A Mobile-Based Nutrition Tracker App Enhanced Dietitian-Guided 2:1:1 Diet-Induced Weight Loss: An 8-Week Retrospective Cohort Study in Taiwan.

Effective weight management interventions involve a combination of behavioral strategies focusing on dietary changes. Tracing the change through mobile apps has been proven to be a valuable platform for facilitating weight management in many countries. However, the effectiveness of mobile app-based dietary intervention on weight management in Taiwan remains to be determined. By using the designated mobile app, this study aimed to assess the efficacy of the diet intervention, which is based on a 2:1:1 portion control plate and a flexible low-carbohydrate (FLC) diet. This 8-week retrospective cohort study involved 10,297 participants who were divided into two groups: the intervention group (joined an 8-week diet intervention program with the daily diet record assessed by registered dietitians) and the control group (voluntarily using the app without instructional materials or coaching). After eight weeks of intervention, the intervention group showed a higher weight loss percentage (-4.78% vs. -1.54%), body mass index (BMI) (-1.26 kg/m2 vs. 0.69 kg/m2), and diet record completeness (73.52% vs. 28.91%) compared with the control group. With respect to gender, male participants showed higher baseline weight and higher weight loss (-6.02%) in the intervention group. In the intervention group, 2871 participants (33.4%) lost less than 4% of their weight, 5071 participants (58.9%) lost 4-8% of their body weight, and 662 participants (7.7%) lost >8% of their weight. Compared to the low-effectiveness group (weight lost <4%), the high-effectiveness group (weight lost >8%) had a significantly higher diet record completeness (91.61 ± 15.99 vs. 55.81 ± 32.92), dietary compliance (green light %) (88.93 ± 9.9 vs. 77.75 ±17.5), protein intake % (26.34 ± 2.85 vs. 23.49 ± 3.56), and fat intake % (49.66 ± 6.36 vs. 44.05 ± 7.37). Most importantly, the high-effectiveness group had a lower carbohydrate intake % (24.1 ± 7.86 vs. 32.46 ± 9.61). The results remained significant after being stratified by gender. This study found that the use of online applications plus the intervention of dietitians is beneficial for short-term weight loss. The composition of nutrients and dietary compliance also significantly impacted weight loss.

Relationship between Aspartame-Induced Cerebral Cortex Injury and Oxidative Stress, Inflammation, Mitochondrial Dysfunction, and Apoptosis in Sprague Dawley Rats.

There are emerging concerns about the potential cerebral cortex injury from aspartame due to the accumulation of the various neurotoxic metabolic components in the central nervous system after long-term dietary exposure. The aim of this study was to evaluate the effect of oral aspartame consumption on cerebral cortex injury in the rat brain, and further evaluate the various underlying molecular mechanisms, with a special focus on oxidative stress, inflammation, mitochondrial dysfunction, and apoptosis pathways. Sprague Dawley rats (nineteen, female) were randomly sub-divided into three groups: (i) normal diet with vehicle: control group (five rats), (ii) low dose of aspartame group (LA): seven rats received 30 mg/kg body weight (bw) daily doses of aspartame, (iii) high dose of aspartame group (HA): seven rats received 60 mg/kg bw daily doses of aspartame. After 8 weeks, the LA and HA groups showed lower expression levels of brain-derived neurotrophic factor (BDNF), antioxidant enzyme activity (SOD2, CAT), antioxidant marker (Nrf2), inflammatory response (IκB), mitochondrial biogenesis (Sirt1, PGC1α, Nrf1, TFAM), mitochondrial DNA (mtDNA) copy number, and apoptosis-related proteins (Bax, Caspase-3) expressions. Aspartame administration also elevated oxidative stress levels (Malondialdehyde, MDA), 8-hydroxy-2-deoxy guanosine (8-OHdG), PGE2 and COX-2 expressions, pro-inflammatory cytokines (TNFα, IL6, IL1ß), antioxidant marker expression (Keap1), inflammatory responses (iNOS, NFκB), and glial fibrillary acidic protein (GFAP) levels in the cerebral cortex of the rats, thereby contributing to the reduced survival of pyramidal cells and astrocyte glial cells of the cerebral cortex. Therefore, these findings imply that aspartame-induced neurotoxicity in rats' cerebral cortex could be regulated through four mechanisms: inflammation, enhanced oxidant stress, decreased mitochondrial biogenesis, and apoptosis pathways.

