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Experimental & Molecular Medicine Jul 2020Childhood obesity has reached epidemic levels and is a serious health concern associated with metabolic syndrome, nonalcoholic fatty liver disease, and gut microbiota... (Randomized Controlled Trial)
Randomized Controlled Trial
Childhood obesity has reached epidemic levels and is a serious health concern associated with metabolic syndrome, nonalcoholic fatty liver disease, and gut microbiota alterations. Physical exercise is known to counteract obesity progression and modulate the gut microbiota composition. This study aims to determine the effect of a 12-week strength and endurance combined training program on gut microbiota and inflammation in obese pediatric patients. Thirty-nine obese children were assigned randomly to the control or training group. Anthropometric and biochemical parameters, muscular strength, and inflammatory signaling pathways in mononuclear cells were evaluated. Bacterial composition and functionality were determined by massive sequencing and metabolomic analysis. Exercise reduced plasma glucose levels and increased dynamic strength in the upper and lower extremities compared with the obese control group. Metagenomic analysis revealed a bacterial composition associated with obesity, showing changes at the phylum, class, and genus levels. Exercise counteracted this profile, significantly reducing the Proteobacteria phylum and Gammaproteobacteria class. Moreover, physical activity tended to increase some genera, such as Blautia, Dialister, and Roseburia, leading to a microbiota profile similar to that of healthy children. Metabolomic analysis revealed changes in short-chain fatty acids, branched-chain amino acids, and several sugars in response to exercise, in correlation with a specific microbiota profile. Finally, the training protocol significantly inhibited the activation of the obesity-associated NLRP3 signaling pathway. Our data suggest the existence of an obesity-related deleterious microbiota profile that is positively modified by physical activity intervention. Exercise training could be considered an efficient nonpharmacological therapy, reducing inflammatory signaling pathways induced by obesity in children via microbiota modulation.
Topics: Case-Control Studies; Child; Endurance Training; Exercise; Female; Gastrointestinal Microbiome; Humans; Inflammation; Male; Metabolomics; Pediatric Obesity; Phylogeny; Principal Component Analysis; Signal Transduction
PubMed: 32624568
DOI: 10.1038/s12276-020-0459-0 -
Gastroenterology Clinics of North... Jun 2023Genetic forms of obesity contribute to ∼7% of severe obesity in children and adolescents. The exact global prevalence of monogenic and syndromic forms of obesity is... (Review)
Review
Genetic forms of obesity contribute to ∼7% of severe obesity in children and adolescents. The exact global prevalence of monogenic and syndromic forms of obesity is not well established, most likely due to missed or delayed diagnosis. The challenge in determining the prevalence can be attributed to the lack of consensus on identifying and evaluating symptoms of genetic defects in a timely manner and hence a vastly undertested patient population. Further large-scale and long-term studies are needed to advance the understanding of this unique phenotype of obesity and effective treatment options."
Topics: Humans; Pediatric Obesity; Phenotype; Prevalence
PubMed: 37197876
DOI: 10.1016/j.gtc.2023.03.005 -
JAMA Network Open Dec 2020Treatment of pediatric obesity is challenging. Preclinical studies in mice indicated that weight and metabolism can be altered by gut microbiome manipulation. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Treatment of pediatric obesity is challenging. Preclinical studies in mice indicated that weight and metabolism can be altered by gut microbiome manipulation.
OBJECTIVE
To assess efficacy of fecal microbiome transfer (FMT) to treat adolescent obesity and improve metabolism.
DESIGN, SETTING, AND PARTICIPANTS
This randomized, double-masked, placebo-controlled trial (October 2017-March 2019) with a 26-week follow-up was conducted among adolescents aged 14 to 18 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or more in Auckland, New Zealand. A total of 87 individuals took part-565 individuals responded to advertisements, 328 were ineligible, and 150 declined participation. Clinical data were analyzed from September 2019 to May 2020.
INTERVENTIONS
Single course of oral encapsulated fecal microbiome from 4 healthy lean donors of the same sex or saline placebo.
MAIN OUTCOMES AND MEASURES
Primary outcome was BMI standard deviation score at 6 weeks using intention-to-treat analysis. Secondary outcomes included body composition, cardiometabolic parameters, well-being, and gut microbiome composition.
