Childhood obesity is defined as a medical condition characterised by abnormally high amounts of body fat relative to lean body mass, which increases the risk of adverse health outcomes among children and adolescents from birth to 18 years. The prevalence of childhood obesity, which has serious healthcare implications, is surging, together with its healthcare burden. In this review we explore the intricate interplay of hereditary, environmental, behavioural, cultural and metabolic factors contributing to the global increase in childhood obesity rates. We examine the influence of prenatal factors, genetic predispositions and epigenetic mechanisms on obesity susceptibility and treatment strategies, emphasising the importance of a multilevel life course framework to understand the multifactorial causes of obesity.

This narrative review examines the epidemiology, burden, aetiology and impact of childhood obesity by focusing on published literature and the efficacy of multilevel interventions. Comprehensive algorithms are provided to illustrate the causes of childhood obesity through the lens of a multilevel life course framework, taking into consideration individual, family, community and societal factors.

Genetic predispositions, including inherited tendencies towards emotional eating, metabolic variations and body fat distribution, significantly influence a child's obesity risk. Environmental factors, such as limited access to nutritious food, sedentary behaviour, insufficient opportunities for physical activity and obesogenic environments, contribute to the increasing prevalence of childhood obesity. Prenatal influences, including maternal hyperglycaemia and nutritional exposures, lead to epigenetic alterations that predispose children to obesity and metabolic disorders. The social environment, including parental influences, cultural norms and peer dynamics, shapes children's dietary habits and physical activity levels. Additionally, the review highlights the importance of early detection of metabolic alterations associated with paediatric obesity and insulin resistance and the potential for epigenetic mechanisms as therapeutic targets. Recommendations are made for tailored medical nutrition therapy, screening for syndromic obesity and multilevel interventions targeting individual and societal factors.

This review underscores the necessity of a comprehensive, multilevel approach that integrates genetic, environmental, behavioural and cultural factors along with lifestyle modifications and public health initiatives to address the complex and multifaceted issue of childhood obesity effectively. Targeted interventions across the life course, policy reforms, community engagement and technological innovations are recommended to mitigate obesity risks and promote long-term health. An infographic is available for this article. INFOGRAPHIC.

Individuals with autism spectrum disorder (ASD) may be at increased risk of both obesity and underweight.

To examine the association between ASD and weight status in children and adolescents, adjusting for individual- and neighbourhood-level sociodemographic factors.

We conducted a cross-sectional study of children and adolescents ≥2 and ≤18 years old using health administrative and demographic data from Ontario, Canada. Using growth measurements from a large primary care database between 2011 and 2016, we categorized weight status using World Health Organization definitions. We defined ASD based on a previously validated algorithm.

We included 568 children and adolescents with ASD and 32 967 without ASD. Comparing those with ASD to those without ASD, prevalence of underweight was 3.5% versus 1.9%, overweight 19.0% versus 18.2%, obesity 12.9% versus 7.3%, and severe obesity 5.8% versus 2.2%. In the fully adjusted multinomial logistic regression model, ASD remained associated with underweight (adjusted odds ratio [aOR] 2.02; 95% confidence interval [CI] 1.27-3.20), obesity (aOR 1.87; 95% CI 1.44-2.43) and severe obesity (aOR 2.62; 95% CI 1.81-3.80).

Children and adolescents with ASD are at increased risk of underweight, obesity, and severe obesity, independent of sociodemographic characteristics. Strategies addressing growth and weight status are warranted in this population.

Emerging research suggests that the intrauterine environment plays a critical role in predisposing individuals to metabolic syndrome (MetS), a constellation of conditions that heightens the risk for heart disease, stroke, and diabetes. Traditionally linked to lifestyle, the risk for MetS is now understood to be also influenced by fetal exposures. The environment in which a child lives offers abundant potential sources that can contribute to an increased risk of developing various diseases, and in some cases, these factors can be avoided. This review integrates findings from both epidemiological and experimental research to underscore the impact of prenatal factors, including maternal nutrition, obesity, gestational diabetes (GDM), and birth size, on the subsequent development of metabolic derangements in offspring, particularly during puberty. The progression of genetic and epigenetic studies has enlightened the pathophysiology of these conditions starting in the intrauterine period and continuing into early life. By examining data and studies, this article elucidates the prenatal influences and underlying mechanisms that contribute to the pathogenesis of MetS. The updated understanding of the link between the intrauterine environment and future health comorbidities will draw attention to intrauterine care and maternal health and contribute to the prevention of serious diseases in adulthood.

Measures of childhood adiposity merit investigation, particularly in individuals of South Asian descent.

To investigate prenatal and childhood factors associated with the trajectory of adiposity in South Asian children, and the cumulative contribution of modifiable factors, such as diet and physical activity, on this trajectory.

This cohort study was a prospective analysis of the South Asian Birth Cohort (START; 2011-2015) for discovery; and the Family Atherosclerosis Monitoring In Early Life (FAMILY; 2002-2009) in Ontario, Canada, and the Born in Bradford (BiB; 2008-2009) cohort in Bradford, UK, for validation. Mother-child pairs included 903 South Asian individuals (START), 675 White European individuals (FAMILY), and 1593 individuals (BiB), of which 52% were South Asian. Analysis was conducted from March 2020 to September 2024.

Maternal, infancy, and early childhood exposures.

Adiposity, assessed by the sum of subscapular and triceps skinfold thicknesses (SSF) from birth to 3 years, aggregated to a single measure as total area under the growth curve (AUC for SSF); multivariable linear regression models to identify determinants of AUC for SSF; and a cumulative score to assess joint contribution of modifiable risk factors to AUC for SSF.

START included 903 children (456 female [50.5%]; mean [SD] maternal age, 30.2 [4.0] years; maternal mean [SD] prepregnancy body mass index [BMI], 23.8 [4.50]). Maternal sum of skinfold thicknesses (β = 0.80 [95% CI, 0.30-1.30] per 10 mm), gestational weight gain (β = 0.38 [95% CI, 0.02-0.74] per 5 kg), a health-conscious diet score (β = -0.68 [95% CI, -1.26 to -0.10] per 1 SD), and infant breastfeeding for the first year (β = -1.68 [95% CI, -2.94 to -0.42), as well as physical activity (β = -0.33 [95% CI, -0.57 to -0.09] per 30-min/d) and screen time (β = 0.49 [95% CI, 0.18-0.81] per 30-min/d) were each independently associated with AUC for SSF. These 6 early-life modifiable factors combined into a single score had a direct, graded association between number of factors and AUC for SSF (P for trend < .001). In the validation cohorts, maternal BMI, breastfeeding, and child physical activity were replicated and showed a similar graded association with AUC for SSF (P for trend < .001) when combined.

In this cohort study of South Asian children, 6 modifiable factors were associated with lower adiposity and combined into a single score. This score may be useful in clinical and public health settings to help mitigate childhood obesity in South Asian individuals and beyond.

Childhood obesity is a growing public health concern, associated with several systemic disorders including changes in retinal microvasculature. This study aims to assess the relationship between body composition, biochemical markers, and retinal microvascular changes in obese children.

