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Vol 15, No 4
Vol 15, No 4 August 2019 ISSN 1708-8569
Review articles
Original articles
Letter to the Editor
Big challenges: obesity and type 2 diabetes in children and adolescents
  Jun-Fen Fu
  [Abstract] [Full Text] [PDF]  
Review articles:
Progress in understanding youth-onset type 2 diabetes in the United States: recent lessons from clinical trials
  Philip Zeitler
Background: Due to the dramatic increase in the rates of childhood obesity and youth-onset type 2 diabetes (T2D) in the late 1990s in the United States, the US government, through the National Institute of Diabetes, Digestive Disease, and Kidney (NIDDK) and the Centers for Disease Control, funded a series of large studies and trials which, together, have formed the basis for much of what we currently understand about youth-onset T2D.
Data sources: The review focus on the recent results and implications of the treatment options for Type 2 Diabetes in Adolescents and Youth (TODAY) study and the Restoring Insulin Secretion (RISE) study.
Results and Conclusions: Both TODAY and RISE studies have provided critical insight into the unique aspects of the pathophysiology of youth-onset type 2 diabetes and also provided the evidence base for our current approach to the management of this disorder.
  [Abstract] [Full Text] [PDF]  
Childhood obesity in New Zealand
  Valentina Chiavaroli, John D. Gibbins, Wayne S. Cutfi eld, Jos谷 G. B. Derraik
Background: Paediatric obesity has reached epidemic proportions globally, resulting in significant adverse effects on health and wellbeing. Early life events, including those that happen before, during, and after pregnancy can predispose children to later obesity. The purpose of this review is to examine the magnitude of obesity among New Zealand children and adolescents, and to determine their underlying risk factors and associated comorbidities.
Data sources: PubMed, Web of Science, and Google Scholar searches were performed using the key terms ※obesity§, ※overweight§, ※children§, ※adolescents§, and ※New Zealand§.
Results: Obesity is a major public health concern in New Zealand, with more than 33% of children and adolescents aged 2每14 years being overweight or obese. Obesity disproportionately affects M芋ori (New Zealand*s indigenous population) and Pacific children and adolescents, as well as those of lower socioeconomic status. New Zealand*s obesity epidemic is associated with numerous health issues, including cardiometabolic, gastrointestinal, and psychological problems, which also disproportionately affect M芋ori and Pacific children and adolescents. Notably, a number of factors may be useful to identify those at increased risk (such as demographic and anthropometric characteristics) and inform possible interventions.
Conclusions: The prevalence of overweight and obese children and adolescents in New Zealand is markedly high, with a greater impact on particular ethnicities and those of lower socioeconomic status. Alleviating the current burden of pediatric obesity should be a key priority for New Zealand, for the benefit of both current and subsequent generations. Future strategies should focus on obesity prevention, particularly starting at a young age and targeting those at greatest risk.
  [Abstract] [Full Text] [PDF]  
The role of gut micorbiome in obesity and diabetes
  Katarzyna G車rowska-Kowolik, Agata Chobot
Background: Obesity and diabetes became a grooving problem in both adults and children. Many hypotheses concerned agents involved in the excessive weight gain process and it*s consequences. Not only genetic or environmental factors, but also intestinal microbiome seems to play a role in the pathophysiology of this phenomenon.
Data sources: A systematic review was conducted using Pubmed as the medical database source. Studies concerning connection between microbiome and metabolic disorders such as obesity and diabetes from last 10 years were analyzed.
Results: Intestinal bacteria may be involved both in the development of obesity, and its further complications. The pro-inflammatory and immunomodulating effect of dysbiosis are possible triggers of insulin resistance and diabetes. Early interventions aimed at the microbiome, as well as attempts to modify the microbiome at later stages may become new opportunities in the prevention and treatment of obesity and carbohydrate metabolism disorders.
Conclusions: The gut microbiome has been shown to be an important part of the metabolic processes. The use of probiotic, prebiotics and symbiotics is promising, but requires further investigations to determine the specific metabolic effects of each bacteria strain and substance.
  [Abstract] [Full Text] [PDF]  
Impact of maternal smoking on the infant gut microbiota and its association with child overweight: a scoping review
  Cara McLean, Shelly Jun, Anita Kozyrskyj
Background: Childhood obesity is a growing public health concern with evidence demonstrating that while infant exposure to maternal smoking is linked to low birth weight at birth, there is a rapid catch up in weight and increased risk of obesity in later life. This scoping review aims to synthesize up-to-date evidence on the impact of maternal smoking on the infant gut microbiota and its association with child overweight.
Methods: We conducted a PRISMA-compliant scoping review. Primary population-based cohort studies published between 1900 and April 2018 were included. Relevant publications were retrieved from seven databases: PubMed, Medline, Embase, Scopus, Biosis, Cochrane library, and Web of Science Core Collection.
