Special Issue "Obesity and Metabolic Dysregulation in Childhood"

A special issue of Children (ISSN 2227-9067).

Deadline for manuscript submissions: closed (15 December 2018).

Special Issue Editor

Dr. Rachana Shah
E-Mail Website
Guest Editor
Assistant Professor of Pediatrics, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia; Perelman School of Medicine at the University of Pennsylvania, USA
Interests: pediatrics, diabetes, obesity, polycystic ovarian syndrome

Special Issue Information

Dear Colleagues,

As any provider caring for children is aware, obesity and its resultant complications are increasingly prevalent and present an immense burden in time, energy, and cost for healthcare practices. The World Health Organization estimates that obesity and overweight effects over 40 million children aged five and under and nearly 350 million children ages 5–18. Initially limited to developed countries, the problem is now global. Various studies have shown rates of metabolic syndrome as high as 50% in obese children, indicating that the cardiometabolic complications of obesity that lead to morbidity and mortality begin young. Yet there is often little consensus on methods of prevention, diagnosis and treatment of pediatric obesity and metabolic syndrome leading to frustration for patients, families and care providers.

In addition to counseling on weight management, practitioners must also be confident in identifying and treating obesity-related complications such as insulin resistance and type 2 diabetes, dyslipidemia, hypertension, fatty liver disease, polycystic ovarian syndrome, obstructive sleep apnea, and the orthopedic complications and psychosocial impacts of obesity. Further, clinicians will need to differentiate whether a child’s abnormal weight gain is due to simple calorie excess or is caused by a hormonal, genetic, or neurologic defect. Finally, providers should be ready to discuss risks and benefits of current treatment options, encompassing various lifestyle modification programs, medications, and bariatric surgery. In our increasingly fast-paced and demanding medical practices, it is clear that access to up-to-date reviews and research for all pediatric care providers is a necessity.

This Special Issue, “Obesity and Metabolic Dysregulation in Childhood”, is dedicated to describing existing gaps, as well as the achievements made in clinical care, education, training, and research. Both reviews and original research will be considered for publication. Examples include, but are not limited to, manuscripts discussing pathogenesis, diagnosis, and treatment of obesity, insulin resistance, lipid disorders, fatty liver disease, and polycystic ovarian syndrome in children and adolescents. This Special Issue will provide a review of the field of pediatric obesity medicine and provide resources for further education and training programs for medical professionals.

Dr. Rachana D. Shah
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • obesity
  • nutrition
  • diabetes
  • metabolic syndrome

Published Papers (9 papers)