Lactic Acid Bacteria from African Fermented Cereal-Based Products: Potential Biological Control Agents for Mycotoxins in Kenya.

Cereals play an important role in global food security. Data from the UN Food and Agriculture Organization projects increased consumption of cereals from 2.6 billion tonnes in 2017 to approximately 2.9 billion tonnes by 2027. However, cereals are prone to contamination by toxigenic fungi, which lead to mycotoxicosis. The current methods for mycotoxin control involve the use of chemical preservatives. However, there are concerns about the use of chemicals in food preservation due to their effects on the health, nutritional quality, and organoleptic properties of food. Therefore, alternative methods are needed that are affordable and simple to use. The fermentation technique is based on the use of microorganisms mainly to impart desirable sensory properties and shelf-life extension. The lactic acid bacteria (LAB) are generally regarded as safe (GRAS) due to their long history of application in food fermentation systems and ability to produce antimicrobial compounds (hydroxyl fatty acids, organic acids, phenyllactic acid, hydrogen peroxide, bacteriocins, and carbon dioxide) with a broad range of antifungal activity. Hence, LAB can inhibit the growth of mycotoxin-producing fungi, thereby preventing the production of mycotoxins. Fermentation is also an efficient technique for improving nutrient bioavailability and other functional properties of cereal-based products. This review seeks to provide evidence of the potential of LAB from African fermented cereal-based products as potential biological agents against mycotoxin-producing fungi.

Potential Role of African Fermented Indigenous Vegetables in Maternal and Child Nutrition in Sub-Saharan Africa.

Hunger and malnutrition continue to affect Africa especially the vulnerable children and women in reproductive age. However, Africa has indigenous foods and associated traditional technologies that can contribute to alleviation of hunger, malnutrition, and communicable and noncommunicable diseases. The importance of African indigenous vegetables is undeniable, only that they are season-linked and considered as "food for poor" despite their high nutritional contents. The utilization of African indigenous vegetables (AIVs) is hindered by postharvest losses and antinutrients affecting the bioavailability of nutrients. In Africa, fermentation is among the oldest food processing technologies with long history of safe use. Apart from extending shelf life and improving food organoleptic properties, fermentation of African indigenous vegetables (AIVs) is known to improve food nutritional values such as proteins, minerals, vitamins, and other beneficial phytochemicals. It can also increase bioavailability of various vitamins, minerals, and phytochemicals and increase synthesis of vital blood pressure regulators thus protecting against cardiovascular diseases and cancer and further helping fight certain malnutrition deficiencies. Some lactic acid bacteria (LAB) involved in food fermentation are known to produce exopolysaccharides with cholesterol-lowering, immunomodulator, antioxidant, and anticancer properties. Fermented foods (vegetables) are superior in quality and safety since most microorganisms involved in fermentation are good starter cultures that can inhibit the growth of foodborne pathogens and detoxify harmful compounds in foods. Thus, fermented foods can boost growth and well-being in children and women due to their higher nutritional contents. Therefore, fermentation of AIVs can contribute to the attainment of food and nutrition security especially among women and children who rely on these vegetables as a staple source of micronutrients and income. These benefits have a positive impact on the implementation of the second sustainable development goals and African Union agenda 2063. This review is aimed at shedding light on the potential of African fermented indigenous vegetables in combating maternal and child malnutrition in Sub-Sahara Africa.

Mangosteen Concentrate Drink Supplementation Promotes Antioxidant Status and Lactate Clearance in Rats after Exercise.

High-strength or long-duration exercise can lead to significant fatigue, oxidative stress, and muscle damage. The purpose of this study was to examine the effect of mangosteen concentrate drink (MCD) supplementation on antioxidant capacity and lactate clearance in rats after running exercise. Forty rats were divided into five groups: N, non-treatment; C, control; or supplemented with MCD, including M1, M5, and M10 (0.9, 4.5, and 9 mL/day) for 6 weeks. The rats were subjected to 30 min running and exhaustive-running tests using a treadmill. The blood lactate; triglyceride; cholesterol and glucose levels; hepatic and muscular malonaldehyde (MDA) levels; and antioxidant enzymes, including superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT), were analyzed. The results of this study demonstrated that MCD supplementation can increase GPx and CAT activities, alleviate oxidative stress in muscle, and increase lactate clearance, and is thereby beneficial to reduced muscle fatigue after exercise.

