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Background: The increasing rate of obesity and overweight among children has highlighted nonalcoholic fatty liver disease (NAFLD) as the most common cause of chronic pediatric liver diseases. There are many publications supporting the idea that gut microbiota is altered in NAFLD. The aim of this study was to evaluate the prevalence of NAFLD among overweight and obese children with and without small intestinal bacterial overgrowth (SIBO) compared to a control group and to assess if intestinal dysbiosis represents a risk factor for NAFLD., Methods: One hundred and twenty-five overweight and obese children aged 10-18 years and 120 controls matched for age and gender were enrolled. SIBO was assessed by glucose hydrogen breath test (GHBT) in all subjects. NAFLD was assessed in all children using abdominal imaging and laboratory findings., Results: Of 125 obese children enrolled, 47 (37.6%) presented intestinal dysbiosis and 78 (62.4%) were SIBO negative. Only four (3.3%) controls were SIBO positive. NAFLD was detected in 28/47 (59.5%) of the SIBO positive obese group, compared to 8/78 (10.2%) of the SIBO negative obese group (p<0.001) and 0/120 (0%) controls (p<0.001). Children from the SIBO positive obese group had higher rates of elevated aminotransferases levels: aspartate aminotransferases (ASAT) (53.1% vs. 6.4%; p<0.001) and alanine aminotransferase (ALAT) (59.5% vs. 7.6%; p<0.001), hypertension (23.4% vs. 5.1%; p=0.002) and metabolic syndrome (44.6% vs. 9%; p=0.002) compared to the SIBO negative obese group., Conclusions: Obese children with SIBO have an increased risk for developing NAFLD. The relationship between intestinal dysbiosis and diet can influence the gut-liver axis.

Introduction: Iron deficiency (ID) is one of the most common causes of anemia in children. Although it is frequently encountered in a clinician's daily practice, the multifactorial etiology of ID still represents a challenge in terms of long-term management. In overweight and obese children, adiposity related inflammation causes ID by decreasing transferrin saturation on one hand and by increasing hepcidin production on the other hand, which in turn decreases iron absorption. Dietary uptake of iron and other micronutrients is also impaired in these children. Aim of the study: To investigate the link between overweight, obesity and iron deficiency in pediatric patients. Materials and methods: A retrospective observational study was conducted over a 1-year period (1st April 2018-31th March 2019), in the Endocrinology Department of "Louis Turcanu" Children's Emergency Clinical Hospital Timisoara. After applying the inclusion criteria, a total of 78 overweight and obese children were enrolled in the study. The Ethics Committee of the "Louis Turcanu" Children's Emergency Clinical Hospital approved the study. Results: The CDC BMI- charts matched for age and sex were used in order to define overweight and obesity (overweight 85th - 95th and obesity > 95th percentiles). According to age patients were divided in 3 groups: toddlers 6% (age 1-5 years); preadolescents 40% (age 5-12 years) and adolescents 54% (age 12-18 years). Overall, the overweight/ obesity ratio in the studied groups was as follows: 20:80 in toddlers, 13:87 in preadolescents and 45,6:54,4 in adolescents. The highest percentage of ID- patients was found in toddlers (60%), followed by preadolescents with half as much patients (32%), and the lowest percentages was observed in adolescents (14%). Although there was a correlation between iron levels and BMI throughout our sample, these obese and overweight children did not associate significant anemia. Conclusions: The negative correlation between BMI and iron levels, even in the absence of anemia, should raise awareness with regard to the micronutrient imbalance that exists in these children from a very young age. Children with elevated BMI may need to be screened for iron deficiency. There is an acute need to expand the studies to establish the cause of ID among children and adolescents. [ABSTRACT FROM AUTHOR]

Prader-Willi syndrome (PWS) is a genetic disorder characterized by absence of the active genes on chromosome 15. Symptoms appear since intrauterine development with decreased fetal movements, low birth weight and persist after birth with hypotonia, feeding difficulties and failure to thrive in the neonatal period. From infancy until adulthood, patients have short stature, become severely obese, with an insatiable appetite and food-seeking behavior. They also have psychiatric disorders, behavioral problems and learning disabilities. Treatment of these patients is multidisciplinary and several drugs have been studied in order to control appetite and reduce the morbidity of obesity, including cardiovascular and metabolic side-effects. The following paper offers an insight in the difficult management of the co-morbidities of Prader-Willi syndrome. [ABSTRACT FROM AUTHOR]