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Research

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Open AccessArticle
Weight Loss Medications in Young Adults after Bariatric Surgery for Weight Regain or Inadequate Weight Loss: A Multi-Center Study
Children 2018, 5(9), 116; https://doi.org/10.3390/children5090116 - 29 Aug 2018
Cited by 6
Abstract
This paper presents a retrospective cohort study of weight loss medications in young adults aged 21 to 30 following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between November 2000 and June 2014. Data were collected from patients who used topiramate, phentermine, and/or [...] Read more.
This paper presents a retrospective cohort study of weight loss medications in young adults aged 21 to 30 following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between November 2000 and June 2014. Data were collected from patients who used topiramate, phentermine, and/or metformin postoperatively. Percentage of patients achieving ≥5%, ≥10%, or ≥15% weight loss on medications was determined and percent weight change on each medication was compared to percent weight change of the rest of the cohort. Our results showed that 54.1% of study patients lost ≥5% of their postsurgical weight; 34.3% and 22.9% lost ≥10% and ≥15%, respectively. RYGB had higher median percent weight loss (−8.1%) than SG (−3.3%) (p = 0.0515). No difference was found in median percent weight loss with medications started at weight plateau (−6.0%) versus after weight regain (−5.4%) (p = 0.5304). Patients taking medications at weight loss plateau lost 41.2% of total body weight from before surgery versus 27.1% after weight regain (p = 0.076). Median percent weight change on metformin was −2.9% compared to the rest of the cohort at −7.7% (p = 0.0241). No difference from the rest of the cohort was found for phentermine (p = 0.2018) or topiramate (p = 0.3187). Topiramate, phentermine, and metformin are promising weight loss medications for 21 to 30 year olds. RYGB patients achieve more weight loss on medications but both RYGB and SG benefit. Median total body weight loss from pre-surgical weight may be higher in patients that start medication at postsurgical nadir weight. Participants on metformin lost significantly smaller percentages of weight on medications, which could be the result of underlying medical conditions. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
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Open AccessArticle
Obesity-Related Metabolic Risk in Sedentary Hispanic Adolescent Girls with Normal BMI
Children 2018, 5(6), 79; https://doi.org/10.3390/children5060079 - 15 Jun 2018
Abstract
Hispanic adolescent girls with normal BMI frequently have high body fat %. Without knowledge of body fat content and distribution, their risk for metabolic complications is unknown. We measured metabolic risk indicators and abdominal fat distribution in post-pubertal Hispanic adolescent girls with Normal [...] Read more.
Hispanic adolescent girls with normal BMI frequently have high body fat %. Without knowledge of body fat content and distribution, their risk for metabolic complications is unknown. We measured metabolic risk indicators and abdominal fat distribution in post-pubertal Hispanic adolescent girls with Normal BMI (N-BMI: BMI < 85th percentile) and compared these indicators between girls with Normal BMI and High Fat content (N-BMI-HF: body fat ≥ 27%; n = 15) and Normal BMI and Normal Fat content (N-BMI-NF: body fat < 27%; n = 8). Plasma concentrations of glucose, insulin, adiponectin, leptin and Hs-CRP were determined. Insulin resistance was calculated using an oral glucose tolerance test. Body fat % was measured by DXA and subcutaneous, visceral and hepatic fat by MRI/MRS. The N-BMI-HF girls had increased abdominal and hepatic fat content and increased insulin resistance, plasma leptin and Hs-CRP concentrations (p < 0.05) as compared to their N-BMI-NF counterparts. In N-BMI girls, insulin resistance, plasma insulin and leptin correlated with BMI and body fat % (p < 0.05). This research confirms the necessity of the development of BMI and body fat % cut-off criteria per sex, age and racial/ethnic group based on metabolic risk factors to optimize the effectiveness of metabolic risk screening procedures. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
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Open AccessArticle
Family Income Reduces Risk of Obesity for White but Not Black Children
Children 2018, 5(6), 73; https://doi.org/10.3390/children5060073 - 10 Jun 2018
Cited by 21
Abstract
Background: Although the protective effects of socioeconomic status (SES) on obesity and cardiovascular disease are well established, these effects may differ across racial and ethnic groups. Aims: Using a national sample, this study investigated racial variation in the association between family income and [...] Read more.
Background: Although the protective effects of socioeconomic status (SES) on obesity and cardiovascular disease are well established, these effects may differ across racial and ethnic groups. Aims: Using a national sample, this study investigated racial variation in the association between family income and childhood obesity in White and Black families. Methods: This cross-sectional study used data from the National Survey of Children’s Health (NSCH), 2003–2004, a nationally representative survey in the United States. This analysis included 76,705 children 2–17 years old who were either White (n = 67,610, 88.14%) or Black (n = 9095, 11.86%). Family income to needs ratio was the independent variable. Childhood obesity was the outcome. Race was the focal moderator. Logistic regression was used for data analysis. Results: Overall, higher income to needs ratio was protective against childhood obesity. Race, however, interacted with income to needs ratio on odds of childhood obesity, indicating smaller effects for Black compared to White families. Race stratified logistic regressions showed an association between family income and childhood obesity for White but not Black families. Conclusions: The protective effect of income against childhood obesity is smaller for Blacks than Whites. Merely equalizing population access to SES and economic resources would not be sufficient for elimination of racial disparities in obesity and related cardiovascular disease in the United States. Policies should go beyond access to SES and address structural barriers in the lives of Blacks which result in a diminished health return of very same SES resources for them. As the likely causes are multi-level barriers, multi-level interventions are needed to eliminate racial disparities in childhood obesity. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)

