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5. Kidney Damage in Pediatric Obesity: Insights from an Emerging Perspective.

Author

Forcina, Gianmario, Luciano, Margherita, Frattolillo, Vittoria, Mori, Simona, Monaco, Noemi, Guarino, Stefano, Marzuillo, Pierluigi, Miraglia del Giudice, Emanuele, and Di Sessa, Anna

Subjects
DISEASE risk factors, CHILDHOOD obesity, INSULIN resistance, CHILDREN'S health, KIDNEY physiology
Abstract

The role of obesity as a risk factor for chronic kidney disease (CKD) in adulthood has been well established. Over the last years, kidney damage (KD) has emerged as a significant consequence of obesity since childhood. Indeed, a complex interplay of metabolic factors, including insulin resistance (IR), hypertension, oxidative stress, adipose tissue dysfunction, and systemic inflammation, might affect renal hemodynamics, contributing to CKD development over time in at-risk young patients. As the prevalence of pediatric obesity continues to rise globally, understanding the implications for kidney health in terms of early intervention is of paramount importance. Careful monitoring of kidney function within a multidisciplinary approach in children with obesity is crucial for detecting early KD, allowing for timely lifestyle modifications and treatment. In this framework, continued research is essential to further elucidate mechanisms linking obesity and KD and to explore not only effective preventive strategies but also the long-term impact of obesity on kidney health in children with obesity. Given the intimate link of KD with the metabolic milieu in children with obesity, we aimed to provide a comprehensive and insightful overview on KD and its implications in pediatric obesity by reviewing the most recent literature in the field. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Severe Obesity Defined by Percentiles of WHO and Cardiometabolic Risk in Youth with Obesity.

Author

Valerio, Giuliana, Di Bonito, Procolo, Di Sessa, Anna, Ballarin, Giada, Calcaterra, Valeria, Corica, Domenico, Faienza, Maria Felicia, Franco, Francesca, Licenziati, Maria Rosaria, Maffeis, Claudio, Maltoni, Giulio, Miraglia del Giudice, Emanuele, Morandi, Anita, Mozzillo, Enza, and Wasniewska, Malgorzata

Subjects
HIGH density lipoproteins, CROSS-sectional method, PREDICTIVE tests, BODY mass index, DATA analysis, RECEIVER operating characteristic curves, BLOOD collection, CARDIOVASCULAR diseases risk factors, RESEARCH, DIASTOLIC blood pressure, SPHYGMOMANOMETERS, ANALYSIS of variance, STATISTICS, MORBID obesity, CHILDHOOD obesity, SYSTOLIC blood pressure, TRIGLYCERIDES, ANTHROPOMETRY, BLOOD pressure, DATA analysis software, REGRESSION analysis, SENSITIVITY & specificity (Statistics), ADOLESCENCE
Abstract

Background/Objectives: The pediatric definition of severe obesity (OB) depends on the body mass index (BMI) references. We evaluated different BMI-derived metrics of the World Health Organization (WHO) system to define which cut-off is associated with the highest cardiometabolic risk (CMR); Methods: In this multicentric study, data were retrieved for 3727 youths (1937 boys; 2225 children, 1502 adolescents). OB was defined as BMI > 97th percentile (BMI97th), severe OB was defined as BMI > 99th percentile (BMI99th), BMI ≥ 120% of the 97th percentile (120% BMI97th), or BMI Z-score > 3 (WHO tables), or BMI ≥ the International Obesity Task Force (IOTF) value crossing a BMI of 35 kg/m2 at the age of 18 (IOTF35). The continuous CMR Z-score (sum of residual standardized for age and sex of waist-to-height ratio, systolic and diastolic blood pressure, triglycerides, and HDL-cholesterol x −1) and the cluster of at least two CMR factors (hypertension, high triglycerides, low HDL-cholesterol, and high waist-to-height ratio) were calculated. Results: Continuous CMR Z-score was significantly higher both in children or adolescents with severe OB defined by 120% BMI97th compared to BMI99th (p < 0.0001), while it was lower only in adolescents with severe OB defined by 120% BMI97th compared to BMI Z-score >3 (p < 0.0001). Compared to 120% BMI97th, BMI Z-score > 3 and IOTF35 had higher specificity, but lower sensitivity in identifying children and adolescents with clustered CMR factors. Conclusions: The definition of severe OB based on 120% BMI97th is superior to BMI99th but it is inferior to BMI Z score > 3 as far as the association between severe OB and CMR factors is concerned. Pediatricians should take into consideration the implication of the use of different BMI metrics in those countries that recommend the WHO system. WHO BMI Z-score > 3 and IOTF35 can be used interchangeably to predict cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Published
2024
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9. Effectiveness of Smartphone App for the Treatment of Pediatric Obesity: A Randomized Controlled Trial.

