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Background: The prevalence of hypertension in children and adolescents is rising, with 13% having elevated blood pressure and 5% having hypertension. Sex differences play a role in cardiovascular diseases in adults but are not well defined in youth. The objective of this study is to identify sex differences in obesity-mediated cardiometabolic risk factors in adolescents. Methods: This is a pilot study of n=82 obese children and adolescents recruited from a High BMI Clinic. Boys (n=42) and girls (n=40) were grouped by age (greater or less than age 12). Clinical data and blood samples were collected at a single time point (initial clinic visit). Serum sterols (glucocorticoids, mineralocorticoids, and sex hormones) were quantified via LC-MS/MS. Data are mean +/- standard deviation with analysis via 2-way ANOVA. Results: Mean BMI was 32.9 and 37.6 kg/m2 in children under/over age 12, respectively, with no difference in boys versus girls. Systolic blood pressure (SBP) was higher in boys and girls over compared to under age 12. Girls over age 12 had higher diastolic blood pressure (DBP) compared to boys (69.4 + 8.6 versus 66.4 + 5.1 mmHG; P Conclusions: Despite having similar BMI and HOMA-IR, girls and boys had differences in DBP and serum sterols. Further analysis will refine associations of sex hormones with anthropometric, blood pressure, and glucose homeostasis measurements in obese girls and boys.

BACKGROUND An increasing number of clinical practice guidelines recommend screening children with obesity for non-alcoholic fatty liver disease (NAFLD). However, there is limited evidence regarding what parameters should be used to initiate the screening. OBJECTIVE The objective of this study was to determine whether obesity class rather than age group can identify a higher percent of children at risk of NAFLD as assessed by abnormal alanine aminotransferase (ALT). METHODS This is a cross-sectional study in a regional referral clinic for evaluation of obesity. Children were stratified by age group or by obesity class, and data obtained at first visit were analysed. RESULTS Of the 784 children, 482 were ≥10, 209 were 6 to 9 and 93 were 2 to 5 years of age. Abnormal ALT was observed in 32.1%, 46.9% and 61.0% of children with class I, II or III obesity, respectively (p

BACKGROUND Obese children are at high risk of several morbidities, including hypertension, coronary artery disease, hyperlipidemia, and diabetes. Per- and polyfluoroalkyl chemicals (PFAS) are a recently recognized class of ‘forever chemicals’ that may contribute to disease risk. The aim of this study was to conduct a pilot investigation of a subset of available biospecimens from obese children with a focus on PFAS with respect to established measures …

Pediatric obesity is a significant public health problem, the negative outcomes of which will challenge individual well-being and societal resources for decades to come. The objective of this study was to determine the effects of dietary counseling on weight management and metabolic abnormalities in children with obesity. One hundred and sixty-five patients aged 2–18 years old were studied over a two and a half year period. Data collected included demographic information, anthropometric assessment, laboratory measurements, and self-reported eating behaviors. Dietary counseling was provided at each visit. The data was analyzed from the first and last visits and the subjects were retrospectively divided into responders and non-responders based on a decrease in their BMI. After receiving dietary guidance, BMI decreased in 44% of the children, and these participants were classified as responders (BMI-R; n = 72). However, BMI did not improve in 56% of the participants, and these were classified as non-responders (BMI-NR; n = 93). At the initial visit, anthropometric measurements and dietary habits were similar between the groups. At the time of the last visit, mean change in BMI was −1.47 (SD 1.31) for BMI-R and +2.40 (SD 9.79) for BMI-NR. Analysis of food intake revealed that BMI-R significantly improved their dietary habits (p = 0.002) by reducing the intake of sugar-sweetened beverages (p = 0.019), processed foods (p = 0.002), sweets (p < 0.001), and unhealthy snacks (p = 0.009), as compared with BMI-NR. There was no change in the intake of second helpings, portion sizes, skipping meals, frequency of meals eaten at school, condiment use, intake of fruits and vegetables and consumption of whole grains between the groups. BMI-R also achieved an improvement in fasted glucose (p = 0.021), triglycerides (p < 0.001), and total cholesterol (p = 0.023), as compared to BMI-NR. In conclusion, children with obesity who were able to decrease their BMI implemented a significant reduction in consumption of foods with high sugar content. Focusing on reducing sugar intake may yield the biggest impact in terms of weight management and the improvement of metabolic abnormalities.

