ESPE Abstracts

Background: The incidence of non-alcoholic fatty liver disease (NAFLD) is dramatically increasing among children worldwide. The gold standard for diagnosis is the liver biopsy. Reliable serum markers are lacking. Recently, circulating miRNAs have been studied as biomarkers of disease progression. Specifically, miR-122 was proposed as predictive marker for liver disease in adults, while no data are available for children.Objective and hypotheses: To inves...

Background: The new adipokine/myokine meteorin-like (Metrnl) has been proposed to be of interest for obesity and metabolic disease through its potential role for brown/beige fat thermogenesis and macrophage activation in mice. METRNL was reported to be expressed in white adipose tissue (AT) and upregulated during adipogenesis and by exercise and.Aims: In this study we analysed the expression of METRNL during human adipogenesis and its regulation...

Background: Obesity in childhood is defined by age- and sex-specific BMI cut-off values. However, BMI does not disclose the distribution of fat mass. Increased abdominal adipose tissue is associated with a higher risk of cardio-metabolic disease in adulthood. Thus, precise measurements of abdominal adipose tissue in children may enable early prevention of disease.Objective and hypotheses: To validate measurements of abdominal adipose tissue by anthropome...

Background: Obesity is a well-recognized complication of craniopharyngioma. Increased hypothalamic involvement (HI) by the tumour and accordant treatment has been associated with greater obesity. Changes in hypothalamic control of the autonomic nervous system (ANS) have been implicated in the development of hypothalamic obesity however, long term changes in the ANS have not been assessed.Objective and hypotheses: We aimed to evaluate ANS activity using h...

Background: Sirtuins are NAD+-dependant protein deacetylases that target histones, transcription factors, co-regulators, as well as metabolic enzymes to adapt gene expression and metabolic activity in response to the cellular energy state. SIRT1 and SIRT2 are two important enzymes of sirtuin family. SIRT1 has an important role in glucose metabolism and improves glucose homeostasis. It can also regulate fatty acid oxidation and hepatic cholesterol and bile acid metab...

Background: Congenital leptin deficiency (CLD) is characterized by severe early-onset obesity due to hyperphagia and impaired satiety. The impact of obesity in obstructive sleep apnoea hypopnoea syndrome (OSAHS) was originally reported as mechanical, but recent data suggest that adipokines may influence central ventilation. We highlight that treatment with recombinant human leptin (RHL) in CLD with OSAHS improves ventilation before weight loss.Case prese...

Background: Childhood obesity is a global health problem and co-morbidities develop already during childhood and adolescence. Male obesity impacts negatively on reproductive function. Testosterone is decreased, sperm quality reduced, and the physical and molecular structure of germ cells altered in obese males. However, less is known about the role of prepubertal obesity on future reproductive function. We therefore explored Leydig cell function and reproductive potential in a...

Background: French health authorities have developed a national program to organize outpatient care networks for the prevention and management of obesity in children and adolescents (Réseau de Prise en Charge de l’Obésité Pédiatrique (REPOP)). To date, REPOP Ile-de-France has more than 250 primary care physicians with dietitians, nurses, educators, and psychologists trained in the management of childhood obesity as part of a standard care pathway, work...

Background: The well-documented increased cardiometabolic risk in haematopoietic stem cell transplantation and total body irradiation (HSCT/TBI) survivors is under-recognised using standard (International Diabetes Federation (IDF)) metabolic syndrome (MetS) criteria. This is defined as the presence of central adiposity using increased waist circumference (WC) or BMI, (often not abnormal in HSCT/TBI survivors despite increased central adiposity), plus additional features includ...

Background: Severe obesity (SO), defined as BMI ≥95th percentile, has increased worldwide among adolescents. American studies estimated that 1.3–2.8% of 12–19-year-old individuals have a BMI >40 kg/m2 or a BMI >35 kg/m2 with at least one serious co-morbidity. The immediate and long-term risks associated with SO in adolescents include cardiovascular and metabolic diseases, obstructive sleep apnoea, and nonalcoholic fatty liver disea...

Background: The melanocortin-4-receptor gene (MC4R) is a key regulator for appetite and satiety. MC4R mutations account for 6–8% of severe obesity in children with variable expression and penetrance.Case presentation: A 3-year-old girl is presented with severe early onset and progressive obesity. She was born full-term with appropriate of gestational age weight by non-consanguineous parents. She had normal psychomotor milestones an...

