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Purpose: Obesity in youth increases the risk for type 2 diabetes (T2D) and elevated abdominal adipose tissue and organ fat may be particularly deleterious. The purpose of this study was to examine associations among measures of adiposity including total, visceral, and organ fat (hepatic and pancreatic) and whether these measures were independently associated with glycemia in Latino youth at risk for diabetes. Methods: Latino adolescents (47 boys and 32 girls, 13.7 ± 1.4 years) with obesity (BMIz 2.3 ± 0.3) were assessed for total fat by DXA and visceral and organ fat by 3 T magnetic resonance imaging. Glycemic indicators included HbA1c, fasting glucose (FG), and 2‐h glucose (2‐HrG) following an oral glucose tolerance test. Pearson correlations and stepwise linear regression analyses controlling for age and sex were used to examine independent associations between adiposity and glycemia. Results: Total fat was associated with visceral (r = 0.66, p = 0.001) and hepatic fat (r = 0.34, p < 0.01) while visceral fat was associated with hepatic (r = 0.42, p < 0.001) and pancreatic fat (r = 0.36, p < 0.001). In stepwise linear regression analysis, hepatic and pancreatic fat were significant predictors of FG, explaining 4.7% and 5.2% of the variance, respectively (total R2 = 0.14, p = 0.02). Hepatic fat was the only significant predictor of 2‐HrG explaining 9.9% of the variance in the model (total R2 = 0.12, p = 0.03). No measure of adiposity was retained as a significant predictor of HbA1c. Conclusion: Hepatic and pancreatic fat were the only adiposity measures independently associated with glycemia but the small amount of variance explained underscores the need for additional T2D biomarkers in high risk youth. [ABSTRACT FROM AUTHOR]

Summary: Background: Glucose concentrations during an oral glucose tolerance test (OGTT) have been used as biomarkers to differentiate type 2 diabetes risk phenotypes. No studies have examined changes in OGTT‐glucose phenotypes following lifestyle intervention among high‐risk youth. Objective: To examine changes in OGTT‐glucose phenotypes following lifestyle intervention and to explore differences in insulin sensitivity and β‐cell function among post‐intervention phenotypes. Methods: Latino adolescents with obesity (n = 48, age 15.4 ± 1.0, BMI% 98.2 ± 1.4, female 56.3%) completed a 12‐week lifestyle intervention that included weekly nutrition education and physical activity. At baseline and 12 weeks, youth completed a 2‐h OGTT with glucose and insulin concentrations assessed at 0′, 30′, 60′, 90′ and 120′. Glucose concentrations during the OGTT were used to identify biomarkers, 1‐h glucose, glucose response curve and time to glucose peak. Using these respective biomarkers, high‐risk (1‐h glucose ≥ 155 mg/dl, Monophasic, Late Peak) and lower‐risk phenotypes (1‐h glucose < 155 mg/dl, Biphasic, Early Peak) were categorized. Insulin sensitivity was estimated by whole‐body insulin sensitivity index (WBISI) and β‐cell function by oral disposition index (oDI). Results: Following intervention, the prevalence of Monophasic phenotypes decreased from 81% to 67% (p = 0.048) and 1‐h glucose ≥ 155 mg/dl from 38% to 10% (p = 0.054). Although Late Peak phenotypes did not significantly change (from 58% to 29%, p = 0.200), Early Peak phenotypes at post‐intervention demonstrated significantly higher WBISI compared to Late Peak (2.3 ± 0.1 vs 1.7 ± 0.2, p = 0.023). Conclusions: OGTT‐glucose phenotypes improve following lifestyle intervention among high‐risk youth. These findings further support their potential utility as clinical biomarkers to identify diabetes risk and risk reduction in youth. [ABSTRACT FROM AUTHOR]