Author

Umano, Giuseppina Rosaria, Masino, Mariapia, Cirillo, Grazia, Rondinelli, Giulia, Massa, Francesca, Mangoni di Santo Stefano, Giuseppe Salvatore R. C., Di Sessa, Anna, Marzuillo, Pierluigi, Miraglia del Giudice, Emanuele, and Buono, Pietro

Subjects
EDUCATION of parents, PATIENT education, MOBILE apps, WEIGHT loss, BEHAVIOR modification, BODY mass index, DATA analysis, RESEARCH funding, ACADEMIC medical centers, EDUCATIONAL outcomes, STATISTICAL sampling, FISHER exact test, MULTIPLE regression analysis, RANDOMIZED controlled trials, DESCRIPTIVE statistics, MANN Whitney U Test, CHI-squared test, TELEMEDICINE, ODDS ratio, LONGITUDINAL method, HEALTH behavior, STATISTICS, FAMILY-centered care, CHILDHOOD obesity, COUNSELING, COMPARATIVE studies, CONFIDENCE intervals, DATA analysis software, DIET, PHYSICAL activity
Abstract

Background: Pediatric obesity treatment is based on high-intensity lifestyle counseling. However, high dropout rates and low effectiveness have been reported, even in specialized centers. Mobile health technologies have been used to overcome these limits with contrasting results. This study aims at evaluating the effectiveness of a six-month intervention with a mobile app for the treatment of pediatric obesity at 6 and 12 months of follow-up. Methods: Seventy-five patients were randomly assigned to standard care or standard care plus mobile app (2:1) using an online randomizer system. The mobile app delivered high-intensity lifestyle counseling for diet and physical activity. Results: At six months of follow-up, the M-App group showed significantly lower dropout rates compared to standard care (p = 0.01). The risk of dropout was significantly higher in controls compared to the intervention group (OR 3.86, 95% C.I. 1.39–10.42, p = 0.01). After one year, we observed lower albeit non-statistically significant dropout rates in the M-App compared to the standard care group (p = 0.24). No differences were observed in z-score BMI and percentage of BMI reduction between the two groups. Conclusions: Our findings suggest that the mobile app might help in the clinical management of children and adolescents with obesity in terms of dropout reduction. [ABSTRACT FROM AUTHOR]

Published
2024
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10. Sex-Related Differences in Cardiovascular Risk in Adolescents with Overweight or Obesity

Author

Di Bonito, Procolo, primary, Di Sessa, Anna, primary, Licenziati, Maria Rosaria, primary, Corica, Domenico, primary, Wasniewska, Malgorzata, primary, Miraglia del Giudice, Emanuele, primary, Morandi, Anita, primary, Maffeis, Claudio, primary, Faienza, Maria Felicia, primary, Mozzillo, Enza, primary, Calcaterra, Valeria, primary, Franco, Francesca, primary, Maltoni, Giulio, primary, Moio, Nicola, primary, Iannuzzi, Arcangelo, primary, and Valerio, Giuliana, primary

Published
2024
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16. Whole-Blood Gene Expression Profile After Hypoxic-Ischemic Encephalopathy

Author

Montaldo, Paolo, primary, Burgod, Constance, additional, Herberg, Jethro A., additional, Kaforou, Myrsini, additional, Cunnington, Aubrey J., additional, Mejias, Asuncion, additional, Cirillo, Grazia, additional, Miraglia Del Giudice, Emanuele, additional, Capristo, Carlo, additional, Bandiya, Prathik, additional, Kamalaratnam, Chinnathambi N., additional, Chandramohan, Rema, additional, Manerkar, Swati, additional, Rodrigo, Ranmali, additional, Sumanasena, Samanmali, additional, Krishnan, Vaisakh, additional, Pant, Stuti, additional, Shankaran, Seetha, additional, and Thayyil, Sudhin, additional

Published
2024
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17. Acute Kidney Injury in Children: A Focus for the General Pediatrician.

