DIABESITA’ & SINDROMEendocrinologia-pediatrica.it/wp-content/uploads/... · Alkhouri N 1,...
60
Pietro VAJRO Dipartimento di Medicina e Chirurgia UNISA – SALERNO [email protected] DIABESITA’ & SINDROME METABOLICA in età pediatrica
Transcript of DIABESITA’ & SINDROMEendocrinologia-pediatrica.it/wp-content/uploads/... · Alkhouri N 1,...
Pietro VAJRO
Dipartimento di Medicina e Chirurgia
UNISA ndash SALERNO
pvajrounisait
DIABESITArsquo amp SINDROME
METABOLICA
in etagrave pediatrica
Alberto B 11 anni
Obeso (BMI gt 97le) WC + 15 cm gt 97 le
PA borderline (128 80 mmHg = 90le)
Acantosi Nigricans collo grado 1-2
Ipercolesterolemia (Col Tot 220 Col LDL 140 HDL 32 mgdl)IPERTRANSAMINASEMIA X 2 VN ONDULANTE
DA CIRCA 2 ANNI
HOMA 50 (IR)
FEGATO VARIABILMENTE IPERECOGENO NEL TEMPOSuccessi parziali in pregressi tentativi dietetici e attivitagrave fisica
Restante EO negativo (Fegato a 1 cm) restanti LFTs OK
Negativitagrave test eziologici principali cause muscolariepatiche di HTS
SINDROME METABOLICA NAFLD laquoOBESITY RELATEDraquo
SINDROME METABOLICA
Insieme di fattori di rischio cardiometabolico
IN ETArsquo ADULTA Preciso inquadramento clinico
SINDROME METABOLICA definizione
Prevalence of the MetS in US adolescents
IN ETArsquo PEDIATRICA Difficile identificazione percheacute esistono diversi criteri tra loro
differenti adattati allrsquoetagrave evolutiva a partire da quelli
degli adulti
COMPONENTI SM
OBESITArsquo VISCERALE
Il girovita egrave misurato utilizzando un metro a nastro flessibile
METODO
- misurazione in posizione eretta con addome rilassato
braccia ai lati del tronco e piedi uniti
- metro posizionato lungo un piano orizzontale a livello della
vita (la parte piugrave stretta dellrsquoaddome allrsquoincirca corrispondente
al punto di mezzo tra lrsquoultima costa e la cresta iliaca)
Le linee guida WHO dicono di misurarla nel punto di mezzo
tra il margine inferiore delle coste palpabile lungo linea
ascellare media e il margine superiore della cresta iliaca
- Misurazione eseguita senza comprimere la cute al termine
di una espirazione tranquilla
Waist circumference and waistndashhip ratio report of a WHO expert
consultation Geneva 8ndash11 December 2008
OBJECTIVES Examine the associations between body mass index (BMI) waist circumference (WC) and waist-to-height ratio (WHtR) with clustered cardiometabolicrisk factors and to determine whether these anthropometric variables can be used to discriminate individuals with increased cardiometabolic risk (increased clustered triglycerides HDL-cholesterol systolic and diastolic blood pressure and HOMA-IR)
STUDY SAMPLE 4255 (2191 girls and 2064 boys) participants (8ndash17 years)
RESULTS
All anthropometric variables were associated with clustered CM riskMagnitudes of associations were similar for BMI WC and WHtR
The associations between BMI WC and WHtR with CM risk factors were non-linear suggesting that at lower levels of adiposity (lower BMIWCWHtR) the magnitude of associations between surrogate measures and risk factors are weak as indicated by the shallow slope whereas a greater magnitude of association with a steeper slope is evident at higher BMI WC or WHtR
The sensitivity (boys 805ndash864 girls 766ndash823) was markedly higher than specificity (boys 5185ndash594 girls 608)
li Pressione Arteriosa aggiustati per- Etagrave- Sesso- le Altezza
COMPONENTI SM
IPERTENSIONE ARTERIOSA
NEW
COMPONENTI SM
DISLIPIDEMIA
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Alberto B 11 anni
Obeso (BMI gt 97le) WC + 15 cm gt 97 le
PA borderline (128 80 mmHg = 90le)
Acantosi Nigricans collo grado 1-2
Ipercolesterolemia (Col Tot 220 Col LDL 140 HDL 32 mgdl)IPERTRANSAMINASEMIA X 2 VN ONDULANTE
DA CIRCA 2 ANNI
HOMA 50 (IR)
FEGATO VARIABILMENTE IPERECOGENO NEL TEMPOSuccessi parziali in pregressi tentativi dietetici e attivitagrave fisica
Restante EO negativo (Fegato a 1 cm) restanti LFTs OK
