37 research outputs found
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
Effectiveness of individual and group programmes to treat obesity and reduce cardiovascular disease risk factors in preâpubertal children
Childhood obesity results in premature atherosclerosis and requires early intervention. Compare the effectiveness of 6âmonth lifestyle interventions (with choice of either individual or group therapy) with standard care on body mass index (BMI) zâscore and cardiovascular disease (CVD) risks factors in children with obesity. This 6âmonth randomized controlled trial with a 6âmonth followâup included 74 preâpubertal children with obesity (7.5â11.9 years) assigned randomly (2:1) to intervention or control. Families in the intervention arm choose between an individually delivered treatment (3 hours paediatricianâ+â4 hours dietician) or group treatment (35âhours with a multidisciplinary team). Children participated also to a weekly physical activity programme. We measured BMI, BMI zâscore; waist circumference (WC); total and abdominal fat; blood pressure; common carotid artery intimaâmedia thickness and incremental elastic modulus (Einc); endotheliumâdependent and independent dilation (nitroglycerinâmediated dilation [NTGMD]) of the brachial artery; fasting plasma glucose, insulin, lipids; and highâsensitivity Câreactive protein (hsâCRP). Compared to controls, at 6 months, abdominal fat and hsâCRP were reduced in both interventions. The group intervention was also effective in reducing BMI (â0.55âkg/m2; 95% confidence interval â1.16 to 0.06) and BMI zâscore (â0.08; â0.15 to 0.00) at 6 months and BMI, BMI zâscore, WC, NTGMD, total and abdominal fat at 12âmonths. Abdominal fat and lowâgrade inflammation were significantly decreased in both interventions. Highâintensity group treatment improved early signs of atherosclerosis in children with obesity. These findings are important for the promotion of cardiometabolic health in this population
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
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
The ABCD of obesity: An EASO position statement on a diagnostic term with clinical and scientific implications
Obesity is a frequent, serious, complex, relapsing, and chronic disease process that represents
a major public health problem. The coining of obesity as an adiposity-based chronic disease
(ABCD) is of particular relevance being in line with EASOâs proposal to improve the International Classification of Diseases ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks. The body mass index as a unique
measurement of obesity does not reflect the whole complexity of the disease. Obesity complications are mainly determined by 2 pathological processes, i.e., physical forces (fat mass
disease) as well as endocrine and immune responses (sick fat disease), which are embedded in
a cultural and physical context leading to a specific ABCD stage
European association for the study of obesity position statement on the global COVID-19 pandemic
COVID-19, the infectious disease caused by the coronavirus SARS-CoV-2, was declared a pandemic by the World Health Organization on March 12, 2020. The European Association for the Study of Obesity (EASO), as a scientific and medical society dedicated to the promotion of health and well-being, is greatly concerned about this global health challenge and its significant impacts on individuals, families, communities, health systems, nations, and wider society
OBEDIS Core Variables Project : European Expert Guidelines on a Minimal Core Set of Variables to Include in Randomized, Controlled Clinical Trials of Obesity Interventions
Heterogeneity of interindividual and intraindividual responses to interventions is often observed in randomized, controlled trials for obesity. To address the global epidemic of obesity and move toward more personalized treatment regimens, the global research community must come together to identify factors that may drive these heterogeneous responses to interventions. This project, called OBEDIS (OBEsity Diverse Interventions Sharing - focusing on dietary and other interventions), provides a set of European guidelines for a minimal set of variables to include in future clinical trials on obesity, regardless of the specific endpoints. Broad adoption of these guidelines will enable researchers to harmonize and merge data from multiple intervention studies, allowing stratification of patients according to precise phenotyping criteria which are measured using standardized methods. In this way, studies across Europe may be pooled for better prediction of individuals' responses to an intervention for obesity - ultimately leading to better patient care and improved obesity outcomes.Peer reviewe
Parental Perceptions of Childrenâs Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017
Introduction: Parents can act as important agents of change
and support for healthy childhood growth and development. Studies have found that parents may not be able to
accurately perceive their childâs weight status. The purpose
of this study was to measure parental perceptions of their
childâs weight status and to identify predictors of potential
parental misperceptions. Methods: We used data from the
World Health Organization (WHO) European Childhood
Obesity Surveillance Initiative and 22 countries. Parents
were asked to identify their perceptions of their childrenâs
weight status as âunderweight,â ânormal weight,â âa little
overweight,â or âextremely overweight.â We categorized
childrenâs (6â9 years; n = 124,296) body mass index (BMI) as
BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the
distribution of children according to the WHO weight status
classification, distribution by parental perception of childâs
weight status, percentages of accurate, overestimating, or
underestimating perceptions, misclassification levels, and
predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with
overweight (including obesity). Statistical analyses were performed using Stata version 15 1. Results: Overall, 64.1% of
parents categorized their childâs weight status accurately
relative to the WHO growth charts. However, parents were
more likely to underestimate their childâs weight if the child
had overweight (82.3%) or obesity (93.8%). Parents were
more likely to underestimate their childâs weight if the child
was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28â1.55); the parent had a lower educational level
(adjOR: 1.41; 95% CI: 1.26â1.57); the father was asked rather
than the mother (adjOR: 1.14; 95% CI: 0.98â1.33); and the
family lived in a rural area (adjOR: 1.10; 95% CI: 0.99â1.24).
Overall, parentsâ BMI was not strongly associated with the
underestimation of childrenâs weight status, but there was a
stronger association in some countries. Discussion/Conclusion: Our study supplements the current literature on factors
that influence parental perceptions of their childâs weight
status. Public health interventions aimed at promoting
healthy childhood growth and development should consider parentsâ knowledge and perceptions, as well as the sociocultural contexts in which children and families live.The authors gratefully acknowledge support from a grant from
the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the
countries was made possible through funding by: Albania: World
Health Organization through the Joint Programme on Children,
Food Security and Nutrition âReducing Malnutrition in Children,â funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health; Bulgaria: Ministry
of Health, National Center of Public Health and Analyses, World
Health Organization Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and World
Health Organization Regional Office for Europe; Czechia: Grants
AZV MZÄR 17-31670 A and MZÄR â RVO EĂ 00023761; Denmark: Danish Ministry of Health; France: French Public Health
Agency; Georgia: World Health Organization; Ireland: Health
Service Executive; Italy: Ministry of Health; Istituto Superiore di
sanitĂ (National Institute of Health); Kazakhstan: Ministry of Health of the Republic of Kazakhstan and World Health Organization Country Office; Latvia: n/a; Lithuania: Science Foundation of
Lithuanian University of Health Sciences and Lithuanian Science
Council and World Health Organization; Malta: Ministry of
Health; Montenegro: World Health Organization and Institute of
Public Health of Montenegro; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of
Health, Regional Health Directorates and the kind technical support of Center for Studies and Research on Social Dynamics and
Health (CEIDSS); Romania: Ministry of Health; Russia (Moscow): n/a; San Marino: Health Ministry; Educational Ministry; Social Security Institute; the Health Authority; Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Tajikistan: World
Health Organization Country Office in Tajikistan and Ministry of
Health and Social Protection; and Turkmenistan: World Health
Organization Country Office in Turkmenistan and Ministry of
Health. The authors alone are responsible for the views expressed
in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.info:eu-repo/semantics/publishedVersio