Objective: To characterize the heterogeneity in response to lifestyle intervention among Latino adolescents with obesity. Methods: We conducted secondary data analysis of 90 Latino adolescents (age 15.4 ± 0.9 y, female 56.7%) with obesity (BMI% 98.1 ± 1.5%) that were enrolled in a 3 month lifestyle intervention and were followed for a year. Covariance pattern mixture models identified response phenotypes defined by changes in insulin sensitivity as measured using a 2 hour oral glucose tolerance test. Baseline characteristics were compared across response phenotypes using one‐way ANOVA and chi‐square test. Results: Three distinct response phenotypes (PH1, PH2, PH3) were identified. PH1 exhibited the most robust response defined by the greatest increase in insulin sensitivity over time (β ± SE, linear 0.52 ± 0.17, P <.001; quadratic −0.03 ± 0.01, P =.001). PH2 showed non‐significant changes, while PH3 demonstrated modest short‐term increases in insulin sensitivity which were not sustained over time (linear 0.08 ± 0.03, P =.002; quadratic −0.01 ± 0.002, P =.003). At baseline, PH3 (1.1 ± 0.4) was the most insulin resistant phenotype and exhibited the highest BMI% (98.5 ± 1.1%), 2 hours glucose concentrations (144.0 ± 27.5 mg/dL), and lowest beta‐cell function as estimated by the oral disposition index (4.5 ± 2.8). Conclusion: Response to lifestyle intervention varies among Latino youth with obesity and suggests that precision approaches are warranted to meet the prevention needs of high risk youth. [ABSTRACT FROM AUTHOR]

Summary: Background: Body composition differences between males and females emerge during adolescence and continue throughout adulthood; however, whether sex moderates body composition changes in adolescents with obesity after an intervention is unknown. Objective: To examine sex as a moderator of changes in adiposity following lifestyle intervention. Methods: A total of 136 Latino youth with obesity (BMI% 98.2 ± 1.3) aged 14 to 16 years old were randomized to either a 12‐week lifestyle intervention (27 males/40 females) or control (35 males/34 females) group. The intervention included nutrition education (1 h/wk) and moderate‐to‐vigorous physical activity (3 h/wk). Anthropometric data (body mass index [BMI], BMI%, waist circumference, total body fat, and fat‐free mass) were obtained pre‐ and post‐intervention. Sex differences were examined by general linear models with significance determined at P <.05 for the F‐statistic. Results: Sex did not moderate changes in BMI (F1,115 = 0.01, P =.9), BMI% (F1,115 = 0.14, P =.7), or waist circumference (F1,117 = 1.1, P =.3). Sex significantly moderated changes in body fat percent (F1,117 = 5.3, P =.02), fat mass (F1,116 = 4.5, P =.04), and fat‐free mass (F1,116 = 4.3, P =.04). Intervention males compared with females had greater relative reductions in fat percent (−4.1 ± 0.8% vs −1.2 ± 0.7%, P =.02) and fat mass (−5.0 ± 1.1 kg vs −1.5 ± 0.9 kg, P =.02) and gained more fat free mass (3.6 ± 0.9 kg vs 0.5 ± 0.8 kg, P =.02) when compared with same sex controls. Conclusion: Males and females exhibited a differential response to lifestyle intervention for percent fat, fat mass, and fat‐free mass indicating that sex‐specific improvements in body composition favours males over females. [ABSTRACT FROM AUTHOR]

Background and Objective: Epicardial adipose thickness (EAT) is increased in adults with type 1 diabetes (T1D) and is thought to contribute to cardiovascular disease (CVD) in this population. Given that CVD risk factors emerge early in life, the purpose of this study was to identify whether EAT is increased in pediatric patients with T1D compared with non‐diabetic controls. Methods: Anthropometric data, blood pressure (BP), and EAT were evaluated in 20 youth with T1D and 20 age, sex, and body mass index (BMI) matched healthy controls between the ages of 5 and 18 years. Results: EAT was 18.5% higher among youth with T1D compared to healthy controls (1.65 ± 0.44 mm vs 1.37 ± 0.27 mm, P = .02). In the entire cohort, EAT was correlated with age (r = 0.71, P < .001), BMI (r = .69, P < .001), waist circumference (r = 0.60, P < .001), systolic BP (r = .34, P =.03), and diastolic BP (r = 0.41, P =.009). Among youth with T1D, there were no significant correlations between EAT and HbA1c (r = −0.16, P = .50), insulin dose (r = .09, P = .71), or duration of disease (r = 0.06, P = .82). Conclusions: Youth with T1D exhibited significantly higher EAT compared to controls. Increased EAT was associated with adiposity and BP, but not duration of disease, insulin dose, or glycemic control. Increased EAT may represent a pathophysiologic mechanism leading to premature CVD in pediatric patients with T1D. [ABSTRACT FROM AUTHOR]