Author

Rivetti, Giulio, Gizzone, Pietro, Petrone, Delfina, Di Sessa, Anna, Miraglia del Giudice, Emanuele, Guarino, Stefano, and Marzuillo, Pierluigi

Subjects
ACUTE kidney failure prevention, FUROSEMIDE, BUMETANIDE, HEALTH, DISEASE management, ACUTE kidney failure in children, INFORMATION resources, ACUTE kidney failure, THEOPHYLLINE, OXIDOREDUCTASES, CHILD care, DOPAMINE, FENOLDOPAM (Drug), BIOMARKERS, SYMPTOMS, CHILDREN
Abstract

Acute kidney injury (AKI) presents significant challenges in pediatric care, often remaining underrecognized. This paper provides an overview of pediatric AKI, highlighting its epidemiology, pathophysiology, diagnosis, predisposing conditions, and treatment. AKI in children stems from diverse causes, including renal tubular damage, vasoconstriction, and inflammation. Diagnosis relies on traditional markers such as serum creatinine and urine output, alongside emerging biomarkers such as Cystatin C, NGAL, KIM-1, IL-18, TIMP-2 and IGFBP7, urinary calprotectin, URBP4, L-FABP, and clusterin. Various pediatric conditions predispose to AKI, including type 1 diabetes, pneumonia, bronchiolitis, appendicitis, gastroenteritis, COVID-19, multisystem inflammatory syndrome, sickle cell disease, and malignancies. Treatment entails supportive care with fluid management and, in severe cases, renal replacement therapy. Timely recognition and management are essential to mitigating adverse outcomes. Enhanced awareness and integration of novel biomarkers could improve pediatric AKI care, warranting further research for better diagnosis and management. [ABSTRACT FROM AUTHOR]

Published
2024
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24. MKRN3 role in regulating pubertal onset: the state of art of functional studies

Author

Palumbo, Stefania, Cirillo, Grazia, Aiello, Francesca, Papparella, Alfonso, Miraglia Del Giudice, Emanuele, Grandone, Anna, Palumbo, Stefania, Cirillo, Grazia, Aiello, Francesca, Papparella, Alfonso, Miraglia Del Giudice, Emanuele, and Grandone, Anna

Subjects
Gonadotropin-Releasing Hormone, central precocious puberty, E3 ubiquitin ligase, Ribonucleoproteins, Ubiquitin-Protein Ligases, Endocrinology, Diabetes and Metabolism, Puberty, functional studies, Humans, Puberty, Precocious, MKRN3, epigenetic, auto-ubiquitination
Abstract

Puberty is a critical process characterized by several physical and psychological changes that culminate in the achievement of sexual maturation and fertility. The onset of puberty depends on several incompletely understood mechanisms that certainly involve gonadotropin-releasing hormone (GnRH) and its effects on the pituitary gland. The role of makorin ring finger protein 3 (MKRN3) in the regulation of pubertal timing was revealed when loss-of-function mutations were identified in patients with central precocious puberty (CPP), which to date, represent the most commonly known genetic cause of this condition. The MKRN3 gene showed ubiquitous expression in tissues from a broad spectrum of species, suggesting an important cellular role. Its involvement in the initiation of puberty and endocrine functions has just begun to be studied. This review discusses some of the recent approaches developed to predict MKRN3 functions and its involvement in pubertal development.