Background: Hypothalamic obesity (HyOb) is a syndrome of inexorable, treatment-resistant obesity seen after congenital (e.g. septo-optic dysplasia (SOD)) or acquired (e.g. tumour-related) hypothalamic damage, often co-existing with hyperphagia, panhypopituitarism, autism, sleep, and temperature dysregulation. Its pathophysiology is poorly understood but hyperphagia and excess caloric intake may be less important than previously thought.Objective and hypo...

Background: A variable prevalence of scoliosis has been reported in Prader–Willi syndrome (PWS). Clinical detection can be challenging. The role of GH therapy (GHT) in the onset and progression of scoliosis remains controversial as does the modality of screening.Objective and hypotheses: To define the prevalence of scoliosis in our PWS patients and analyse the role of age, gender, genotype, BMI, and GHT on its onset and severity.<p class="abstex...

Background: Prolonged poor dietary habits can result in hypothalamic inflammation and gliosis with more recent studies suggest that other brain areas may also be affected. Western or high fat diet intake has been associated with increased cognitive impairment and aberrant feeding behavior, with males and females being differentially affected. The hippocampus participates in both of these functions. Saturated free fatty acids can induce astrocyte inflammation and this could pot...

Background: In adults, bariatric surgery has gradually emerged as a ‘metabolic’ surgery, able to rapidly improve metabolic disturbances linked to severe obesity. Even if type 2 diabetes is rare in european obese adolescents, alterations in insulin sensitivity are present in almost all.Objective and hypotheses: To evaluate the modification of insulin resistance (IR) and insulin sensitivity (IS) in severe obese adolescents who underwent bariatric...

Background: Altered circadian and ultradian blood pressure (BP) and heart rate (HR) rhythmicity has been described in many diseases with increased cardiovascular risk.Objective and hypotheses: We tested the hypothesis that rhythmicity in obese children is changed, compared to healthy subjects.Method: Circadian and ultradian BP and HR rhythmicity was assessed with Fourier analysis from 24-h ambulatory BP measurement (ABPM) in 75 obe...

Background: Obesity ignites numerous health and psychosocial problems and is associated with various comorbidities. BMI is also independently associated with improved risk for numerous kidney disorders. As renal length is considered a vital parameter in the clinical assessment of renal patients, normal renal length has to be defined in accordance to BMI. The aim of this study is to define normal kidney length in obese children, comparing ultrasound measurements of the kidney l...

Background: We previously reported that children with an earlier adiposity rebound (AR), which is defined as the time at which the BMI starts to rise after infancy, have a higher BMI and a greater atherogenic metabolic status at age 12. In addition, it has been reported that higher levels of leptin at age 3 is associated with greater weight gain and adiposity by age 7. This finding suggests that leptin resistance may begin in early childhood, even before age 3.<p class="ab...

Background: Obesity in children is already a global health problem. Obese children and adolescents with insulin resistance provide the pediatric healthcare professionals management challenge. Obesity with insulin resistance, dyslipidemia and elevated blood pressure constitute the metabolic syndrome and each of these is an independent risk factor for cardiovascular disease (CVD). Metformin is well-established oral hypoglycaemic agent in the treatment of adult and young patients...

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies, affecting 5–10% of population. Insulin resistance, apolipoprotein B:apolipoprotein A1 ratio, and BMI commonly increases in obese PCOS patients and are among the indicators of the disease. On the other hand, metformin and cinnamon are generally believed to control these.Objective and hypotheses: To compare the effects of cinnamon with those of the metformin on in...

Aim: The purpose of this study was to assess whether pantoprazole could be a new treatment option in the therapy of children with obesity and insulin resistance.Methods: This study was conducted on 46 children and adolescents with exogenous obesity and insulin resistance. The patients were randomly chosen and divided into therapeutic groups of metformin, pantoprazole, and metformin plus pantoprazole.Results: There was no difference...

Introduction and objective: Atherosclerosis is one of the most important causes of obesity-related diseases. The clinical symptoms usually begin in adulthood, but the pathological changes in vascular structure could be observed in a much earlier period. Carotid intima–media thickness (cIMK) which is one of the noninvasive marker of early atherosclerotic changes, has been shown to be significantly increased in obese children. Subepicardial adipose tissue (SAT) is a compone...

