Pawel Matusik

Prevalence of metabolic syndrome in European obese children.

UNLABELLED The rapid rising prevalence of childhood obesity is related to increased risk of obesity-related diseases during adulthood. The aim of the present study was to review the data concerning the prevalence of metabolic syndrome (MS) in European children and adolescents (Part 1) and to determine and compare the prevalence of MS among overweight and obese children, and adolescents in five European countries using four MS definitions (Part 2). In total, 1 241 European obese children from five different countries (France: n =283, Greece: n =145, Italy: n =274, Poland: n =90, and Hungary: n =449) were studied for MS according to the definition of Ferranti et al., the World Health Organisation, the National Cholesterol Education Program and the International Diabetes Federation. We used age- and sex-specific cut-off values for the diagnosis of high blood pressure and increased waist circumference. The prevalence of MS was 35.7%, 31.4%, 20.3%, and 16.4%, respectively, according to the above-mentioned definitions. Only 6.3-8.8% of obese adolescents were free from any risk factors and the clustering of three risk factors or more was very high: 20.3-35.7% (depending on the type of definition). A total of 12.2% of children had MS and 55.8% were free from MS according to all four definitions. CONCLUSIONS The prevalence of MS is high among European obese children whatever criteria are used. There is an urgent need to achieve consensus concerning the definition of MS in adolescents and children.

Omega-3 fatty acids for treatment of non-alcoholic fatty liver disease: design and rationale of randomized controlled trial

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a liver manifestation of metabolic syndrome since obesity and insulin resistance are the main pathogenic contributors for both conditions. NAFLD carries increased risk of atherosclerosis and cardiovascular diseases. There is an urgent need to find effective and safe therapy for children and adults with NAFLD. Data from research and clinical studies suggest that omega-3 fatty acids may be beneficial in metabolic syndrome-related conditions and can reduce the risk of cardiovascular disease.Methods/designWe are conducting a randomized, multicenter, double-blind, placebo-controlled trial of treatment with omega-3 fatty acids in children with NAFLD. Patients are randomized to receive either omega-3 fatty acids containing docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) or placebo for 24 weeks. The dose of omega-3 (DHA+ EPA) ranges from 450 to 1300 mg daily. Low calorie diet and increased physical activity are advised and monitored using validated questionnaires. The primary outcome of the trial is the number of patients who decreased ALT activity by ≥ 0,3 of upper limit of normal. The main secondary outcomes are improvement in the laboratory liver tests, liver steatosis on ultrasound, markers of insulin resistance and difference in fat/lean body mass composition after 6 months of intervention.DiscussionPotential efficacy of omega-3 fatty acids in the treatment of NAFLD will provide needed rationale for use of this safe diet supplement together with weight reduction therapy in the growing population of children with NAFLD.Trial registrationNCT01547910

Omega-3 Fatty Acids Therapy in Children with Nonalcoholic Fatty Liver Disease: A Randomized Controlled Trial

OBJECTIVE To evaluate the efficacy and safety of omega-3 fatty acid supplementation in children with nonalcoholic fatty liver disease (NAFLD). STUDY DESIGN Overweight/obese children with NAFLD (n = 76; median age, 13 years; IQR, 11.1-15.2 years) were eligible to participate in the study. The diagnosis of NAFLD was based on elevated alanine aminotransferase (ALT) to ≥ 30% of the upper limit of normal (ULN) and liver hyperechogenicity on ultrasound. Patients were randomized to receive omega-3 fatty acids (docosahexaenoic acid and eicosapentaenoic acid, 450-1300 mg/day) or placebo (omega-6 sunflower oil). The primary outcome was the number of patients who demonstrated decreased ALT activity by ≥ 0.3 times the ULN. Secondary outcomes included alterations in liver function tests, liver hyperechogenicity, insulin resistance, and other metabolic markers after 6 months of intervention. RESULTS Out of 76 enrolled patients, 64 completed the trial and were analyzed. After 6 months, we found no significant differences between the omega-3 and placebo groups in the number of patients with decreased ALT by ≥ 0.3 times the ULN (24 vs 23) or in median (IQR) ALT activity (48.5 [31-62] U/L vs 39 [27-55] U/L), liver hyperechogenicity, insulin resistance, or serum lipid levels. However, patients in the omega-3 group had lower levels of aspartate aminotransferase (28 [25-36] U/L vs 39 [27-55] U/L; P = .04) and gamma-glutamyl transpeptidase (26 [17.5-36.5] U/L vs 35 [22-52] U/L; P = .04), and significantly higher levels of adiponectin. CONCLUSION Omega-3 fatty acid supplementation did not increase the number of patients with decreased ALT levels and it did not affect liver steatosis on ultrasound, but it improved aspartate aminotransferase and gamma-glutamyl transpeptidase levels in children with NAFLD compared with placebo. TRIAL REGISTRATION Registered with ClinicalTrials.gov: NCT01547910.

