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Obese Children (obese + child)

Distribution by Scientific Domains

Medical Sciences	77%
Life Sciences	13%
Psychology	8%

Selected Abstracts

An INSIG2 Polymorphism Affects Glucose Homeostasis in Sardinian Obese Children and Adolescents

ANNALS OF HUMAN GENETICS, Issue 5 2010
Patrizia Zavattari
Summary Allelic variants of a single nucleotide polymorphism (SNP), rs7566605, located approximately 10 kb upstream of the INSIG2 gene have been found in association with body weight and with other clinical features related to obesity in some populations but not in others. Our objective was to test the association of this SNP in obese children and adolescents from the genetically isolated population of Sardinia. We tested the association of rs7566605 with body mass index (BMI) and with serum glucose and insulin concentrations and a surrogate measure of insulin resistance (HOMA-IR) in a cohort of 747 Sardinian obese children and adolescents. A case control analysis was performed using 548 ethnically-matched healthy controls. Allelic frequencies of the SNP were similar between patients and controls. Mean glucose and insulin concentration and mean HOMA-IR values were significantly higher in patients carrying the CC genotype than in the CG and GG carriers. In the patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT), allele C was significantly more frequent than in controls. Although INSIG2 polymorphisms do not consistently associate with BMI, the observation of an association with glucose concentration would support a role for this gene in the metabolic complications of obesity. [source]

Abnormal vascular reactivity at rest and exercise in obese boys

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2 2009
L. Karpoff
Abstract Background, Obese children exhibit vascular disorders at rest depending on their pubertal status, degree of obesity, and level of insulin resistance. However, data regarding their vascular function during exercise remain scarce. The aims of the present study were to evaluate vascular morphology and function at rest, and lower limb blood flow during exercise, in prepubertal boys with mild-to-moderate obesity and in lean controls. Materials and methods, Twelve moderately obese prepubertal boys [Body Mass Index (BMI: 23·9 ± 2·6 kg m,2)] and thirteen controls (BMI:17·4 ± 1·8 kg m,2), matched for age (mean age: 11·6 ± 0·6 years) were recruited. We measured carotid intima-media thickness (IMT) and wall compliance and incremental elastic modulus, resting brachial flow-mediated dilation (FMD) and nitrate-dependent dilation (NDD), lower limb blood flow during local knee-extensor incremental and maximal exercise, body fat content (DEXA), blood pressure, blood lipids, insulin and glucose. Results, Compared to lean controls, obese boys had greater IMT (0·47 ± 0·06 vs. 0·42 ± 0·03 mm, P < 0·05) but lower FMD (4·6 ± 2·8 vs. 8·8 ± 3·2%, P < 0·01) in spite of similar maximal shear rate, without NDD differences. Lower limb blood flow (mL min,1·100 g,1) increased significantly from rest to maximal exercise in both groups, although obese children reached lower values than lean counterparts whatever the exercise intensity. Conclusions, Mild-to-moderate obesity in prepubertal boys without insulin resistance is associated with impaired endothelial function and blunted muscle perfusion response to local dynamic exercise without alteration of vascular smooth muscle reactivity. [source]

Children's Weight and Academic Performance in Elementary School: Cause for Concern?

ANALYSES OF SOCIAL ISSUES & PUBLIC POLICY, Issue 1 2009
David Clark
In this study, the authors examined the relationship of 9,471 elementary students' grades in five subject areas (math, reading, language, science, and social studies), their conduct grades, and their scores on the Texas Assessment of Knowledge & Skills (TAKS) Reading, Math, Writing, and Science measures for the 2006,2007 school year as a function of their weight status in two ways: (1) Obese versus Nonobese and (2) Obese, Overweight, Healthy Weight, and Underweight. Obese children had statistically significantly lower course grades in all areas, as well as poorer conduct grades, than nonobese children. Similar results were present for the four TAKS measures. Comparisons of these measures by the four weight categories indicated the presence of trends such that as students' weight increased from one category to the next, their school grades and standardized test scores decreased. Partial correlation analyses, in which the effects of economic disadvantage and conduct grades were controlled, revealed that obesity was related with teacher-assigned grades and with TAKS scores. Interestingly, within ethnic groups, differences were present between obese and nonobese students only for White students and Hispanic students. The implications of these findings, as well as suggestions for further research, are discussed. [source]

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

ACTA PAEDIATRICA, Issue 1 2009
P Nowicka
Abstract 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. [source]

Obese children show increased intimal wall thickness and decreased pulse wave velocity

CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 5 2008
Frida Dangardt
Summary Objective:, Childhood obesity confers an increased risk of vascular changes and adult cardiovascular disease. Using a high-resolution ultrasound technique that enables separation of intimal and medial layers, we examined the intimal thickness (IT) and intimal,medial thickness (IMT) of radial (RA) and dorsal pedal (DPA) arteries and the pulse wave velocity (PWV) in overweight/obese children and adolescents and in healthy subjects. Methods and results:, IT and IMT of RA and DPA and PWV were measured in 33 obese children and adolescents (13·9 ± 1·6 years) and in 18 matched lean controls (14·3 ± 2·2). Increased RA IT was found in the obese group, whereas no differences in RA IMT or medial thickness were observed. Obese females accounted for the entire difference in RA IT (P = 0·04). DPA IT was inversely correlated with HDL cholesterol in the obese group (,0·56, P = 0·0089). PWV was lower in the obese group than in the lean group (6·2 ± 0·8 versus 7·0 ± 0·9 m s,1, respectively; P = 0·001). Conclusions:, Obese children and adolescents, primarily females, present with increased RA IT. The decreased PWV in the obese versus lean subjects might reflect general vasodilatation. [source]

Abnormal vascular reactivity at rest and exercise in obese boys

A common variant in the patatin-like phospholipase 3 gene (PNPLA3) is associated with fatty liver disease in obese children and adolescents,,

HEPATOLOGY, Issue 4 2010
Nicola Santoro
The genetic factors associated with susceptibility to nonalcoholic fatty liver disease (NAFLD) in pediatric obesity remain largely unknown. Recently, a nonsynonymous single-nucleotide polymorphism (rs738409), in the patatin-like phospholipase 3 gene (PNPLA3) has been associated with hepatic steatosis in adults. In a multiethnic group of 85 obese youths, we genotyped the PNLPA3 single-nucleotide polymorphism, measured hepatic fat content by magnetic resonance imaging and insulin sensitivity by the insulin clamp. Because PNPLA3 might affect adipogenesis/lipogenesis, we explored the putative association with the distribution of adipose cell size and the expression of some adipogenic/lipogenic genes in a subset of subjects who underwent a subcutaneous fat biopsy. Steatosis was present in 41% of Caucasians, 23% of African Americans, and 66% of Hispanics. The frequency of PNPLA3(rs738409) G allele was 0.324 in Caucasians, 0.183 in African Americans, and 0.483 in Hispanics. The prevalence of the G allele was higher in subjects showing hepatic steatosis. Surprisingly, subjects carrying the G allele showed comparable hepatic glucose production rates, peripheral glucose disposal rate, and glycerol turnover as the CC homozygotes. Carriers of the G allele showed smaller adipocytes than those with CC genotype (P = 0.005). Although the expression of PNPLA3, PNPLA2, PPAR,2(peroxisome proliferator-activated receptor gamma 2), SREBP1c(sterol regulatory element binding protein 1c), and ACACA(acetyl coenzyme A carboxylase) was not different between genotypes, carriers of the G allele showed lower leptin (LEP)(P = 0.03) and sirtuin 1 (SIRT1) expression (P = 0.04). Conclusion: A common variant of the PNPLA3 gene confers susceptibility to hepatic steatosis in obese youths without increasing the level of hepatic and peripheral insulin resistance. The rs738409 PNPLA3 G allele is associated with morphological changes in adipocyte cell size. (HEPATOLOGY 2010.) [source]

Dieting history in obese youngsters with and without disordered eating

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 8 2006
Line Claus MA
Abstract Objective: This article examines the relationship between the emergence of disordered eating and the history of weight and dieting in obese youngsters. Method: Both child and parent reports were obtained from 40 obese disordered eaters (objective bulimic episodes, n = 20; objective overeating episodes, n = 20) and 40 obese matched controls aged 10,16 years. Results: No significant differences between subsamples with regard to weight and dieting history were found. In dieters, it was shown that overweight onset preceded dieting onset, which in turn preceded dietary restraint onset. Despite some discordance regarding precise onset ages of different behaviors, parent and child re ports revealed the same temporal sequences. Conclusion: A developmental pathway from weight problems through dieting to binge eating is plausible for a subgroup of obese children. Convergence between parent and child reports supports the assumption that children's reports are a viable means of monitoring dieting and weight behaviors. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:721,728 [source]

Comorbidity between obesity and attention deficit/hyperactivity disorder: Population study with 13,15-year-olds

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 6 2006
Luis Rojo MD
Abstract Objective: This study analyzes whether obese children have a higher risk of attention deficit/hyperactivity "characteristics" (AD/HD) than do children with other nutritional states. Method: This study included 35,403 participants from 486 community schools. They completed the AD/HD scale of the Strengths and Difficulties Questionnaire (SDQ) and were weighed and measured. 2879 of the participants were obese and 78 were morbidly obese (BMI >40). Results: A discrete, nonsignificant, increment was found in the AD/HD characteristics of male participants with morbid obesity, as compared with the other nutritional states. Among morbidly obese females, the prevalence of AD/HD characteristics was slightly superior, although not significantly, to that found in participants with normal weight, overweight or obese (BMI <40). Conclusion: Among nonclinical populations with a communitarian origin, previous findings reporting high rates of AD/HD in obese children are not replicated. This increment in the prevalence of AD/HD among hospitalized obese children could be the result of selection bias. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006 [source]

Systematic review of interventions in the management of overweight and obese children which include a dietary component