Background: Prader–Willi syndrome (PWS) is characterized by a switch from failure to thrive to excessive weight gain and hyperphagia with impaired satiety in early childhood. An elevated, more unfavorable ratio between acylated:unacylated ghrelin (AG:UAG) may be involved in the underlying mechanisms of this switch.Objective and hypotheses: To assess the evolution of the appetite regulating hormones AG, UAG, and the AG:UAG ratio in infants with PWS a...

Background: Patients with homozygous and compound heterozygous familial hypercholesterolemia (FH) have markedly elevated plasma LDL cholesterol (LDL-C) from birth. If untreated, patients develop cardiovascular atherosclerosis resulting in death before the second decade of life. Medication and apheresis are only partially effective in reducing LDL-C levels, and do not significantly improve the prognosis. Liver transplantation (LT) can nearly normalize the cholesterol metabolism...

Background: Since metformin (MET), approved for treatment of type 2 diabetes (T2D), is the most commonly used oral anti-hyperglycaemic agent in youths MET prescriptions (Rx) could be used as a proxy for T2D burden in these populations. However, the extent of off-label use of MET in paediatrics is not well studied.Objective and hypotheses: Estimate the annual prevalence of ≥1 MET Rx among youths and calculate proportions with concomitant diagnoses o...

Background: Proprotein convertase subtilisin/kexin types 1 and 2 (PCSK1 and PCSK2) are expressed in neuroendocrine tissues where they cleave a subset of inactive prohormones into biologically active hormones, including pro-opiomelanocortin (POMC), proTRH, proinsulin, proglucagon, and proGnRH. Congenital deficiency of PCSK1 is a very rare syndrome causing malabsorptive diarrhea contrasting with severe early-onset obesity and hypopituitarism. We described here a new case of cong...

Background: Obesity is a potential late-effect of therapies for childhood cancer. Reported prevalence rates of obesity in childhood cancer survivors are heterogenous and currently unavailable for children treated according to protocols of the German Society for Paediatric Oncology. Furthermore, risk factors for the development of obesity following childhood cancer remain largely unknown.Methods: From a cohort of n=149 patients followed in a late...

Background: The lipodystrophy syndromes are a heterogeneous group of congenital or acquired disorders characterized by either complete or partial lack of adipose tissue (lipoatrophy). Berardinelli Seip congenital lipodystrophy (BSCL) is a rare metabolic disorder characterized by severe generalised lipodystrophy since birth, insulin resistance, and dyslipemia since early infancy.Case presentation: We report a 6-year-old girl who arrived from Pakistan with...

Background: Despite the lack of drugs, conservative management of childhood obesity allows for considerable weight reduction.Objective and hypotheses: i) To evaluate anthropometric and metabolic changes in obese children after intense weight loss. ii) To analyze the influence of the amount of weight loss and the time spent to attain it on the observed changes. iii) To investigate BMI evolution during the first 3 years after weight reduction.<p class=...

Background: The prevalence of dysglycaemia is high among overweight children and adolescents. Current screening criteria with fasting laboratory values have low sensitivity to detect IGT. Fasting triglycerides (TG) >1.17 mmol/l has been proposed as a criterion for screening obese children and adolescents at risk for IGT.Aims and objectives: We aimed to compare the performance of different screening criteria for detecting IGT in obese and overweight c...

Background: Irisin is a newly discovered myokine which regulates energy metabolism and obesity (type 2 diabetes pathogenesis). However, results of the clinical studies investigating the relation of irisin with metabolic and anthropometric parameters remain controversial, and studies in obese children are limited.Objective and hypotheses: We aimed to investigate the relation of serum irisin level with metabolic and anthropometric parameters in obese child...

Background: Emerging evidence suggests FTO polymorphisms are associated with obesity-related comorbidities including type 2 diabetes (T2DM), hypertension and polycystic ovarian syndrome (PCOS). However association of FTO with other comorbidities such as obstructive sleep apnoea (OSA) in paediatric populations is less clear.Objective and hypotheses: To investigate the prevalence of obesity-related comorbidities according to FTO genotype in an obese paedia...