In this cross-sectional study, 45 overweight and obese children and 46 age- and sex-matched healthy individuals were evaluated. In addition to physical examination, anthropometric measurements were obtained using a body composition analyzer. A comprehensive ophthalmic assessment was conducted for all participants, which included advanced optical biometry, autorefractometry, visual acuity testing, and slit-lamp examination. Retinal microvasculature was assessed using optical coherence tomography angiography (OCT-A). Biochemical markers, including lipid profile, liver function tests, and CRP (as marker of inflammation), were also analyzed.

The mean ages were 10.18 and 9.40 years in the obese/overweight and normal weight groups, respectively. Increased foveal thickness (p = 0.04) and foveal vessel density (p = 0.01) in the superficial capillary plexus, and decreased vessel density in the inferior parafoveal region of the deep capillary plexus (p = 0.03) were observed in obese/overweight children. Adjusted and crude regression analysis showed significant associations between body mass index, percent body fat, fasting blood glucose, and serum alanine transaminase levels with foveal vessel density, as well as between body mass index and serum triglycerides levels with foveal thickness.

Our findings suggest that childhood obesity is associated with significant alterations in retinal microvasculature. We propose that retinal health assessments and biochemical evaluations be considered in the clinical management of obese children.

This study aimed to explore the possible bidirectional interrelations between fructose-induced metabolic syndrome (MS) and apical periodontitis (AP).

Twenty-eight male Wistar rats were distributed into four groups (n = 7, per group): Control (C), AP, Fructose Consumption (FRUT) and Fructose Consumption and AP (FRUT+AP). The rats in groups C and AP received filtered water, while those in groups FRUT and FRUT+AP received a 20% fructose solution mixed with water to induce MS. The groups AP and FRUT+AP had the pulp of their right mandibular first molar exposed to induce AP. Food consumption, murinometric measurements, blood glucose levels and glucose tolerance were monitored. Fifty-six days after the start of the experiment, the animals were euthanized, and serum samples were collected for metabolomic analysis. Mandibles, livers and right kidneys were also collected. The area and volume of the periapical lesions were calculated using micro-computed tomography. Histopathological evaluation was performed. Kruskal-Wallis followed by the Student-Newman-Keuls or Mann-Whitney tests and one-way anova followed by Tukey's or Independent t-test were used for non-parametric and parametric data, respectively (p < .05). Multivariate analysis and variable importance in projection score were applied to assess metabolite profile differences among groups (p < .05).

FRUT and FRUT+AP groups showed significantly increased fluid intake, body mass, abdominal circumference, blood glucose levels, liver weight and visceral fat weight (p < .05), indicating the development of MS. The analyses of the metabolite profile suggest increasing glucose, histidine, lactate, fatty acid and phenylalanine in the FRUT+AP group. There were no significant differences in volume and area of periapical lesions in micro-CT analyses (p = .1048 and p = .7494, respectively). Histopathological analysis of the hemimandibles demonstrated areas of inflammatory response, necrosis and microabscess in the periapical region. Hepatic histopathological observations indicated notable differences in cell appearance, with the FRUT and FRUT+AP groups showing signs of microsteatosis. Kidney analysis revealed Bowman's space dilation in the FRUT and AP groups, while the FRUT+AP group exhibited retracted Bowman's space, suggesting a possible alteration in renal filtration capacity.

MS had no impact on the progression of AP in rats. However, AP exacerbated the systemic state affected by MS, with changes in liver and kidney tissues and metabolite levels.

Studies have suggested that phytochemicals in green tea have systemic anti-inflammatory and neuroprotective effects. However, the mechanisms behind these effects are poorly understood, possibly due to the differential metabolism of phytochemicals resulting from variations in gut microbiome composition. To unravel this complex relationship, our team utilized a novel combined microbiome analysis and metabolomics approach applied to low complexity microbiome (LCM) and human colonized (HU) gnotobiotic mice treated with an acute dose of powdered matcha green tea. A total of 20 LCM mice received 10 distinct human fecal slurries for an n = 2 mice per human gut microbiome; 9 LCM mice remained un-colonized with human slurries throughout the experiment. We performed untargeted metabolomics on green tea and plasma to identify green tea compounds that were found in the plasma of LCM and HU mice that had consumed green tea. 16S ribosomal RNA gene sequencing was performed on feces of all mice at study end to assess microbiome composition. We found multiple green tea compounds in plasma associated with microbiome presence and diversity (including acetylagmatine, lactiflorin, and aspartic acid negatively associated with diversity). Additionally, we detected strong associations between bioactive green tea compounds in plasma and specific gut bacteria, including associations between spiramycin and Gemmiger and between wildforlide and Anaerorhabdus. Notably, some of the physiologically relevant green tea compounds are likely derived from plant-associated microbes, highlighting the importance of considering foods and food products as meta-organisms. Overall, we describe a novel workflow for discovering relationships between individual food compounds and the composition of the gut microbiome.

Foods contain thousands of unique and biologically important compounds beyond the macro- and micro-nutrients listed on nutrition facts labels. In mammals, many of these compounds are metabolized or co-metabolized by the community of microbes in the colon. These microbes may impact the thousands of biologically important compounds we consume; therefore, understanding microbial metabolism of food compounds will be important for understanding how foods impact health. We used metabolomics to track green tea compounds in plasma of mice with and without complex microbiomes. From this, we can start to recognize certain groups of green tea-derived compounds that are impacted by mammalian microbiomes. This research presents a novel technique for understanding microbial metabolism of food-derived compounds in the gut, which can be applied to other foods.

Evidence is scarce on the mechanisms involved in the relationship between dietary inflammatory index and mental health in adolescents. This study aimed to assess the association between children-DII (C-DII) and depressive and anxiety disorder symptoms in adolescents and to explore whether inflammation and cardiometabolic risk factors mediate this association.

The study was conducted at the Ankara City Hospital Pediatrics Polyclinic and 304 adolescents. In cross-sectional study, adolescents were asked general information questions. Anthropometric measurements were performed and some biochemical parameters and inflammation (C-reactive protein (CRP)) were obtained. The C-DII score was calculated from 24-h dietary recalls. Depression and anxiety levels of the participants were assessed by self-report. Structural equation modelling analyzed how cardiometabolic risk factors and inflammation mediate the relationship between mental health and dietary inflammation.

C-DII scores were positively associated with depression and anxiety score (β [95% confidence interval (CI)] = 0.224 [0.08-0.25] for depression; 0.923 [0.04-1.67] for anxiety). Except for dietary inflammation with anxiety in girls, these relationships remained statistically significant in all subgroups by sex. It was determined that CRP partially mediated the relationship between dietary inflammation and depression and anxiety. It was determined that body mass index (BMI)-z score and waist circumference (WC) mediated the relationship between dietary inflammation and depression scores.

Our findings indicate that the higher pro-inflammatory potential of diet is associated with a higher risk of depression and anxiety, and this association may be mediated by CRP for depression and anxiety, WC, and BMI-z score for only depression. Further research is required to verify our findings and clarify the latent mechanism in larger populations.

The increasing prevalence of metabolic syndrome (MetS) among adolescents necessitates a simple and easy-to-use screening tool. This study aimed to develop and validate a simple model based on age, sex, race, and weight-for-age or BMI-for-age to identify adolescents with MetS.

A cross-sectional study of adolescents (aged 12-18 years) who participated in the American National Health and Nutrition Examination Survey (NHANES) was performed. Participants with pre-existing hypertension, diabetes or dyslipidemia were excluded. Data from 2005-2018 were randomly divided into training (70%) and validation (30%) sets. Anthropometric, demographic data, and MetS criteria were extracted.