Objective: Treating pediatric severe obesity is challenging because of the complex biological, behavioral, and environmental factors that underpin the disease. The multifactorial etiology of obesity combined with the physiologic complexity of the energy regulatory system contributes to treatment variability. The goal of this secondary analysis of pooled data was to describe the degree of individual variation in response to various interventions among adolescents with severe obesity.Methods: Data from three centers across the United States conducting either lifestyle (n = 53), pharmacotherapy (n = 40), or metabolic and bariatric surgery (n = 78) interventions were pooled. Inclusion criteria were severe obesity at baseline and at least one follow-up visit > 30 days after treatment start.Results: Change in BMI following intervention ranged from -50.2% to +12.9%, with each intervention (lifestyle [range: -25.4% to 5.0%], pharmacotherapy [range: -10.8% to 12.9%], and metabolic and bariatric surgery [range: -50.2% to -13.3%]) exhibiting wide individual variation in response. Changes in cardiometabolic risk factors demonstrated similarly high variability.Conclusions: Adolescents with severe obesity demonstrated a high degree of heterogeneity in terms of BMI reduction and cardiometabolic risk factor response across treatment modalities. Reporting individual response data in trials and identifying factors driving variability in response will be vital for advancing precision medicine approaches to address obesity. [ABSTRACT FROM AUTHOR]

Background Obese youth with prediabetes are at increased risk for premature morbidity and mortality through multiple mechanisms, including increased systemic inflammation. GlycA is a novel measure of systemic inflammation that predicts type II diabetes, cardiovascular events, and all-cause mortality in adults. Objective The purpose of the present study was to examine changes in GlycA after lifestyle intervention among obese, prediabetic Latino youth. Methods Obese, prediabetic Latino youth (n = 27; 15.5 ± 1.1 years, 13 males/14 females) completed a 12-week lifestyle intervention that included weekly nutrition education and 3 d/wk of moderate to vigorous physical activity. Prediabetes was characterized by an expanded definition of impaired glucose tolerance, using 2-hour glucose ≥120 mg/dL after an oral glucose tolerance test. GlycA was assessed at baseline and 12 weeks using nuclear magnetic resonance spectroscopy. Results After the lifestyle intervention, GlycA was significantly reduced (445.3 ± 51.3 μmol/L to 419.0 ± 50.0 μmol/L, P =.01) (mean ± standard deviation). Additional improvements were observed in multiple cardiovascular risk factors, including body mass index (BMI; 34.8 ± 5.0 kg/m2 to 34.0 ± 5.1 kg/m2, P <.001), total cholesterol (154.1 ± 30.3 mg/dL to 143.3 ± 29.1 mg/dL, P =.003), and 2-hour glucose (141.0 ± 13.2 mg/dL to 115.9 ± 31.4 mg/dL, P <.001). Decreases in GlycA were associated with decreases in 2-hour glucose (r = 0.49, P =.008) and BMI (r = 0.41, P =.03). Conclusion These data are consistent with the hypothesis that lifestyle intervention might improve GlycA levels in obese, prediabetic adolescent Latinos, but randomized trial evidence is needed. Healthy lifestyle modifications among high-risk youth may decrease future risk of cardiometabolic disease through reducing systemic inflammation, in addition to improving traditional cardiovascular risk factors. Highlights • Systemic inflammation predicts incident cardiovascular disease and type II diabetes. • We evaluated effects of a 12-week lifestyle program among obese Latino adolescents. • GlycA levels fell by 6% after lifestyle intervention over 12 weeks, • Improvements in GlycA were associated with improvements in diabetes risk factors. [ABSTRACT FROM AUTHOR]