Small and large birth weights (BWs) for gestational age (GA) represent extremes, but the correlation between extreme BW and metabolic syndrome (MetS) has not been fully elucidated. In this study, we examined this correlation in obese children based on changes in their metabolic profile from childhood to adolescence. A retrospective observational study was performed on 535 obese patients aged 0–18 years in the Clinical and Emergency Hospital for Children "Louis Turcanu" in Timisoara, Romania, based on clinical and biological data from January 2015 to December 2019. We emphasized the links between extreme BW and obesity, extreme BW and cardiometabolic risk, obesity and cardiometabolic risk, and extreme BW, obesity and MetS. Children born large for gestational age (LGA) predominated over those born small for gestational age (SGA). Our findings showed that BW has an independent effect on triglycerides and insulin resistance, whereas obesity had a direct influence on hypertension, impaired glucose metabolism and hypertriglyceridemia. The influences of BW and obesity on the development of MetS and its components are difficult to separate; therefore, large prospective studies in normal-weight patients are needed. [ABSTRACT FROM AUTHOR]

The "catch-up growth" phenomenon in children born small for gestational age (SGA) has been linked to early onset obesity with the subsequent emergence of metabolic syndrome (MetS). The intima media thickness of the common carotid artery (CIMT) is a well-known marker of subclinical atherosclerosis. Aim: to determine the association between being born SGA and CIMT, a measure of atherogenesis and to investigate metabolic risk factors which impact on CIMT in obese children. Material and methods: A prospective study was carried out over a 1 year period (July 2012-June 2013). We analyzed 122 obese patients, 96 patients appropriate for gestational age (AGA) and 26 patients SGA. Both groups were matched for age, sex and BMI. Blood pressure, lipids and glucose were determined. Oral glucose tolerance tests (oGTT) were performed. Insulin resistance (IR) was assessed by homeostasis model assessment (HOMA). CIMT was measured in all the patients. Results: CIMT in obese children born SGA was significantly increased as compared with obese children born AGA similar age, sex and BMI (p=0.0035). We demonstrated a strong correlation between CIMT and all other metabolic factors (r=0.98). In both groups, mean CIMT of was significantly related to diastolic blood pressure, triglycerides and HOMA. CIMT was not significantly related to systolic blood pressure and baseline glucose. Conclusion: High triglycerides levels and low HDL-cholesterol levels, IR and diastolic blood pressure, which are all components of MetS are strong predictors of increased CIMT in obese children. Being born SGA increases the atherogenic risk. [ABSTRACT FROM AUTHOR]

The intima media thickness of the common carotid artery (CIMT) is a well-known marker of subclinical atherosclerosis. The "catch-up growth" phenomenon in children born small for gestational age (SGA) has been linked to early onset obesity with the subsequent emergence of metabolic syndrome (MetS). Aim: to determine the association between being born SGA and CIMT, a measure of atherogenesis and to establish cut off values for CIMT in obese children. Material and methods. A prospective study was carried out over a 1 year period (Jul 2012-June 2013). We analyzed 122 obese patients, 96 patients appropriate for gestational age (AGA) and 26 patients SGA. Both groups were matched for age, sex and BMI. CIMT was measured in all the patients. Using ROC curve, cut off values have been obtained for both groups. Results. CIMT in obese children born SGA was significantly increased as compared with obese children born AGA similar age, sex and BMI (p = 0.0035). A CIMT cut off value of 0.049 cm has been obtained with a high sensitivity and specificity. Conclusion. Being born SGA increases the atherogenic risk. CIMT is a well-known marker of subclinical atherosclerosis and is a noninvasive and inexpensive method for detecting development of subclinical atherosclerosis. Further population studies regarding reference values for CIMT in obese children born SGA and AGA are necessary. [ABSTRACT FROM AUTHOR]