Background: At a population level, increasing age/sex corrected BMI Z-score (BMI-Z) is associated with increased risk of complications. It is unclear whether severity of obesity is a good predictor of comorbidities within groups of obese children. This knowledge is required to inform clinical management and pathways of care.Objective and hypotheses: In obese youth, to identify whether 1 increasing BMI-Z+/− waist/height ratio(WHtR) is associated wit...

Background: Incidence of Obesity in infants is increasing with the risk to continue till adulthood with the entire health burden that can produce.Objective and hypotheses: To elucidate the early factors that can determine obesity we studied a group of obese children (group 1) compared with a control group regarding, mode of delivery, breast feed and its duration, age at start of solid food, and how take care of the child.Method: 23...

Background: The prevelance of pediatric obesity is increasing in childhood. Nonalcoholic fatty liver disease (NAFLD) is frequently associated with obesity, insulin resistance (IR), diabetes, and hypertriglyceridemia. Gut microbiota was suggested to play a role in both etiology of NAFLD and also progression to steatohepatitis. Feacal calprotectin (FCP) is a noninvasive marker of intestinal inflammation.Objective and hypotheses: To evaluate FCP and its ass...

Background: Epidemiologic studies have documented that sleep duration is associated with obesity risk children’s.Objectives: To investigate sleep duration of 4-year-old children (h/day) and to evaluate the association of sleep patterns with weight status at 4 years.Methods: 393 children from the INMA birth cohort of Asturias (Spain). We analysed sleep duration (h/day) during the night and afternoon nap, reported by their paren...

Background: Ghrelin is 28-amino acid peptide predominantly produced by the stomach and have an orexigenic property as well as potent GH-releasing activity. Acylated ghrelin (AG) is the active form of this hormone. Obestatin is a 23-amino acid peptide, is produced by post-translational modification of a protein precursor that also produces ghrelin. Obestatin has the opposite effect of ghrelin on food intake.Objective and hypotheses: To evaluate acylated g...

Background: The melanocortin-4-receptor gene (MC4R) is a key regulator of energy homeostasis, food intake, and body weight which has intensively been analysed in molecular genetic obesity research. MC4R dysfunction in humans causes hyperphagia, impaired satiety and obesity. Most patients are heterozygotes, with some reports of homozygotes and compound heterozygotes.Objective and hypotheses: A 2-year-old boy with progressive weight gain from infa...

Background: Prader–Willi syndrome (PWS) is caused by absence of expression of imprinted genes on the paternal chromosome 15 (15q11.2–q13) due to a paternal deletion, maternal uniparental disomy 15 and rarely an imprinting defect. The clinical signs of PWS are hypotonia, muscle weakness, excessive eating, morbid obesity, delayed global development, hypogonadism, and short stature. Marfan syndrome is caused by mutations in the FBN1 gene, located on chromosome ...

Background: Severe obesity among adolescents is increasing worldwide. Bariatric surgery is a controversial subject in this group of age, surgical timing is even more controversial. Patterns of surgical weight loss could be different between patients with greater excess weight, perhaps with less promising results.Objective and hypotheses: To compare anthropometric outcomes among adolescents with BMI 35–40 and over 40, underwent laparoscopic sleeve ga...

Background: To evaluate potential function of visfatin in SW872 adipocytes under the conditions which produce insulin resistance by free fatty acids (FFAs). Then to explore the mechanism of visfatin on the level of signal molecules.Objective and hypotheses: To evaluate the effects of visfatin on the mRNA expressions of the insulin signal molecules including insulin receptor substrate 1 (IRS1), IRS2, and phosphatidylinositol 3 kinase (PI3K) on the states ...

Background: Assessment in childhood obesity includes looking for obesity syndromes. Dysmorphic features should guide investigations. When clinical signs are subtle, genetic investigations aide diagnosis. A case (S) of progressive childhood obesity is described. He was found to have a pathogenic GNAS mutation which was also present in his mother. Both mother and son had a similar phenotype and did not have hypocalcaemia or PTH resistance described in pseudohypoparathyr...

Background: Multiprofessional therapy programs for obese children and their families, including physical activity, nutritional, and behavioral interventions, have been shown to be effective, in group (MGP) as well as in individual (MIT) settings. However, due to limited personal and financial resources, <1% of children affected participate in such programs.Objective and hypotheses: Health IT systems (HIS) have the potential to improve therapy assisti...

