Physical fitness and activity, metabolic profile, adipokines and endothelial function in children / Aptidão e atividade física, perfil metabólico, adipocinas e função endotelial em crianças

Abstract Objectives: The prevalence of obesity is increasing. The aim of this study was to investigate if there is endothelial dysfunction in children with normal or excess weight, and whether the metabolic profile, adipokines, and endothelial dysfunction would be more strongly associated with physical fitness or with physical activity levels. Method: Cross-sectional study involving children aged 5-12 years. The evaluation included venous occlusion plethysmography, serum levels of adiponectin, leptin and insulin, lipid profile, physical activity score (PAQ-C questionnaire), and physical fitness evaluation (Yo-Yo test). Results: A total of 62 children participated in this study. Based on the body mass index, 27 were eutrophic, 10 overweight and 25 obese. Triglycerides, LDL cholesterol, HOMA-IR, and leptin were higher in the obese and excess-weight groups compared to the eutrophic group (p < 0.01). HDL cholesterol and adiponectin levels were higher in the eutrophic group compared to the obese and excess-weight groups (p < 0.01). Flow-mediated vasodilation after hyperemia was higher in the eutrophic group in comparison to obese and excess-weight subjects (p < 0.05). There was no difference in the physical activity levels among groups measured by PAQ-C. The Yo-Yo test was significantly associated with HDL cholesterol (rho = −0.41; p = 0.01), and this association remained after adjusting for body mass index z-score (rho = 0.28; p = 0.03). Conclusion: This study showed that endothelial dysfunction is already present in obese children, suggesting a predisposition to atherosclerotic disease. Moreover, HDL cholesterol levels were correlated with physical fitness, regardless of body mass index.

Resumo: Objetivos: A prevalência da obesidade está aumentando. O objetivo deste estudo foi investigar se há disfunção endotelial nas crianças com peso normal ou excesso de peso e se o perfil metabólico, as adipocinas e a disfunção endotelial seriam mais fortemente associados à aptidão física ou aos níveis de atividade física. Método: Estudo transversal que envolve crianças de 5-12 anos. A avaliação incluiu pletismografia de oclusão venosa, níveis séricos de adiponectina, leptina, insulina e lipidograma, escore de atividade física (questionário PAQ-C) e avaliação da aptidão física (teste Yo-yo). Resultados: Um total de 62 crianças participou deste estudo. Com base no índice de massa corporal, 27 eram eutróficos, 10 estavam acima do peso e 25 estavam obesos. Os níveis de triglicerídeos, colesterol LDL, HOMA-RI e leptina estavam mais elevados nas crianças obesas e com excesso de peso que o grupo de eutróficos (p < 0,01). Os níveis de colesterol HDL e adiponectina estavam mais elevados no grupo de eutróficos em comparação ao grupo de obesos e com excesso de peso (p < 0,01). A vasodilatação mediada pelo fluxo após hiperemia foi maior no grupo de eutróficos em comparação aos indivíduos obesos e com excesso de peso (p < 0,05). Não houve nenhuma diferença nos níveis de atividade física entre os grupos medidos pelo PAQ-C. O teste de ida e volta foi significativamente associado ao colesterol HDL (ró = −0,41; p = 0,01) e essa associação continuou após ajustar o escore z do índice de massa corporal (ró = 0,28; p = 0,03). Conclusão: Este estudo mostrou que a disfunção endotelial já está presente nas crianças obesas, sugeriu uma predisposição à doença aterosclerótica. Além disso, os níveis de colesterol HDL foram correlacionados à aptidão física, independentemente do índice de massa corporal.

Composición corporal y gasto energético en población de niños y adolescentes con mielomeningocele / Body composition and energy expenditure in a population of children and adolescents with myelomeningocele

Introducción: El mielomeningocele es un defecto congénito con cierre incompleto del tubo neural. Presenta alteraciones en la composición corporal y alta prevalencia de obesidad. Es difícil detectar el indicador más apropiado para diagnóstico nutricional por impresición de las medidas antropométricas. Objetivo: Describir en una población de pacientes con mielomeningocele seguidos en el "Hospital Garrahan", la composición corporal, gasto energético en reposo y trastornos metabólicos, comparando los pacientes con mielomeningocele obesos con una población control con obesidad multifactorial. Población y Métodos: Se realizó antropometría, impedanciometría, pliegues cutáneos, perímetro braquial, calorimetría indirecta y determinaciones bioquímicas a todos los pacientes con mielomeningocele entre junio/2013-abril/2014, previa firma del Consentimiento Informado. Resultados: Se evaluaron 131 pacientes de 0,718,6 años, clasificados según Score-Z de Índice de Masa Corporal en 15% bajo peso, 42% normopeso, 12% sobrepeso y 31% obesidad. Se encontró alta correlación (r²0,74) entre %masa grasa por impedanciometría vs calculado con pliegues cutaneos. Los pacientes con % masa grasa elevada vs %masa grasa normal tuvieron mayor score-Z de Indice de Masa Corporal (1,07 vs -0,27 p0,0001) aunque ambos valores se encontraban dentro de parámetros normales. Hubo menor gasto energético en reposo en los pacientes con mielomeningocele obesos comparado con el esperado y con obesos multifactoriales. Conclusiones: Se encontró alto porcentaje de sobrepeso/obesidad en la población con mielomeningocele. Los pliegues cutáneos serían más apropiados para detectar obesidad. Los pacientes con mielomeningocele obesos presentaron gasto energetico en reposo menor al esperado y a los controles. La indicación de energía debe ser personalizada.

