Is Macronutrients Intake a Challenge for Cardiometabolic Risk in Obese Adolescents?

(1) Background: Pediatric obesity is an emerging public health issue, mainly related to western diet. A cross-sectional study was conducted to explore the association between macronutrients intake and cardiometabolic risk factors in obese adolescents. (2) Methods: Ninety-three Italian obese adolescents were recruited; anthropometric parameters, body composition, glucose and lipid metabolism profiles were measured. Macronutrients intake was estimated by a software-assisted analysis of a 120-item frequency questionnaire. The association between macronutrients and cardiometabolic risk factors was assessed by bivariate correlation, and multiple regression analysis was used to adjust for confounders such as age and sex. (3) Results: By multiple regression analysis, we found that higher energy and lower carbohydrate intakes predicted higher body mass index (BMI) z-score, p = 0.005, and higher saturated fats intake and higher age predicted higher HOmeostasis Model Assessment of insulin resistance (HOMA-IR) and lower QUantitative Insulin-sensitivity ChecK (QUICK) index, p = 0.001. In addition, a saturated fats intake <7% was associated with normal HOMA-IR, and a higher total fats intake predicted a higher HOMA of percent \u3b2-cell function (HOMA-\u3b2), p = 0.011. (4) Conclusions: Higher energy intake and lower carbohydrate dietary intake predicted higher BMI z-score after adjustment for age and sex. Higher total and saturated fats dietary intakes predicted insulin resistance, even after adjustment for confounding factors. A dietary pattern including appropriate high-quality carbohydrate and reduced saturated fat intakes could result in reduced cardiometabolic risk in obese adolescents

Evaluation of Different Adiposity Indices and Association with Metabolic Syndrome Risk in Obese Children: Is there a Winner?

Body shape index (ABSI) and triponderal mass index (TMI) have been recently associated with cardiovascular risk in adults. A cross-sectional study was conducted to evaluate the relationship between different anthropometric adiposity indexes and metabolic syndrome (MetS) in Caucasian obese children and adolescents. Consecutive obese children aged 657 years have been enrolled. Anthropometric parameters, body composition (by bioelectrical impedance), and systolic and diastolic blood pressure have been measured. Fasting blood samples have been analyzed for lipids, insulin, glucose. A multivariate logistic regression analyses, with body mass index z-score, waist to height ratio, ABSI z-score, TMI, conicity index as predictors for MetS (IDEFICS and IDF criteria according to age) has been performed. Four hundred and three (179 boys and 224 girls) obese children, aged 7\u201320 years, have been evaluated. When we explored the joint contribution of each anthropometric and adiposity index of interest and BMIz on the risk of MetS, we found that the inclusion of ABSIz improved the prediction of MetS compared to BMIz alone. ABSI-BMI can be a useful index for evaluating the relative contribution of central obesity to cardiometabolic risk in clinical management of obese children and adolescents

Predictive ability of the estimate of fat mass to detect early-onset metabolic syndrome in prepubertal children with obesity

Body mass index (BMI), usually used as a body fatness marker, does not accurately dis-criminate between amounts of lean and fat mass, crucial factors in determining metabolic syndrome (MS) risk. We assessed the predictive ability of the estimate of FM (eFM) calculated using the following formula: FM = weight − exp(0.3073 × height2 −10.0155×d-growth-standards/standards/body-mass-index-for-age-bmi-for-age weight−1 +0.004571×weight− 0.9180×ln(age) + 0.6488×age0.5 + 0.04723×male + 2.8055) (exp = exponential function, score 1 if child was of black (BA), south Asian (SA), other Asian (AO), or other (other) ethnic origin and score 0 if not, ln = natural logarithmic transformation, male = 1, female = 0), to detect MS in 185 prepubertal obese children compared to other adiposity parameters. The eFM, BMI, waist circumference (WC), body shape index (ABSI), tri-ponderal mass index, and conicity index (C-Index) were calculated. Patients were classified as hav-ing MS if they met ≥ 3/5 of the following criteria: WC ≥ 95th percentile; triglycerides ≥ 95th percen-tile; HDL-cholesterol ≤ 5th percentile; blood pressure ≥ 95th percentile; fasting blood glucose ≥ 100 mg/dL; and/or HOMA-IR ≥ 97.5th percentile. MS occurred in 18.9% of obese subjects (p < 0.001), with a higher prevalence in females vs. males (p = 0.005). The eFM was correlated with BMI, WC, ABSI, and Con-I (p < 0.001). Higher eFM values were present in the MS vs. non-MS group (p < 0.001); the eFM was higher in patients with hypertension and insulin resistance (p <0.01). The eFM shows a good predictive ability for MS. Additional to BMI, the identification of new parameters determi-nable with simple anthropometric measures and with a good ability for the early detection of MS, such as the eFM, may be useful in clinical practice, particularly when instrumentation to estimate the body composition is not available

Effect of Docosahexaenoic Acid Supplementation on Microbiota in Obese ChiLdrEn : A Pilot Study (The DAMOCLE Study)

Abstract: Obesity is an inflammatory condition associated with metabolic alterations including insulin resistance. Recent researches suggested that gut microbiota plays a role in its pathogenesis. Obesity has been associated with lower bacterial diversity and higher Firmicutes/Bacteroidetes ratio (F/R ratio) compared to normal\u2010weight condition. The objective of our study was to determine the effect of 4 months algae DHA supplementation, combined with dietary and habits education, on gut microbiota composition and biochemical parameters of 12 caucasian obese children. Anthropometric measures, metabolic profile and gut microbiota analysis trough stool samples were assessed at baseline (t0), after 4 months DHA supplementation plus diet-lifestyle intervention (t1), and lastly after additional 4 months of dietary dietary-lifestyle intervention without DHA supplementation (t2). No significant improvement in dietary habits nor in metabolic profile was found after the intervention, while a significant lowering of F/R ratio was observed from t0 to t1 and even more evident at t2 control