The training group included 1974 adolescents (52% boys, median age 15 years), and the validation group included 848 adolescents (50% boys, median age 14 years). Both weight- and BMI-for-age demonstrated good discrimination ability in the training group (AUC = 0.897 and 0.902, respectively), with no significant difference between them (p = 0.344). Multivariable models showed similar discrimination ability. Therefore, weight-for-age was chosen and using Youden's index, the 93rd weight-for-age percentile (SDS 1.5) was identified as the optimal cut-off value for MetS. Similar values were observed in the validation group.

Among adolescents aged 12-18 years, weight-for-age percentiles are an easy-to-use primary screening indicator for the presence of MetS.

The prevalence of metabolic syndrome in adolescents is increasing. An early detection screening tool is required to prevent related adulthood morbidity. Screening adolescents for metabolic syndrome is challenging. This study suggests the use of weight-for-age as a single criterion for primary screening of adolescents aged 12-18. Using weight-for-age as a single predictor of metabolic syndrome is expected to increase screening rates compared to using BMI-for-age, due to its simplicity.

This study aims to investigate the prognostic value of Temporal Muscle Thickness (TMT) in Chinese patients with newly diagnosed isocitrate dehydrogenase (IDH) wild-type glioblastoma.

Data were retrospectively collected from patients with isocitrate dehydrogenase wild-type genotype glioblastoma, who underwent surgical treatment and concurrent chemoradiotherapy at our center between May 2019 and May 2023. Multi-model and multivariate Cox regression were used to examine factors associated with overall and progression-free survival. Subgroup analysis and sensitivity tests were performed to verify the robustness of the results. Restricted cubic spline regression was used to explore the possible nonlinear relationship between TMT and OS/PFS.

A total of 344 patients were enrolled in this study. The main analysis showed that TMT was positively correlated with overall survival and progression-free survival. The results of multivariate Cox regression after segmentation according to the optimal cutoff value showed that age ≥ 60 years (HR = 1.47, 95% CI: 1.14-1.90, p = 0.003), diabetes (HR = 1.95, 95% CI: 1.26-3.04, p = 0.003) were the risk factors for death. However, TMT ≥ 8.425 mm (HR = 0.45, 95% CI: 0.36-0.57, p < 0.001), Karnofsky ≥ 70 (HR = 0.76, 95% CI: 0.59-0.97, p < 0.031) were associated with a lower risk of death. Age ≥ 60 years (HR = 1.33, 95% CI: 1.03-1.71, p = 0.028) was a risk factor for recurrence, Karnofsky ≥ 70 (HR = 0.76, 95% CI: 0.59-0.97, p = 0.027), TMT ≥ 8.4 mm (HR = 0.64, 95% CI: 0.50-0.80, p < 0.001), and combination of targeted therapy (HR = 0.65, 95% CI: 0.47-0.90, p = 0.01) reduced recurrence risk.

TMT is an independent predictor of OS and PFS in IDH wild-type GBM patients and can be used to predict prognosis in clinical practice.

Question Performance status of glioblastoma patients is crucial for treatment decision-making and prognosis assessment; however, there is currently no objective evaluation metric for the Chinese population. Findings Temporal muscle thickness at initial diagnosis is positively correlated with overall survival and progression-free survival in Chinese patients with newly diagnosed IDH wild-type glioblastoma. Clinical relevance Temporal muscle thickness at initial diagnosis is an independent, objective prognostic factor for newly diagnosed IDH wild-type glioblastoma patients in China. It contributes to the formulation of individualized treatment plans and serves as a stratification factor in clinical trials.

Epidemiological surveys indicate an increasing incidence of type 2 diabetes mellitus (T2DM) among children and adolescents worldwide. Due to rapid disease progression, severe long-term cardiorenal complications, a lack of effective treatment strategies, and substantial socioeconomic burdens, it has become an urgent public health issue that requires management and resolution. Adolescent T2DM differs from adult T2DM. Despite a significant increase in our understanding of youth-onset T2DM over the past two decades, the related review and evidence-based content remain limited.

To visualize the hotspots and trends in pediatric and adolescent T2DM research and to forecast their future research themes.

This study utilized the terms "children", "adolescents", and "type 2 diabetes", retrieving relevant articles published between 1983 and 2023 from three citation databases within the Web of Science Core Collection (SCI, SSCI, ESCI). Utilizing CiteSpace and VoSviewer software, we analyze and visually represent the annual output of literature, countries involved, and participating institutions. This allows us to predict trends in this research field. Our analysis encompasses co-cited authors, journal overlays, citation overlays, time-zone views, keyword analysis, and reference analysis, etc.

A total of 9210 articles were included, and the annual publication volume in this field showed a steady growth trend. The United States had the highest number of publications and the highest H-index. The United States also had the most research institutions and the strongest research capacity. The global hot journals were primarily diabetes professional journals but also included journals related to nutrition, endocrinology, and metabolism. Keyword analysis showed that research related to endothelial dysfunction, exposure risk, cardiac metabolic risk, changes in gut microbiota, the impact on comorbidities and outcomes, etc., were emerging keywords. They have maintained their popularity in this field, suggesting that these areas have garnered significant research interest in recent years.

Pediatric and adolescent T2DM is increasingly drawing global attention, with genes, behaviors, environmental factors, and multisystemic interventions potentially emerging as future research hot spots.

Background: Cardiovascular diseases increasingly impact youth, with early development of risk factors such as obesity, hypertension, and inadequate nutrient intake. Proper nutrient intake and physical fitness are vital for reducing these risks, especially in pediatric populations. This study explores the connection between physical fitness, metabolic risk, and nutrient status among 1656 Chilean schoolchildren from diverse socio-economic backgrounds. Methods: Anthropometric measures included weight, height, skinfold thickness, waist circumference, and blood pressure. Physical fitness was assessed via handgrip strength, standing long jump, and a six-minute walk test. Nutrient intake was also evaluated, and a composite metabolic risk score was calculated based on waist circumference, skinfolds, and blood pressure. Results: Boys consistently outperformed girls in physical fitness tests, including grip strength and horizontal jump, with differences becoming more pronounced in higher grades and Tanner stages. Girls exhibited higher subcutaneous fat levels and obesity prevalence during later grades, highlighting gender-specific patterns in body composition. Better physical fitness was associated with lower waist circumference, skinfold thickness, and metabolic risk scores. A moderate correlation between aerobic fitness (distance/height) and blood pressure (r = 0.27, p = 0.01) was observed. Z-Score MR analysis revealed that students in the lowest fitness tertile exhibited significantly higher cardiovascular risk profiles compared to their fitter peers. Conclusions: Physical fitness plays a critical role in reducing cardiovascular risk in children. The findings underscore the importance of promoting gender- and age-specific interventions that include both aerobic and strength-based physical activities. Comprehensive school programs focusing on nutrition and physical activity are essential to mitigating cardiovascular risk and promoting long-term health outcomes. Future longitudinal studies are recommended to establish causal relationships and evaluate the impact of targeted interventions.

Increased adiposity has been directly associated with insulin resistance (IR), and cytokines released by adipose tissue seem to link adiposity to IR in youth. We used an antibody-based array to investigate the differential levels of serum cytokines according to insulin status in a cohort of overweight/obese and inactive adolescents and evaluated their potential associations with clinical and metabolic characteristics.