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2007
Clare E Collins PhD BSc Dip Nutr Diet Dip Clin Epi APD
Background, The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective. Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness, if the risk of obesity-related morbidity and mortality is yet be reduced. Diet plays a pivotal role in successful treatment of obesity but to date, there is limited evidence on which to base practice. Objectives, To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese. Search strategy, Published English language literature was searched using the electronic databases CINAHL, MEDLINE, PRE-MEDLINE, DARE, COCHRANE, EMBASE, AUSTROM, Current Concepts and Dissertation Abstracts. The databases were limited to English Language from 1975 until 2003. Government reports from the UK, USA and Australian were also searched and a hand search performed for the Journal of the Dietitians Association of Australia, International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles. Selection criteria, (i) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity; (ii) Children aged less than 18 years; and (iii) Participants were defined as overweight or obese by relative weight or a measure of body weight status, studies that reported body weight per se were excluded. Data collection and analysis, An experienced professional librarian searched the databases, and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion. The included studies were critically appraised for methodological quality by two people independently. Data were extracted from the appropriate articles and when a discrepancy arose, a third party would arbitrate. Main results, There were 116 articles that met the inclusion criteria. While 49 articles described randomised controlled trials, they arose from 37 separate studies. There were 67 non-randomised trials. Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data. There was a high degree of heterogeneity between studies and this made comparisons between studies problematic. Interventions that include diet therapy generally result in significant weight loss, at least in the short term. Many studies were poorly designed and had no or only minimal follow up. The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported, making repetition of the studies difficult. Reviewers' conclusions, There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity. These studies require adequate follow up to ascertain if weight loss can be sustained in the long term. Details of the dietary prescription, adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice. [source]

The relationship between obesity and markers of oxidative stress in dogs

JOURNAL OF ANIMAL PHYSIOLOGY AND NUTRITION, Issue 2 2009
M. G. Cline
Obesity, a serious epidemic affecting much of our pet population, increases the risk of developing numerous diseases. It has been demonstrated that obesity increases oxidative stress in obese children, cats and other species. Oxidative stress can result in DNA damage with subsequent alterations in gene expression, cell signaling, mutations, cell death or cell transformation. These effects of oxidative damage predispose animals and humans to numerous disease processes and cancer. The objective of the study was to demonstrate that obese dogs are under oxidative stress resulting in DNA damage and decreased endogenous antioxidant protection measured by serum glutathione levels and the ratio of reduced (GSH) to oxidized (GSSG) glutathione. In this case,control study, 10 obese dogs were compared with aged-matched healthy control dogs. Dogs with BCS of 7 or greater (9 pt scale) were considered obese. Dogs were evaluated by history, physical exam, body condition score, CBC, serum biochemical analysis and total T4, with both groups showing no significant differences in CBC, serum biochemical or T4 analysis. Single-cell gel electrophoresis (Comet assay) was used to measure DNA damage, and high performance liquid chromatography was used to measure serum glutathione. Reduced glutathione levels were significantly higher in the obese group (p = 0.012). The results of this pilot study suggest that obesity is associated with an increase in antioxidant potential, therefore justifying a larger study with antioxidant supplementation to determine how antioxidants in weight loss diets effects endogenous antioxidant capabilities. [source]

The neurobiology and genetics of eating and weight regulation

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2008
J. Hebebrand
Over the past 15 years tremendous advances have been made in the elucidation of pathways relevant to eating behaviour and body weight regulation. It has become evident that these pathways are intricately interwoven with those underlying mood and anxiety regulation, motor activity, cognition, sleep, fertility and libido. In addition, advances have been made in determining genetic variation underlying inter-individual differences in body weight. To illustrate these novel findings we will focus on: 1) Monogenic and oligogenic obesity: The underlying genes were initially detected in animal models. Based on mutation screens of the human homologues functionally relevant mutations were detected in the genes coding for leptin, its receptors and the melanocortin-4 receptor (MC4R). The effect of such mutations is large. Leptin gene mutations lead to hyperphagia and subsequently obesity. Hyperphagia, albeit of a substantially reduced magnitude, has also been observed in obese children with mutations in the MC4R. 2) Polygenic obesity: The advent of genome wide association studies has led to the detection of single polygenes, among which FTO features prominently. Typically, a variant predisposing to obesity accounts for a body weight elevated by on average 200 to 1500 grams. Such polygenes act in concert to account for inter-individual differences in body weight. 3) Leptin has been shown to have profound implications for anorexia nervosa. Serum leptin levels in this eating disorders are annormaly low. The hypoleptinemia entails a down-regulation of the hypothalamic-pituitary-gonadal-axis, which underlies the amenorrhea characteristic of anorexia nervosa. Furthermore, the hypoleptinemia induces hyperactivity in a rat model of anorexia nervosa. In patients, leptin levels are inversely correlated with activity levels. [source]

Symptoms and quality of life in obese children and adolescents with non-alcoholic fatty liver disease