Massive rectal bleeding treated with transcatheter artery embolization: an unusual presentation of the solitary rectal ulcer syndrome

Clinical History/Pre-treatment Imaging: A 35-year-old paraplegic man because of a thoracic spinal cord injury and, history of constipation and self-digitation maneuver to evacuate, complained rectal bleeding and maroon-colored stools from some days. Laboratory findings revealed hemoglobin of 8.3 g/dL and a hematocrit of 25% requiring the transfusion of 3 units of packed blood cells. Esophagogastroscopy was negative and colonoscopy was inconclusive showing blood and clots. Abdominal contrast enhanced CT showed endorectal active contrast extravasation from left superior hemorrhoidal artery (SHA). Endovascular angiography and embolization was performed for controlling acute bleeding. Treatment Options/Results: Selective catheter angiography at the inferior mesenteric artery demonstrated active extravasation from a peripheral posterior branch of the left SHA (Fig.1). It was subsequently super-selective embolized with coils. Post-embolization images demonstrated resolved bleeding (Fig.2). Two days later endoscopy revealed a single shallow longitudinal ulcerating lesion covered by white slough on a hyperemic surrounding mucosa. Combination of symptomatology, patient history and endoscopy prompted the diagnosis of Solitary Rectal Ulcer Syndrome (SRUS). Discussion: SRUS is a rare benign disorder supposed to be secondary to straining, self-inducted trauma, paradoxical contraction of puborectal muscle, rectal prolapse and intussusception. Although rectal bleeding is one of the most common clinical features, massive hemorrhage is extremely rare. Patients with a massively bleeding rectal ulcer that does not stabilize with endoscopic or supportive therapy must be considered for operative treatment, including endovascular embolization. Take-home points: -SRUS is an extremely rare cause of massive lower gastrointestinal bleeding. -Embolization is a safe and effective alternative to endoscopic treatment and surgery for the rapid clinical stabilization

Gastrointestinal bleeding from Dieulafoy’s lesion: endovascular management with gelfoam and coil

Clinical History/Pre-treatment Imaging: A 56-year-old man was admitted to our hospital for some day of asthenia. He reported aspirin intake for a mouth. His past medical history included splenectomy for trauma. Laboratory tests showed hemoglobin of 9.1 g/dL and digital rectal examination revealed melena. Esophagogastroduodenoscopy showed, in proximal gastric body, active arterial spurting from two close minute mucosal defect. These lesions were successfully treated with combined mechanical hemostasis and injection therapy. However, a following laboratory test revealed hemoglobin drop. Treatment Options/Results: Patient performed endovascular angiography but no active source of gastrointestinal (GI) bleeding were found. After celiac trunk catheterization, images revealed distal left gastric artery branches maintaining constant arterial caliber and tortuous appearance (Fig.1), finding suspected of Dieulafoy’s lesion. To minimize risk of premature rebleeding, embolization with gelfoam and coil was performed demonstrating reduce flow towards the proximal stomach (Fig.2). Discussion: Although often misdiagnosed, Dieulafoy’s lesion represents an important etiology of acute, life-threatening and recurrent GI bleeding. Hemostasis with angiographic embolization has been reported in sporadic case reports. To minimize the risk of bowel infarction, the super-selective catheterization technique and a temporary agent such as gelfoam slurry is mandatory. In our patient, despite active bleeding was no seen, we have decided to release also a proximal single coil. To our knowledge, it allows to reduce recurrent bleeding risk decreasing perfusion pressure but to maintain sufficient tissue blood flow avoiding ischemia. Take-home points: The embolization strategy is essential in the endovascular management of Dieulafoy’s lesion to balance the risk of rebleeding and the risk of bowel ischemia

Prophylactic balloon occlusion of internal iliac arteries in women with placenta previa: analysis of the radiation dose to the foetus

Purpose: To evaluate the foetal radiation exposure during the prophylactic balloon occlusion of the internal iliac arteries (PBOIIA) for the prevention of intrapartum hemorrhage. Moreover, we analyzed the safety and efficacy of this procedure. Material and methods: We evaluated six consecutive pregnant women with placenta previa which underwent PBOIIA in conjunction with cesarean section. Three procedures were performed in the obstetric operating room fitted with a moveable angiographic C-arm system and three in the angiographic room with a fixed C-arm system. Fluoroscopic times, dose area products and foetal radiation doses were recorded. We also compared PBOIIA group with no endovascular intervention group (two cases) in terms of pre- and post-delivery hemoglobin, blood transfusion and the postoperative hospitalization time. Results: The total mean dose area product (mGycm2), mean foetal radiation dose (mGy) and mean fluoroscopic time (min) were 20978, 9.03 and 3.63, respectively. The mean foetal radiation dose and mean fluoroscopic time were 6.63 and 4.97 for the procedures performed in the obstetric operating room, but 11.43 and 2.29 when considering procedures in the angiographic room. Technical success was achieved in all six cases. One case needed blood transfusion (post-delivery hemoglobin from 8.5 to 7.4 g/dL). The mean postoperative hospitalization time was 3.33 days. In the no endovascular intervention group all patients needed transfusion and one had hysterectomy. The length of hospital stay was 4 days. Conclusion: PBOIIA was associated with an acceptable foetal radiation dose, which is below the specific threshold level for deterministic effect. It was safe and effective with the blood loss volume effectively controlled