RESULTS
Eighty-seven participants (59% female adolescents, mean [SD] age 17.2 [1.4] years) were randomized 1:1, in groups stratified by sex, to FMT (42 participants) or placebo (45 participants). There was no effect of FMT on BMI standard deviation score at 6 weeks (adjusted mean difference [aMD] -0.026; 95% CI -0.074, 0.022). Reductions in android-to-gynoid-fat ratio in the FMT vs placebo group were observed at 6, 12, and 26 weeks, with aMDs of -0.021 (95% CI, -0.041 to -0.001), -0.023 (95% CI, -0.043 to -0.003), and -0.029 (95% CI, -0.049 to -0.008), respectively. There were no observed effects on insulin sensitivity, liver function, lipid profile, inflammatory markers, blood pressure, total body fat percentage, gut health, and health-related quality of life. Gut microbiome profiling revealed a shift in community composition among the FMT group, maintained up to 12 weeks. In post-hoc exploratory analyses among participants with metabolic syndrome at baseline, FMT led to greater resolution of this condition (18 to 4) compared with placebo (13 to 10) by 26 weeks (adjusted odds ratio, 0.06; 95% CI, 0.01-0.45; P = .007). There were no serious adverse events recorded throughout the trial.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial of adolescents with obesite, there was no effect of FMT on weight loss in adolescents with obesity, although a reduction in abdominal adiposity was observed. Post-hoc analyses indicated a resolution of undiagnosed metabolic syndrome with FMT among those with this condition. Further trials are needed to confirm these results and identify organisms and mechanisms responsible for mediating the observed benefits.
TRIAL REGISTRATION
Australian New Zealand Clinical Trials Registry Identifier: ACTRN12615001351505.
Topics: Adolescent; Body Mass Index; Double-Blind Method; Fecal Microbiota Transplantation; Female; Gastrointestinal Microbiome; Humans; Male; Monitoring, Physiologic; New Zealand; Pediatric Obesity; Quality of Life; Treatment Outcome
PubMed: 33346848
DOI: 10.1001/jamanetworkopen.2020.30415 -
Current Problems in Pediatric and... Sep 2020
Topics: Adolescent; Child; Female; Humans; Male; Overweight; Pediatric Obesity
PubMed: 32952064
DOI: 10.1016/j.cppeds.2020.100872 -
Childhood Obesity (Print) Jan 2022
Topics: Humans; Pediatric Obesity
PubMed: 34870485
DOI: 10.1089/chi.2021.0291 -
Health and Quality of Life Outcomes Jul 2020Obesity has become a serious public health problem and family- and school-based interventions including physical exercise and diet control have been widely applied to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND PURPOSE
Obesity has become a serious public health problem and family- and school-based interventions including physical exercise and diet control have been widely applied to attempt to combat this issue. The purpose of our study was to verify the effectiveness of an obesity-related comprehensive intervention model aimed at improving quality of life (QoL) among adolescents.
METHODS
A cluster randomized controlled trial (RCT) was conducted involving 948 subjects who were divided into an intervention group (n = 518) and a control group (n = 430). The intervention group received 1 year of obesity-related health education, physical exercise, and diet control. Their baseline body mass index (BMI) was calculated, and their QoL and basic information were assessed both before and after the intervention period using a self-designed Adolescent Quality of Life Scale and a basic information questionnaire.
RESULTS
After the intervention, significant differences in the psychological, social, and pubertal dimensions, and in total QoL (P < 0.05) were observed in the intervention group relative to the control group. Improved psychological QoL in the intervention group was our most robust study finding, with increases in psychological (B = 1.883, SE = 0.646, P = 0.004), pubertal (B = 0.853, SE = 0.296, P = 0.004) and total (B = 3.024, SE = 1.214, P = 0.013) QoL all being higher in this group. This intervention effect was found to be more substantial in boys than in girls.
CONCLUSIONS
Family-individual-school-based interventions combining obesity-related health education, physical exercise, and diet control can improve psychological, pubertal, and total QoL in children, with these effects being most pronounced in boys.
TRIAL REGISTRATION
retrospectively registered NCT02343588 .