Negativitagrave test eziologici principali cause muscolariepatiche di HTS
SINDROME METABOLICA NAFLD laquoOBESITY RELATEDraquo
SINDROME METABOLICA
Insieme di fattori di rischio cardiometabolico
IN ETArsquo ADULTA Preciso inquadramento clinico
SINDROME METABOLICA definizione
Prevalence of the MetS in US adolescents
IN ETArsquo PEDIATRICA Difficile identificazione percheacute esistono diversi criteri tra loro
differenti adattati allrsquoetagrave evolutiva a partire da quelli
degli adulti
COMPONENTI SM
OBESITArsquo VISCERALE
Il girovita egrave misurato utilizzando un metro a nastro flessibile
METODO
- misurazione in posizione eretta con addome rilassato
braccia ai lati del tronco e piedi uniti
- metro posizionato lungo un piano orizzontale a livello della
vita (la parte piugrave stretta dellrsquoaddome allrsquoincirca corrispondente
al punto di mezzo tra lrsquoultima costa e la cresta iliaca)
Le linee guida WHO dicono di misurarla nel punto di mezzo
tra il margine inferiore delle coste palpabile lungo linea
ascellare media e il margine superiore della cresta iliaca
- Misurazione eseguita senza comprimere la cute al termine
di una espirazione tranquilla
Waist circumference and waistndashhip ratio report of a WHO expert
consultation Geneva 8ndash11 December 2008
OBJECTIVES Examine the associations between body mass index (BMI) waist circumference (WC) and waist-to-height ratio (WHtR) with clustered cardiometabolicrisk factors and to determine whether these anthropometric variables can be used to discriminate individuals with increased cardiometabolic risk (increased clustered triglycerides HDL-cholesterol systolic and diastolic blood pressure and HOMA-IR)
STUDY SAMPLE 4255 (2191 girls and 2064 boys) participants (8ndash17 years)
RESULTS
All anthropometric variables were associated with clustered CM riskMagnitudes of associations were similar for BMI WC and WHtR
The associations between BMI WC and WHtR with CM risk factors were non-linear suggesting that at lower levels of adiposity (lower BMIWCWHtR) the magnitude of associations between surrogate measures and risk factors are weak as indicated by the shallow slope whereas a greater magnitude of association with a steeper slope is evident at higher BMI WC or WHtR
The sensitivity (boys 805ndash864 girls 766ndash823) was markedly higher than specificity (boys 5185ndash594 girls 608)
li Pressione Arteriosa aggiustati per- Etagrave- Sesso- le Altezza
COMPONENTI SM
IPERTENSIONE ARTERIOSA
NEW
COMPONENTI SM
DISLIPIDEMIA
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
SINDROME METABOLICA
Insieme di fattori di rischio cardiometabolico
IN ETArsquo ADULTA Preciso inquadramento clinico
SINDROME METABOLICA definizione
Prevalence of the MetS in US adolescents
IN ETArsquo PEDIATRICA Difficile identificazione percheacute esistono diversi criteri tra loro
differenti adattati allrsquoetagrave evolutiva a partire da quelli
degli adulti
COMPONENTI SM
OBESITArsquo VISCERALE
Il girovita egrave misurato utilizzando un metro a nastro flessibile
METODO
- misurazione in posizione eretta con addome rilassato
braccia ai lati del tronco e piedi uniti
- metro posizionato lungo un piano orizzontale a livello della
vita (la parte piugrave stretta dellrsquoaddome allrsquoincirca corrispondente
al punto di mezzo tra lrsquoultima costa e la cresta iliaca)
Le linee guida WHO dicono di misurarla nel punto di mezzo
tra il margine inferiore delle coste palpabile lungo linea
ascellare media e il margine superiore della cresta iliaca
- Misurazione eseguita senza comprimere la cute al termine
di una espirazione tranquilla
Waist circumference and waistndashhip ratio report of a WHO expert
consultation Geneva 8ndash11 December 2008
OBJECTIVES Examine the associations between body mass index (BMI) waist circumference (WC) and waist-to-height ratio (WHtR) with clustered cardiometabolicrisk factors and to determine whether these anthropometric variables can be used to discriminate individuals with increased cardiometabolic risk (increased clustered triglycerides HDL-cholesterol systolic and diastolic blood pressure and HOMA-IR)