Introduction. Myelomeningocele is a congenital defect that occurs when the neural tube fails to close completely. It causes body composition alterations and a high prevalence of obesity. It is difficult to detect the most adequate indicator for a nutritional diagnosis due to the impossibility of recording accurate anthropometric measurements. Objective. To describe body composition, resting energy expenditure and metabolic disorders in a population of patients with myelomeningocele managed at "Hospital Garrahan" by comparing obese patients with myelomeningocele and a control population with multifactorial obesity. Population and methods. An anthropometry, an impedance analysis, skinfold equations, arm circumference equations, indirect calorimetry, and biochemical determinations were done to all patients with myelomeningocele between June 2013 and April 2014, once the informed consent had been signed. Results. 131 patients aged 0.7-18.6 years were assessed; they were classified according to their body mass index Z-score into low weight (15%), normal weight (42%), overweight (12%), and obese (31%). A high correlation (r: 20.74) was observed between the fat mass % measured by impedance analysis versus that estimated using skinfolds. Patients with a high fat mass % had a higher body mass index Z-score than those with a normal fat mass % (1.07 versus -0.27, p: 0.0001) although both values were within normal parameters. A lower resting energy expenditure was observed among obese patients with myelomeningocele than predicted and in comparison with multifactorial obese controls. Conclusions. A high percentage of overweight/obesity was found in the population with myelomeningocele. Skinfold equations would be more adequate to detect obesity. Obese patients with myelomeningocele had a lower resting energy expenditure than predicted and in comparison with controls. Energy indication should be customized.

Overweight in youth and sleep quality: is there a link?

ABSTRACT Objective Overweight seems to be related to a higher prevalence of sleep disturbances. Decreased sleep duration and altered sleep quality are risk factors for obesity. Our aim was to compare the sleep pattern of overweight children with that of a matched control group and assess the relationship between sleep quality and obesity. Materials and methods Retrospective cohort study comparing 41 overweight children with a normal-weight control group, both submitted to polysomnography. The samples were matched for age, sex, and apnea-hypopnea index. Body mass index (BMI) z-scores were calculated using World Health Organization (WHO) growth charts. Insulin resistance in the study group was determined using the homeostatic model assessment for insulin resistance (HOMA-IR). Sleep patterns were compared. The statistical analysis was performed using SPSS® version 21. Results The mean age (± standard deviation) of the population was 10 ± 3.4 years (min. 5 years; max. 17 years). Fifty-six percent of the participants in both groups were girls. N3% was lower in the study group (18.95 ± 6.18%) compared with the control group (21.61 ± 7.39%; t (40) = 2.156, p = 0.037). We found a correlation in the study group between HOMA-IR and N3% (Rs = -0.434, p = 0.008). Conclusion The present study suggests a link between overweight/obesity and altered sleep quality due to compromised non-rapid eye movement sleep, an indirect marker of sleep quality. There was also a link between slow-wave sleep duration and insulin resistance. We must find a strategy to provide adequate slow-wave sleep duration to reduce the obesity epidemic at young ages. Further research is needed.

La deficiencia de vitamina D y la resistencia a la insulina como factores de riesgo de dislipidemia en niños obesos / Vitamin D deficiency and insulin resistance as risk factors for dyslipidemia in obese children

Introducción. La dislipidemia es una de las mayores complicaciones de la obesidad; la deficiencia de vitamina D y la resistencia a la insulina son complicaciones metabólicas que se presentan en niños obesos con dislipidemia. Objetivo. Determinar si la deficiencia de vitamina D y la resistencia a la insulina son factores de riesgo de dislipidemia en niños obesos. Materiales y métodos. Este estudio se llevó a cabo en el Departamento de Pediatría del Hospital Universitario y de Investigación Bagcilar en Estambul, Turquía, entre 2014 y 2015. Se incluyeron en el estudio pacientes obesos de 8 a 14 años de edad. Se midió la concentración sérica de triglicéridos, colesterol total, colesterol de las LDL, colesterol de las HDL, glucemia en ayunas, insulina, alanina aminotransferasa y vitamina D; también se hicieron ecografías hepáticas. La resistencia a la insulina se calculó utilizando el índice de la evaluación del modelo homeostático (HOMA-IR). Resultados. Se incluyeron en el estudio 108 niños obesos, de los cuales 39 (36,11%) padecían dislipidemia. Los valores promedio de glucemia en ayunas (88,74 ± 7,58 frente a 95,31 ± 6,82; p= 0,0001), insulina (14,71 ± 12,44 frente a 24,39 ± 15,02; p= 0,0001) y alanina aminotransferasa (23,45 ± 11,18 frente a 30,4 ± 18,95; p= 0,018) fueron significativamente más altos en los niños con dislipidemia. En los niños obesos con dislipidemia, la tasa promedio de esteatosis hepática y el índice HOMA-IR fueron más altos: 28 niños (71,9%) tuvieron esteatosis hepática y 37 (94,87%), presentaron resistencia a la insulina; las concentraciones de vitamina D fueron <20 ng/ml en el 69,3% de los niños. La deficiencia de vitamina D fue notablemente más frecuente (p= 0,033). El análisis de regresión multivariante confirmó que el aumento del índice HOMA-IR (p= 0,015) y el bajo nivel de vitamina D (p= 0,04) fueron factores importantes de riesgo de dislipidemia. Conclusión. En los niños obesos de nuestra región se observanbajas concentraciones de vitamina D y aumento del índice HOMA-IR, ambos factores de riesgo significativos para la dislipidemia.