Results: A total of three prospective cohort studies were included which utilized high-throughput 16S rRNA gene sequencing to assess the gut microbiota and included a total of 1277 infant/neonatal participants. Neonates exposed to environmental smoke had a higher relative abundance of Ruminococcus and Akkermansia . Infants exposed to environmental smoke during pregnancy or postnatally were found to have increased gut bacterial richness, particularly Firmicutes at 3 months of age, while 6-month-old infants born to smoking mothers had an increased abundance of Bacteroides and Staphylococcus. Elevated Firmicutes richness at 3 months of age was associated with elevated odds of child overweight and obesity at 1 and 3 years of age.
Conclusions: The limited evidence to date warrants further large scale, longitudinal studies to explore the impact of maternal smoking and environmental tobacco smoke on the infant gut microbiome and its relation to child overweight.
  [Abstract] [Full Text] [PDF]  
Prevention and treatment of childhood and adolescent obesity: a systematic review of meta-analyses
  Theodora Psaltopoulou, Stamatios Tzanninis, Ioannis Ntanasis-Stathopoulos, George Panotopoulos, Myrto Kostopoulou, Ioannis-Georgios Tzanninis, Anastasia Tsagianni, Theodoros N. Sergentanis
Background: The goal of this systematic review is to synthesize the published meta-analyses assessing the role of nutritional, behavioral and physical activity factors/interventions on the prevention or treatment of pediatric and adolescent obesity.
Methods: An online search was conducted in PubMed (end-of-search: September 30, 2015); English-language meta-analyses pooling observational and/or interventional studies examining weight-related indices on children and adolescents were included.
Results: Sixty-six meta-analyses corresponding to more than 900,000 children and adolescents were retrieved. The majority of meta-analyses included interventional studies most of which referred to mixed or combined interventions, including components such as diet, physical activity and sedentary behavior reduction. Discrepancies between meta-analyses on observational and interventional studies were noted. Combined interventions including physical activity and nutritional modifications seemed to represent the most effective means for tackling childhood obesity.
Conclusions: Synthesis of interventional or observational evidence may yield discrepant results. The combination of enhanced physical activity and improved nutrition emerged as a promising intervention in the fight against childhood/adolescent obesity. However, further research is needed about the most effective multidimensional prevention strategy.
  [Abstract] [Full Text] [PDF]  
FTO gene polymorphisms and obesity risk in Chinese population: a meta-analysis
  Ning-Ning Zhao, Guan-Ping Dong, Wei Wu, Jin-Ling Wang, Rahim Ullah, Jun-Fen Fu
Background: There is tremendous increase in obesity worldwide. Many factors including diet, life style, genetic, and epigenetic changes contribute to obesity. The fat mass and obesity-associated (FTO) gene polymorphisms are strongly associated with obesity. It has been reported that FTO single-nucleotide polymorphisms (SNPs) are associated with obesity in European populations; however, it was controversial in Chinese population. The present meta-analysis study was designed to investigate the association between FTO polymorphisms and obesity risk in Chinese population.
Methods: The investigators searched studies using the following databases: PubMed, web of science, and Cochrane Central Register of Controlled Trials. A random-effects model was used to calculate the pooled odds ratios (ORs). The heterogeneity among the studies was measured by I2 value. Subgroup analysis was used to find out the potential factors influencing the heterogeneity.
Results: A total of 18 articles including 26 studies were included in the present meta-analysis. Overall, the FTO SNPs were significantly associated with obesity in Chinese population (OR 1.30; 95% CI 1.19每1.42; P < 0.001) under per-allele comparison. The subgroup analysis also showed strong association between four FTO SNPs (rs9939609, rs6499640, rs8050136, and rs1558902) and obesity risk. Furthermore, subgroup analysis stratified by children/adolescent and adult groups showed same trend.
Conclusions: The present meta-analysis indicated that FTO SNPs are associated with obesity risk in both children/adolescents and adults in Chinese population.
  [Abstract] [Full Text] [PDF]  
Original articles:
Antibiotic use in early childhood and risk of obesity: longitudinal analysis of a national cohort
  Dervla Kelly, Alan Kelly, Tom O*Dowd, Catherine B. Hayes
Background: Taking oral antibiotics during childhood has been linked with an increased risk of childhood obesity. This study assessed any potential association in number of courses of antibiotics taken between 2每3 and 4每5 years of age and body mass trajectory up to age 5.
Methods: The study was a secondary analysis of 8186 children and their parents from the infant cohort of the Irish National Longitudinal Study of Children. Antibiotic use was measured by parental recall between ages 2每3 and 4每5. Longitudinal models described the relationship between antibiotic exposure and body mass index (BMI) standard deviation scores and binary outcomes, and examined interactions between covariates, which included socioeconomic status, diet assessed by food frequency questionnaires and maternal BMI.
Results: Any antibiotic usage between 2 and 3 years did not predict risk of overweight or obesity at age 5. Four or more courses of antibiotics between 2 and 3 years were independently associated with obesity at age 5 (odds ratio 1.6, 95% confidence interval 1.11每2.31). Effect size was modest (coefficient + 0.09 body mass SD units, standard error 0.04, P = 0.037). Maternal BMI modified the relationship: ≡ 4 courses of antibiotics between 2 and 3 years were associated with a + 0.12 body mass SD units increase in weight at age 5 among children of normal-weight mothers (P = 0.035), but not in children of overweight mothers.