OBJECTIVES: We aimed to quantify the burden of cardiometabolic risk factors (CMRF) in South American children. METHODS: We included primary quantitative white and gray literature in any language reporting after 1999 on the prevalence of glucose intolerance, obesity, hypertension and/or dyslipidemia in South Americans aged 2–21 years old. Studies were excluded for lack of available data, population with additional comorbidity, and/or CMRF criteria not defined. We searched PubMed, the Latin American and Caribbean Health Sciences Literature, and Google Scholar and performed reference handsearching. We assigned data quality via Effective Public Healthcare Panacea Project Quality Assessment Tool for Quantitative Studies modified for selection bias and data collection. We analyzed CMRF by available sociodemographic variables. RESULTS: Included studies (68 of 1,179; n = 115,674 children aged 2–19 years) came from 8 countries (Argentina, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru and Venezuela). CMRF definitions ranged widely. By any definition, 33.41% (n = 4,480/13,408) had low HDL cholesterol, 25.33% (n = 3,396/13,408) had elevated triglycerides, 13.92% (n = 2,900/20,830) had elevated waist circumference, 10.38% (n = 3,909/37,646) were obese by any definition, 10.49% (n = 858/9,672) had elevated blood pressure (BP), and 5.62% (n = 1,015/15,270) had glucose intolerance. By International Diabetes Federation definitions, 33.39% (n = 3,495/10,466) had HDL ≤ 40 mg/dL (16/22 studies); 23.45% (n = 909/3,876) had triglycerides ≥ 150 mg/dL (6/22 studies); 8.84% (n = 1,373/15,533) had waist circumference ≥ 90% for age, gender and height (20/30 studies); 6.10% (n = 733/12,010) had fasting glucose ≥ 100 mg/dL (17/21 studies) and 14.04% (n = 404/2,877) had systolic BP ≥ 130 mmHg (4/4 studies). CMRF varied by country, study setting (rural, urban or mixed), and indigenous population. Overall, Brazil had the highest prevalence of glucose intolerance and elevated BP; Chile had the highest prevalence of obesity and low HDL. Obesity was more prevalent in rural settings (7/65 studies); urban settings (19/28) had increased dyslipidemia. CONCLUSIONS: South American children experience a high prevalence of CMRF and need further characterization of the sociomedical determinants of their risk. FUNDING SOURCES: None.

Background Obesity affects nearly one in five children and is associated with increased risk of premature death. Obesity-related heart disease contributes to premature death. We aimed to use cardiovascular magnetic resonance (CMR) to comprehensively characterize the changes in cardiac geometry and function in obese children. Methods and results Forty-one obese/overweight (age 12 ± 3 years, 56 % female) and 29 healthy weight children (age 14 ± 3 years, 41 % female) underwent CMR, including both standard cine imaging and displacement encoded imaging, for a complete assessment of left ventricular (LV) structure and function. After adjusting for age, LV mass index was 23 % greater (27 ± 4 g/m2.7 vs 22 ± 3 g/m2.7, p

Background Obesity affects one in five children in the US and these children tend to maintain excess weight into adulthood. It has recently been shown that childhood obesity is associated with both cardiac remodeling (hypertrophy) and contractile dysfunction. However, the etiology of these cardiac changes is not well understood. We hypothesized that cardiac remodeling and dysfunction could not be entirely explained by elevations in blood pressure and that excess abdominal and epicardial adiposity may also correlate with cardiac changes.

The incidence of venous thromboembolism in children has increased significantly over the past 20 years. Over the same period of time, there was an increase in the prevalence of obesity in the pediatric population. Obesity is a known risk factor for VTE in adults, but little information is available in children.This study evaluates the relation between obesity and VTE using a retrospective, case-control design, comparing the body mass index (BMI) of patients admitted with a diagnosis of VTE versus patients admitted with other diagnoses, at a single institution, between 2007 and 2011.We studied 48 inpatients diagnosed with deep venous thrombosis or pulmonary embolism and a control group of 274 age and gender matched patients admitted with other diagnoses. We found obese patients (BMI95th percentile) to have significantly higher risk of VTE (odds ratio 2.1, with 95% CI 1.1-4.2) than patients of normal weight (BMI85th percentile). Overweight patients (BMI 85th-95th percentile) did not demonstrate a significant change in risk. Most of the VTE patients were adolescents and the majority of them had other identifiable risk factors for thrombosis.This study establishes a correlation between obesity and VTE in a group of hospitalized children, showing a risk for VTE in obese children similar to the one described in much larger adult cohorts.