STUDY SAMPLE 4255 (2191 girls and 2064 boys) participants (8ndash17 years)
RESULTS
All anthropometric variables were associated with clustered CM riskMagnitudes of associations were similar for BMI WC and WHtR
The associations between BMI WC and WHtR with CM risk factors were non-linear suggesting that at lower levels of adiposity (lower BMIWCWHtR) the magnitude of associations between surrogate measures and risk factors are weak as indicated by the shallow slope whereas a greater magnitude of association with a steeper slope is evident at higher BMI WC or WHtR
The sensitivity (boys 805ndash864 girls 766ndash823) was markedly higher than specificity (boys 5185ndash594 girls 608)
li Pressione Arteriosa aggiustati per- Etagrave- Sesso- le Altezza
COMPONENTI SM
IPERTENSIONE ARTERIOSA
NEW
COMPONENTI SM
DISLIPIDEMIA
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
IN ETArsquo ADULTA Preciso inquadramento clinico
SINDROME METABOLICA definizione
Prevalence of the MetS in US adolescents
IN ETArsquo PEDIATRICA Difficile identificazione percheacute esistono diversi criteri tra loro
differenti adattati allrsquoetagrave evolutiva a partire da quelli
degli adulti
COMPONENTI SM
OBESITArsquo VISCERALE
Il girovita egrave misurato utilizzando un metro a nastro flessibile
METODO
- misurazione in posizione eretta con addome rilassato
braccia ai lati del tronco e piedi uniti
- metro posizionato lungo un piano orizzontale a livello della
vita (la parte piugrave stretta dellrsquoaddome allrsquoincirca corrispondente
al punto di mezzo tra lrsquoultima costa e la cresta iliaca)
Le linee guida WHO dicono di misurarla nel punto di mezzo
tra il margine inferiore delle coste palpabile lungo linea
ascellare media e il margine superiore della cresta iliaca
- Misurazione eseguita senza comprimere la cute al termine
di una espirazione tranquilla
Waist circumference and waistndashhip ratio report of a WHO expert
consultation Geneva 8ndash11 December 2008
OBJECTIVES Examine the associations between body mass index (BMI) waist circumference (WC) and waist-to-height ratio (WHtR) with clustered cardiometabolicrisk factors and to determine whether these anthropometric variables can be used to discriminate individuals with increased cardiometabolic risk (increased clustered triglycerides HDL-cholesterol systolic and diastolic blood pressure and HOMA-IR)
STUDY SAMPLE 4255 (2191 girls and 2064 boys) participants (8ndash17 years)
RESULTS
All anthropometric variables were associated with clustered CM riskMagnitudes of associations were similar for BMI WC and WHtR
The associations between BMI WC and WHtR with CM risk factors were non-linear suggesting that at lower levels of adiposity (lower BMIWCWHtR) the magnitude of associations between surrogate measures and risk factors are weak as indicated by the shallow slope whereas a greater magnitude of association with a steeper slope is evident at higher BMI WC or WHtR
The sensitivity (boys 805ndash864 girls 766ndash823) was markedly higher than specificity (boys 5185ndash594 girls 608)
li Pressione Arteriosa aggiustati per- Etagrave- Sesso- le Altezza
COMPONENTI SM
IPERTENSIONE ARTERIOSA
NEW
COMPONENTI SM
DISLIPIDEMIA
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Prevalence of the MetS in US adolescents
IN ETArsquo PEDIATRICA Difficile identificazione percheacute esistono diversi criteri tra loro
differenti adattati allrsquoetagrave evolutiva a partire da quelli
degli adulti
COMPONENTI SM
OBESITArsquo VISCERALE
Il girovita egrave misurato utilizzando un metro a nastro flessibile
METODO
- misurazione in posizione eretta con addome rilassato
braccia ai lati del tronco e piedi uniti
- metro posizionato lungo un piano orizzontale a livello della