Background The identification and subsequent management of liver diseases in children is challenging due to the lack of non-invasive imaging biomarkers. Ultrasound shear-wave elastography (US-SWE) is an emerging imaging technique which can quantitatively assess liver stiffness and may be useful as a tool in the management of liver disease in overweight and obese children. Purpose To evaluate US-SWE velocities of the liver in normal-weight and obese children, to correlate US-SWE findings with age and body-mass-index (BMI), and to compare US-SWE values with qualitative assessment (i.e. normal versus abnormal echogenicity) of the liver by conventional US. Material and Methods A cohort of 300 children (mean age, 9.9 ± 5.3 years; age range, 0.06-18.9 years) were studied, comprising 176 normal-weight and 124 obese participants. In each patient, both US-SWE and conventional US of the liver were obtained. Three pediatric radiologists individually and in consensus determined whether liver parenchyma was of normal or abnormal echogenicity. Results US-SWE velocities differed between normal-weight and obese children (1.08 ± 0.14 versus 1.44 ± 0.39 m/s; P < 0.001), but not by gender. Multivariate linear regression demonstrated US-SWE velocity to be primarily associated with age in normal-weight children ( P < 0.05) and with BMI in obese children ( P < 0.001). In the obese group, mean US-SWE velocity was statistically higher in participants with abnormal echogenic livers than in those with normal-appearing livers (1.53 ± 0.38 vs. 1.17 ± 0.27). The difference was not significant in the normal-weight group. Conclusion US-SWE provides a useful quantitative imaging biomarker for evaluating liver stiffness in children. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND We evaluated the 12-month effects of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) program versus an attention control program (Healthy Teens) on overweight/obesity and depressive symptoms in high school adolescents. METHODS A cluster randomized controlled trial was conducted. Participants were 779 culturally diverse adolescents in the US Southwest. COPE is a cognitive-behavioral skills-building intervention with 20 min of physical activity integrated into a health course and taught by teachers once a week for 15 weeks. Outcome measures included body mass index ( BMI) and depressive symptoms. RESULTS COPE teens had a significantly lower BMI at 12 months (F1,698 = 11.22, p = .001) than Healthy Teens (24.95 versus 25.48). There was a significant decrease in the proportion of overweight and obese COPE teens from baseline to 12 months (χ2 = 5.40, p = .02) as compared with Healthy Teens. For youth who began the study with extremely elevated depressive symptoms, COPE teens had significantly lower depression at 12 months compared with Healthy Teens ( COPE M = 42.39; Healthy Teens M = 57.90); ( F1,12 = 5.78, p = .03). CONCLUSIONS COPE can improve long-term physical and mental health outcomes in teens. [ABSTRACT FROM AUTHOR]

Objective: The soluble receptor for advanced glycation end products (sRAGE) has anti-atherogenic properties in adults, however, little is known about the relationship between sRAGE and cardiometabolic disease risk in pediatric populations. Therefore, the purpose of this investigation is to examine the relationship between sRAGE and cardiometabolic risk factors in Latino youth. Research design and methods: Data from 133 Latino youth (58% female; age 16.3±2.8 yr) enrolled in the Arizona Insulin Resistance Registry were analyzed. Cardiometabolic syndrome was determined using a continuous risk score normalized to the population. Components included waist circumference, high-density lipoprotein cholesterol (HDL-c), triglycerides, mean arterial pressure (MAP), and homeostatic assessment of insulin resistance (HOMA-IR). sRAGE levels were determined from fasting serum using an enzyme-linked immunosorbent assay. Results: In univariate analysis, sRAGE was inversely associated with waist circumference (r=-0.22, p=0.01), MAP (r=-0.15, p=0.09), and HOMA-IR (r=-0.29, p<0.01) and positively associated with HDL-c (r=0.19, p<0.05). In multiple regression analysis with age, sex, and BMI, sRAGE remained an independent predictor of cardiometabolic syndrome risk score (R² =0.55, p<0.001). Conclusions: These data suggest that sRAGE may be an early independent biomarker of cardiometabolic disease risk in youth. Prospective studies are needed to establish the predictive utility of sRAGE for long-term disease outcomes. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this investigation was to compare the homeostasis model assessment of insulin resistance (HOMA-IR) to more direct measures of insulin action before and after lifestyle interventions in obese Latino youth. Study design. Eleven obese Latino boys (age 15.1 ± 1.6 years, body mass index (BMI) percentile 97.3 ± 3.5%) and twenty obese Latina girls (age 14.7 ± 1.8 years, BMI percentile 96.6 ± 3.6%) participated in two distinct lifestyle interventions. Boys participated in a 16-week exercise intervention and girls participated in a 12-week nutrition education program. Insulin sensitivity was determined by the frequently sampled intravenous glucose tolerance test (FSIVGTT) in boys and by a 3-hour oral glucose tolerance test with multiple sampling calculations for the whole-body insulin sensitivity index (WBISI) in girls. HOMA-IR was measured for both groups. Results. HOMA-IR was correlated at baseline to the FSIVGTT (r = −0.57, p = 0.07) and the WBISI (r = −0.78, p<0.01) and at follow-up (FSIVGTT: r = −0.81, p<0.003; WBISI: r = −0.71, p = 0.001). Post-intervention, insulin sensitivity increased 45% in the boys and 34% in the girls; however, these improvements were not reflected by significant changes in HOMA-IR. Conclusions. Improvements in insulin sensitivity following an intervention measured either by the FSIVGTT or an OGTT were not detected by HOMA-IR. Researchers and clinicians should exercise caution in relying on fasting indices, such as HOMA-IR, to determine the impact of lifestyle interventions on insulin sensitivity in overweight youth. [ABSTRACT FROM AUTHOR]