Curcumin supplementation ameliorated vascular dysfunction and improved antioxidant status in rats fed a high-sucrose, high-fat diet.

Vascular endothelial dysfunction is a potential risk factor for cardiovascular disease. This study evaluated the effect of curcumin on factors associated with vascular dysfunction using rats fed a high-sucrose, high-fat (HSF) diet. The experiment included 2 animal feeding phases. In the first feeding phase, male Sprague-Dawley rats were randomly divided into 2 groups: the control group (n = 8) was fed a standard diet (AIN-93G) and the HSF group (n = 24) was fed an HSF diet for 8 weeks to induce obesity. In the second feeding phase, lasting 4 weeks, the HSF group was randomly divided into 3 subgroups: the O group (n = 8) continued feeding on the HSF diet, the OA group (n = 8) had the HSF diet replaced with AIN-93G, and the OC group (n = 8) was fed the HSF diet supplemented with curcumin (300 mg/kg body weight daily). After 8 weeks, the HSF diet significantly elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), insulin, homeostatic model assessment insulin resistance (HOMA-IR), low-density lipoprotein cholesterol (LDL-C), homocysteine (Hcy), C-reactive protein (CRP), vascular cell adhesion molecule 1 (VCAM-1), and intercellular adhesion molecule 1 (ICAM-1) but significantly reduced levels of nitric oxide (NO) and high-density lipoprotein cholesterol (HDL-C). After dietary intervention, the OA and OC groups exhibited significantly lower levels of AST, ALT, HOMA-IR, cholesterol, LDL-C, Hcy, CRP, VCAM-1, and ICAM-1 and higher levels of NO and catalase (CAT) activity compared with the O group. Superoxide dismutase, CAT, and glutathione peroxidase activities were increased in the OA group, while CAT levels were enhanced in the OC group. In conclusion, this study showed that curcumin supplementation and diet modification can inhibit HSF diet-induced vascular dysfunction potentially by enhancing NO production and antioxidant enzyme activities, thereby suppressing inflammation and oxidative damage in the vascular endothelium.

Alpha-mangostin from mangosteen (Garcinia mangostana Linn.) pericarp extract reduces high fat-diet induced hepatic steatosis in rats by regulating mitochondria function and apoptosis.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is caused by multiple factors including hepatic oxidative stress, lipotoxicity, and mitochondrial dysfunction. Obesity is among the risk factors for NAFLD alongside type 2 diabetes mellitus and hyperlipidemia. α- mangostin (α-MG) extracts from the pericarps of mangosteen (Garcinia mangostana Linn.) may regulate high fat diet-induced hepatic steatosis; however the underlying mechanisms remain unknown. The aim of this study was to investigate the regulatory effect of α-MG on high fat diet-induced hepatic steatosis and the underlying mechanisms related to mitochondrial functionality and apoptosis in vivo and in vitro. METHODS: Sprague Dawley (SD) rats were fed on either AIM 93-M control diet, a high-fat diet (HFD), or high-fat diet supplemented with 25 mg/day mangosteen pericarp extract (MGE) for 11 weeks. Thereafter, the following were determined: body weight change, plasma free fatty acids, liver triglyceride content, antioxidant enzymes (superoxide dismutase, SOD; glutathione, GSH; glutathione peroxidase, GPx; glutathione reductase GRd; catalase, CAT) and mitochondrial complex enzyme activities. In the in vitro study, primary liver cells were treated with 1 mM free fatty acid (FFA) (palmitate: oleate acid = 2:0.25) to induce steatosis. Thereafter, the effects of α-MG (10 µM, 20 µM, 30 µM) on total and mitochondria ROS (tROS, mitoROS), mitochondria bioenergetic functions, and mitochondrial pathway of apoptosis were examined in the FFA-treated primary liver cells. RESULTS: The MGE group showed significantly decreased plasma free fatty acids and hepatic triglycerides (TG) and thiorbarbituric acid reactive substances (TBARS) levels; increased activities of antioxidant enzymes (SOD, GSH, GPx, GRd, CAT); and enhanced NADH-cytochrome c reductase (NCCR) and succinate-cytochrome c reductase (SCCR) activities in the liver tissue compared with HFD group. In the in vitro study, α-MG significantly increased mitochondrial membrane potential, enhanced cellular oxygen consumption rate (OCR), decreased tROS (total ROS) and mitoROS (mitochondrial ROS) levels ; reduced Ca2+ and cytochrome c (cyt c) release from mitochondria, and reduced caspases 9 and 3 activities compared with control group. CONCLUSION: These findings demonstrate α-MG attenuated hepatic steatosis in high fat-diet fed rats potentially through enhanced cellular antioxidant capacity and improved mitochondrial functions as well as suppressed apoptosis of hepatocytes. The findings of study represent a novel nutritional approach on the use of α-MG in the prevention and management of NAFLD.