vita (la parte piugrave stretta dellrsquoaddome allrsquoincirca corrispondente
al punto di mezzo tra lrsquoultima costa e la cresta iliaca)
Le linee guida WHO dicono di misurarla nel punto di mezzo
tra il margine inferiore delle coste palpabile lungo linea
ascellare media e il margine superiore della cresta iliaca
- Misurazione eseguita senza comprimere la cute al termine
di una espirazione tranquilla
Waist circumference and waistndashhip ratio report of a WHO expert
consultation Geneva 8ndash11 December 2008
OBJECTIVES Examine the associations between body mass index (BMI) waist circumference (WC) and waist-to-height ratio (WHtR) with clustered cardiometabolicrisk factors and to determine whether these anthropometric variables can be used to discriminate individuals with increased cardiometabolic risk (increased clustered triglycerides HDL-cholesterol systolic and diastolic blood pressure and HOMA-IR)
STUDY SAMPLE 4255 (2191 girls and 2064 boys) participants (8ndash17 years)
RESULTS
All anthropometric variables were associated with clustered CM riskMagnitudes of associations were similar for BMI WC and WHtR
The associations between BMI WC and WHtR with CM risk factors were non-linear suggesting that at lower levels of adiposity (lower BMIWCWHtR) the magnitude of associations between surrogate measures and risk factors are weak as indicated by the shallow slope whereas a greater magnitude of association with a steeper slope is evident at higher BMI WC or WHtR
The sensitivity (boys 805ndash864 girls 766ndash823) was markedly higher than specificity (boys 5185ndash594 girls 608)
li Pressione Arteriosa aggiustati per- Etagrave- Sesso- le Altezza
COMPONENTI SM
IPERTENSIONE ARTERIOSA
NEW
COMPONENTI SM
DISLIPIDEMIA
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
COMPONENTI SM
OBESITArsquo VISCERALE
Il girovita egrave misurato utilizzando un metro a nastro flessibile
METODO
- misurazione in posizione eretta con addome rilassato
braccia ai lati del tronco e piedi uniti
- metro posizionato lungo un piano orizzontale a livello della
vita (la parte piugrave stretta dellrsquoaddome allrsquoincirca corrispondente
al punto di mezzo tra lrsquoultima costa e la cresta iliaca)
Le linee guida WHO dicono di misurarla nel punto di mezzo
tra il margine inferiore delle coste palpabile lungo linea
ascellare media e il margine superiore della cresta iliaca
- Misurazione eseguita senza comprimere la cute al termine
di una espirazione tranquilla
Waist circumference and waistndashhip ratio report of a WHO expert
consultation Geneva 8ndash11 December 2008
OBJECTIVES Examine the associations between body mass index (BMI) waist circumference (WC) and waist-to-height ratio (WHtR) with clustered cardiometabolicrisk factors and to determine whether these anthropometric variables can be used to discriminate individuals with increased cardiometabolic risk (increased clustered triglycerides HDL-cholesterol systolic and diastolic blood pressure and HOMA-IR)
STUDY SAMPLE 4255 (2191 girls and 2064 boys) participants (8ndash17 years)
RESULTS
All anthropometric variables were associated with clustered CM riskMagnitudes of associations were similar for BMI WC and WHtR
The associations between BMI WC and WHtR with CM risk factors were non-linear suggesting that at lower levels of adiposity (lower BMIWCWHtR) the magnitude of associations between surrogate measures and risk factors are weak as indicated by the shallow slope whereas a greater magnitude of association with a steeper slope is evident at higher BMI WC or WHtR
The sensitivity (boys 805ndash864 girls 766ndash823) was markedly higher than specificity (boys 5185ndash594 girls 608)
li Pressione Arteriosa aggiustati per- Etagrave- Sesso- le Altezza
COMPONENTI SM
IPERTENSIONE ARTERIOSA
NEW
COMPONENTI SM
DISLIPIDEMIA
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