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010
K. D. KISTLER
Aliment Pharmacol Ther,31, 396,406 Summary Background, Data on the quality of life (QOL) of children with non-alcoholic fatty liver disease (NAFLD) are needed to estimate the true burden of illness in children with NAFLD. Aim, To characterize QOL and symptoms of children with NAFLD and to compare QOL in children with NAFLD with that in a sample of healthy children. Methods, Quality of life and symptoms were assessed in children with biopsy-proven NAFLD enrolled in the NASH Clinical Research Network. PedsQL scores were compared with scores from healthy children. For children with NAFLD, between-group comparisons were made to test associations of demography, histological severity, symptoms and QOL. Results, A total of 239 children (mean age 12.6 years) were studied. Children with NAFLD had worse total (72.8 vs. 83.8, P < 0.01), physical (77.2 vs. 87.5, P < 0.01) and psychosocial health (70.4 vs. 81.9, P < 0.01) scores compared with healthy children. QOL scores did not significantly differ by histological severity of NAFLD. Fatigue, trouble sleeping and sadness accounted for almost half of the variance in QOL scores. Impaired QOL was present in 39% of children with NAFLD. Conclusions, Children with NAFLD have a decrement in QOL. Symptoms were a major determinant of this impairment. Interventions are needed to restore and optimize QOL in children with NAFLD. [source]

Response of fractional synthesis rate (FSR) of fibrinogen, concentration of D-dimer and fibrinolytic balance to physical activity-based intervention in obese children

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 8 2008
P. BALAGOPAL
Summary.,Background:,Physical activity-induced reduction in obesity-related hyperfibrinogenemia in children has been reported. The underlying mechanisms remain elusive. Further, the effect of such interventions on fibrinolysis in children is scarce. Objectives: To investigate in obese children, before and after a physical activity-based intervention: (i) the mechanistic role of fractional synthesis rate (FSR) of fibrinogen in the reduction of hyperfibrinogenemia; and (ii) the changes in fibrinolytic factors. Methods:,Subjects included 21 (age > 14 < 18 years; Tanner stage, IV,V) children (15 obese, BMI >95%tile for age and sex and six lean, BMI <85%tile). After baseline measurements of FSR of fibrinogen, and concentrations of fibrinogen, D-dimer, PAI-1 and t-PA in all children, studies were repeated after a 3-month randomized controlled physical activity-based lifestyle intervention in obese children only. Results:,FSR of fibrinogen was higher (P = 0.002) in the obese (vs. lean) group, which was reduced (P = 0.001) after intervention. This almost completely accounted for the reduction in obesity-related hyperfibrinogenemia. High levels of D-dimer decreased (P = 0.001) after intervention, whereas fibrinolysis was not enhanced. Conclusions:,The direct reduction in the FSR of fibrinogen and the remarkable correlation between the magnitudes of reduction in fibrinogen FSR and concentration signify a mechanistic role for FSR in the regulation of physical activity-induced reversal of hyperfibrinogenemia in obese children. The congruent reductions in the FSR of fibrinogen and the concentrations of fibrinogen and D-dimer in response to intervention despite depressed fibrinolysis suggest an overall improvement in the hypercoagulable state in obese children with physical activity-based lifestyle intervention. [source]

A phase 2 clinical trial of metformin as a treatment for non-diabetic paediatric non-alcoholic steatohepatitis

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2005
J. B. Schwimmer
Summary Background :,Children with non-alcoholic steatohepatitis are insulin-resistant and metformin has been proposed as a potential therapy. However, paediatric safety and efficacy data are absent. Aim :,To test the hypothesis that metformin therapy will safely improve markers of liver disease in paediatric non-alcoholic steatohepatitis. Methods :,Single-arm open-label pilot study of metformin 500 mg twice daily for 24 weeks in non-diabetic children with biopsy-proven non-alcoholic steatohepatitis. Results :,Ten obese children (mean body mass index 30.4) enrolled and completed the trial. Mean alanine aminotransferase and aspartate aminotransferase (AST) improved significantly (P < 0.01) from baseline (184, 114 U/L) to end of treatment (98, 68 U/L). Alanine aminotransferase normalized in 40% and AST normalized in 50% of subjects. Children demonstrated significant improvements in liver fat measured by magnetic resonance spectroscopy (30,23%, P < 0.01); insulin sensitivity measured by quantitative insulin sensitivity check index (0.294,0.310, P < 0.05); and quality of life measured by pediatric quality of life inventory 4.0 (69,81, P < 0.01). Conclusion :,Open-label treatment with metformin for 24 weeks was notable for improvement in liver chemistry, liver fat, insulin sensitivity and quality of life. A large randomized-controlled trial is needed to definitively determine the efficacy of metformin for paediatric non-alcoholic steatohepatitis. [source]