Published
2022
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25. One-Hour Post-Load Plasma Glucose and Altered Glucometabolic Profile in Youths with Overweight or Obesity

Author

Di Bonito, Procolo, primary, Valerio, Giuliana, additional, Licenziati, Maria Rosaria, additional, Corica, Domenico, additional, Wasniewska, Malgorzata, additional, Di Sessa, Anna, additional, Miraglia del Giudice, Emanuele, additional, Morandi, Anita, additional, Maffeis, Claudio, additional, Mozzillo, Enza, additional, Calcaterra, Valeria, additional, Franco, Francesca, additional, Maltoni, Giulio, additional, and Faienza, Maria Felicia, additional

Published
2023
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26. From Clinical Scenarios to the Management of Lower Urinary Tract Symptoms in Children: A Focus for the General Pediatrician

Author

Palma, Pier Luigi, primary, Marzuillo, Pierluigi, additional, Di Sessa, Anna, additional, Guarino, Stefano, additional, Capalbo, Daniela, additional, Marrapodi, Maria Maddalena, additional, Buccella, Giulia, additional, Cameli, Sabrina, additional, Miraglia del Giudice, Emanuele, additional, Torella, Marco, additional, Colacurci, Nicola, additional, and Capristo, Carlo, additional

Published
2023
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27. Central sensitivity to thyroid hormones is reduced in youths with overweight or obesity and impaired glucose tolerance

Author

Di Bonito, Procolo, primary, Corica, Domenico, additional, Licenziati, Maria Rosaria, additional, Di Sessa, Anna, additional, Miraglia del Giudice, Emanuele, additional, Faienza, Maria Felicia, additional, Calcaterra, Valeria, additional, Franco, Francesca, additional, Maltoni, Giulio, additional, Valerio, Giuliana, additional, and Wasniewska, Malgorzata, additional

Published
2023
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28. The Impact of COVID-19 Pandemic Lockdown on the Relationship between Pediatric MAFLD and Renal Function

Author

Valentino, Maria Sole, primary, Marzuillo, Pierluigi, additional, Esposito, Claudia, additional, Bartiromo, Mario, additional, Nardolillo, Michele, additional, Villani, Annalisa Valentina, additional, Maresca, Alessandro, additional, Furcolo, Giuseppe, additional, Guarino, Stefano, additional, Miraglia del Giudice, Emanuele, additional, and Di Sessa, Anna, additional

Published
2023
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31. Effects of Lockdown for COVID-19 Pandemic on Chronic Kidney Disease Progression in Children with Congenital Anomalies of the Kidney and Urinary Tract: A Retrospective Pilot Study

Author

Palma, Pier Luigi, primary, Sessa, Anna Di, additional, Passaro, Antonio Paride, additional, Palladino, Eleonora, additional, Furcolo, Giuseppe, additional, Barlabà, Annalisa, additional, Rivetti, Giulio, additional, Lucia, Maeva De, additional, Miraglia del Giudice, Emanuele, additional, Guarino, Stefano, additional, and Marzuillo, Pierluigi, additional

Published
2023
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32. Which Is the Most Appropriate Cut-Off of HbA1c for Prediabetes Screening in Caucasian Youths with Overweight or Obesity?

Author

Di Bonito, Procolo, primary, Licenziati, Maria Rosaria, additional, Corica, Domenico, additional, Wasniewska, Malgorzata, additional, Di Sessa, Anna, additional, Miraglia del Giudice, Emanuele, additional, Morandi, Anita, additional, Maffeis, Claudio, additional, Faienza, Maria Felicia, additional, Mozzillo, Enza, additional, Calcaterra, Valeria, additional, Franco, Francesca, additional, Maltoni, Giulio, additional, and Valerio, Giuliana, additional

Published
2023
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36. The lncOb rs10487505 polymorphism impairs insulin sensitivity and glucose tolerance in children and adolescents with obesity.