OBJECTIVES Examine the associations between body mass index (BMI) waist circumference (WC) and waist-to-height ratio (WHtR) with clustered cardiometabolicrisk factors and to determine whether these anthropometric variables can be used to discriminate individuals with increased cardiometabolic risk (increased clustered triglycerides HDL-cholesterol systolic and diastolic blood pressure and HOMA-IR)
STUDY SAMPLE 4255 (2191 girls and 2064 boys) participants (8ndash17 years)
RESULTS
All anthropometric variables were associated with clustered CM riskMagnitudes of associations were similar for BMI WC and WHtR
The associations between BMI WC and WHtR with CM risk factors were non-linear suggesting that at lower levels of adiposity (lower BMIWCWHtR) the magnitude of associations between surrogate measures and risk factors are weak as indicated by the shallow slope whereas a greater magnitude of association with a steeper slope is evident at higher BMI WC or WHtR
The sensitivity (boys 805ndash864 girls 766ndash823) was markedly higher than specificity (boys 5185ndash594 girls 608)
li Pressione Arteriosa aggiustati per- Etagrave- Sesso- le Altezza
COMPONENTI SM
IPERTENSIONE ARTERIOSA
NEW
COMPONENTI SM
DISLIPIDEMIA
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
RESULTS
All anthropometric variables were associated with clustered CM riskMagnitudes of associations were similar for BMI WC and WHtR
The associations between BMI WC and WHtR with CM risk factors were non-linear suggesting that at lower levels of adiposity (lower BMIWCWHtR) the magnitude of associations between surrogate measures and risk factors are weak as indicated by the shallow slope whereas a greater magnitude of association with a steeper slope is evident at higher BMI WC or WHtR
The sensitivity (boys 805ndash864 girls 766ndash823) was markedly higher than specificity (boys 5185ndash594 girls 608)
li Pressione Arteriosa aggiustati per- Etagrave- Sesso- le Altezza
COMPONENTI SM
IPERTENSIONE ARTERIOSA
NEW
COMPONENTI SM
DISLIPIDEMIA
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
li Pressione Arteriosa aggiustati per- Etagrave- Sesso- le Altezza
COMPONENTI SM
IPERTENSIONE ARTERIOSA
NEW
COMPONENTI SM
DISLIPIDEMIA
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
COMPONENTI SM
IPERTENSIONE ARTERIOSA
NEW
COMPONENTI SM
DISLIPIDEMIA
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
COMPONENTI SM
DISLIPIDEMIA
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
CRITERI SMInternational
Diabetes Federation(IDF)
National CholesterolEducation Program Adult Trial Panel III
American HeartAssociation (AHA)
Etagrave gt10 ANNI 12-19 ANNI 12-19 ANNI
Glicemia a digiuno
gt100 mgdL gt110 mgdL ge110 mgdL
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Acanthosis nigricans is among the most common dermatologic manifestations of obesity and IRhyperinsulinemia
Hyperinsulinemia stimulate insulin-like growth factor (IGF) receptors with subsequent keratinocyte proliferation
The Scientific World Journal
Volume 2015 Article ID 479354 11 pages
httpdxdoiorg1011552015479354
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
IPERURICEMIAThe pathogenesis of the association between hyperuricaemiaand MetS is not fully understoodbull the excess insulin concentrations increase sodium and
UA reabsorption by the kidney
bull hyperuricaemia in turn reduces nitric oxide bioavailability which is essential for insulin action
bull Therefore UA seems to be involved itself in IR pathogenesis inducing a vicious cycle that is associated with the onset of some components of the MetS
Santos RD Elevated uric acid the metabolic syndrome and cardiovascular disease cause consequence or just a not so innocent bystander Endocrine
201241(3)350-2
COMPONENTI SM
ALTERATO PROFILO GLICIDICO
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
OLD MetS Scenario
Lifestyle
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
NEW Components of the
Metabolic Syndrome
FATTY LIVER
OSAS
PCOS