We performed a cross-sectional data analysis from 122 adolescents (11-17 years of age). We assessed body composition, cardiometabolic risk factors, biochemical variables, and physical fitness. The concentration of 55 cytokines was quantified in blood samples. The homeostasis model assessment insulin resistance (HOMA-IR) and AST/ALT and TG/HDL ratios were calculated. IR adolescents as defined as HOMA-IR >2.5. The number of adolescents with IR in the study was 91 (66 % girls). In the IS group, after controlling for confounders, higher IL-15 levels were significantly associated with higher alanine aminotransferase levels and lower AST/ALT ratio, respectively (Ps<0.05). In the same line, there were significantly higher alanine aminotransferase levels and lower AST/ALT ratio, respectively, with FGF-9 (Ps<0.05). Likewise, higher alanine aminotransferase levels were significantly associated positively with HGF (p=0.045). Additionally, leptin levels are associated with six adiposity indexes (i.e., fat mass/height index, body fat, body mass index, android fat mass and gynoid fat mass) in overweight/obese adolescents with IR (Ps<0.05).

These data may provide novel insights into the pathogenic mechanisms underlying IR in youth, offering new targets for prevention.

Obesity is one of the leading causes of chronic diseases, and its prevalence is still rising in children and adolescent populations. Chronic cardiovascular complications result in metabolic syndrome (MS) and type 2 diabetes mellitus. Key factors in the development of MS are insulin resistance and low-grade inflammation. The disorder of glucose and insulin metabolism has not been fully elucidated so far, and an oral glucose tolerance test (OGTT) has been the only tool used to look into the complex metabolism disorder in children and adolescents with obesity. Continuous glucose monitoring (CGM) has become commercially available for over two decades and is primarily used to manage type 1 diabetes mellitus in pediatric populations. This review aims to present the current knowledge about the use of CGM in children and adolescent populations with obesity. CGM systems have the potential to serve as valuable tools in everyday clinical practices, not only in the better diagnosis of chronic complications associated with obesity, but CGM can also assist in interventions to make better adjustments to nutritional and therapeutic approaches based on real-time glucose monitoring data. Despite these promising benefits, further research is needed to fully understand the role of CGM in metabolic disorders in pediatric populations with obesity, which will additionally strengthen the importance of CGM systems in everyday clinical practices.

Obesity is a consequence of multiple factors, including genetics, lifestyle and nutritional choices, physical activity, sleep duration, screen time, and mood disorders. These behavioral elements can impair the regulation of energy balance and obesity management that link obesity to a constellation of chronic conditions that lead to a high prevalence of cardiometabolic risk factors, metabolic syndrome, and nonalcoholic fatty liver disease. Multidisciplinary therapy is defined as an approach delivered by a multidisciplinary-trained health team covering at least two components of behavior, physical activity/exercise, dietary habits, and/or psychological counseling associated with clinical interventions. This narrative review summarizes the effects of multidisciplinary therapy on neuroendocrine regulation of energy balance, inflammatory biomarkers, cardiometabolic risk factors, metabolic syndrome, nonalcoholic fatty liver diseases, behavior, and quality of life. We found that multidisciplinary therapy, including medical, nutritional, exercise, and behavioral counseling, and/or education, was useful for addressing outcomes such as visceral adiposity, neuroendocrine regulation of energy balance, inflammatory biomarkers, cardiometabolic risk factors, nonalcoholic fatty liver disease, and metabolic syndrome. The effects were mediated by improvements in neuroendocrine regulation of energy balance, downregulation of the pro-inflammatory states, and a reduction in comorbidities. Multidisciplinary therapy also improved mood disorders and quality of life.

Studies have suggested that phytochemicals in green tea have systemic anti-inflammatory and neuroprotective effects. However, the mechanisms behind these effects are poorly understood, possibly due to differential metabolism of phytochemicals resulting from variation in gut microbiome composition. To unravel this complex relationship, our team utilized a novel combined microbiome analysis and metabolomics approach applied to low complexity microbiome (LCM) and human colonized (HU) gnotobiotic mice treated with an acute dose of powdered matcha green tea. A total of 20 LCM mice received 10 distinct human fecal slurries for an n=2 mice per human gut microbiome; 9 LCM mice remained un-colonized with human slurries throughout the experiment. We performed untargeted metabolomics on green tea and plasma to identify green tea compounds that were found in plasma of LCM and HU mice that had consumed green tea. 16S ribosomal RNA gene sequencing was performed on feces of all mice at study end to assess microbiome composition. We found multiple green tea compounds in plasma associated with microbiome presence and diversity (including acetylagmatine, lactiflorin, and aspartic acid negatively associated with diversity). Additionally, we detected strong associations between bioactive green tea compounds in plasma and specific gut bacteria, including associations between spiramycin and Gemmiger, and between wildforlide and Anaerorhabdus. Additionally, some of the physiologically relevant green tea compounds are likely derived from plant-associated microbes, highlighting the importance of considering foods and food products as meta-organisms. Overall, we describe a novel workflow for discovering relationships between individual food compounds and composition of the gut microbiome.

Introduction: a relationship has been observed between elevated levels of liver enzymes and uric acid with the presence of metabolic syndrome (MS) in the pediatric population. Objective: to compare serum liver enzyme and uric acid levels between adolescents with and without MS. Methods: a cross-sectional study was carried out in adolescents with obesity between 10 and 18 years old. Somatometric data, serum insulin, lipid profile, uric acid levels and liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT] and gamma-glutamyl transferase [GGT]) were analyzed. Statistical analysis: Student's t test or the Chi-square test was used to evaluate differences between groups. Results: a total of 1095 adolescents with obesity were included (444 with MS and 651 without MS). The group with MS had a higher BMI (with MS 2.28 vs without MS 2.11 p < 0.001), with no difference in body fat (42.9 % vs 42.9 %, p = 0.978). The MS group had significantly higher levels of AST (34.4 vs. 29.5, p = 0.013), ALT (42.2 vs. 34.6, p = 0.003), and uric acid (6.17 vs. 5.74, p = 0.002). comparison to the group without MS. The proportion of ALT (40.5 % vs 29.5 %, p = 0.029) and altered uric acid (58.1 % vs. 45.6 %, p = 0.019) was higher in the MS group. Conclusions: serum levels of ALT, AST and uric acid in adolescents with obesity and MS were higher compared to those without MS. Altered ALT was a risk factor for SM.

To analyse the feasibility and acceptability of a culinary nutritional intervention aimed at increasing plant-based foods consumption in the context of the Mediterranean diet in parent-child dyads.

The Nutritional and Culinary Habits to Empower Families (n-CHEF) is a 9-month feasibility study that included four culinary nutritional workshops (two face to face, two online) led by a chef and a dietitian-nutritionist. These workshops combined cooking with plant-based foods, with nutritional advice and experimental activities. The main outcomes were retention, quality of the intervention (monitoring workshops, acceptability and perceived impact) and changes in dietary and cooking habits.

Parent-child dyads, Spain.

Parent-child (aged 10-14 years) dyads.