Author

Umano, Giuseppina Rosaria, Cirillo, Grazia, Sanchez, Gianmaria, Rondinelli, Giulia, Foderini, Maria Vittoria, Ferrara, Serena, Di Sessa, Anna, Marzuillo, Pierluigi, Papparella, Alfonso, Santoro, Nicola, and Miraglia del Giudice, Emanuele

Subjects
ADOLESCENT obesity, INSULIN sensitivity, CHILDHOOD obesity, REGULATION of body weight, LINCRNA, RECESSIVE genes
Abstract

Objective: Leptin plays a key role in the regulation of body weight and other endocrine systems. Recently, impairment of leptin gene transcription due to genetic variations in a long noncoding RNA (lncOb) has been described. This retrospective study aims to characterize the clinical and metabolic phenotype of children and adolescents with obesity who were homozygous for the lncOb rs10487505 leptin lowering allele. Methods: Enrolled children underwent an anthropometrical evaluation, biochemical assessment, and genotyping for lncOb rs10487505. Plasma leptin levels were assessed in 150 participants. A total of 434 patients were included and divided into two groups according to rs10487505 recessive inheritance (CC vs. GG/GC). Results: Children who were homozygous for the C allele showed higher fasting insulin (p = 0.01), homeostasis model assessment of insulin resistance (p = 0.01), lower whole‐body insulin sensitivity index (p = 0.02), and lower disposition index (p = 0.03). Moreover, CC patients presented with a higher prevalence of prediabetes (9.3% vs. 3.4%, p = 0.04) and a 2.9‐fold (95% CI: 1.1–7.9, p = 0.04) higher risk of prediabetes compared with G‐carriers independently from confounders. Leptin plasma levels were significantly lower in the CC group (p = 0.002). Hormone levels correlated with BMI z score (r = 0.19, p = 0.04), fasting insulin (r = −0.34, p < 0.0001), homeostasis model assessment of insulin resistance (r = −0.33, p < 0.0001), and disposition index (r = 0.20, p = 0.04). Conclusions: The lncOb rs10487505 polymorphism affects leptin circulating levels, worsens insulin resistance, and heightens the risk of prediabetes in children and adolescents with obesity. [ABSTRACT FROM AUTHOR]

Published
2023
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37. Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians

Author

Saggese, Giuseppe, Vierucci, Francesco, Prodam, Flavia, Cardinale, Fabio, Cetin, Irene, Chiappini, Elena, de’ Angelis, Gian Luigi, Massari, Maddalena, Miraglia Del Giudice, Emanuele, Miraglia Del Giudice, Michele, Peroni, Diego, Terracciano, Luigi, Agostiniani, Rino, Careddu, Domenico, Ghiglioni, Daniele Giovanni, Bona, Gianni, Di Mauro, Giuseppe, and Corsello, Giovanni

Published
2018
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39. Diagnostic Performance of the Acute Kidney Injury Baseline Creatinine Equations in Children and Adolescents with Type 1 Diabetes Mellitus Onset

Author

Palma, Pier Luigi, primary, Guarino, Stefano, additional, Di Sessa, Anna, additional, Rivetti, Giulio, additional, Barlabà, Annalisa, additional, Scaglione, Federica, additional, Capalbo, Daniela, additional, Papparella, Alfonso, additional, Miraglia del Giudice, Emanuele, additional, and Marzuillo, Pierluigi, additional

Published
2022
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40. Pediatric non-alcoholic fatty liver disease: current perspectives on diagnosis and management

Author

Di Sessa, Anna, Cirillo, Grazia, Guarino, Stefano, Marzuillo, Pierluigi, Miraglia Del Giudice, Emanuele, Di Sessa, Anna, Cirillo, Grazia, Guarino, Stefano, Marzuillo, Pierluigi, and Miraglia Del Giudice, Emanuele

Subjects
diagnosi, pediatric, diagnosis, nutritional and metabolic diseases, Review, fatty, liver, digestive system, digestive system diseases, management
Abstract

Non-alcoholic fatty liver disease (NAFLD) represents the most common cause of chronic liver disease in childhood. To date, the “multiple-hit” hypothesis is largely recognized as an explanation of NAFLD pathogenesis and progression. Obesity and features of the metabolic syndrome have been closely linked to NAFLD development. Due to the increased prevalence of obesity worldwide, NAFLD has reached epidemic proportions over time. Given its unfavorable cardiometabolic burden (such as cardiovascular and metabolic consequences), it represents a worrying phenomenon needing a more comprehensive and successful management. Laboratory tests and classical imaging techniques play a pivotal role in NAFLD diagnosis, but novel noninvasive alternative methods to diagnose and monitor NAFLD have been investigated. Currently, lifestyle modifications remain the mainstay treatment, although its efficacy is poor because of the lack of compliance. Pediatric research is focusing on multiple alternative treatments targeting the main pathogenic factors such as insulin-resistance, dyslipidemia, gut-liver axis and microbiota, oxidative stress, and proinflammatory pathways. Results from these studies are promising but larger validation is needed. Innovative therapeutic approaches might add an important piece in the complex knowledge of pediatric NAFLD. We aimed to summarize recent insights into NAFLD diagnosis and treatment in children, with a focus on possible future perspectives in pediatric research.