Introduction. Dyslipidemia is one of the major complications of obesity; vitamin D deficiency and insulin resistance are attending metabolic complications in dyslipidemic obese children. Objective. To determine if vitamin D deficiency and insulin resistance are risk factors for dyslipidemia in obese children. Materials and Methods. This study was conducted in the Department of Pediatrics at Bagcilar Training and Research Hospital in Istanbul, Turkey between 2014 and 2015. Obese patients whose age range was 8-14 were included in the study. The serum triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting glucose, insulin, alanine aminotransferase, vitamin D levels were measured; a liver ultrasonography was performed. Homeostatic model assessment (HOMA-IR), was used to calculate insulin resistance. Results. 108 obese children were included; 39 (36.11%) had dyslipidemia. The average fasting blood glucose (88.74 ± 7.58 vs. 95.31 ± 6.82; p= 0.0001), insulin level (14.71 ± 12.44 vs. 24.39 ± 15.02; p= 0.0001) and alanine aminotransferase level (23.45 ± 11.18 vs. 30.4 ± 18.95; p= 0.018) were significantly higher in the children with dyslipidemia. In the dyslipidemic obese children, the average hepatosteatosis rate and HOMA-IR level were higher; 28 (71.9%) had hepatosteatosis, 37 (94.87%) had insulin resistance; the vitamin D levels were <20 ng/ml in 69.3%. Vitamin D deficiency was significantly more common (p= 0.033). The multivariate regression analysis confirmed that the increase in the HOMA-IR level (p= 0.015) and the low vitamin D level (p= 0.04) were important risk factors for dyslipidemia. Conclusion. Obese children in our region exhibit low vitamin D and increased HOMA-IR levels, which are efficient risk factors of dyslipidemia.

Resistencia a la insulina en niños y adolescentes con obesidad de Asunción, Paraguay / Insulin resistance in children and adolescents with obesity in Asuncion, Paraguay

Introducción: Existe un incremento marcado en la prevalencia de la obesidad y del síndrome metabólico, y con ellos, la resistencia a la insulina en niños y adolescentes. Objetivo: Determinar la presencia de resistencia a la insulina en un grupo de pacientes pediátricos con obesidad. Material y Método: Diseño prospectivo, observacional, descriptivo. Se incluyeron 41 pacientes de 6 a 16 años con diagnóstico de obesidad en quienes se determino insulina basal y glicemia tras 8 horas de ayuno. La resistencia a la insulina se definió mediante el índice HOMA (Homeostasis Model Assessment), utilizándose el punto de corte establecido por Keskin de 3,1. Los resultados fueron expresados en términos de media y desviación estándar. Resultados: Fueron evaluados 1215 pacientes, de los cuales el 13,2% (n=160) eran obesos. De ellos, fueron seleccionados al azar 41 pacientes, de los cuales el 51% (n=21) eran de sexo masculino, con una edad promedio de 9,6 años (±2,9). El 12% (n=5) de los pacientes presentó resistencia a la insulina, con una media de HOMA de 4,23 (±0,59). De ellos, el 60% (n=3) correspondió al sexo masculino. Conclusión: La presencia de resistencia a la insulina en el 12% de la población estudiada, a una edad temprana, constituye signo de alarma, y conlleva grave riesgo cardiovascular.

Introduction: There exists a marked increase in the prevalence of obesity and metabolic syndrome, and alongside them, insulin resistance in children and adolescents. Objective: To determine the presence of insulin resistance in a group of pediatric patients who suffer obesity. Materials and Methods: Prospective, observational, descriptive design. Forty one patients aged 6 to 16 with diagnosed obesity, whose basal insulin and glycaemia were determined following 8 hours of fasting. Insulin resistance was defined according to HOMA (Homeostasis Model Assessment), using the 3,1 cut-off point established by Keskin. Results were expressed in terms of mean and standard deviation. Results: 1215 patients were evaluated, of which 13,2% (n=160) were obese. 41 patients were randomly selected among them, of which 51% (n=21) were males, with an average age of 9,6 years (±2,9). 12% (n=5) of patients presented insulin resistance, with a HOMA mean of 4,23 (±0,59). Among those, 60% (n=3) corresponded to males. Conclusion: The presence of insulin resistance in 12% of the studied population, and at an early age, constitutes a sign of alarm and entails serious cardiovascular risk.