Reduced physical activity level and cardiorespiratory fitness in children with chronic diseases

We aimed to compare physical activity level and cardiorespiratory fitness in children with different chronic diseases, such as type 1 diabetes mellitus (T1DM), obesity (OB) and juvenile idiopathic arthritis (JIA), with healthy controls (HC). We performed a cross-sectional study including 209 children: OB: n = 45, T1DM: n = 48, JIA: n = 31, and HC: n = 85. Physical activity level was assessed by accelerometer and cardiorespiratory fitness by a treadmill test. ANOVA, linear regressions and Pearson correlations were used. Children with chronic diseases had reduced total daily physical activity counts (T1DM 497 ± 54cpm, p = 0.003; JIA 518 ± 28, p < 0.001, OB 590 ± 25, p = 0.003) and cardiorespiratory fitness (JIA 39.3 ± 1.7, p = 0.001, OB 41.7 ± 1.2, p = 0.020) compared to HC (668 ± 35cpm; 45.3 ± 0.9mlkg−1 min−1, respectively). Only 60.4% of HC, 51.6% of OB, 38.1% of JIA and 38.5% of T1DM children met the recommended daily 60min of moderate-to-vigorous physical activity. Low cardiorespiratory fitness was associated with female gender and low daily PA. Conclusion: Children with chronic diseases had reduced physical activity and cardiorespiratory fitness. As the benefits of PA on health have been well demonstrated during growth, it should be encouraged in those children to prevent a reduction of cardiorespiratory fitness and the development of comorbiditie

Impaired endothelial and smooth muscle functions and arterial stiffness appear before puberty in obese children and are associated with elevated ambulatory blood pressure

Aims To determine whether impaired brachial endothelial (flow-mediated dilation, FMD) and smooth muscle function (nitroglycerin-mediated dilation, NTGMD), and remodelling of the common carotid artery (CCA) develop before puberty in obese children. Methods and results Arterial intima-media thickness (IMT), FMD and NTGMD were measured by high-resolution ultrasound in 48 obese and 23 lean pre-pubertal children (8.8 ± 1.5 years old). We assessed central pulse pressure, incremental elastic modulus (Einc), casual and ambulatory systolic (SBP) and diastolic blood pressure (DBP), and body fatness by DXA. Obese children had significantly lower FMD (4.5 ± 4.0 vs. 8.3 ± 1.7%), NTGMD (19.0 ± 9.0 vs. 25.8 ± 6.1%), and increased Einc (13.9 ± 5.2 vs. 10.4 ± 5.2 mmHg/102), ambulatory SBP (121.3 ± 12.6 vs. 106.6 ± 7.1, mmHg), and DBP (69.1 ± 5.7 vs. 63.7 ± 4.5) than lean subjects, whereas IMT was not augmented. Ambulatory systolic hypertension was present in 47% of obese subjects. FMD, NTGMD, and Einc were correlated with body fatness, body mass index, and blood pressure (BP). Conclusion Impaired endothelial and smooth muscle functions and altered wall material develop before puberty in obese children, however remodelling of the CCA is not yet present. Arterial dysfunction may be considered as the first marker of atherosclerosis and is associated with elevated BP. Ambulatory blood pressure monitoring may be a potential tool to improve risk stratification in obese childre

Impact of obesity on global and regional systolic function in children: a CMR study

International audiencen.

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations

Effectiveness of individual and group programmes to treat obesity and reduce cardiovascular disease risk factors in pre‐pubertal children

Childhood obesity results in premature atherosclerosis and requires early intervention. Compare the effectiveness of 6‐month lifestyle interventions (with choice of either individual or group therapy) with standard care on body mass index (BMI) z‐score and cardiovascular disease (CVD) risks factors in children with obesity. This 6‐month randomized controlled trial with a 6‐month follow‐up included 74 pre‐pubertal children with obesity (7.5‐11.9 years) assigned randomly (2:1) to intervention or control. Families in the intervention arm choose between an individually delivered treatment (3 hours paediatrician + 4 hours dietician) or group treatment (35 hours with a multidisciplinary team). Children participated also to a weekly physical activity programme. We measured BMI, BMI z‐score; waist circumference (WC); total and abdominal fat; blood pressure; common carotid artery intima‐media thickness and incremental elastic modulus (Einc); endothelium‐dependent and independent dilation (nitroglycerin‐mediated dilation [NTGMD]) of the brachial artery; fasting plasma glucose, insulin, lipids; and high‐sensitivity C‐reactive protein (hs‐CRP). Compared to controls, at 6 months, abdominal fat and hs‐CRP were reduced in both interventions. The group intervention was also effective in reducing BMI (−0.55 kg/m2; 95% confidence interval −1.16 to 0.06) and BMI z‐score (−0.08; −0.15 to 0.00) at 6 months and BMI, BMI z‐score, WC, NTGMD, total and abdominal fat at 12 months. Abdominal fat and low‐grade inflammation were significantly decreased in both interventions. High‐intensity group treatment improved early signs of atherosclerosis in children with obesity. These findings are important for the promotion of cardiometabolic health in this population