Fifteen parent-child dyads were recruited, of which thirteen were retained during the 6-month follow-up. All but one parent-child dyads attended the four workshops. The overall assessment of the workshops was positive, although the online workshops were rated lower than the face to face. In general, parent-child dyads reported benefits in terms of nutrition and cooking aspects. Parents significantly increased their adherence to the Mediterranean diet, but non-significant changes were observed in children. However, children increased their consumption of vegetables and legumes and reduced snacks and ready meals. Parents also changed some of their culinary habits and increased their confidence in cooking at home.

The n-CHEF showed that the culinary nutritional intervention had good levels of recruitment, retention and acceptability among parent-child dyads. In addition, dietary and culinary knowledge and habits can be improved, although further studies are needed to know the long-term effects in larger populations.

Longitudinal electronic health records (EHR) can be utilized to identify patterns of disease development and progression in real-world settings. Unsupervised temporal matching algorithms are being repurposed to EHR from signal processing- and protein-sequence alignment tasks where they have shown immense promise for gaining insight into disease. The robustness of these algorithms for classifying EHR clinical data remains to be determined. Timeseries compiled from clinical measurements, such as blood pressure, have far more irregularity in sampling and missingness than the data for which these algorithms were developed, necessitating a systematic evaluation of these methods. We applied 30 state-of-the-art unsupervised machine learning algorithms to 6,912 systematically generated simulated clinical datasets across five parameters. These algorithms included eight temporal matching algorithms with fourteen partitional and eight fuzzy clustering methods. Nemenyi tests were used to determine differences in accuracy using the Adjusted Rand Index (ARI). Dynamic time warping and its lower-bound variants had the highest accuracies across all cohorts (median ARI>0.70). All 30 methods were better at discriminating classes with differences in magnitude compared to differences in trajectory shapes. Missingness impacted accuracies only when classes were different by trajectory shape. The method with the highest ARI was then used to cluster a large pediatric metabolic syndrome (MetS) cohort (N = 43,426). We identified three unique childhood BMI patterns with high average cluster consensus (>70%). The algorithm identified a cluster with consistently high BMI which had the greatest risk of MetS, consistent with prior literature (OR = 4.87, 95% CI: 3.93-6.12). While these algorithms have been shown to have similar accuracies for regular timeseries, their accuracies in clinical applications vary substantially in discriminating differences in shape and especially with moderate to high missingness (>10%). This systematic assessment also shows that the most robust algorithms tested here can derive meaningful insights from longitudinal clinical data.

As adiposity increases in youth, so does the prevalence of cardiometabolic risk factors (CMRFs). The etiology of adiposity-based chronic disease and CMRFs includes ethnoracial disparities that are rarely considered in current treatment approaches. Precision interventions require further characterization of these disparities among high-risk youth. The objective of this study was to characterize differences in CMRF among African American (AA) and Hispanic (H) adolescents with varying levels of adiposity. A cross-sectional analysis of 2284 adolescents aged 12-17 was conducted using 3-year clinical data from Lifedoc Health. CMRF prevalence were compared using χ2, with logistic regression models (LRM) applied to explore the relationships between exposures (age, sex, ethnoracial group, adiposity) and CMRF outcomes. Prevalence of CMRF rose with increasing adiposity, which was the strongest determinant of risk overall. However, individual risk profiles differed between the two groups, with H having higher prevalence of metabolic syndrome (MetS), higher triglycerides and liver enzymes, and low high-density lipoprotein cholesterol (HDL-c). Meanwhile, AA had higher prevalence of elevated blood pressure (BP) in the overweight category, prediabetes in overweight to severe obesity, and type 2 diabetes in obesity. LRM showed 3.0-fold greater chance of impaired glucose metabolism in AA than H, who were 1.7, 5.9, and 8.3 times more likely to have low HDL-c, high liver enzymes, and high triglycerides, respectively. Overweight/obesity prevalence was very high among AA and H adolescents. Excess adiposity was associated with an increased prevalence of CMRF, with individual risk factors differing between groups as adiposity increased. Research within routine clinical settings is required to better characterize these discrepancies and ameliorate their adverse impact on health in the transition to adulthood.

Childhood obesity is a growing global health concern, but few studies have investigated dietary factors specifically related to obesity and abdominal obesity in children and adolescents. Herein, we aimed to identify the dietary factors affecting childhood obesity in Korean children and adolescents.

Data from the Korea National Health and Nutrition Survey (KNHANES) VIII were analyzed using K-means clustering analysis to identify distinct clusters based on nine variables related to dietary habit, nutritional status, and nutritional education. Multiple logistic regression analysis was used to examine the association between incident obesity risk and the different clusters. We enrolled 2,290 participants aged 6-18 years, and separated them into two distinct clusters; Healthy and Unhealthy Dietary Habit Groups, clusters 1 and 2, respectively.

Cluster 1 was characterized by a lower obesity prevalence, healthier dietary habits (regular breakfast consumption; fruit and vegetable, reduced total energy, and lower protein and fat intakes), and greater nutritional education than Cluster 2. After adjusting for confounders, compared with Cluster 1, Cluster 2 demonstrated a significantly higher prevalence (OR [95% CI]) of both general and abdominal obesity (1.49 [1.05-2.13], p=0.027 and 1.43 [1.09-1.88], p=0.009).

Maintaining optimal dietary quality and patterns are crucial to prevent childhood obesity. Further research is warranted to explore specific dietary interventions tailored to different clusters to effectively address childhood obesity.

This retrospective cohort study aimed to determine whether severe calcidiol deficiency [25-hydroxyvitamin (OH)D <30 nmol/L] improvement has a beneficial effect on cardiometabolic parameters in children and adolescents (5-17 years) with or without metabolic syndrome (MetS). Logistic regression analysis was performed to test for multivariate associations between potential confounders and changes in vitamin D (VD) status from baseline to follow-up care when predicting binary categorical outcomes. Of 562 participants, 146 (26%) had MetS. Individuals with severe VD deficiency (VDD) were more likely to have MetS with elevated blood pressure than those with sufficient (≥75 nmol) VD levels (adjusted odds ratio [AOR], 4.46; 1.08-18.43; p < .05) at follow-up. In the logistic regression model, every unit increase in VD across time decreased the odds of MetS (AOR, 0.98; 95% confidence interval: [0.96, 0.99]; p < .05). Improvement in VD status demonstrated a beneficial metabolic effect in children and adolescents with severe VDD.

With the increasing prevalence of obesity, childhood type 2 diabetes (T2D) is a growing concern in Taiwan. Unlike its adult counterpart, T2D in children exhibits a more aggressive nature and earlier onset of complications. Metformin represents the first line of drug, but if blood sugar levels do not improve, other drugs are used. This retrospective cohort study endeavors to scrutinize and assess the pattern of treatment modification and associate factors among 79 young people with T2D in Taiwan. The study categorized participants into three distinct groups based on their treatment trajectory and outcomes: (1) those maintaining metformin (n = 34); (2) cases achieving remission (n = 7); and (3) individuals experiencing escalation through oral drugs or insulin (n = 38). The average follow-up period spanned 3.48 years. Findings from univariate analysis using a Cox proportional hazards model and propensity score weighting revealed that HbA1c and weight gain correlated with elevated risk of treatment escalation. Conversely, factors such as hypertension, high weight or body mass index (BMI) SDS, leptin levels, c-peptide concentrations, peak c-peptide values during glucagon stimulation test and LDL-cholesterol levels were associated with reduced risk of escalation. However, in multivariate analyses employing stepwise selection, the sole predictive factor for treatment escalation emerged as weight gain one year post-therapy (HR: 1.06, p < 0.001). This study underscores the interconnectedness between weight management and the trajectory toward either treatment escalation or disease remission. Furthermore, it highlights the cost-effective potential of intervening in younger populations. Ultimately, these insights accentuate the considerable opportunity for enhancing health care management strategies concerning pediatric T2D in Taiwan.

