boys. Conclusion Our study shows that to increase help seeking behaviour of adolescents, apart from health and life skill education, their medical screening with a focus on reproductive health by trained physicians, parental involvement, supported by adolescent friendly centers (AFC) for counseling, referral and follow up are essential.     

Evaluation of body composition by means of anthropometric measures in obese and non obese adolescents from two socioeconomic levels

Anthropometric measures of 120 female adolescents were analyzed, 60 of them from a low socio-economic level (LSEL),and 60 from a high socio-economic level (HSEL), with 30 obese and 30 non-obese in each group, in an attempt to verify differences between the socio-economic levels in relation to the body-composition and the distribution of fat throughout the body. The weight,height, upper arm circumference and 4 skin folds (triceps, biceps,subscapular and suprailiac) were measured, and the arm muscle area, arm fat area and percentage of body fat were estimated. Those who were obese from LSEL presented an average height lower (p<0.05) than the obese from HSEL, and a greater proportion of this group presented a height deficit for their age. The arm muscle area was greater (p<0.05) in the obese from HSEL, but the percentage of body fat was similar in the two groups as well as the measures of the isolated skin folds. The increase in fat in the obese from LSEL, when compared with the non-obese, was 2.8 times greater than the muscle. In the HSEL, this increase was 1.3 times greater. It was concluded that the obese from both socio-economic levels presented different types of obesity in relation to body composition,but were similar in relation to body fat distribution.