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
SM amp IPOVITAMINOSI D
Association between fat accumulation and low vitamin D concentrations
1) sequestration of this fat-soluble vitamin in adipose tissue
2) negative effect of adipokines produced by adipocytes (ie leptin) on synthesis of the active form of vitamin D
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
PREVALENZA MetS IN PEDIATRIA
Friend A Craig L Turner S The prevalence of metabolic
syndrome in children a systematic review of the literature
Metab Syndr Relat Disord 20131171-80
bull 33 nella popolazione pediatrica generale
bull 119 nei sovrappeso
bull 292 nella popolazione obesa
bull Piugrave elevata nei M vs F (52 vs 31) e negli adolescenti vs bambini (56 vs 29)
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
hellipE IN ITALIA GRADIENTE GEOGRAFICO NORD-SUD
bull Nord Italia 194 - 233 Calcaterra et al 2008 Lafortuna et
al 2010
bull Sud Italia 292 - 308 Santoro et al 2013 Viggiano et
al 2009
SINDROME METABOLICA
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
MetS and Obesitybull Obesity is linked to several metabolic abnormalities
bull There is a close relation between the degree ofobesity and MetS 387 and 497 of moderateand severe obese children were affected by MetS
Weiss et al NEJM 2004
bull The process of atherosclerosis begins at early ageand it is associated with obesity and othercomponents of metabolic syndrome in children
Berenson et al NEJM 1998
bull MetS abnormalities tracked from childhood toadulthood
Katzmarzyk et al J Clin Epidemiol 2001
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Lrsquoobesitagrave infantile non sembra essere un fattore di rischio indipendente per lo sviluppo di SM dellrsquoadulto se il soggetto riesce a perdere peso nel corso della transizione
La SM dellrsquoadulto associata a obesitagrave ersquo conseguenza del tracking bambino obeso adulto obeso
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Pediatric MetS TRACKING to adulthoodJ Clin Epidemiol 2001 54190-5
STABILITY OF INDICATORS OF THE
METABOLIC SYNDROME FROM
CHILDHOOD AND ADOLESCENCE TO
YOUNG ADULTHOOD THE QUEacuteBEC
FAMILY STUDY
Katzmarzyk PT Peacuterusse L Malina
R Bergeron J Despreacutes
JP Bouchard C
Abstract
The sample included 76 males and 71
females measured between the
ages of 8 and 18 years and again as
young adults (12 year follow-up) [hellip]
The results indicate that indicators
of the MS are moderately stable
from childhood and adolescence
into young adulthood
Am J Hum Biol 200416690-6STABILITY OF VARIABLES ASSOCIATED
WITH THE METABOLIC S FROM
ADOLESCENCE TO ADULTHOOD THE
AEROBICS CENTER LONGITUDINAL
STUDY
Eisenmann JC Welk GJ Wickel
EE Blair SN Aerobics Center
Longitudinal Study
Abstract
[hellip] 48 subjects who had 1 clinical visit
during adolescence (mean age = 158
years) and a FU visit during adulthood
(mean age = 266 years) [hellip]
Tracking was moderate for all variables
The MS tracks moderately well from
adolescence to adulthood
These findings support the prevention
amp treatment of obesity atherosclerosis
T2D and the MS during childhood and
adolescence
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
bull Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive
obesity in childhood
bull ORs for the association of childhood BMI with adult MetS significantly
increased with increasing childhood HOMA (pthinspltthinsp0001)
bull These findings suggest that IR amplifies the association between
childhood adiposity and adult MetS and underscore the importance of
preventing both adiposity and IR in early life
Individuals with insulin-resistant (IR) obesity in childhood were 17 times
(pthinsp=thinsp0011) more likely to have adult MetS than those with insulin-sensitive obesity in childhood
bull These findings suggest that IR AMPLIFIES THE ASSOCIATION
BETWEEN CHILDHOOD ADIPOSITY AND ADULT METS and underscore
the importance of preventing both adiposity and IR in early life