Purpose: We examined whether physical fitness and dietary intake predicted better glycemic control and lipid profile in adolescents with type 1 diabetes mellitus (T1DM). Methods: The sample consisted of 109 adolescents with T1DM [age, 15.3 ± 1.9 yr; diabetes duration, 6.2 ± 3.7 yr; body mass index (BMI), 23.3 ± 4.0 kg/m2; and hemoglobin A1c (HbA1c), 8.7 ± 1.6%]. Stepwise regression analyses were performed with the following independent variables: age, sex, duration of diabetes, BMI, Tanner stage, physical fitness, and average carbohydrate and total and saturated fat intake, and the following dependent variables: total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglycerides, and HbA1c. Physical fitness was measured by peak oxygen consumption (VO2peak) during progressive cycle ergometry, and 3-day food intake was analyzed using Nutritionist Pro™ software. Results: Sex and VO2peak explained 19% of the variance for HbA1c. Age, VO2peak, and saturated fat intake predicted 23% of the variance for total cholesterol, although only diabetes duration and saturated fat intake predicted LDL-c (11%). Duration of diabetes explained 5% of the variance in triglyceride levels, and there were no significant independent predictors for HDL-c. Conclusions: Greater fitness levels predicted both better glycemic control and total cholesterol in adolescents with T1DM, whereas lower saturated fat affected total cholesterol but not glycemic control. These findings support the importance of physical fitness and diets of lower saturated fat for overall metabolic health in adolescents with T1DM. [ABSTRACT FROM AUTHOR]

Objective: The increased incidence of type 2 diabetes (T2D) among youth is hypothesized to be due, in part, to low levels of fitness and activity. Therefore, the purpose of this investigation was to examine whether cardiorespiratory fitness and physical activity are reduced in youth with T2D compared with overweight controls. Participants: Thirteen adolescent boys with previously diagnosed T2D (mean duration 2.4 ± 1.8 yr) were matched for age and body mass index to 13 overweight, non-diabetic controls. Methods: Cardiorespiratory fitness was assessed during a progressive exercise test to volitional fatigue and physical activity was estimated from a 7-d physical activity recall. Results: Youth with T2D reported performing ∼60% less moderate to vigorous physical activity compared with their non-diabetic counterparts (0.6 ± 0.2 vs. 1.4 ± 0.3 h/d, p = 0.04). Furthermore, diabetic youth exhibited significantly lower cardiorespiratory fitness levels compared with controls (28.7 ± 1.6 vs. 34.6 ± 2.2 mL/kg/min, p < 0.05). Conclusions: These findings support the hypothesis that cardiorespiratory fitness and physical activity are reduced in youth with T2D. Whether reduced fitness and activity contributed to the pathophysiology of the disorder cannot be determined from the cross-sectional analysis. Longitudinal studies are warranted to examine whether improvements in fitness and increased physical activity can prevent the development of T2D in high-risk youth. [ABSTRACT FROM AUTHOR]

The article discusses a study to determine interrelationships between insulin-like growth factor-I (IGF-I) IGF binding proteins (IGFBPs) and adiposity in overweight Hispanic American adolescents in the U.S. The study, which involved 178 adolescents with an average body mass index of 28.2, made use of immunoradiometric assays to obtain measurements of IGF-I, IGFBP-1 and IGFBP-3. Magnetic resonance imaging (MRI) was utilized to measure visceral and subcutaneous adipose tissue. The study found that the three IGFs are inversely related to adiposity in the adolescents.