Background: childhood obesity is one of the major health problem worldwide. Obesity is associated with low-level chronic inflammation resulting from inflammatory cytokine release in white adipose tissue. We aim to specify inflammatory markers tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) in children and adolescents to determine their relationship with obesity. Materials and methods: forty obese patients and 46 controls were included in the study from the pediatric clinic. Blood samples from the study group were centrifuged, and the sera were stored at -80 °C after separation. Serum levels of TNF-alpha and IL-10 were determined using Human ELISA kits for TNF-alpha and IL-10. Results: serum samples from 86 children, including 45 girls (52.3 %) in the study group, were analyzed for TNF-alpha and IL-10 levels. TNF-alpha levels in the obese and control groups were 1.04 ± 0.79 and 0.60 ± 0.72 pg/ml, respectively (p = 0.010). Also, IL-10 levels in the obese and control groups were 0.76 ± 0.62 and 1.54 ± 0.71 pg/ml, respectively (p < 0.001). Gender was not identified as a factor for serum TNF-alpha and IL-10 levels (p = 0.281 and p = 0.477, respectively). Moreover, white blood cell (WBC) and serum C-reactive protein (CRP) levels were higher in the obese patient group than in the control group (p = 0.002 and p = 0.010, respectively). Conclusion: TNF-alpha levels were higher than control in obese patients and it was important in terms of showing that obesity triggers inflammation in the body. IL-10 levels, which inhibit inflammation, were lower in obese patients than controls.

Previous reports identified an association between obese adolescents (OAs) and lower extremity (LE) fractures after blunt trauma. However, the type of LE fracture remains unclear. We hypothesized that OAs presenting after motor vehicle collision (MVC) have a higher risk of severe LE fracture and will require a longer length of stay (LOS) and more support services upon discharge, compared to non-OAs.

The 2017-2019 Trauma Quality Improvement Program database was queried for adolescents (12-17-years-old) presenting after MVC. The primary outcome was LE fracture. A severe fracture was defined by abbreviated injury scale ≥3. OAs were defined by a body mass index (BMI) ≥30.

From 22,610 MVCs, 3325 (14.7 %) included OAs. The rate of any LE fracture was higher for OAs (21.6 % vs. 18.8 %, p < 0.001). On subset analysis the only LE fracture at higher risk in OAs was a femur fracture (13 % vs. 9.1 %, p < 0.001). After adjusting for sex and age, the risk for severe LE fracture (OR 1.34, CI 1.18-1.53, p < 0.001) was higher for OAs. OAs with a femur fracture had a longer median LOS (5 vs. 4 days, p = 0.003) and were more likely discharged with additional support services including home-health or inpatient rehabilitation (30.6 % vs. 21.4 %, p < 0.001).

OAs sustaining MVCs have increased associated risk of femur fractures. OAs are more likely to have a higher-grade LE injury, experience a longer LOS, and require additional support services upon discharge. Future research is needed to determine if early disposition planning with social work assistance can help shorten LOS.

Projected to impact 310 million children by the next decade, childhood obesity is linked to serious health issues like metabolic disturbance and cardiovascular diseases. This study introduces a novel approach for the integrated assessment of inflammatory, glycemic and lipid disorders in obese children in resources-limited settings and also identifies key factors contributing to these changes. Conducting a cross-sectional analysis of 231 children aged 5-12 years from public schools in Brazil's semi-arid region, the research involved collecting medical history, anthropometric measurements, and blood samples to analyze glycemic and lipid profiles, along with C-reactive protein levels. We used an adapted the Molecular Degree of Perturbation model to analyze deviations in metabolic markers from a healthy control group. Statistical analyses included Mann-Whitney and Fisher exact tests, backward logistic regression, and hierarchical cluster analysis. The study identified a direct and independent association between elevated Metabolic Disturbance Degree and both overweight and obesity in children, with significant differences in CRP, Triglycerides, and HDL levels noted between obese and healthy-weight groups. The findings highlight the critical need for early detection and comprehensive understanding of obesity-related changes to mitigate the severe health risks associated with childhood obesity.

Long-term lifestyle interventions in childhood and adolescence can significantly improve cardiometabolic health, but the underlying molecular mechanisms remain poorly understood. To address this knowledge gap, we conducted an 8-year diet and physical activity intervention in a general population of children. The research revealed that the intervention influenced 80 serum metabolites over two years, with 17 metabolites continuing to be affected after eight years. The intervention primarily impacted fatty amides, including palmitic amide, linoleamide, oleamide, and others, as well as unsaturated fatty acids, acylcarnitines, phospholipids, sterols, gut microbiota-derived metabolites, amino acids, and purine metabolites. Particularly noteworthy were the pronounced changes in serum fatty amides. These serum metabolite alterations could represent molecular mechanisms responsible for the observed benefits of long-term lifestyle interventions on cardiometabolic and overall health since childhood. Understanding these metabolic changes may provide valuable insights into the prevention of cardiometabolic and other non-communicable diseases since childhood.

Prevalence, risk factors and metabolic complications of overweight/obesity (OW/OB) are not well described in the childhood survivors of acute lymphoblastic leukemia (ALL). Longitudinal changes in body mass index-z score (BMIz) from diagnosis to the last follow-up visit after the end of treatment were evaluated in 73 children at first complete remission. Of them, 40 were tested for adipokine profiles at visit. The mean BMIz increased gradually from diagnosis (0.07 ± 1.68) to the end of dexamethasone containing reinduction therapy (0.70 ± 1.48, P:0.007), followed by a fall at the end of treatment (0.15 ± 1.24) and a rise again at visit (0.40 ± 1.23, P:0.007). OW/OB percentage of 15% at diagnosis, increased to 35% at visit (p < 0.05). Post-treatment OW/OB in survivors was related with being OW/OB at diagnosis (OR 5.4, 95% CI [0.94-31.7]; P = 0.02) and after dexamethasone containing reinduction therapy (OR 5.1, 95% CI [1.1-21.4]; P = 0.05), but not with age at diagnosis, gender, treatment intensity and cranial irradiation. Metabolic syndrome (MetS) was more prevalent in survivors (13%) than in Turkish children (2%). As compared with controls, survivors had higher leptin level (8.1 ± 8.6 vs 3.2 ± 2.2 ng/ml, P = 0.01) and leptin/adiponectin ratio (2.1 ± 3.5 vs 0.6 ± 0.5, P = 0.03). Leptin/adiponectin ratio was correlated with HOMA-IR (r: 0.57, P = 0.001). The prevalence of OW/OB and MetS are elevated in the childhood survivors of ALL. Post-treatment OW/OB in survivors is related with OW/OB at diagnosis and dexamethasone containing therapy. Elevated leptin level and leptin: adiponectin ratio may serve as an early sign of metabolic derangement increasing the risk for early cardiovascular disease.