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Dig Dis Sci1997 Jul42(7)1428-32
Liver involvement in 72 obese children Ultrasonography and liver enzyme levels at diagnosis and during follow-up
in an Italian populationFranzese A Vajro P Argenziano A et al
Department of Pediatrics University of Naples Federico II Italy
Bright liver and hypertransaminasemia were not due to any of the most common causes of liver disease
Both were rapidly responsive to loss of weight confirming that liver involvement was secondary to obesity and that steatosis or steatohepatitis rather than fibrosis were involved
52
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Scarsa percezione del problema non solo dalle famiglie ma
anche dai medici di qualsiasi specialitagrave
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
SUR
VIV
AL
FREE
OF
LIV
ER T
RA
NSP
LAN
TATI
ON
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
TYPE I
TYPE II
Progression after2 years in twoobese childen
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Digestive Disease Week (DDW) 2015
Transpl Int 2015 Sep 24 [Epub ahead of print]Liver Transplantation for Nonalcoholic Steatohepatitis (NASH) in Young PatientsAlkhouri N1 Hanouneh IA1 Zein NN1 Lopez R2 Kelly D1 Eghtesad B1 Fung JJ1
FREQUENCY OF PEDIATRIC NASH AS AN INDICATION FOR LIVER TRANSPLANTATION children and young adult patients (lt 40 years) who underwent LT in the US for NASH cirrhosis from the 1987-2012 UNOS database
A TOTAL OF 330 PATIENTS WERE INCLUDED MEAN BMI WAS 336 plusmn 63Age at time of LT ranged between 4 and 40 years (mean 339 plusmn 66 years)
14 SUBJECTS WERE lt 18 YEARS OF AGE AT TIME OF LT and 20 WERE AGED 18-25 YEARS Median follow-up after 1st LT was 458 months [107 973]
During this time 30 OF SUBJECTS (N = 100) DIED 115 (N = 38) WERE RE-TRANSPLANTED INCLUDING 13 FOR NASH RECURRENCE
NASH end-stage liver disease LT in childhoodearly adulthood A significant N of young pts LT for NASH cirrhosis re-transplant
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
THE ldquoREFERENCE (IMPERFECT) STANDARDrdquo LIVER BIOPSY
Liver biopsy with histology is required for definitive diagnosis of NAFLD Unfortunately due to its both invasive technique and high cost liver biopsy may not be proposed as a screening procedure
Indications for liver biopsy should include bull young age (lt 10 years)bull family history of severe NAFLD bull presence of hepatosplenomegalybull persistent hypertransaminasemiabull insulin resistancebull non-conclusive results for Wilson disease or AIH and co-morbidities for other
suspected liver diseases Any pharmacological intervention should be preceded by a liver biopsy
FOR DIFFERENTIAL DIAGNOSIS LIVER BIOPSY SHOULD BE CONSIDERED THE LASTTEST AFTER NONINVASIVE BIOCHEMICAL AND METABOLIC TESTS
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISCHIO CARDIOVASCOLARE
NAFLD
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
- Inflammatory cytokines- IR
- Atherogenic lipid profile- VLDL LDL- Oxidative stress
ADULTS
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Increased carotid intima-media thickness (IMT)
amp brachial artery flow-mediated dilation (FMD)
PEDIATRIC
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Association Between NAFLD amp Cardiovascular Riskin Obese Children and Adolescents
Hayrullah Alp et al
Canadian Journal of Cardiology Volume 29 Issue 9 Pages 1118ndash1125 September 2013
Authors evaluated cardiac functions cardiovascular risk and associated parameters with grades of NAFLD in 400 obese children (93 NAFLD + 307 NAFLD -) and 150 healthy ctrls
RESULTS
NAFLD groups had a significantly higher body mass index (2915 plusmn 342 and 3046 plusmn 460 P lt 0001) total adipose tissue mass (3795 plusmn 446 and 4657 plusmn 645 P lt 0001) higherinsulin alanine aminotransferase and aspartate aminotransferase levels
Increased end-systolic thickness of the interventricular septum (P lt 0001)