Background: The melanocortin-4-receptor (MC4R) plays a key role in body weight regulation. Hypothalamic activation of MC4R reduces food intake and increases energy expenditure. Mutations in the MC4R gene lead to the most common cause of monogenetic obesity. More than 150 different mutations are currently known. Their prevalence in obese subjects differs between 0.2 and 5.8%, depending on ethnicity, age and grade of obesity of the analysed cohort. Impact on phenotype a...

Background: ATP-binding cassette transporter A1 (ABCA1) mediates the transport of cholesterol and phospholipids from cells to lipid-poor apolipoproteins. It has been demonstrated that the ABCA1 gene C69T single nucleotide polymorphism (SNP; TT genotype) is associated with lower HDL cholesterol and higher triglycerides (TG) levels. The relation of this polymorphism with type 2 diabetes mellitus has also been shown.Objective and hypotheses: As dys...

Background: Childhood obesity starts in early childhood. The natural history of childhood obesity has not been reported and it is unknown how obese children in early childhood improve to become non-obese adolescents.Objective and hypotheses: To investigate the natural history of obese children from early childhood to puberty and identify patterns and trends in this process.Method: 1207 children (614 boys and 593 girls) born in Fuji...

Background: Elevated blood pressure (BP) may occur from childhood, increasing the risk for hypertension in adulthood.Aim: To investigate the effect of anthropometric characteristics and lifestyle habits in children’s and adolescents’ BP.Methods: 949 children (<12 years old) from Lakonia, 178 teenagers (12–18 years old) from Athens and 372 from Kalamata, Greece, had participated during 2011–2014. A specially ...

Background: Nesfatin-1, a recently discovered anorexigenic neuropeptide, seems to play an important role in hypothalamic pathways regulating food intake and energy homeostasis.Objective and hypotheses: The aim of this study is to evaluate the relation of serum nesfatin-1 level with anthropometric and metabolic parameters in children and adolescents.Method: This study included 78 Korean children and adolescents (42 obese/overweight ...

Background: A subset of central obese but normal weight individuals has been identified, who harbor potentially increased risks for development of MS despite a normal BMI.Objective and hypotheses: We try to evaluate metabolic syndrome (MS) components of normal weight central obese adolescents in Korea stratified by waist-to-height ratio (WHR).Method: This is a cross-sectional study. Data were obtained from the Korean National Healt...

Background: Prader–Willi Syndrome (PWS) is a genetic disorder associated with hyperphagia and hyperghrelinemia with major morbidity due to obesity. The aetiology of hyperphagia is unknown, but presumed to be multifactorial, and, as ghrelin is orexigenic, high levels may contribute to weight issues in PWS. Currently, there is no effective medical treatment for hyperphagia in PWS, but targeting appetite could be beneficial. Exenatide (Byetta (synthetic exendin-4); AstraZene...

Background: Isolated hypocortisolism due to ACTH deficiency is a rare condition that can be caused by mutations in the gene encoding pro-opiomelanocortin (POMC). POMC is the precursor to bioactive peptides (ACTH, β-endorphin, and α-β-γ-MSH). Mutations that inactive POMC typically result in secondary adrenal insufficiency, severe obesity and red hair; fewer than 50 affected individuals have been reported in the literature.Case presenta...

Background: Some obese children are metabolically healthy obese (MHO), while some are metabolically unhealthy obese (MUO) having dyslipidemia and/or insulin resistance which increase mortality and morbidity related to cardiovascular diseases during adulthood.Objective and hypotheses: This study is designed to assess factors affecting metabolic condition in obesity and compare clinical and laboratory findings between MHO and MUO children.<p class="abs...

Background: Patients who had undergone hematopoietic stem cell transplantation (HSCT) during childhood have been reported to have a higher risk of early metabolic syndrome (MS) and diabetes mellitus (DM) with a consequent increased risk of cardiovascular disease. Previous studies reported a cumulative incidence of abnormal glucose tolerance of 11.6% at 5 years from HSCT and of 69.3% at 10 years and a prevalence of MS of 32% at 4 years from HSCT.Objective...