Background: Lipopolysaccharides (LPSs) are a component of certain types of bacteria and can induce an inflammatory response in the body, including in the pancreas. Cannabidiol (CBD), a nonpsychoactive compound found in cannabis, has been shown to have anti-inflammatory effects and may offer potential therapeutic benefits for conditions involving inflammation and damage. The aim of this study was to investigate any potential preventative effects of CBD on experimental LPS-induced pancreatic pathology in rats. Materials and Methods: Thirty-two rats were randomly divided into four groups as control, LPS (5 mg/kg, intraperitoneally [i.p.]), LPS+CBD, and CBD (5 mg/kg, i.p.) groups. Six hours after administering LPS, the rats were euthanized, and blood and pancreatic tissue samples were taken for biochemical, polymerase chain reaction (PCR), histopathological, and immunohistochemical examinations. Results: The results indicated that LPS decreased serum glucose levels and increased lipase levels. It also caused severe hyperemia, increased vacuolization in endocrine cells, edema, and slight inflammatory cell infiltrations at the histopathological examination. Insulin and amylin expressions decreased during immunohistochemical analyses. At the PCR analysis, Silent Information Regulator 2 homolog 1 and peroxisome proliferator-activated receptor gamma coactivator-1 alpha expressions decreased and tumor protein p53 expressions increased in the LPS group. CBD improved the biochemical, PCR, histopathological, and immunohistochemical results. Conclusions: The findings of the current investigation demonstrated that LPS damages both the endocrine and exocrine pancreas. However, CBD demonstrated marked ameliorative effects in the pancreas in LPS induced rat model pancreatitis.

Metabolic syndrome (MetS) is a constellation of coexisting cardiovascular risk factors. This study aimed to assess the evidence for the association between the apolipoprotein B/A1 ratio, apolipoprotein B, and apolipoprotein A1, and the MetS in children and adolescents.

The English electronic databases including PubMed, Embase, Web of Science, and Scopus were searched up to February 28, 2022. To ascertain the validity of eligible studies, modified JBI scale was used. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using the random-effects model to evaluate the association between the apolipoprotein B/A1 ratio, apolipoprotein B, and apolipoprotein A1 and the MetS. Heterogeneity amongst the studies was determined by the use of the Galbraith diagram, Cochran's Q-test, and I2 test. Publication bias was assessed using Egger's and Begg's tests.

From 7356 records, 5 studies were included in the meta-analysis, representing a total number of 232 participants with MetS and 1320 participants as control group. The results indicated that increased levels of apolipoprotein B/A1 ratio (SMD 1.26; 95% CI: 1.04, 1.47) and apolipoprotein B (SMD 0.75; 95% CI: 0.36, 1.14) and decreased levels of apolipoprotein A1 (SMD -0.53; 95% CI: -0.69, -0.37) are linked to the presence of MetS. The notable findings were, children and adolescents with MetS had elevated levels of the apolipoprotein B/A1 ratio, apolipoprotein B, and decreased levels of apolipoprotein A1.

Our results suggest the need to evaluate the levels of apolipoproteins for detecting the risk of MetS in children and adolescents.

The online version contains supplementary material available at 10.1007/s40200-023-01235-z.

Childhood obesity has emerged as a major global health issue, contributing to the increased prevalence of chronic conditions and adversely affecting the quality of life and future prospects of affected individuals, thereby presenting a substantial societal challenge. This complex condition, influenced by the interplay of genetic predispositions and environmental factors, is characterized by excessive energy intake due to uncontrolled appetite regulation and a Westernized diet. Managing obesity in childhood requires specific considerations compared with adulthood, given the vulnerability of the critical juvenile-adolescent period to toxicity and developmental defects. Consequently, common treatment options for adult obesity may not directly apply to younger populations. Therefore, research on childhood obesity has focused on genetic defects in regulating energy intake, alongside pharmacotherapy and dietary interventions as management approaches, with an emphasis on safety concerns. This review aims to summarize canonical knowledge and recent findings on genetic factors contributing to childhood obesity. Additionally, it assesses the efficacy and safety of existing pharmacotherapies and dietary interventions and suggests future research directions. By providing a comprehensive understanding of the complex dynamics of childhood obesity, this review aims to offer insights into more targeted and effective strategies for addressing this condition, including personalized healthcare solutions.

To investigate the effect of increasing sleep duration for 1 week, compared to a week of habitual and decreased sleep, on insulin sensitivity (IS) in adolescents at risk for type 2 diabetes (T2D).

Adolescents, 13-18 years old, at risk for T2D, with obesity and other risk factors, were recruited for a randomized (1:1), open-label, sex-stratified crossover study, that manipulated time-in-bed to modify sleep duration (measured by actigraphy). Following a week of habitual (HB) sleep, time-in-bed was increased (IN) and decreased (DE) by 1 hour 30 min/night for 1 week, counterbalanced across participants (HBINDE or HBDEIN), and separated by a week of washout sleep. The main outcome measure was IS, obtained via 2-hour oral-glucose-tolerance-test conducted after each sleep week.

Of the 43 participants recruited, 36 (84%) completed all sleep interventions (52.8% female, age = 15.1 years, body mass index = 99.9th percentile, order: HBINDE = 18 and HBDEIN = 18). On average, during the HB week, participants slept 7 hours 31 min/night; sleep duration was 1 hour 02 min/night higher during the IN week and 1 hour 19 min/night lower during the DE week. We found a significant effect of sleep week on IS with a large effect size. Following the IN sleep week, IS was 20% higher compared to after the HB and DE sleep weeks, but there was no significant difference in IS following HB versus DE sleep weeks.

Whenever possible, clinicians should empower youth at risk of T2D to improve their sleep duration, since even a modest increase in sleep duration of 1 h/night for 1 week can have a positive impact on IS in this population.

Sleep Extension and IS in Adolescents, https://clinicaltrials.gov/study/NCT03754036, November 23rd, 2018.

ClinicalTrials.gov (ID:NCT03754036).

Background: As many as 60% of pediatric patients taking second-generation antipsychotics (SGA) experience weight gain (antipsychotic-induced weight gain). However, the subgroup that experienced substantial weight increase was poorly understood. This study aimed to identify the development and predictors of clinically significant weight gain (CSWG) among pediatric SGA recipients. Methods: A retrospective analysis of the 2016 to 2021 IQVIA Ambulatory EMR-US database was conducted. The study cohort comprised SGA-naive patients ages 5 to 19, continuously prescribed SGA for ≥90 days. CSWG was defined as a weight gain in BMI z-score >0.5. The development of CSWG was described using the group-based trajectory model approach, and multinomial logistic regression analysis was conducted to examine the risk factors associated with the CSWG trajectories. Results: Of the 16,262 SGA recipients who met the inclusion criteria, 4 distinctive CSWG trajectories were identified: (1) Rapid (14.6%), (2) Gradual (12.6%), (3) Transit (7%), and (4) no CSWG (65.8%). Factors associated with a higher likelihood of having rapid or gradual CSWG versus nonsignificant weight gain were being younger (OR [95% CI] = 12-17 vs. 5-11, Rapid, 0.727 [0.655-0.806]; Gradual, 0.776 [0.668-0.903]), male (Rapid, 1.131 [1.021-1.253]), non-Hispanic White (Black vs. White: Rapid, 0.833 [0.709-0.98]), with lower baseline BMI z-score (Rapid, 0.376 [0.361-0.392]; Gradual, 0.449 [0.424-0.476]), and receiving olanzapine as the initial SGA (Rapid, 1.38 [1.093-1.74]). The Area under the Receiver operating characteristic (ROC) Curve for the comparison of rapid and gradual CSWG with no CSWG trajectory were 0.83 and 0.80, respectively. Conclusions: SGA recipients experienced four distinctive CSWG trajectories (Rapid, Gradual, Transient, and No CSWG). The risk of CSWG could be predicted using patient characteristics at the SGA initiation. This insight highlights the importance of personalized monitoring and timely intervention strategies for at-risk individuals who experienced persistent CSWG in real practice.