Hb and dyslipidaemia as predicting markers of serum alanine aminotransferase elevation in Chinese adolescents.

OBJECTIVE: Fe is an essential element for erythropoiesis and Hb synthesis. High Hb levels affect the blood's viscosity and are associated with cardiovascular dysfunction. The aim of the present study was to examine relationships of Hb and cardiometabolic abnormalities with the risk of alanine aminotransferase (ALT) elevation in adolescents. DESIGN: A population-based, cross-sectional study. SETTING: National Nutrition and Health Survey in Taiwan (2010-2011, adolescents). SUBJECTS: Healthy adolescents aged 13-18 years. RESULTS: In total, 1941 adolescents (963 boys and 978 girls) were entered in the study. The mean age was 15·3 (sd 0·1) years (boys, 15·3 (sd 0·1) years; girls, 15·2 (sd 0·1) years). ALT tertile cut-off points for boys were 11 and 16 U/l, and for girls were 9 and 12 U/l. Girls without dyslipidaemia and presenting in the highest quartile (Q1) of Hb (>13·6 g/dl) were 1·89 and 3·76 times more likely to have raised serum ALT (9 and >12 U/l, respectively) than the reference (lowest quartile of Hb (Q1), 12 U/l) than the reference (Q1 of Hb, 15·4 g/dl), who were 7·40 times more likely to have elevated serum ALT of >16 U/l than the reference (Q1 of Hb, <14·1 g/dl). CONCLUSIONS: Our findings suggest that an increased Hb level is a predictor of elevated serum ALT in adolescent girls with dyslipidaemia. Our study also highlights the importance of further research to establish cut-off points for Hb and its utility in diagnosing and preventing the onset of dyslipidaemia in adolescents.

Dose-related effects of ferric citrate supplementation on endoplasmic reticular stress responses and insulin signalling pathways in streptozotocin-nicotinamide-induced diabetes.

Diabetic patients are at high risk of developing anemia; however, pharmacological doses of iron supplementation may vary greatly depending on diabetes-related complications. The aim of this study was to investigate the dose-dependent effect of iron on glucose disposal with a special focus on endoplasmic reticular (ER) stress, iron metabolism, and insulin signalling pathways. Diabetes was induced in overnight fasted rats by intraperitoneal (i.p.) injections of 40 mg kg(-1) streptozotocin (STZ) and 100 mg kg(-1) nicotinamide. Diabetic rats were fed a standard diet (36.7 mg ferric iron per kg diet) or pharmacological doses of ferric citrate (0.5, 1, 2, and 3 g ferric iron per kg diet). Ferric citrate supplementation showed a dose-related effect on hepatic ER stress responses and total iron levels, which were associated with increased hepcidin and decreased ferroportin expressions. Iron-fed rats had increased sizes of their pancreatic islets and hyperinsulinemia compared to rats fed a standard diet. A western blot analysis revealed that iron feeding decreased total insulin receptor substrate 1 (IRS1), phosphorylated IRS1ser307, and AS160 but increased phosphorylated GSK-3ß. Iron supplementation inhibited the nuclear translocation of AKT but promoted FOXO1 translocation to nuclei. Ferric citrate supplementation showed a dose-related effect on ER stress responses, hepatic iron, and the insulin signaling pathway. Adverse effects were more evident at high iron doses (>1 g ferric iron per kg diet), which is equivalent to a 60 kg human male consuming >500 mg elemental iron per day.