Background: Overweight (OW) and obesity in paediatric population has been shown to be associated with an increase in prevalence of insulin resistance and type 2 diabetes (T2D) in youth.Objective and hypotheses: The aim of this study was to assess the efficiency and safety of metformin use in combination with lifestyle changes or alone for weight management in OW and obese (OB) children and adolescents.Methods: Study included 145 10...

Background: Insulin-like factor 5 (INSL5), a member of the insulin superfamily, is expressed in the colorectum and hypothalamus. INSL5 levels are elevated by prolonged calorie restriction and declined with feeding, suggesting that it might be an orexigenic hormone.Objectives and hypotheses: Our aim was to explore the relationship between INSL5 and different metabolic parameters in lean and obese subjects and to identify possible links between INSL5 and t...

Background: The correlation between obesity and depression is well established. Tryptophan (Trp) is an essential amino acid that acts as substrate for serotonin and melatonin biosynthesis, both know to play a role in satiety, anxiety, and depression. Furthermore, low plasma Trp levels have been associated with obesity.Objective: To investigate the effects of Trp supplementation as a conjunctive therapy to conventional life-style intervention on weight lo...

Background: ROHHADNET syndrome is characterised by rapid onset childhood obesity, hypoventilation, variable hypothalamic-pituitary and autonomic dysfunction, and neuroendocrine tumors in 30–40%. Autoimmunity and paraneoplastic syndrome have been proposed as possible pathophysiological mechanisms, but the exact aetiology remains unclear.Objective and hypotheses: We present the clinical course of ROHHADNET syndrome in a 17-year-old girl, with consecut...

Background: Cell death-inducing DFF45-like effector C (CIDEC) is a novel lipid droplet-coating protein that promotes triglyceride accumulation and inhibits lipolysis. TNFα downregulates CIDEC levels to enhance basal lipolysis, while CIDEC overexpression could block this effect. However, the signalling mechanism by which TNFα regulates CIDEC expression in human is still unknown.Objective and hypotheses: The aim of this study was to investigate t...

Background: Infants born small-for-gestational age (SGA) who develop postnatal weight catch-up are at risk for insulin resistance, central adiposity and cardiovascular disease in later life, even in the absence of overweight.Objective and hypotheses: In young (age 3–6 years) non-obese SGA children, we assessed arterial health by intima-media thickness (IMT) and abdominal fat distribution (subcutaneous, visceral, pre-peritoneal and hepatic components...

Background: Asymmetric dimethylarginine (ADMA) is an endogenous competitive inhibitor of endothelial nitric oxide synthase (NOS), which prevents synthesis of nitric oxide (NO). Low levels of NO are associated with endothelial dysfunction and an increased risk of cardiovascular disease. Diseases associated with high levels of ADMA include metabolic syndrome, chronic kidney disease, diabetes mellitus, insulin resistance, hyperthyroidism and multiple organ failure. Notable, GH tr...

Background: Phthalates are synthetic chemicals produced in extremely large volumes for a wide variety of uses in personal care and consumer products, including building materials, food packaging, medical devices, toys and cosmetics. Though a few studies have shown that concentrations of phthalate metabolites are associated with obesity and insulin resistance in adults, studies in children are limited.Objectives: We studied to examine the associations of ...

Background: Severe obesity due to hypothalamic involvement has major impact on prognosis in long-term survivors of childhood-onset craniopharyngioma. The long-term effects of rehabilitation efforts on weight development and obesity in these patients are not analysed up to now.Method: 108 patients with childhood-onset craniopharyngioma recruited in HIT Endo before 2001 were included in the study. Long-term weight development (BMI SDS after ...

Background: The age at weaning programs life history adaptively. Shorter infancy resulted in longer/thinner animals with a reproductive-strategic shift to earlier physical and sexual development (BMC Med, 2013).Hypotheses: The length of infancy impacts also the stress-response and has behavioural consequences.Method: Sprague-Dawley pups (generation F1), which usually are weaned at age 21 days, were weaned by cross-fostering at age ...

Background: POMC plays a major role in central body weight regulation. Recently we have shown that a POMC hypermethylation variant is significantly associated with obesity in children and adolescents (Kuehnen et al. PLoS Genetics 2012).Objective and hypotheses: Here we report about our extended studies to elucidate the mechanism behind the occurrence of the POMC hypermethylation variant in obese individuals.<p clas...