Interventions for treating children and adolescents with overweight and obesity:An overview of Cochrane reviews

Children and adolescents with overweight and obesity are a global health concern. This is an integrative overview of six Cochrane systematic reviews, providing an up-to-date synthesis of the evidence examining interventions for the treatment of children and adolescents with overweight or obesity. The data extraction and quality assessments for each review were conducted by one author and checked by a second. The six high quality reviews provide evidence on the effectiveness of behaviour changing interventions conducted in children <6 years (7 trials), 6-11 years (70 trials), adolescents 12-17 years (44 trials) and interventions that target only parents of children aged 5-11 years (20 trials); in addition to interventions examining surgery (1 trial) and drugs (21 trials). Most of the evidence was derived from high-income countries and published in the last two decades. Collectively, the evidence suggests that multi-component behaviour changing interventions may be beneficial in achieving small reductions in body weight status in children of all ages, with low adverse event occurrence were reported. More research is required to understand which specific intervention components are most effective and in whom, and how best to maintain intervention effects. Evidence from surgical and drug interventions was too limited to make inferences about use and safety, and adverse events were a serious consideration

Insulin secretion response during oral glucose tolerance test is related to low cardiorespiratory fitness in obese adolescents

Background: The obesity paradox refers to a category of subjects who may be less prone to develop co-morbidities, such as type 2 diabetes. Cardiorespiratory fitness (CRF) has been identified as one of the key factors. We aimed at exploring the difference in insulin metabolism between fit and unfit obese adolescents. Methods: We recruited 22 obese adolescents and assessed CRF during an incremental treadmill test. According to a cut-off at 80% of predicted maximal oxygen consumption (VO2max), subjects were separated into low or normal CRF. Body composition was determined by densitometry. Serum levels of insulin were measured sequentially during an oral glucose tolerance test and insulin secretion responses were calculated. Results: Compared to adolescents with normal CRF, the ones with low CRF had higher insulin resistance indices (p=0.023) and insulin secretion response (p=0.010), independently of the body mass index z-score. Conclusions: Interventions in obese adolescents should focus on the maintenance or improvement of CRF to at least 80% of predicted VO2max. Indeed, this cut-off was significantly related to insulin secretion responses, independently of the adiposity level. A CRF above the proposed cut-off may prevent the development of insulin resistance

Sugar-sweetened beverages and weight gain in children and adults: a systematic review from 2013 to 2015 and a comparison with previous studies

Objective: Partly inconsistent findings from previous reviews have fueled discussions on the impact of sugar-sweetened beverages (SSBs) on obesity development. The aim was to systematically review the recent evidence in children and adults. Methods: Data were retrieved from the databases MEDLINE, EMBASE, and Cochrane library for the period January 2013 to October 2015. A systematic review of prospective cohort studies and randomized controlled trials (RCTs) relating SSBs to weight measures was conducted. Results: 30 publications met the inclusion criteria. Prospective cohort studies (96%; n = 26) showed a positive association between consumption of SSBs and weight/BMI in adults and children (n = 242,352), and only one cohort study in children showed no association. Findings from three RCTs in children demonstrated that SSB consumption had an effect on BMI/BMI z-score. The one RCT in adults showed no significant effect of the intervention. 63% of the studies were of good, 30% of medium quality, and none was funded by industry. Conclusion: Recent evidence suggests that SSB consumption is positively associated with or has an effect on obesity indices in children and adults. By combining the already published evidence with the new one, we conclude that public health policies should aim to reduce the consumption of SSBs and encourage healthy alternatives such as water. (c) 2017 The Author(s) Published by S. Karger GmbH, Freibur