Th17 Cells as Potential Probiotic Therapeutic Targets in Inflammatory Bowel Diseases.

Inflammatory bowel diseases (IBD) are characterized by wasting and chronic intestinal inflammation triggered by various cytokine-mediated pathways. In recent years, it was shown that T helper 17 (Th17) cells are involved in the pathogenesis of IBD, which makes them an attractive therapeutic target. Th17 cells preferentially produce interleukin (IL)-17A-F as signature cytokines. The role of the interplay between host genetics and intestinal microbiota in the pathogenesis of IBD was demonstrated. Probiotics are live microorganisms that when orally ingested in adequate amounts, confer a health benefit to the host by modulating the enteric flora or by stimulating the local immune system. Several studies indicated the effectiveness of probiotics in preventing and treating IBD (ulcerative colitis, and Crohn's disease). Furthermore, there is mounting evidence of probiotics selectively targeting the Th17 lineage in the prevention and management of inflammatory and autoimmune diseases such as IBD. This review highlights critical roles of Th17 cells in the pathogenesis of IBD and the rationale for using probiotics as a novel therapeutic approach for IBD through manipulation of Th17 cells. The potential molecular mechanisms by which probiotics modulate Th17 cells differentiation and production are also discussed.

Relationship between hemoglobin levels and risk for suspected non-alcoholic fatty liver in Taiwanese adults.

Body iron levels have recently been shown to be a strong predictor for non-alcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence of NAFLD in a general adult population, and to investigate the relationship between body iron levels, NAFLD and the metabolic syndrome (MetS). 2186 adults participated in the third National Nutrition and Health Survey in Taiwan (NAHSIT, 2005-2008). The participants underwent anthropometry measurements and phlebotomy after an overnight fast, and those with excessive alcohol intake, iron overload of serum ferritin > 600 ng/ml, hepatitis viral infection and hepatocellular carcinoma were excluded. Suspected NAFLD was diagnosed by three alanine transaminase (ALT) cut-points: cut-point 1: serum ALT > 40 U/l; cut-point 2: ALT ≥ 25 U/l for male and ALT ≥ 17 U/l for female; and cut-point 3: ALT ≥ 35 U/l for male and ALT ≥ 26 U/l for female. The prevalence proportion of suspected NAFLD among Taiwanese adults was 6.6% (cut-point 1), 36% (cut-point 2); and 14.3% (cut-point 3). Body iron levels were significantly higher in individuals with suspected NAFLD compared with those without. Distribution of hemoglobin levels, but not serum ferritin levels, by decade of age showed strong correlation with the prevalence of suspected NAFLD in individuals with MetS. Multivariate adjusted odds ratio (OR) showed that the best predictors for suspected NAFLD with the MetS were hemoglobin [OR 1.43 (1.21-1.68); P < 0.0001] and hyperlipidemia [OR 1.52 (1.19-1.94); P = 0.0007]. In individuals without MetS, the adjusted OR of suspected NAFLD was markedly higher for hemoglobin [OR 1.25 (1.12-1.41); P < 0.0001]. In conclusion, adults with high hemoglobin levels (14.4 µg/dl for male and 13.2 µg/dl for female) are at the greatest risk for developing abnormal liver function. Hemoglobin test should be considered as a part of clinical evaluation for patients with NAFLD.

Interactive effects of dietary fat/carbohydrate ratio and body mass index on iron deficiency anemia among Taiwanese women.

Whether being overweight or obese is associated with increased risk of iron deficiency anemia (IDA) remains controversial. We evaluated the dietary intakes and risk for IDA in relation to body mass index (BMI). One thousand two hundred and seventy-four females aged ≥ 19 years, enrolled in the third Nutrition and Health Survey in Taiwan (NAHSIT) 2005-2008, were selected. Half of the women were either overweight (24.0%) or obese (25.3%). The overall prevalence of anemia, iron deficiency and IDA among adult women was 19.5%, 8.6% and 6.2%. BMI showed a protective effect on IDA: overweight (odds ratio, OR: 0.365 (0.181-0.736)) and obese (OR: 0.480 (0.259-0.891)) when compared with normal weight. Univariate analysis identified increased IDA risk for overweight/obese women who consumed higher dietary fat but lower carbohydrate (CHO) (OR: 10.119 (1.267-80.79)). No such relationship was found in IDA women with normal weight (OR: 0.375 (0.036-4.022)). Analysis of interaction(s) showed individuals within the highest BMI tertile (T3) had the lowest risk for IDA and the risk increased with increasing tertile groups of fat/CHO ratio; OR 0.381 (0.144-1.008; p = 0.051), 0.370 (0.133-1.026; p = 0.056) and 0.748 (0.314-1.783; p = 0.513); for T1, T2 and T3, respectively. In conclusion, a protective effect of BMI on IDA may be attenuated in women who had increased fat/CHO ratio.