Larger left ventricular mass (P lt 0003) and index (P lt 0003) in NAFLD groups
Children with NAFLD had higher Tei index values
Also Carotid artery IMT and EAT thickness were significantly higher in obese children
Waist and hip circumference total cholesterol level total adipose tissue mass and interventricular septum were statistically different in NAFLD groups
CONCLUSIONS Children with NAFLD had mildly altered left and right ventricular functionsand all obese children had increased IMT and EAT thickness
Also grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
InsulinLipids
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
NAILA KHALI
Bisphenol A and cardiometabolic risk
factors in obese children Science of The Total EnvironmentVolumes 470ndash
471 1 February 2014 Pages 726-732
CONCLUSION
BPA exposure in obese children at least in
males is associated with
- adverse liver and metabolic effects
- high diastolic blood pressure
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumptiom paralleling the ponderal
excess and all the other anthropometric parameters
SLEEP DEBTFRAGMENTATION
NOCTURNAL BREATHING PROBLEMSDAYTIME
SLEEPINESS
RESULTS= increased with increasing BMI correlating with the
presence of clinical markers of Met Syndr (acantosis nigricans)
FREE AND TOTAL ENDOCRINE DIRUPTOR BPA LEVELS
RESULTS =increased paralleling the BMI increase (rgt08)
Re-use of disposable plastic correlation with urinary BPA
levels Blood Pressure
44 Italian children [Cases n=31 overweightobese Controls n=23 normal
weight]
Fifty-four Italian children
cases n=31 overweightobese
controls n=23 normal weight
FRUCTOSE FREQUENCY OF SUGAR-ENRICHED DRINK
CONSUMPTION AND THE AMOUNT OF FRUCTOSE PER
PORTION ANDOR PER WEEK
RESULTS= increased consumption paralleling the ponderal
excess and all the other anthropometric parameters
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
FRUCTOSE AND GUT-LIVER AXIS
Pediatr Obes 2015 Jun10(3)188-95
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Scuola Intervento (n=80) Scuola Controllo (n=35)
Arruolamento dei bambini (n=115) Etagrave = 3-6 aa
1 Indagine conoscitiva basale (tempo 0)
2 Intervento educativopreventivo UNISA + CONI + Centale Latte + Coldiretti
3 Primo follow-up con valutazione a 7 mesi (tempo 1)
4 Secondo follow-up con valutazione a 15 mesi (tempo 2)
INTERVENTO DI PREVENZIONE PRESCOLARE
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
RISULTATI
INDAGINE CONOSCITIVA BASALE
366
115 bambini prescolari
25
WC WtHR
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
le BMI
le C VITA
sds WtHR
r=-04 plt005
Sis
tolica
Score
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
TAKE HOME MESSAGE
OBESITArsquo PEDIATRICA
SINDROME METABOLICA
NAFLD PCOS OSA ENDOCRINE DISRUPTORS
PRECOCI COMPLICANZE CARDIOVASCOLARI
BIDIREZIONALITArsquo
NAFLD PEDIATRICA
IMPORTANTE RICONOSCERLA PRESTO PERCHErsquo
- PUOrsquo ESSERE PREZIOSA PRIMA SPIA DI ALTRE
COMPLICANZE METABOLICHE E CARDIOVASCOLARI
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
CONCLUSIONShellip
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
ehellipALBERTO
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
Int J Pediatr Obes 2008 Oct 13 Suppl 23-8
Prevalence of metabolic syndrome in European obese children
Bokor S Frelut ML Vania A Hadjiathanasiou CG Anastasakou M Malecka-
Tendera E Matusik P Molnaacuter D
A total of 122 of children had MS
558 were free from MS according to all four definitions
The prevalence of MS was
- 357 (France)
- 314 (Greece)
- 203 (Italy)
- 164 (Poland-Hungary)
- Only 63-88 of obese adolescents were free from any component of MetS
CONCLUSIONS The prevalence of MS is high among European obese children
whatever criteria are used There is an urgent need to achieve consensus
concerning the definition of MS in adolescents and children
FATTY LIVER DISEASE CAUSES IN CHILDREN
FATTY LIVER DISEASE CAUSES IN CHILDREN