Review

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Open AccessReview
Emerging Topics in Cardiometabolic and Psychologic Sequelae, Pathogenesis, and Treatment of Polycystic Ovarian Syndrome: A Review
Children 2019, 6(8), 89; https://doi.org/10.3390/children6080089 - 31 Jul 2019
Abstract
Polycystic ovarian syndrome (PCOS) is a common endocrine disorder, affecting 6–10% of reproductive age women and influences the reproductive, metabolic, dermatologic, and psychiatric health of affected girls and women. Despite its prevalence, the pathogenesis of the disease is largely unknown, and treatment options [...] Read more.
Polycystic ovarian syndrome (PCOS) is a common endocrine disorder, affecting 6–10% of reproductive age women and influences the reproductive, metabolic, dermatologic, and psychiatric health of affected girls and women. Despite its prevalence, the pathogenesis of the disease is largely unknown, and treatment options are limited. Thus, PCOS has been a ripe area for research in recent years, and novel etiologic pathways, diagnostic parameters, and treatment options are being explored. This review focuses on recent data suggesting pathogenic and therapeutic considerations, as well as the psychiatric and metabolic sequelae of PCOS. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
Open AccessReview
Obesity and Hypogonadism—A Narrative Review Highlighting the Need for High-Quality Data in Adolescents
Children 2019, 6(5), 63; https://doi.org/10.3390/children6050063 - 01 May 2019
Abstract
The prevalence of obesity continues to rise in adult and pediatric populations throughout the world. Obesity has a direct impact on all organ systems, including the reproductive system. This review summarizes current knowledge about the effects of obesity on the male reproductive system [...] Read more.
The prevalence of obesity continues to rise in adult and pediatric populations throughout the world. Obesity has a direct impact on all organ systems, including the reproductive system. This review summarizes current knowledge about the effects of obesity on the male reproductive system across age, highlighting the need for more data in children and adolescents. Male hypogonadism is commonly seen in patients with obesity and affects the onset, duration, and progression of puberty. Different pathophysiologic mechanisms include increased peripheral conversion of testosterone to estrone and increased inflammation due to increased fat, both of which lead to suppression of the hypothalamic-pituitary-gonadotropin (HPG) axis and delayed development of secondary sexual characteristics in adolescent males. Evaluation of the HPG axis in obesity includes a thorough history to exclude other causes of hypogonadism and syndromic associations. Evaluation should also include investigating the complications of low testosterone, including increased visceral fat, decreased bone density, cardiovascular disease risk, and impaired mood and cognition, among others. The mainstay of treatment is weight reduction, but medications such as testosterone and clomiphene citrate used in adults, remain scarcely used in adolescents. Male hypogonadism associated with obesity is common and providers who care for adolescents and young adults with obesity should be aware of its impact and management. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
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Open AccessReview
Pediatric Fatty Liver and Obesity: Not Always Just a Matter of Non-Alcoholic Fatty Liver Disease
Children 2018, 5(12), 169; https://doi.org/10.3390/children5120169 - 13 Dec 2018
Cited by 2
Abstract
Obesity-related non-alcoholic fatty liver disease (NAFLD) represents the most common cause of pediatric liver disease due to overweight/obesity large-scale epidemics. In clinical practice, diagnosis is usually based on clinical features, blood tests, and liver imaging. Here, we underline the need to make a [...] Read more.
Obesity-related non-alcoholic fatty liver disease (NAFLD) represents the most common cause of pediatric liver disease due to overweight/obesity large-scale epidemics. In clinical practice, diagnosis is usually based on clinical features, blood tests, and liver imaging. Here, we underline the need to make a correct differential diagnosis for a number of genetic, metabolic, gastrointestinal, nutritional, endocrine, muscular, and systemic disorders, and for iatrogenic/viral/autoimmune hepatitis as well. This is all the more important for patients who are not in the NAFLD classical age range and for those for whom a satisfactory response of liver test abnormalities to weight loss after dietary counseling and physical activity measures cannot be obtained or verified due to poor compliance. A correct diagnosis may be life-saving, as some of these conditions which appear similar to NAFLD have a specific therapy. In this study, the characteristics of the main conditions which require consideration are summarized, and a practical diagnostic algorithm is discussed. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
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Open AccessReview
Development of the Gut Microbiome in Children, and Lifetime Implications for Obesity and Cardiometabolic Disease
Children 2018, 5(12), 160; https://doi.org/10.3390/children5120160 - 27 Nov 2018
Cited by 2
Abstract
Emerging evidence suggests that microbiome composition and function is associated with development of obesity and metabolic disease. Microbial colonization expands rapidly following birth, and microbiome composition is particularly variable during infancy. Factors that influence the formation of the gut microbiome during infancy and [...] Read more.
Emerging evidence suggests that microbiome composition and function is associated with development of obesity and metabolic disease. Microbial colonization expands rapidly following birth, and microbiome composition is particularly variable during infancy. Factors that influence the formation of the gut microbiome during infancy and childhood may have a significant impact on development of obesity and metabolic dysfunction, with life-long consequences. In this review, we examine the determinants of gut microbiome composition during infancy and childhood, and evaluate the potential impact on obesity and cardiometabolic risk. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
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Open AccessReview
Extracellular Vesicles: A Potential Novel Regulator of Obesity and Its Associated Complications
Children 2018, 5(11), 152; https://doi.org/10.3390/children5110152 - 15 Nov 2018
Cited by 2
Abstract
Childhood obesity continues to be a major public health concern. Obesity causes various metabolic complications, including insulin resistance, type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), dyslipidemia, and cardiovascular disease. However, currently, we have a limited understanding of the pathophysiology in [...] Read more.
Childhood obesity continues to be a major public health concern. Obesity causes various metabolic complications, including insulin resistance, type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), dyslipidemia, and cardiovascular disease. However, currently, we have a limited understanding of the pathophysiology in the development of these processes. Extracellular vesicles (EVs) are nano-sized vesicles secreted by different cell types that travel to various organ systems carrying molecular and genetic information. These vesicles have been proposed as a novel intercellular communication mode in systemic metabolic regulation and in several pathophysiologic processes. In particular, recent studies indicate that EVs play a critical role in the pathogenesis of obesity and its metabolic complications. In this study, we reviewed the current literature that supports the role of EVs in the regulation of metabolic homeostasis and pathogenesis of obesity and its associated metabolic complications, with a short discussion about future directions in the EV research field. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
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Other

