Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) cohort

BACKGROUNDThe triglyceride-to-HDL cholesterol (TG/HDL-C) ratio was introduced as a tool to estimate insulin resistance, because circulating lipid measurements are available in routine settings. Insulin, C-peptide, and free fatty acids are components of other insulin-sensitivity indices but their measurement is expensive. Easier and more affordable tools are of interest for both pediatric and adult patients.METHODSStudy participants from the Relationship Between Insulin Sensitivity and Cardiovascular Disease [43.9 (8.3) years, n = 1260] as well as the Beta-Cell Function in Juvenile Diabetes and Obesity study cohorts [15 (1.9) years, n = 29] underwent oral-glucose-tolerance tests and euglycemic clamp tests for estimation of whole-body insulin sensitivity and calculation of insulin sensitivity indices. To refine the TG/HDL ratio, mathematical modeling was applied including body mass index (BMI), fasting TG, and HDL cholesterol and compared to the clamp-derived M-value as an estimate of insulin sensitivity. Each modeling result was scored by identifying insulin resistance and correlation coefficient. The Single Point Insulin Sensitivity Estimator (SPISE) was compared to traditional insulin sensitivity indices using area under the ROC curve (aROC) analysis and χ(2) test.RESULTSThe novel formula for SPISE was computed as follows: SPISE = 600 × HDL-C(0.185)/(TG(0.2) × BMI(1.338)), with fasting HDL-C (mg/dL), fasting TG concentrations (mg/dL), and BMI (kg/m(2)). A cutoff value of 6.61 corresponds to an M-value smaller than 4.7 mg · kg(-1) · min(-1) (aROC, M:0.797). SPISE showed a significantly better aROC than the TG/HDL-C ratio. SPISE aROC was comparable to the Matsuda ISI (insulin sensitivity index) and equal to the QUICKI (quantitative insulin sensitivity check index) and HOMA-IR (homeostasis model assessment-insulin resistance) when calculated with M-values.CONCLUSIONSThe SPISE seems well suited to surrogate whole-body insulin sensitivity from inexpensive fasting single-point blood draw and BMI in white adolescents and adults.

OBJECTIVE:Current guidelines for prevention of obesity in childhood and adolescence are discussed.METHODS:A literature search was performed in Medline via PubMed, and appropriate studies were analyzed.RESULTS:Programs to prevent childhood obesity have so far remained mainly school-based and effects have been limited. Analyses by age group show that prevention programs have the best results in younger children (<12 years). Evidence-based recommendations for pre-school- and early school-aged children indicate the need for interventions that address parents and teachers alike. During adolescence, school-based interventions proved most effective when adolescents were addressed directly. To date, obesity prevention programs have mainly focused on behavior-oriented prevention. Recommendations for community- or environment-based prevention have been suggested by the German Alliance of Noncommunicable Diseases and include a minimum of 1 h of physical activity at school, promotion of healthy food choices by taxing unhealthy foods, mandatory standards for meals at kindergartens and schools as well as a ban on unhealthy food advertisement aimed at children.CONCLUSION:Behavior-oriented prevention programs showed only limited long-term effects. Certain groups at risk for the development of obesity are not reached effectively by current programs. Although universally valid conclusions cannot be drawn given the heterogeneity of available studies, clearly combining behavior-based programs with community-based prevention to counteract an 'obesogenic environment' is crucial for sustainable success of future obesity prevention programs.

Background: In order to assess the relationship between hypertension or dyslipidemia and obesity, the body mass index (BMI) is usually used. Unlike waist circumference (WC), BMI does not reflect body fat distribution. The aim of this study is to investigate whether BMI or WC is a better predictor of hypertension or dyslipidemia in overweight/obese children and adolescents. Methods: As of November 2012, the APV database contained data on 81,819 patients from 189 specialized pediatric obesity institutions in Germany, Austria and Switzerland. Logistic regression analysis was conducted using odds ratios (OR) with 95% CI. Results: The average age of the youths (n = 5.978) was 13.9 ± 1.8 years. Mean BMI-SDS was 2.0 ± 0.5, and mean WC-SDS was 2.2 ± 0.5. Both BMI-SDS and WC-SDS are significant predictors of hypertension and dyslipidemia: BMI-SDS is a better predictor (OR = 2.60) for hypertension than WC-SDS (OR = 1.85), while WC-SDS (OR = 1.90) was slightly superior to BMI-SDS (OR = 1.86) in predicting adverse lipid profiles. Compared to normal-weight patients, obese patients (BMI ≥97th percentile) exhibited increased systolic (+6.3 mm Hg) and diastolic blood pressure (+3.9 mm Hg). However, this difference was only +4.8 mm Hg (systolic) and +2.6 mm Hg (diastolic) if WC >97th percentile was used. Conclusion: BMI-SDS is more closely associated with hypertension, while WC-SDS is more closely associated with dyslipidemia. However, the additional measurement of WC has only a small benefit in obese youths.