Paediatric obesity, physical activity and the musculoskeletal system

OBESITY REVIEWS, Issue 5 2009
S. P. Shultz
Summary The current epidemic of paediatric obesity is consistent with a myriad of health-related comorbid conditions. Despite the higher prevalence of orthopaedic conditions in overweight children, a paucity of published research has considered the influence of these conditions on the ability to undertake physical activity. As physical activity participation is directly related to improvements in physical fitness, skeletal health and metabolic conditions, higher levels of physical activity are encouraged, and exercise is commonly prescribed in the treatment and management of childhood obesity. However, research has not correlated orthopaedic conditions, including the increased joint pain and discomfort that is commonly reported by overweight children, with decreases in physical activity. Research has confirmed that overweight children typically display a slower, more tentative walking pattern with increased forces to the hip, knee and ankle during ,normal' gait. This research, combined with anthropometric data indicating a higher prevalence of musculoskeletal malalignment in overweight children, suggests that such individuals are poorly equipped to undertake certain forms of physical activity. Concomitant increases in obesity and decreases in physical activity level strongly support the need to better understand the musculoskeletal factors associated with the performance of motor tasks by overweight and obese children. [source]

Changes in body composition after a 12-wk aerobic exercise program in obese boys

PEDIATRIC DIABETES, Issue 2 2000
Richard A DeStefano
Previous studies have shown that vigorous aerobic training programs for obese children result in minimal weight changes, and concluded that they may not be beneficial. Weight change alone may not detect important beneficial changes in body composition associated with vigorous training in these children. Fifteen obese boys (aged 9,12 yr, body mass index (BMI) 31.8±6.5, average percent body fat (%BF) 41±4.2) underwent a supervised aerobic and resistance training program (12 wk, 2 days/wk for 30 min/session), to investigate the effects on weight and body composition. After the 3-month training period, weight loss averaged only 1.5±1.0 kg (not significant), but total body fat decreased by 4.1±1.8 kg (p<0.05) and fat-free mass (FFM) increased by 2.6±1.1 kg (p<0.05) based on hydrostatic weighing. As a result, %BF fell by 10% (p<0.01). There was a 5.8±2.8 mL/kg/min (p<0.05) increase in peak volume of oxygen uptake (VO2), along with a 248±120 kcal/d (p<0.05) increase in resting energy expenditure (REE). Activity questionnaires showed a significant increase in high intensity recreational activities (6.5±1.5 vs 3.5±0.5 h physical activity/wk; p<0.01) in the home and a significant decrease in low intensity activities (7±2.0 vs 12±3.5 h TV viewing/wk; p<0.01). Conclusions: Vigorous supervised aerobic training in obese boys has beneficial effects on body composition, fitness and leisure time activities that are not apparent by measurement of changes in body weight alone. [source]

The effect of low-carbohydrate diet on left ventricular diastolic function in obese children

PEDIATRICS INTERNATIONAL, Issue 2 2010
Cenap Zeybek
Abstract Background:, This study was conducted to evaluate left ventricle (LV) functions using conventional and tissue Doppler imaging in childhood obesity and to identify the effects of diet on LV diastolic functions. Methods:, Conventional and tissue Doppler echocardiographic measurements were compared in 34 obese children and 24 age- and gender-matched lean controls. Fasting plasma glucose, insulin and homeostatic model assessment of insulin resistance levels were also obtained. Thirty-one of the obese children were subjected to a low-carbohydrate diet and their follow-up measurements were obtained after 6 months. Results:, Left atrial diameter, LV mass and LV mass index were higher in obese children than in lean controls. Lateral mitral myocardial early diastolic (Em) and peak Em/myocardial late diastolic (Am) were lower, and mitral E/Em and lateral mitral myocardial isovolumetric relaxation time were higher in obese subjects than in lean controls. Insulin and homeostatic model assessment of insulin resistance levels were higher in obese patients and decreased significantly after diet. After diet therapy, lateral mitral Em and peak Em/Am, were increased, mitral E/Em and myocardial isovolumetric relaxation time were decreased. Conclusions:, Obesity predisposes children to increased preload reserve, left ventricular subclinical diastolic dysfunction and deterioration in diastolic filling. Weight reduction with a low-carbohydrate diet seems to be associated with significant improvement in LV diastolic function and a decrease in diastolic filling, as well as causing reversal in insulin resistance seen in obese children. [source]

Cost-effectiveness of routine and group programs for treatment of obese children

PEDIATRICS INTERNATIONAL, Issue 5 2009
Marja Kalavainen
Abstract Background:, Cost-effectiveness analyses facilitate the allocation of health care resources. The aim of the study was to compare the cost-effectiveness of group treatment, already known to be more effective, with routine counseling in obese children. Method:, A prospective 6-month intervention assessed family-based group treatment (15 separate sessions for parents and children) and routine counseling (two appointments for children). Children's weights and heights were measured at baseline, at the end of the intervention and at follow up 6 months later, and the changes in weight for height and body mass index standard deviations scores (BMI-SDS) were calculated and used as main outcome measures. The mean costs and effects of the programs were analyzed to produce the incremental cost-effectiveness ratio, which is an estimate of the additional costs per 1% decrease in weight for height or 0.1 decrease in BMI-SDS. Cost-effectiveness analysis was performed from the perspective of the service provider. Results:, At the end of the intervention, group treatment costs were 1.4-fold (non-calculable 6 months later) when counted per 1% weight for height decrease, and 3.5-fold (2.8-fold 6 months later) when counted per 0.1 BMI-SDS decrease. Incremental cost-effectiveness ratio estimates were ,53 when calculated for 1% weight for height decrease, and ,266 (,275 6 months later) when calculated for 0.1 BMI-SDS decrease. Conclusions:, Family-based group treatment is more costly compared with individual routine counseling. Salaries form most of the total costs. [source]