Conclusions: Number of antibiotic courses, rather than antibiotic use, may be an important factor in any link between early antibiotic exposure and subsequent childhood obesity. Research is needed to confirm differential effects on babies of normal versus overweight/obese mothers independent of socioeconomic factors.
  [Abstract] [Full Text] [PDF]  
Early testing of insulin resistance: a tale of two lipid ratios in a group of 5th graders screened by the Coronary Artery Risk Detection in Appalachian Communities Project (CARDIAC Project)
  Charles Ituka Mosimah, Christa Lilly, Awung-Njia Forbin, Pamela J. Murray, Lee Pyles, Elloise Elliot, William Neal
Background: In West Virginia (WV), 47% of fifth-grade children are either overweight or obese. There is no clear consensus regarding the definition of insulin resistance in children, and directly measuring insulin on the population level is costly. Two proposed measures examined further in this study include triglyceride (TRIG)/high-density lipoprotein cholesterol (HDLC) ratio and TRIG/low-density lipoprotein (LDL-C) ratio. The purpose of this study is to examine the relationship between TRIG/HDL-C ratio, TRIG/LDL-C ratio and insulin resistance in fifth-graders with acanthosis nigricans (AN).
Methods: Between 2007 and 2016, 52,545 fifth-grade students in WV were assessed for AN. Fasting glucose and insulin levels were collected only for a sub-group of students who were AN-positive and was used to determine insulin resistance using the Homeostatic Model for Insulin Resistance (HOMA-IR) equation. Statistical analysis included t tests and logistic regression with receiver operating characteristic curves.
Results: Of the students assessed for AN, 4.5% (n = 2360) tested positive. The prevalence of insulin resistance was 79% (n = 814) among 1030 with AN and complete HOMA-IR. TRIG/HDL-C ratio and TRIG/LDL-C ratio were significantly associated with insulin resistance (TRIG/HDL-C:Est. = 0.36, P < 0.0001, AUC = 0.68; TRIG/LDL-C: Est. = 0.87, P < 0.0001, AUC = 0.69). Multivariate analysis showed that increased body mass index (Est. = 0.05, P < 0.0001), gender (Est. = 0.49, P < 0.0001) and TRIG/HDL-C ratio (Est. = 0.21, P < 0.0001) were significantly associated with insulin resistance.
Conclusions: TRIG/HDL-C is a better surrogate marker of insulin resistance in AN-positive children compared to TRIG/LDL-C ratio; so, on a population-level, cholesterol rather than insulin may be obtained for preliminary testing of early insulin resistance in children.
  [Abstract] [Full Text] [PDF]  
Clinical characteristics and beta-cell function of Chinese children and adolescents with type 2 diabetes from 2009 to 2018
  Zhen-Ran Xu, Miao-Ying Zhang, Jin-Wen Ni, Ruo-Qian Cheng, Zhang-Qian Zheng, Li Xi, Fei-Hong Luo
Background: The limited available studies have unveiled different natural histories and prognosis associated with pediatric type 2 diabetes (T2D) and adult T2D. To date, data on the clinical features, metabolic profiles and beta-cell function characteristics are still limited in the Chinese pediatric T2D population.
Methods: A total of 56 children with T2D, 31 with prediabetes and 159 with obesity were recruited. Clinical characteristics, metabolic profiles, beta-cell function and insulin resistance were analyzed.
Results: The mean onset age of T2D was 12.35 ㊣ 1.99 (7.9每17.8) years, and 7% of children were younger than 10 years; 55% of them were male, 57% had a family history of diabetes and 64% had classic symptoms, and 25% had a low or high birth weight. 89% of T2D patients were obese or overweight. A total of 58% of the patients with prediabetes were male. The fast serum C-peptide level was highest in the obesity group (P < 0.001), and there was no significant difference between the T2D and prediabetes groups. The mean homeostatic model of assessment of beta-cell function was the highest in the obesity group and was lowest in the T2D group (P < 0.001). The T2D group had the most serious lipid metabolism disorder, with the highest levels of total triglycerides, total cholesterol, and low density lipoprotein and the lowest high density lipoprotein level among the three groups.
Conclusions: A younger onset age and greater male susceptibility were found in Chinese pediatric T2D patients, and there was a stepwise deterioration trend in beta-cell function among patients with obesity, prediabetes and T2D. Based on our results, together with the SEARCH study results, an early screening and intervention program for T2D is recommended in high-risk or obese Chinese pediatric populations starting at 7 years.
  [Abstract] [Full Text] [PDF]  
Letter to the Editor:
Epidemiological characteristics of childhood obesity in eastern China, 2017每2019
  Xi-Yan Zhang, Wen-Yi Yang, Jie Yang, Yan, Wang, Yao Xiang, Liu-Wei Gao, Feng-Yun Zhang, Yong-Lin Zhou
  [Abstract] [Full Text] [PDF]  
World Journal of Pediatric Surgery
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