Published
2019

41. Pediatric Sleep Questionnaire Predicts Moderate-to-Severe Obstructive Sleep Apnea in Children and Adolescents with Obesity

Author

Umano, Giuseppina Rosaria, primary, Rondinelli, Giulia, additional, Luciano, Margherita, additional, Pennarella, Alessandro, additional, Aiello, Francesca, additional, Mangoni di Santo Stefano, Giuseppe Salvatore R. C., additional, Di Sessa, Anna, additional, Marzuillo, Pierluigi, additional, Papparella, Alfonso, additional, and Miraglia del Giudice, Emanuele, additional

Published
2022
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42. Gut microbiota and COVID-19: An intriguing pediatric perspective

Author

Valentino, Maria Sole, primary, Esposito, Claudia, additional, Colosimo, Simone, additional, Caprio, Angela Maria, additional, Puzone, Simona, additional, Guarino, Stefano, additional, Marzuillo, Pierluigi, additional, Miraglia del Giudice, Emanuele, additional, and Di Sessa, Anna, additional

Published
2022
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49. Acute Kidney Injury in Children with Acute Appendicitis

Author

Marzuillo, Pierluigi, primary, Coppola, Crescenzo, additional, Caiazzo, Roberta, additional, Macchini, Giulia, additional, Di Sessa, Anna, additional, Guarino, Stefano, additional, Esposito, Francesco, additional, Miraglia del Giudice, Emanuele, additional, and Tipo, Vincenzo, additional

Published
2022
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50. Omics era in type 2 diabetes: From childhood to adulthood

Author

Passaro, Antonio Paride, Marzuillo, Pierluigi, Guarino, Stefano, Scaglione, Federica, Miraglia del Giudice, Emanuele, Di Sessa, Anna, Passaro, Antonio Paride, Marzuillo, Pierluigi, Guarino, Stefano, Scaglione, Federica, Miraglia Del Giudice, Emanuele, and Di Sessa, Anna

Subjects
Adult, endocrine system, endocrine system diseases, Endocrinology, Diabetes and Metabolism, Diabetes, Omics, nutritional and metabolic diseases, Minireviews, Type 2 diabetes, Diabete, Omic, Internal Medicine, Adults, human activities, Children
Abstract

Parallel to the dramatic rise of pediatric obesity, estimates reported an increased prevalence of type 2 diabetes (T2D) already in childhood. The close relationship between obesity and T2D in children is mainly sustained by insulin resistance (IR). In addition, the cardiometabolic burden of T2D including nonalcoholic fatty liver disease, cardiovascular disease and metabolic syndrome is also strictly related to IR. Although T2D pathophysiology has been largely studied in an attempt to improve therapeutic options, molecular mechanisms are still not fully elucidated. In this perspective, omics approaches (including lipidomics, metabolomics, proteomics and metagenomics) are providing the most attractive therapeutic options for T2D. In particular, distinct both lipids and metabolites are emerging as potential therapeutic tools. Of note, among lipid classes, the pathogenic role of ceramides in T2D context has been supported by several data. Thus, selective changes of ceramides expression might represent innovative therapeutic strategies for T2D treatment. More, distinct metabolomics pathways have been also found to be associated with higher T2D risk, by providing novel potential T2D biomarkers. Taken together, omics data are responsible for the expanding knowledge of T2D pathophysiology, by providing novel insights to improve therapeutic strategies for this tangled disease. We aimed to summarize the most recent evidence in the intriguing field of the omics approaches in T2D both in adults and children.

Published
2021

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