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Open AccessCase Report
Use of Lisdexamfetamine to Treat Obesity in an Adolescent with Severe Obesity and Binge Eating
Children 2019, 6(2), 22; https://doi.org/10.3390/children6020022 - 04 Feb 2019
Cited by 2
Abstract
Approximately two-thirds of US children and adolescents have either obesity or overweight status, with almost 24% of adolescents (ages 12–19 years) afflicted with severe obesity, defined as >1.2 × the 95th BMI percentile for age/gender. Despite the increasing disproportionate rise in severe or [...] Read more.
Approximately two-thirds of US children and adolescents have either obesity or overweight status, with almost 24% of adolescents (ages 12–19 years) afflicted with severe obesity, defined as >1.2 × the 95th BMI percentile for age/gender. Despite the increasing disproportionate rise in severe or extreme childhood obesity, many children in weight management programs do not achieve a healthy weight. Most often, these patients will go on to require metabolic and bariatric surgery (MBS), but challenges and limitations may prohibit MBS on adolescents. Thus, tertiary care pediatric weight management centers are compelled to treat select pediatric obesity subtypes presenting with disease progression and disability with the available adult FDA-approved therapeutic modalities, specifically pharmacotherapy, in order to alleviate the disease state and provide relief to the patient. Here, we describe a case of severe pediatric obesity where a dedicated multidisciplinary pediatric weight management team at a tertiary care center utilizes a progressive pharmacotherapeutic approach with enormous benefits to the patient, highlighting the urgent gap and clinical care needs of this special population niche of severe adolescent obesity. Full article
(This article belongs to the Special Issue Obesity and Metabolic Dysregulation in Childhood)
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