Incense burning is a significant source of indoor air pollution in many Asian regions. There is emerging evidence that maternal prenatal exposure to incense-burning smoke may be a risk factor for childhood obesity. We aimed to extend this new line of research by investigating the independent and joint effect of incense-burning smoke exposure, and children's outdoor activity in early life, on preschoolers' obesity. A total of 69,637 mother-child dyads were recruited from all kindergartens in the Longhua District of Shenzhen, China. Information on sociodemographic characteristics, maternal exposure to incense-burning smoke (IBS) during pregnancy, and frequency and duration of outdoor activity at the age of 1-3 years was collected by a self-administered questionnaire. In addition, the heights and weights of the children were measured by the research team. Logistic regression models and cross-over analyses were conducted to investigate the independent and combined effects of maternal exposure to incense-burning smoke during pregnancy and children's early outdoor activity on obesity in preschoolers. We found that prenatal exposure to incense-burning smoke increased the risk of the presence of obesity in preschoolers' (AOR = 1.13, 95% CI = 1.03-1.23). Additionally, lower frequencies (<3 times/week) or shorter durations (<60 min/time) of outdoor activity from the age of 1-3 years were significantly associated with the presence of obesity, with AORs of 1.24 (95% CI =1.18-1.32) and 1.11 (95% CI = 1.05-1.17), respectively. Furthermore, the cross-over analysis showed that prenatal exposure to IBS combined with a lower frequency of early outdoor activity (AOR = 1.47, 95% CI = 1.31-1.66) or a shorter duration of outdoor activity during ages of 1-3 years (AOR = 1.22, 95% CI = 1.07-1.39) increased the risk of obesity in preschoolers. Finally, additive interactions between prenatal exposure to IBS and postnatal outdoor activity on obesity were identified. Our study indicates that maternal exposure to incense-burning smoke during pregnancy and early lower postanal outdoor activity may independently and jointly increase the risk of obesity among preschoolers.

Metabolic syndrome (MetS) is a complex disorder characterized by abdominal obesity, elevated blood pressure, hyperlipidemia, and elevated fasting blood glucose levels. The diagnostic criteria for MetS in adults are well-established, but there is currently no consensus on the definition in children and adolescents. The etiology of MetS is believed to involve a complex interplay between genetic predisposition and environmental factors. While genetic predisposition explains only a small part of MetS pathogenesis, modifiable environmental risk factors play a significant role. Factors such as maternal weight during pregnancy, children's lifestyle, sedentariness, high-fat diet, fructose and branched-chain amino acid consumption, vitamin D deficiency, and sleep disturbances contribute to the development of MetS. Early identification and treatment of MetS in children and adolescents is crucial to prevent the development of chronic diseases later in life. In this review we discuss the latest research on factors contributing to the pathogenesis of MetS in children, focusing on non-modifiable and modifiable risk factors, including genetics, dysbiosis and chronic low-grade inflammation.

The association of asthma and metabolic syndrome (MetS) among adolescents and young adults (AYAs) remains unclear, as well as the role of obesity in this relationship.

AYAs aged 12-25 years who participated in the 2011-2020 National Health and Nutrition Examination Survey were included in this cross-sectional analysis. The moderating effect of obesity (age- and sex-adjusted body mass index ≥ 95th%ile for adolescents or ≥ 30 kg/m2 for adults) on asthma and MetS were evaluated in four groups: 1) both asthma and obesity; 2) asthma and no obesity; 3) obesity and no asthma; and 4) healthy controls with no obesity/asthma.

A total of 7,709 AYAs (53.9% aged 12-18 years, 51.1% males, and 54.4% non-Hispanic White) were included in this analysis. 3.6% (95% CI 2.8-4.3%) had obesity and asthma, 7.6% (95% CI 6.8-8.4%) had asthma and no obesity, 21.4% (95% CI 19.6-23.2%) had obesity and no asthma, and 67.4% (95% CI 65.4-69.4%) had neither obesity nor asthma. The estimated prevalence of MetS was greater among those with both obesity and asthma versus those with only asthma (4.5% [95% CI 1.7-7.3%] vs. 0.2% [95% CI 0-0.5%], p < 0.001). Compared to healthy controls, those with both obesity and asthma had ∼10 times higher odds of having MetS (aOR 10.5, 95% CI 3.9-28.1).

Our results show the association between MetS and asthma is stronger in AYAs with BMI-defined obesity. Efforts to prevent and treat obesity may reduce MetS occurrence in AYAs with asthma.

The objective of this study was to examine the hypothesis that abdominal and gluteal adipocyte turnover, lipid dynamics, and fibrogenesis are dysregulated among insulin-resistant (IR) compared with insulin-sensitive (IS) adolescents with obesity.

Seven IS and seven IR adolescents with obesity participated in a 3-h oral glucose tolerance test and a multi-section magnetic resonance imaging scan of the abdominal region to examine body fat distribution patterns and liver fat content. An 8-week 70% deuterated water (2 H2 O) labeling protocol examined adipocyte turnover, lipid dynamics, and fibrogenesis in vivo from biopsied abdominal and gluteal fat.

Abdominal and gluteal subcutaneous adipose tissue (SAT) turnover rates of lipid components were similar among IS and IR adolescents with obesity. However, the insoluble collagen (type I, subunit α2) isoform measured from abdominal, but not gluteal, SAT was elevated in IR compared with IS individuals. In addition, abdominal insoluble collagen Iα2 was associated with ratios of visceral-to-total (visceral adipose tissue + SAT) abdominal fat and whole-body and adipose tissue insulin signaling, and it trended toward a positive association with liver fat content.

Altered extracellular matrix dynamics, but not expandability, potentially decreases abdominal SAT lipid storage capacity, contributing to the pathophysiological pathways linking adipose tissue and whole-body IR with altered ectopic storage of lipids within the liver among IR adolescents with obesity.

Obesity is associated with negative effects on the brain. We exploit Artificial Intelligence (AI) tools to explore whether differences in clinical measurements following lifestyle interventions in overweight population could be reflected in brain morphology. In the DIRECT-PLUS clinical trial, participants with criterion for metabolic syndrome underwent an 18-month lifestyle intervention. Structural brain MRIs were acquired before and after the intervention. We utilized an ensemble learning framework to predict Body-Mass Index (BMI) scores, which correspond to adiposity-related clinical measurements from brain MRIs. We revealed that patient-specific reduction in BMI predictions was associated with actual weight loss and was significantly higher in active diet groups compared to a control group. Moreover, explainable AI (XAI) maps highlighted brain regions contributing to BMI predictions that were distinct from regions associated with age prediction. Our DIRECT-PLUS analysis results imply that predicted BMI and its reduction are unique neural biomarkers for obesity-related brain modifications and weight loss.