Childhood Obesity: Knowledge, Attitudes, and Practices of European Pediatric Care Providers

OBJECTIVE: To determine and compare attitudes, skills, and practices in childhood obesity management in 4 European countries with different obesity prevalence, health care systems, and economic situations. METHODS: A cross-sectional survey was distributed to primary health care providers from France, Italy, Poland, and Ukraine. The questionnaire was returned by 1119 participants with a response rate of 32.4%. RESULTS: The study revealed that most of the primary health care providers were convinced of their critical role in obesity management but did not feel sufficiently competent to perform effectively. The adherence to recommended practices such as routine weight and height measurements, BMI calculation, and plotting growth parameters on recommended growth charts was poor. Most primary health care providers recognized the need for continuing professional education in obesity management, stressing the importance of appropriate dietary counseling. CONCLUSIONS: The study underlines insufficient implementation of national guidelines for management of obesity regardless of the country and its health system. It also makes clear that the critical problem is not elaboration of guidelines but rather creating support systems for implementation of the medical standards among the primary care practitioners.

Overweight prevention strategies in preschool children

During the last several decades, the prevalence of childhood overweight and obesity achieved an alarming rate. Unfortunately, it also affects children in the preschool age. In this review, special emphases are made on determinants and risk factors for obesity development in early age, effectiveness of preventive strategies in preschool children and outcome measurements of intervention programme in preschool children. It is concluded that prevention of overweight and obesity in younger children is not an easy task but it could be even more rewarding than in the older age group. All the efforts should be made to stop this adverse public health problem from expanding.

Nutritional state of Polish prepubertal children assessed by population-specific and international standards.

Objective: To assess the frequency of obesity, overweight and underweight (thinness) in Polish 7–9‐year‐old children using a population specific definition as compared to the French, US and IOTF references based on body mass index (BMI).

Evaluation of nutritional status of children and adolescents with idiopathic scoliosis: a pilot study.

BACKGROUND Body composition changes during childhood and adolescence. It is markedly different in children with idiopathic scoliosis (IS). This study was carried out to assess the nutritional status of patients with IS based on standard anthropometric indices and bioimpedance measurements (BIA). MATERIAL AND METHODS 59 patients with IS (45 girls/ 14 boys) at a mean age of 13.37 ± 2.67 years were qualified into the study. Scoliotic curves were assessed radiographically by measuring Cobbs angle and apical vertebral rotation (AVR, standing A-P view). Height, weight, waist and hip circumferences were measured and the body mass index (BMI), BMI Z-score, waist/height ratio (WHtR) and waist/hip ratio (WHR) were calculated for each participant. A bioelectrical impedance analyzer was used to assess body composition in every child. RESULTS 64.4% of the children in the study had normal weight, while 23.7% of them were underweight and 11.9% overweight or obese. More patients in the juvenile IS group were underweight and fewer were overweight compared with the adolescent IS (AIS) group. Normal nutritional status was found significantly more frequently in girls. Body composition correlated significantly with scoliotic curve severity in the study group. Higher correlation coefficients were seen in overweight and obese patients, but significance was reached only for predicted muscle mass. WHtR correlated significantly with curve severity in the entire group, in AIS patients and in girls. Scoliotic curve severity also correlated significantly with the degree, as measured by the BMI Z-score, of both overweight (positively) and underweight (negatively). CONCLUSIONS 1. Overweight and obesity appear to have a similar prevalence in scoliotic adolescents and in the general pediatric population. 2. Scoliotic curve severity appears to be related to body composition parameters, especially in overweight and obese patients. 3. Adipose tissue distribution measured by WHtR seems to be significantly related to the clinical grade of IS. 4. Further investigations concerning the nutritional status of children and adolescents with IS are recommended.