Variation analysis of ,3 -adrenergic receptor and melanocortin-4 receptor genes in childhood obesity

PEDIATRICS INTERNATIONAL, Issue 2 2007
TOMOE KINOSHITA
Abstract Background: Decreased energy expenditure and increased food intake are principal causes for obesity. In the present study, genotypes of ,3 -adrenergic receptor (,3AR) and of melanocortin-4 receptor (MC4R), both of which are believed to have a close link to the cause of obesity, were analyzed and compared with phenotypes of childhood obesity. Methods: Thirty-five obese children with moderate to severe obesity were enrolled. Direct sequencing of the MC4R coding region and pinpoint-polymerase chain reaction were used to detect genomic variation in the ,3AR gene using peripheral blood-derived DNA. Results: Allele frequency of Trp64Arg variation in the ,3AR gene in the obese subjects was 0.16, which is comparable with that in the healthy general population in eastern Asia. Comparison of phenotypical characteristics did not show a significant difference between Trp/Trp and Trp/Arg subjects. It was notable that body height SD was significantly higher in the Trp/Trp than the Trp/Arg subjects (0.93 ± 1.0 SD vs 0.07 ± 1.3 SD, P= 0.03). Annual weight gains were far beyond a hypothetical fat gain in an Arg64 heterozygote with decreased energy consumption, suggesting increased food intake in childhood obesity. There was, however, no variation in the MC4R gene despite thorough sequencing of the entire coding region. Conclusions: The Trp64Arg variation in the ,3AR gene has no relationship to the degree or the incidence of childhood obesity. The majority of childhood obesity can be characterized as tall stature, more rapid weight gain than that expected by decreased energy expenditure. Further investigation is necessary in regard to the increased food intake as a major cause of childhood obesity. [source]

Threshold values of visceral fat and waist girth in Japanese obese children

PEDIATRICS INTERNATIONAL, Issue 5 2005
Kohtaro Asayama
AbstractBackground:,In order to define the diagnostic criteria for visceral adipose tissue (VAT) accumulation and abdominal obesity in Japanese youths, a cross-sectional, multicenter study was conducted. Methods:,Subjects were 194 boys and 96 girls ranging in age from 6 to 15 years. Obese youths were classified according to the occurrence of abnormal values in serum triglyceride, alanine aminotransferase or insulin level. A threshold value of each criterion was calculated, using the analysis of receiver operating characteristic (ROC) curve. The areas of total abdominal adipose tissue (AT), VAT and subcutaneous adipose tissue (SAT) were estimated by single slice computed tomography at the level of umbilicus. Results:,VAT area was greater in boys than it was in girls. The critical values for VAT area and waist circumference in all subjects were 54.8 cm2 and 83.5 cm, respectively. The values for the area under the ROC curves were VAT area > total AT area > waist circumference > SAT area > percentage overweight > percentage body fat. The sensitivity and specificity for VAT area were 90.5 and 79.5%, respectively. Those for waist circumference were high enough (> 70%) for clinical use. In the linear regression analysis assigning VAT area as an independent variable and waist circumference as a dependent variable, the expected value for the waist circumference was 82 cm. Conclusion:,In Japanese obese youths ranging in age from 6 to 15 years, the diagnostic criteria for the waist circumference was 82 cm, and that for VAT area was 55 cm2. [source]

Unfavorable lipid profiles in mild obesity with excess body fat percentage

PEDIATRICS INTERNATIONAL, Issue 1 2000
Akiho Tamura
Abstract Background: The aim of the present study was to investigate the usefulness of subclassifications of overweight children using the body fat percentage (Fat%) to predict the serum lipid profile. Methods: School children (431, 236 boys and 195 girls) aged 9,12 years were divided into three obesity groups (non-, mild and advanced obesity) and were further divided into two subgroups according to the Fat% measured by bioelectrical impedance analysis. The mean fasting serum lipid levels were also evaluated. Results: In the non-obesity and the advanced obesity groups, the Fat%-based subclassification demonstrated no essential differences in lipid profiles or in the prevalence of hyperlipidemia between the two subgroups. However, in the mild obesity group, the levels of low-density lipoprotein cholesterol and triglyceride and the atherogenic index were significantly higher and the high-density lipoprotein cholesterol level was significantly lower in the adipositic subgroup (Fat%, age/sex-specific cut-off value) than in the non-adipositic subgroup. Multiple comparison of lipid levels among all six categories of children indicated that the adipositic subgroup of mild obesity had no advantage over the advanced obesity group with respect to the atherogenic potential and that the non-adipositic subgroup of mild obesity showed no additional risks compared to the non-obesity group. Moreover, the prevalence of hyperlipidemia in the adipositic subgroup of mild obesity (50.0%) was significantly different from that in its non-adipositic counterpart (13.3%) and was equivalent to that in the advanced obesity group. Conclusions: These results suggest that Fat% evaluation is useful to divide mildly obese children into two distinct subtypes based on serum lipid profiles and that the excess Fat% in mildly obese school children is a predictor of atherogenesis. [source]