Although randomized controlled trials demonstrated the long-term efficacy of lifestyle interventions in overweight children, the effects of these interventions in clinical practice under real-life conditions are largely unknown. One hundred twenty-nine centers specialized in outpatient pediatric obesity care participated in this quality assessment. All patients presenting before the year 2006 for lifestyle intervention of at least 6 months duration in these institutions were analyzed in a 2-year follow-up. A total of 21,784 (45% male) overweight children and adolescents aged 2-20 years (mean BMI 30.4 kg/m(2), mean SDS-BMI 2.51, mean age 12.6 years) were included in the analysis. Based on an intention-to-treat analysis with variables set back to baseline in lost of follow-up, 22% of the children reduced their SDS-BMI after 6 months, 15% after 12 months, and 7% after 24 months, but only in 24, 17, and 8% of children, respectively, complete data were available. In the five treatment centers with the best outcome (518 patients), 83% of the children reduced their overweight after 6 months, 67% after 12 months, and 51% after 24 months. Under real-life conditions, most treatment centers cannot prove the long-term efficacy of their interventions due to high drop-out rate or lack of documentation. Conversely, some institutions achieved a reduction of overweight in nearly the half of their patients 24 months after baseline demonstrating the great heterogeneity in outcome. To improve the effectiveness of lifestyle interventions in real-life studying, the process and structure quality as well as their long-term results is urgently needed.

Due to its unique composition and multiple benefits, breast milk is the nutrition of first choice for pre-term infants; however, it bears the risk of transferring infection. For this reason, the Austrian Nutrition Commission issued a guideline stipulating a restriction on breast-feeding or pasteurisation of breast milk in the case of CMV-positive mothers. On the basis of new data, this recommendation has been revised and critically reassessed. As an alternative to the current procedure, the Nutrition Commission of the Austrian Society of Pediatrics and Adolescent Medicine has recommended a procedure based on the CPQCC recommendation, which is discussed in this article.

W 2005 roku, dzieki wspolnemu wysilkowi glownych europejskich towarzystw naukowych aktywnych na polu leczenia otylości zostal powolany zespol ekspertow nazwany Bariatryczno-Naukową Grupą Badawczą (BSCG). Towarzystwami, ktore stworzyly ten zespol i oddelegowaly swoich przedstawicieli do prac w opracowaniu wytycznych byly: Miedzynarodowe Towarzystwo Chirurgicznego Leczenia Otylości (IFSO), Oddzial Europejski Miedzynarodowego Towarzystwa Chirurgicznego Leczenia Otylości (IFSO-EC), Europejskie Towarzystwo Badan nad Otylością (EASO), Europejska Grupa ds. Otylości u Dzieci (ECOG) (razem z Miedzynarodową Grupą Zwalczania Otylości). Bariatryczno-Naukowa Grupa Badawcza skladala sie z wladz reprezentujących powyzsze towarzystwa (czterech czynnych przewodniczących, dwoch bylych, jeden honorowy, dwoch dyrektorow wykonawczych), a takze najwybitniejszych ekspertow w tej dziedzinie. Sklad BSCG pozwolil na calościowe objecie zagadnienia leczenia otylości olbrzymiej z uwzglednieniem roznorodności geograficznej i etnicznej Europy. Czlonkowie BSCG odbyli wiele spotkan poświeconych stworzeniu wytycznych, ktore odzwierciedlalyby wspolczesną wiedze i doświadczenie w zakresie leczenia otylości olbrzymiej.

Objective: Although the obesity epidemic is progressing in European children too, there is no consensus on the population-specific prevalence of comorbidities or efficient diagnostic strategies. Therefore, weight-related risk factors, their interrelationship, and association with biological parameters were assessed in a large group of overweight (OW) children, documented by an electronic database.Methods and Procedures: Data of 26,008 children (age 12.6 +/- 2.9 years, 56% females) presented for OW (BMI > 90th percentile) or obesity (> 97th percentile) in 98 specialized centers were evaluated using a simple software (Adipositas Patienten Verlaufsbeobachtung (APV)) for standardized longitudinal documentation. After local anonymization, data were transmitted for central analysis including multiple logistic regression.Results: A total of 5.9% of the children were normal weight, 41% obese (OB), and 37% extremely OB (> 99.5th percentile, XXL; 41% of the girls). In 50%, at least one risk factor and in 11% a cluster of two were found, comprising increased blood pressure (BP): 35.4%, dyslipidemia: 32% (total cholesterol: 14.1%, low-density lipoprotein (LDL)-cholesterol: 15.8%, high-density lipoprotein (HDL)-cholesterol: 11.1%, triglycerides: 14.3%), impaired glucose tolerance (IGtT): 6.5% and suspicion of diabetes: 0.7%. The degree of OW was inversely associated with HDL-cholesterol and directly with clustered risk factors, impaired glucose metabolism, increased BP and triglycerides (odds ratios (ORs) XXL vs. normal = 6.15, > 10, 4.3, 3.0 and 2.5, respectively), but not with LDL-cholesterol.Discussion: In a very large cohort of young Europeans risk factors for cardiovascular (CV) diseases are frequently found, related to the degree of OW and tend to cluster, thus a comprehensive screening is justified in all OW or OB children. Electronic patient documentation is feasible in a large obesity care network.