Interleukin-10 as a potential regulator of hepcidin homeostasis in overweight and obese children: a cross-sectional study in Taiwan.

OBJECTIVE: A sharp increase in the prevalence of obesity and a decline in iron deficiency in children was observed between the two consecutive Nutrition and Health Surveys in Taiwan. The aim of this study was to evaluate the distribution of hepcidin in relation to nutritional status in children. METHODS: 648 children ages 7 to 13 y living in Taipei and New Taipei City were enrolled in this study. Parameters for obesity, iron status, and inflammatory markers were evaluated. RESULTS: There were no differences in the prevalence of iron deficiency and iron depletion between normal and overweight/obese children. A V-sharp hepcidin distribution curve was seen in normal weight children and overweight/obese boys. Serum hepcidin levels remained stable in overweight/obese girls during transition from childhood to teenager. Overweight/obese children had increased serum nitric oxide (NO) and interleukin (IL)-1ß but decreased IL-10 concentration compared with normal weight children. A strong inverse relationship was found between IL-10 and body mass index (BMI; odds ratio (OR), 0.86, 95% confidence interval [CI], 0.83-0.89). By contrast, positive correlations were observed between BMI and IL-1ß (OR, 1.60; 95% CI, 1.29-1.98); and between BMI and NO (OR, 1.04, 95% CI, 1.02-1.07). Multivariate linear regression analysis showed serum hepcidin was significantly correlated with IL-10 (ß = 0.26, P < 0.0001). CONCLUSIONS: Our results raise the possibility that IL-10 may play a role in iron homeostasis. Decreased circulating IL-10 concentration may temporary protect young overweight/obese girls against the development of iron deficiency. However, long-term decrease in hepcidin concentration may increase the risk for iron overload in overweight/obese children.

Interleukin 10 and clustering of metabolic syndrome components in pediatrics.

BACKGROUND: Interleukin 10 (IL-10) has multifaceted anti-inflammatory properties that are known to regulate insulin sensitivity and atherosclerotic development. However, studies in children are limited and have yielded conflicting results. The aim of this study was to evaluate whether changes in this circulating anti-inflammatory cytokine is a marker for metabolic syndrome. MATERIALS AND METHODS: This cross-sectional study involved children and young adolescents from eight elementary schools and two junior high schools located in Taipei and New Taipei City. A total of 553 children ages 8, 11 and 13 years old were included in the analysis. Parameters for obesity, anti- and pro-inflammatory cytokines, and metabolic risk profiles were evaluated. RESULTS: Overweight/obese children had lower serum IL-10 concentrations compared with normal weight children in the same age group (all P < 0·001). IL-10 quartiles were negatively associated with body mass index (BMI) and percentage (%) body fat (all P < 0·05). Multivariate regression analysis showed significant inverse relationship between IL-10 concentrations and % body fat (ß = -0·009, P < 0·0001), and total cholesterol (ß = -0·726, P = 0·003), and a small positive correlation between IL-10 and systolic blood pressure (ß = 0·980, P = 0·027). In normal weight children, IL-10 concentrations were independently associated with fasting plasma insulin (ß = 0·2912, P = 0·001) and waist circumference (ß = 0·0069, P = 0·022). By contrast, % body fat (ß = -0·016, P = 0·0009) was independently associated with IL-10 concentrations in overweight and obese children. Association between IL-10 and fasting plasma insulin concentrations was weaker in overweight/obese children compared with normal weight (ß = 0·283, P = 0·011 vs. ß = 0·2912, P = 0·001). CONCLUSION: Our data indicate that changes in circulating IL-10 concentrations are marker of metabolic risk in children.