Topics: Adolescent; Body Mass Index; Child; China; Exercise; Female; Humans; Male; Pediatric Obesity; Quality of Life; School Health Services; Socioeconomic Factors; Students
PubMed: 32631401
DOI: 10.1186/s12955-020-01459-0 -
Public Health Research & Practice Mar 2019
Topics: Australia; Child; Humans; Pediatric Obesity
PubMed: 30972401
DOI: 10.17061/phrp2911900 -
Current Pain and Headache Reports May 2018The purpose of this work was to review the current literature on the epidemiology and pathophysiology of pediatric obesity and migraine, underlying pathogenic mechanisms... (Review)
Review
PURPOSE OF REVIEW
The purpose of this work was to review the current literature on the epidemiology and pathophysiology of pediatric obesity and migraine, underlying pathogenic mechanisms that may explain the association between the two disorders, and the effects of treatment.
RECENT FINDINGS
In children and adolescents, the bulk of the available data support an association between obesity and headache disorders in general, though a small number of studies contradict these findings. Relative to the adult population, however, few studies have focused specifically on migraine, and no wide-ranging meta-analyses have been conducted to date. It seems that the pathophysiology of obesity and migraine in adults holds true for the pediatric population as well. The association between obesity and migraine in the pediatric population is likely to be multifactorial and to involve both central and peripheral mechanisms. More attention is currently being addressed to the role of the hypothalamus and the bioactive neurotransmitters and neuropeptides that modulate energy homeostasis, namely serotonin, orexin, and the adiponectins, in migraine. A few innovative studies have demonstrated some benefit for migraine from weight reduction treatments such as exercise and lifestyle management. Many open questions remain regarding the modifiable nature of the obesity-migraine relationship and its implications in clinical practice. Further studies of these issues are needed.
Topics: Child; Exercise; Humans; Life Style; Migraine Disorders; Multicenter Studies as Topic; Pediatric Obesity; Risk Factors
PubMed: 29725875
DOI: 10.1007/s11916-018-0696-2 -
Clinical Pediatrics Mar 2022While discussing obesity with pediatric patients and their families can be difficult, it is an essential step toward appropriate weight management. There is paucity of...
While discussing obesity with pediatric patients and their families can be difficult, it is an essential step toward appropriate weight management. There is paucity of data regarding language preferences when discussing obesity in this population. In this pilot qualitative study, we interviewed 8 parents of patients diagnosed with obesity to identify language and communication preferences for discussing their child's weight. Interviews were analyzed for emerging themes. Important trends appeared revealing that parents prefer neutral, medical terms discussed at well-child checks or obesity-specific visits. Providers should frame lifestyle changes as positive for all patients and set achievable goals with the help of visual aids. Our analysis uncovered several important communication strategies that can better equip providers to discuss obesity with their pediatric patients. This research may serve as a foundation for larger studies into the topic.
Topics: Adult; Chicago; Female; Humans; Male; Middle Aged; Pediatric Obesity; Pilot Projects; Professional-Family Relations; Qualitative Research; Surveys and Questionnaires
PubMed: 35001640
DOI: 10.1177/00099228211070390 -
Pediatric Annals Feb 2023In 1997, the World Health Organization declared obesity a global epidemic. Despite multiple efforts, obesity rates have been exponentially increasing for the past few... (Review)
Review
In 1997, the World Health Organization declared obesity a global epidemic. Despite multiple efforts, obesity rates have been exponentially increasing for the past few decades. In the last few years, obesity rates have reached an alarming number. Multiple factors play a role in pediatric obesity, such as diet, sedentarism, and poor sleep, as well as psychosocial and environmental factors. Pediatricians and primary care providers are key in the management of overweight and obesity. They have the advantage of observing children over a long period of time, having a family centered perspective, and often being seen as a reliable source of information. Studies have shown that not only is obesity underdiagnosed, but there is a lack of knowledge among physicians and available resources regarding pediatric obesity. This article reviews the principles of prevention in a primary care outpatient setting. Additionally, it discusses some of the challenges commonly faced when addressing pediatric obesity. .
Topics: Child; Humans; Pediatric Obesity; Primary Health Care; Diet; Physicians
PubMed: 36779884
DOI: 10.3928/19382359-20230102-04