Daily differences in patterns of physical activity among overweight/obese children engaged in a physical activity program

AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 6 2007
Luísa Aires
The aim of this study was to compare the physical activity of overweight/obese children during days when they attended a physical activity program, and days when they did not. This is a cross-sectional intervention study of daily physical activity. The participants were referred by family, doctors, or hospital pediatricians to take part in a 10-month interdisciplinary, outpatient obesity intervention program for children. The subjects included 41 overweight and obese children aged 8,16 years, 19 boys (46%) and 22 girls (54%); BMI: 25.7 + 3.3 kg m,2. The MTI Actigraph was used as an objective measure of daily physical activity over seven consecutive days. Physical activity program days presented a significantly higher percentage of time (4.68%) spent in moderate-to-vigorous activity compared with no physical activity program days (3.16%) and weekend (2.7%). The results of this study suggest that a physical activity program can help increasing daily physical activity in obese children, with a special focus on MVPA level. Our data point that obese children are less active at weekend than during weekdays. Am. J. Hum. Biol., 2007. © 2007 Wiley-Liss, Inc. [source]

Six-minute walk test in obese children and adolescents: Reproducibility and validity,

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2009
Gunilla Morinder
Abstract Background and Purpose.,The six-minute walk test (6MWT) is increasingly used in clinical practice. The aims of this study were to determine the reproducibility of the 6MWT in obese children and adolescents, to describe walking capacity in this population and compare the results with values from normal-weight children (known group validity), and, finally, to describe the correlation between distance walked and estimated maximum oxygen uptake (VO2max).,Methods.,Reproducibility was determined by a test,retest design and known group validity by a comparative design. The 6MWT was first test,retested in 49 obese children (30 boys, 19 girls, 8,16 years, body mass index [BMI] 24.9,52.1,kg?m,2). Then, for validation, 250 obese children (126 boys, 124 girls, 8,16 years, BMI 23.2,57,kg/m2) and 97 normal-weight children (48 boys, 49 girls, 8,16 years, BMI 13.3,23.2,kg·m,2) performed the 6MWT. The obese children also performed a sub-maximal bicycle ergometry test.,Results.,In the test,retest, the obese children walked 571,m the first test and 57,m the second (p = 0.578). The measurement error (Sw) was 24,m, coefficient of variation (CV): 4.3% and the intraclass correlation (ICC1:1): 0.84. Repeatability was 68,m, and limits of agreement were +71 and ,65,m. In comparison mean (standard deviation), six-minute walk distance (6MWD) in the obese children was 571,m (65.5), and in the normal-weight children, 663,m (61.1) (p < 0.001). The correlation between 6MWD and estimated VO2max (r = 0.34) was low.,Conclusions.,The 6MWT showed good reproducibility and known group validity, and can be recommended for use in clinical practice in the studied population. To evaluate individual outcomes after intervention, the 6MWD needs to change by >68,m to be statistically significant. The 6MWD performed by obese children averaged 86% of the distance normal-weight children walked. In obese children, the correlation between 6MWD and estimated VO2max was low, hence the 6MWT cannot substitute a bicycle ergometry test. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Practitioner Review: Bridging the gap between research and clinical practice in pediatric obesity

THE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 2 2007
Elissa Jelalian
Background:, Pediatric obesity is a significant public health concern, with rising prevalence rates in both developed and developing countries. This is of particular significance given that overweight children and adolescents are at increased risk for multiple medical comorbidities, as well as psychosocial and behavioral difficulties. The current review highlights findings from the empirical pediatric obesity treatment literature, with particular attention to diet, physical activity, and behavior interventions. Evaluation and treatment considerations relevant to working with overweight children and adolescents with psychiatric comorbidities are reviewed. Methods:, Review of the relevant treatment literature, with a focus on randomized clinical trials, was conducted. Recommendations regarding treatment of children and adolescents with psychiatric comorbidities are based on relevant prospective studies of the relationship between weight status and psychological variables and studies with adult populations. Results:, Well-established pediatric weight control interventions have been conducted in research settings. These studies provide a starting point, but are limited by homogeneous samples that may exclude participants with psychiatric comorbidities. Practitioners treating obese children and adolescents with psychiatric disorders are encouraged to assess individual, familial, and contextual variables specific to weight (e.g., motivation and existing support to change current eating and physical activity patterns, extent of weight-related conflict within family, impact of weight on current functioning) in order to prioritize treatment objectives. Conclusions:, The review concludes with a discussion of current empirical and practical challenges, including explicitly targeting obese children and adolescents with psychiatric concerns and determining appropriateness of pursuing weight control interventions in this population. [source]

An INSIG2 Polymorphism Affects Glucose Homeostasis in Sardinian Obese Children and Adolescents

