Causative Mechanisms of Childhood and Adolescent Obesity Leading to Adult Cardiometabolic Disease: A Literature Review

The past few decades have shown a worrisome increase in the prevalence of obesity and its related illnesses. This increasing burden has a noteworthy impact on overall worldwide mortality and morbidity, with significant economic implications as well. The same trend is apparent regarding pediatric obesity. This is a particularly concerning aspect when considering the well-established link between cardiovascular disease and obesity, and the fact that childhood obesity frequently leads to adult obesity. Moreover, most obese adults have a history of excess weight starting in childhood. In addition, given the cumulative character of both time and severity of exposure to obesity as a risk factor for associated diseases, the repercussions of obesity prevalence and related morbidity could be exponential in time. The purpose of this review is to outline key aspects regarding the current knowledge on childhood and adolescent obesity as a cardiometabolic risk factor, as well as the most common etiological pathways involved in the development of weight excess and associated cardiovascular and metabolic diseases

Cardiovascular risk in obese children

Institutul Inimii de Urgență pentru Boli Cardiovasculare „Niculae Stăncioiu”, Cluj-Napoca, județul Cluj, România, Universitatea „Lucian Blaga” din Sibiu, județul Sibiu, RomâniaIntroduction. The global prevalence of obesity is on the rise [1]. The well established correlation between excess weight and cardiovascular disease has been raising concerns regarding this pandemic [2, 3]. Paediatric obesity is also on the rise, which may indicate the development of a growing incidence of obesity-related comorbidities and cardiac patients in the future [4]. Assertive action in this direction requires a keen knowledge of the mechanisms that clarify the relationship between obesity and cardiovascular disease. Aim of the study. To provide an overview of the current literature regarding the influence of paediatric obesity on cardiovascular risk and the underlying pathophysiological mechanisms. Materials and methods. We performed literature searches using the Medline/ PubMed databases and referred to international guidelines where applicable. Results and conclusions. The complex mechanisms that establish the link between obesity and cardiovascular risk begin in the early years of childhood and contribute to the formation of a cluster of detrimental characteristics that include physical inactivity, unhealthy eating habits, smoking and an altered metabolism defined by elevated insulin resistance and dyslipidemia. It is reasonable to assume that there is a high chance that today’s obese children migh become tomorrow’s cardiac patients. This knowledge encourages the development of protocols to better define the cardiovascular risk of obese children and to take preventive action where possible

Factori determinanți ai obezității la copil

Institutul Inimii de Urgență pentru Boli Cardiovasculare „Niculae Stăncioiu” Cluj-Napoca, județul Cluj, România, Universitatea „Lucian Blaga” din Sibiu, județul Sibiu, RomâniaIntroduction. The usual approach when defining the fundamental etiology of obesity is to consider the energy imbalance between calories consumed and calories expended as the main determinant factor in the pathogenesis of weight excess [1]. In recent times, considerable scientific efforts have been made, however, to provide nuance regarding the inner workings of the exact mechanisms that lead to the development of obesity [2]. One direction for research has revolved around the factors regarding childhood obesity – an illness which is escalating globally [3, 4]. There is a well-documented relation between developing a weight excess in childhood and adult obesity [5], as a majority of overweight adults have in fact retained this status since childhood [6]. Preventive action against obesity is dependent upon the understanding of its determinant factors. These factors represent targets upon which to act in order to attempt to minimize the impact of this global disease. Aim of the study. To provide an overview of the current literature regarding the main determinant factors of childhood obesity and identify potential targets for preventive measures in this respect. Material and methods. We performed literature searches using the Medline/ PubMed databases and referred to international guidelines where applicable. Results and conclusions. The intricate interactions between environment and genotype can reveal a series of crucial points where decisive preventive actions could have a significant impact on the reduction of the burden of obesity

Assessing Obesogenic School Environments in Sibiu County, Romania: Adapting the ISCOLE School Environment Questionnaire

The impact of the school environment on childhood weight status has garnered significant attention in recent years. This study aimed to adapt and validate the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) School and Environment questionnaire in order to assess the potential obesogenic impact of school environments in Sibiu County, Romania. The ISCOLE questionnaire was chosen for its rigorous methodology. It was derived from a comprehensive study conducted across 12 countries which aimed to capture multifaceted influences on childhood weight while emphasizing educational settings in the collection of data. To guide the translation and adaptation of the questionnaire, a multidisciplinary committee was assembled which comprised experts in teaching and school administration to ensure target responder relevance, experts in clinical research to ensure methodological robustness, experts in language adaptation to preserve the original intent of the survey, and experts in public health to steer the interpretation of the results, with potential policy implications. The data were analyzed by distinguishing between urban and rural settings, and a two-step cluster analysis was implemented to identify potential intervention targets. To assess the validity of the adapted tool, the questionnaire’s construct validity and internal consistency were explored. A response rate of 71.2% of the approached schools in Sibiu County was achieved. Of the 84 responding school representatives, 37 (44%) were from a rural setting. The rural schools had significantly more limited access to gymnasiums, secured lockers, showers, and bicycle racks, and exhibited more serious problems regarding the inadequate disposal of garbage in the school vicinity. A two-step cluster analysis revealed distinct school categories, providing opportunities for public policy interventions. One of these primarily concerned rural schools with limited infrastructure but with proactive practices and policies which were termed “unable but willing”; on the opposing spectrum, the category “able but unwilling” mainly comprised urban schools which had available facilities but lacked local proactive initiatives. The findings emphasize the urgent need for targeted measures to bridge these discrepancies by investing in infrastructure in rural schools and promoting active school practices and policies in urban settings. The assessment of obesogenic school environments in Sibiu County provides a pilot model for broader applications due to the diverse school landscape and supportive local authorities. The results, which were achieved using low-cost methods, can guide future educational policies, health promotion initiatives, and preventive interventions

