Insulin resistance and its association with the components of the metabolic syndrome among obese children and adolescents

<p>Abstract</p> <p>Background</p> <p>Insulin resistance is the primary metabolic disorder associated with obesity; yet little is known about its role as a determinant of the metabolic syndrome in obese children. The aim of this study is to assess the association between the degree of insulin resistance and the different components of the metabolic syndrome among obese children and adolescents.</p> <p>Methods</p> <p>An analytical, cross-sectional and population-based study was performed in forty-four public primary schools in Campeche City, Mexico. A total of 466 obese children and adolescents between 11-13 years of age were recruited. Fasting glucose and insulin concentrations, high density lipoprotein cholesterol, triglycerides, waist circumference, systolic and diastolic blood pressures were measured; insulin resistance and metabolic syndrome were also evaluated.</p> <p>Results</p> <p>Out of the total population studied, 69% presented low values of high density lipoprotein cholesterol, 49% suffered from abdominal obesity, 29% had hypertriglyceridemia, 8% presented high systolic and 13% high diastolic blood pressure, 4% showed impaired fasting glucose, 51% presented insulin resistance and 20% metabolic syndrome. In spite of being obese, 13% of the investigated population did not present any metabolic disorder. For each one of the components of the metabolic syndrome, when insulin resistance increased so did odds ratios as cardiometabolic risk factors.</p> <p>Conclusions</p> <p>Regardless of age and gender an increased degree of insulin resistance is associated with a higher prevalence of disorders in each of the components of the metabolic syndrome and with a heightened risk of suffering metabolic syndrome among obese children and adolescents.</p

C-reactive protein reference percentiles among pre-adolescent children in Europe based on the IDEFICS study population

OBJECTIVES: C-reactive protein (CRP) is involved in a wide range of diseases. It is a powerful marker for inflammatory processes used for diagnostic and monitoring purposes. We aimed to establish reference values as data on the distribution of serum CRP levels in young European children are scarce. SUBJECTS: Reference values of high-sensitivity CRP concentrations were calculated for 9855 children aged 2.0-10.9 years, stratified by age and sex. The children were recruited during the population-based European IDEFICS study (Identification and prevention of Dietary-and lifestyle-induced health Effects in Children and infantS) with 18 745 participants recruited from 2007 to 2010. RESULTS: In 44.1 % of the children, CRP values were below or equal the detection limit of 0.2 mg/l. Median CRP concentrations showed a slight negative age trend in boys and girls, whereas serum CRP values were slightly higher in girls than in boys across all age groups. CONCLUSIONS: Our population-based reference values of CRP may guide paediatric practice as elevated values may require further investigation or treatment. Therefore, the presented reference values represent a basis for clinical evaluation and for future research on risk assessment of diseases associated with increased CRP levels among children

Maternal blood cadmium, lead and arsenic levels, nutrient combinations, and offspring birthweight

Abstract Background Cadmium (Cd), lead (Pb) and arsenic (As) are common environmental contaminants that have been associated with lower birthweight. Although some essential metals may mitigate exposure, data are inconsistent. This study sought to evaluate the relationship between toxic metals, nutrient combinations and birthweight among 275 mother-child pairs. Methods Non-essential metals, Cd, Pb, As, and essential metals, iron (Fe), zinc (Zn), selenium (Se), copper (Cu), calcium (Ca), magnesium (Mg), and manganese (Mn) were measured in maternal whole blood obtained during the first trimester using inductively coupled plasma mass spectrometry. Folate concentrations were measured by microbial assay. Birthweight was obtained from medical records. We used quantile regression to evaluate the association between toxic metals and nutrients due to their underlying wedge-shaped relationship. Ordinary linear regression was used to evaluate associations between birth weight and toxic metals. Results After multivariate adjustment, the negative association between Pb or Cd and a combination of Fe, Se, Ca and folate was robust, persistent and dose-dependent (p < 0.05). However, a combination of Zn, Cu, Mn and Mg was positively associated with Pb and Cd levels. While prenatal blood Cd and Pb were also associated with lower birthweight. Fe, Se, Ca and folate did not modify these associations. Conclusion Small sample size and cross-sectional design notwithstanding, the robust and persistent negative associations between some, but not all, nutrient combinations with these ubiquitous environmental contaminants suggest that only some recommended nutrient combinations may mitigate toxic metal exposure in chronically exposed populations. Larger longitudinal studies are required to confirm these findings

Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence

Julia C Durante,1,2 Jessica Sims,1,2 Jason Jarin,2,3 Melanie A Gold,4 Sarah E Messiah,5– 7 Jenny KR Francis1,2,8 1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA; 2Children’s Health System of Texas, Dallas, TX, USA; 3Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA; 4Department of Pediatrics and Department of Population & Family Health, Columbia University Irving Medical Center, New York, NY, USA; 5University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, TX, USA; 6Center for Pediatric and Population Health, UTHealth School of Public Health, Dallas, TX, USA; 7Department of Pediatrics, McGovern Medical School, Houston, TX, USA; 8Peter O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USACorrespondence: Jenny KR Francis, Department of Adolescent & Young Adult Medicine, University of Texas Southwestern/Children’s Health, 2350 N Stemmons Fwy, Ste F5200, Dallas, TX, 75207, USA, Tel +1 214-456-6790, Fax +1 214-456-2230, Email [email protected]: Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.Keywords: long-acting reversible contraception, LARC, Contraception, adolescent, pregnancy prevention, birth control, communication, contraception counselin

Effectiveness of Bariatric Surgery in Reducing Weight and Body Mass Index Among Hispanic Adolescents

BACKGROUND: Ethnic minority adolescents and Hispanics in particular, are disproportionately affected by extreme obesity and its associated co-morbidities. Bariatric surgery is one of the few effective treatments for morbid obesity, yet little information about weight outcomes after surgery in this demographic are available. We determined the effectiveness of bariatric surgery in reducing weight and body mass index (BMI) in adolescents, a majority of whom were non-Mexican American Hispanic and originated from Central and/or South America and the Caribbean Basin region. METHODS: Adolescents (16-to-19 years old) who had undergone gastric bypass or adjustable gastric band surgery between 2001 and 2010 and who had complete follow up data available (91%) were included in the analysis. Mean weight and BMI before and 1-year after surgery were compared. RESULTS: Among 71 adolescents (80% Hispanic, 77% female), Mean BMI and weight, and z-scores and percentile transformations were all significantly lower after surgery for the entire sample (P<0.001). Gastric bypass surgery showed significantly better weight loss outcomes for all anthropometric measures versus adjustable gastric band surgery (P<0.05). The weight loss was similar among Hispanics and non-Hispanics. No perioperative complications were reported. Three patients who stopped taking supplements as prescribed experienced iron-deficiency anemia within the year following surgery. CONCLUSIONS: Our results show that bariatric surgery can markedly reduce weight among a predominantly Hispanic adolescent patient sample, and gastric bypass procedure in particular. These findings indicate that bariatric surgery has the potential to be safe and effective in substantially reducing weight in a group of adolescents who are at particularly high risk for obesity-related health consequences

Prevalence of Metabolic Syndrome in US-Born Latin and Caribbean Youth

Little is knows about the prevalence of the metabolic syndrome (MS) among overweight first or second generation United States immigrant children/adolescents from Central/South America and the Caribbean basin. Analysis of anthropometric and laboratory data (N = 224) in overweight children ages 3-18 (64% Hispanic, 25% AfroCaribbean/black, 8% white, 3% multiracial) was conducted. The main outcome measure was the prevalence of individual parameters of MS and the MS (defined as > or =3 abnormal components). The prevalence of the MS was 29% for the overall sample; an additional 28% had two MS components. Boys were significantly more likely than girls to have abnormal systolic blood pressure (P < 0.05). Hispanics were significantly more likely than blacks to have abnormal triglyceride and HDL cholesterol (P < 0.01 for both comparisons). Our results indicate that both sub-groups of, and major ethnic groups (Mexican- and African American) are at equal risk for cardiometabolic disease. Early identification of MS in recent immigrant children may improve their future cardiometabolic health