Association Study and Mutation Analysis of Adiponectin Shows Association of Variants in APM1 with Complex Obesity in Women

ANNALS OF HUMAN GENETICS, Issue 5 2009
Sigri Beckers
Summary We performed an association study and mutation analysis of the adiponectin (APM1) gene to study its involvement in the development of obesity. We also studied the interaction with peroxisome proliferator-activated receptor , (PPAR,). 223 obese women and 87 healthy female control subjects were used for association analysis. Mutation analysis was done on 95 morbidly obese adults and 123 overweight and obese children and adolescents. We selected 6 haplotype tagging SNPs in APM1 and the Pro12Ala variant (rs1805192) in PPAR, to study the interaction. The G allele of rs2241766 was more common in controls (cases 10.8% vs. controls 18.4%, nominal p = 0.011; OR = 0.57, nominal p = 0.018). The rs2241766/rs3774261 haplotype was also associated with obesity (nominal p = 0.004). Only the latter association remained significant after controlling for the False Discovery Rate. Resequencing of exon 2, exon 3 and intron 2 in 95 individuals did not reveal any SNPs in high linkage disequilibrium with rs2241766. No interaction with the Pro12Ala variant in PPAR, was detected. Mutation analysis of APM1 did not identify mutations. In conclusion, we found an association of an APM1 haplotype with obesity and found that APM1 mutations are not a common cause of monogenic obesity in our cohort. [source]

Coping in Children and Adolescents with Obesity: The Costs and Benefits of Realistic versus Unrealistic Weight Evaluations

APPLIED PSYCHOLOGY: HEALTH AND WELL-BEING, Issue 2 2010
Stefanie Meier
The study analysed differences in coping strategies between obese and non-obese children and adolescents (age: 8,14 years) in response to a social stressor. Physicians' diagnoses of obesity and self-reports on height and weight as well as gender and age were considered. A sample of 757 participants responded to an established German coping questionnaire. In addition to general coping strategies, two more potentially weight-related coping strategies were assessed. Adolescent obese girls who reported height and weight realistically showed particularly little social support-seeking behavior. Media use in general increased with age, but was especially high for adolescent obese boys who evaluated themselves as obese. Finally, girls in general and obese children and adolescents who evaluated themselves as overweight or obese showed higher stress-related eating. With regard to coping it seems to be a disadvantage for obese children and adolescents to see themselves as obese. In contrast, obese children and adolescents who have unrealistically positive self-evaluations of their weight report coping strategies similar to those reported by normal weight children and adolescents. It is assumed that positive self-evaluations of body weight prevent especially obese adolescents from inactivity and social isolation. Findings are relevant for the design of interventions to treat obesity. [source]

Day type and the relationship between weight status and sleep duration in children and adolescents

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2010
Tim Olds
Abstract Objective: This study aimed to explore sleep duration in young Australians on different types of days across weight classes. Methods: Use of time and anthropometric data were collected on 8,866 nights from 3,884 9,18 year old Australians. The association between sleep duration and weight status was examined using factorial ANOVA for four day types: S-S (to bed and waking on school days); S-NS (to bed on school day and waking on non-school day); NS-NS (to bed and waking on non-school days); NS-S (to bed on non-school day and waking on school day). Results: Sleep duration varied with weight status when all day types were considered together (p=0.0012). Obese adolescents slept less than normal and underweight adolescents. However, the relationship varied for different day types; with the strongest relationship for NS-S days (on which obese children slept 65 min less than very underweight children, p<0.0001). Conclusions: The association between weight status and sleep duration showed consistent gradients across weight categories, but only for certain day types. Implications: These patterns cast light on the direction of causation in the obesity-sleep duration relationship. Findings suggest that short sleep duration contributes to obesity, or that a third unidentified factor has an impact on both. [source]

Single-port appendectomy in obese children: an optimal alternative?

ACTA PAEDIATRICA, Issue 9 2010
T Petnehazy
Abstract Introduction:, The aim of this study was to evaluate our experience with single-port appendectomy (SPA) in obese children. Methods:, From January 2003 to June 2009, 94 SPA (65 women and 29 men, mean age of 12.4 years) were performed in children with appendicitis. Sixty-five of these patients were found to have normal weight, whereas 29 were obese. Patients' records were evaluated regarding operative time, intra- and post-operative complications, initiation of oral intake and histopathological findings. Results:, There was no significant difference in operative time between obese and normal weight patients. In the obese group, one wound healing disturbance was documented. In the normal weight group, there were one post-operative bleeding and one wound infection. There was no difference with regards to the introduction of feeds following appendectomy between the groups. Histological examinations revealed 15 normal, 32 acute, 21 phlegmonous, 20 chronic and two perforated cases of appendicitis, three neurogenic appendicopathies and one case of enterobius vermicularis related appendicitis. Conclusions:, Our results indicate that the advantages of single-port appendectomy in the evaluation of the peritoneal cavity, the minimal rate of intra-operative incidents with this technique and superior cosmetics validate this alternative approach of minimal access appendectomy in obese children. [source]