Obesity risk factors in a representative group of Polish prepubertal children

Introduction The study aim was to evaluate risk factors of obesity in Polish children aged 7 to 9 years. Material and methods A representative group of 2571 children (1268 girls and 1303 boys) was randomly selected according to the European Childhood Obesity Group protocol. Weight and height were measured and body mass index (BMI) was calculated. A questionnaire was completed by the childrens parents with respect to behavioural and family-related risk factors of obesity. International Obesity Task Force criteria were used for classification of childrens obesity. Results Obesity was found in 3.7% of girls and 3.6% of boys. There was a statistically significant association between the prevalence of obesity in girls and their mothers obesity: OR = 5.06 (1.96–13.05), p < 0.001, fathers obesity: OR = 5.19 (1.96–13.69), p < 0.001, and both parents’ obesity: OR = 5.43 (1.39–21.29), p = 0.01. Obesity in boys was significantly associated with mothers obesity: OR = 5.6 (2.6–12.02), p < 0.001, fathers obesity: OR = 6.21 (2.89–13.37), p < 0.001, and both parents’ obesity: OR = 7.22 (2.44–31.33), p < 0.001. Skipping or irregular eating of breakfast was a risk factor for obesity in girls with OR = 2.71 (1.33–5.51), p = 0.005. Neither family income nor parents’ education level was related to their offsprings obesity. TV watching, physical activity level and eating in fast food places were not significant risk factors for obesity. Conclusions Eating breakfast regularly seems to protect girls from obesity development while low physical activity is not a significant obesity risk factor in this age group for either boys or girls. This finding stresses the more important role of healthy diet than physical activity promotion in obesity prevention in prepubertal children.

Oxidative/Antioxidative status in obese and sport trained children: a comparative study.

The aim of the study was to compare oxidative/antioxidative status in obese and sport trained children and to correlate obtained redox markers with anthropometrical measurements, body composition parameters, and adipokines levels. 78 (44 males) obese (SG) and 80 (40 males) normal weight sport trained (CG) children matched for age and Tanner stage were recruited for the study. Body composition parameters and basal metabolic rate (BMR) were assessed by bioelectrical impedance analysis (BIA). Oxidative/antioxidative status was evaluated in plasma by total oxidative status (PerOX), oxidized-LDL cholesterol (oxLDL), total antioxidative capacity (ImAnOx), and glutathione peroxidase activity (GPx). Leptin and adiponectin levels and adiponectin/leptin ratio (A/L) were also investigated. OxLDL was higher in SG versus CG (P < 0.05), but ImAnOx and GPx were reduced in SG versus CG (P < 0.01). Redox markers correlated significantly with BMI Z-score, WHR, WHtR, body composition parameters, leptin (in boys only), and A/L ratio (in boys only) in SG and in a whole studied population. PerOX significantly correlated with BMR in the CG. Antioxidative/oxidative status in obese children is significantly impaired and related adipose tissue excess and its hormonal activity. Oxidative status assessed by PerOx is also high in sport trained children but antioxidative defense is significantly more efficient with no overproduction of oxidized LDL.

Association of Body Composition with Curve Severity in Children and Adolescents with Idiopathic Scoliosis (IS)

The link between scoliotic deformity and body composition assessed with bioimpedance (BIA) has not been well researched. The objective of this study was to correlate the extent of scoliotic-curve severity with the anthropometrical status of patients with idiopathic scoliosis (IS) based on standard anthropometric measurements and BIA. The study encompassed 279 IS patients (224 girls/55 boys), aged 14.21 ± 2.75 years. Scoliotic curve severity assessed by Cobb’s angle was categorized as moderate (10°–39°) or severe (≥40°). Corrected height, weight, waist and hip circumferences were measured and body mass index (BMI), corrected height z-score, BMI Z-score, waist/height ratio (WHtR) and waist/hip ratio (WHR) were calculated for the entire group. Body composition parameters: fat mass (FAT), fat-free mass (FFM) and predicted muscle mass (PMM) were determined using a bioelectrical impedance analyzer. The mean Cobb angle was 19.96° ± 7.92° in the moderate group and 52.36° ± 12.54° in the severe group. The corrected body heights, body weights and BMIs were significantly higher in the severe IS group than in the moderate group (p < 0.05). Significantly higher FAT and lower FFM and PMM were observed in the severe IS group (p < 0.05). The corrected heights and weights were significantly higher in patients with severe IS and normal weight (p < 0.01). Normal and overweight patients with a severe IS had significantly higher adiposity levels assessed by FAT, FFM and PMM for normal and BMI, BMI z-score, WHtR, FAT and PMM for overweight, respectively. Overweight IS patients were significantly younger and taller than underweight and normal weight patients. The scoliotic curve severity is significantly related to the degree of adiposity in IS patients. BMI z-score, WHtR and BIA seem to be useful tools for determining baseline anthropometric characteristics of IS children.