Gender Particularities and Prevalence of Atypical Clinical Presentation in Non-ST Elevation Acute Coronary Syndrome

Clinical presentation is one of the factors that can influence how quickly a patient with an acute coronary syndrome is treated, particularly if it is atypical. The purposes of this study are to explore gender-related differences in patients presenting with non-ST elevation acute coronary syndromes (NSTEACS) from the perspective of a series of common risk factors as well as treatment strategies and to evaluate the prevalence of atypical clinical presentation of NSTEACS in the study group. In addition, we explored the differences between the two entities that define NSTEACS: unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). We conducted a retrospective study by reviewing discharge documents of patients admitted in the cardiology department of the Clinical Rehabilitation Hospital in Cluj-Napoca with NSTEACS between January 2014 and December 2015. We retrieved demographic data, clinical presentation and history, laboratory tests, and coronary angiography records as well as the implemented treatment strategies. Women in the study group were more frequently hypertensive than men (89.5% vs. 75.4%; p = 0.043), had a higher mean serum HDL cholesterol value (43 vs. 38 mg/dL p = 0.022), were more frequently diagnosed with microvascular coronary heart disease (32% vs. 9.8%, p = 0.036), and were more often treated conservatively (49.1% vs. 30.8%, p = 0.038), while men were significantly more prone to smoking than women (30.8% vs. 14%, p = 0.028) and had higher mean serum creatinine (1.2 vs. 0.8 mg/dL; p = 0.022) and uric acid values (6.9 vs. 6.2 mg/dL; p = 0.048). Out of the 122 included patients, 109 had documented information regarding symptoms. The prevalence of atypical presentation was 4.6% (95% CI 0.7–8.5%). In our study group, patients with UA had a more frequent history of cardiovascular ischemic diseases (77.4% vs. 56.7%, p = 0.015), the mean value for BUN was higher in NSTEMI patients compared to patients with UA (47 vs. 39 mg/dL, p = 0.038) and NSTEMI patients more frequently received interventional treatment compared to patients with UA (60% vs. 41.9%; p = 0.046)

Carrageenan-Based Compounds as Wound Healing Materials

The following review is focused on carrageenan, a heteroglycan-based substance that is a very significant wound healing biomaterial. Every biomaterial has advantages and weaknesses of its own, but these drawbacks are typically outweighed by combining the material in various ways with other substances. Carrageenans’ key benefits include their water solubility, which enables them to keep the wound and periwound damp and absorb the wound exudate. They have low cytotoxicity, antimicrobial and antioxidant qualities, do not stick to the wound bed, and hence do not cause pain when removed from the wounded region. When combined with other materials, they can aid in hemostasis. This review emphasizes the advantages of using carrageenan for wound healing, including the use of several mixes that improve its properties

Fecal Microbiota Transplantation in Patients Co-Infected with SARS-CoV2 and <i>Clostridioides difficile</i>

Background: The COVID-19 pandemic has challenged the treatment of Clostridioides Difficile (CD)-infected patients given the increasing number of co-infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this context, fecal microbiota transplantation (FMT) shows promise in modulating the immune system’s function and alleviating the burdens associated with this condition. Methods: To achieve this goal, we performed a comparative, retrospective, single-center study on 86 patients (admitted between January 2020 and March 2022). We based our approach on specific inclusion criteria: 1. The study group included 46 co-infected patients (COVID-19 and CD) receiving antibiotics and FMT; 2. In the control group, 40 co-infected patients received antibiotics only. Our results showed no significant group differences in terms of gender, age, risk factors such as cardiovascular and neurological diseases, type 2 diabetes, and obesity (p > 0.05), or in pre-treatment inflammatory status, evaluated by white blood cell (WBC) count and C-reactive protein (CRP) levels. We report a significant decrease in inflammatory syndrome (CRP, WBC) in coinfected patients receiving FMT in addition to antibiotics (p p < 0.05). Conclusion: Our study provides new data to support the multiple benefits of FMT in the case of COVID-19 and CD co-infection by improving patients’ quality of life and inflammatory syndrome

Telocytes&rsquo; Role in Modulating Gut Motility Function and Development: Medical Hypotheses and Literature Review

This review article explores the telocytes&rsquo; roles in inflammatory bowel diseases (IBD), presenting the mechanisms and hypotheses related to epithelial regeneration, progressive fibrosis, and dysmotility as a consequence of TCs&rsquo; reduced or absent number. Based on the presented mechanisms and hypotheses, we aim to provide a functional model to illustrate TCs&rsquo; possible roles in the normal and pathological functioning of the digestive tract. TCs are influenced by the compression of nearby blood vessels and the degree of fibrosis of the surrounding tissues and mediate these processes in response. The changes in intestinal tube vascularization induced by the movement of the food bowl, and the consequent pH changes that show an anisotropy in the thickness of the intestinal tube wall, have led to the identification of a pattern of intestinal tube development based on telocytes&rsquo; ability to communicate and modulate surrounding cell functions. In the construction of the theoretical model, given the predictable occurrence of colic in the infant, the two-layer arrangement of the nerve plexuses associated with the intestinal tube was considered to be incompletely adapted to the motility required with a diversified diet. There is resulting evidence of possible therapeutic targets for diseases associated with changes in local nerve tissue development