Thyroid hormones regulate metabolism and have a major impact in maintaining cardiovascular homeostasis. The purpose of our study was to examine the relation of thyrotropin (TSH) and thyroid hormones with cardiometabolic parameters in children and adolescents with obesity, overweight, and normal body mass index (BMI) before and after the implementation of a comprehensive, multidisciplinary, personalized, lifestyle intervention program for 1 year. One thousand three hundred and eleven (n = 1311) children and adolescents aged 2 to 18 years (mean age ± SD: 10.10 ± 2.92 years) were studied prospectively. Patients were categorized as having obesity (n = 727, 55.45%), overweight (n = 384, 29.29%) or normal BMI (n = 200, 15.26%) according to the International Obesity Task Force (IOTF) cutoff points. All patients received personalized guidance on diet, sleep, and physical activity at regular intervals throughout the 1-year period. Detailed clinical evaluation and hematologic, biochemical and endocrinologic investigations were performed at the beginning and the end of the study. Subjects with obesity had a more adverse cardiometabolic risk profile than subjects with overweight and normal BMI on both assessments. At initial evaluation, total T3 concentrations were positively associated with uric acid and HbA1C, and free T4 concentrations were negatively associated with insulin concentrations, while there was no association between TSH concentrations and cardiometabolic risk parameters. Following the 1 year of the multidisciplinary, lifestyle intervention program, the concentrations of lipids, HbA1C, ALT, and γGT improved significantly in all subjects. Changes in TSH concentrations were positively associated with changes in systolic blood pressure (SBP), glucose, triglycerides, and cholesterol concentrations. Changes in free T4 concentrations were negatively associated with changes in cholesterol and insulin concentrations. Furthermore, changes in T3 concentrations were positively associated with changes in HbA1C, glucose, uric acid, and triglyceride concentrations. These findings indicate that in children and adolescents with overweight and obesity, thyroid hormones are associated with indices conferring cardiometabolic risk.

Background: Childhood obesity is a growing global health concern. Metabolomics, the comprehensive study of metabolites within biological systems, offers a powerful approach to better define the phenotype and understand the complex biochemical alterations associated with obesity. The aim of this systematic review was to summarize current knowledge in the field of metabolomics in childhood obesity and to identify metabolic signatures or biomarkers associated with overweight/obesity (Ov/Ob) and Metabolically Unhealthy Obesity (MUO) in children and adolescents. Methods: We performed a systematic search of Medline and Scopus databases according to PRISMA guidelines. We included only longitudinal prospective studies or randomized controlled trials with ≥12 months of follow-up, as well as meta-analyses of the above that assessed the relation between metabolic signatures related to obesity and Body Mass Index (BMI) or other measures of adiposity in children and adolescents aged 2–19 years with overweight or obesity. Initially, 595 records were identified from PubMed and 1565 from Scopus. After removing duplicates and screening for relevance, 157 reports were assessed for eligibility. From the additional search, 75 new records were retrieved, of which none were eligible for our study. Finally, 7 reports were included in the present systematic review (4 reporting on Ov/Ob and 4 on MUO). Results: The presented studies suggest that the metabolism of amino acids and lipids is primarily affected by childhood obesity. Metabolites like glycoprotein acetyls, the Apolipoprotein B/Apolipoprotein A-1 ratio, and lactate have emerged as potential biomarkers for insulin resistance and metabolic syndrome, highlighting their potential value in clinical applications. Conclusions: There is a need for future longitudinal studies to assess metabolic changes over time, interventional studies to evaluate the efficacy of therapeutic strategies, and large-scale population studies to explore metabolic diversity across different demographics. Our findings reveal specific biomarkers in the amino acid and lipid pathway that may serve as early indicators of childhood obesity and its associated cardiometabolic complications.

Background/Objective: Secreted frizzled-related protein 5 (Sfrp5) is an anti-inflammatory adipokine that has been implicated in the pathophysiology of obesity and its metabolic complications. Despite the fact that numerous studies have been carried out in adults, limited data on Sfrp5 exist for youth, especially in relation to overweight and obesity. Methods: In our study, we assessed the concentrations of Sfrp5, total oxidative (TOS) and antioxidative (TAS) status, high-sensitivity C-reactive protein (hs-CRP), and several cytokines (IL-1α, IL-1β, IL-2, IL-6, IL-8, IL-12, TNF-α) in 120 children and adolescents (mean age ± SE: 11.48 ± 0.25 years; 48 prepubertal, 72 pubertal; 74 males and 46 females) before and 1 year after the implementation of a personalized, structured, lifestyle intervention program of healthy diet, sleep, and physical exercise. Results: Based on the body mass index (BMI), participants were categorized as having morbid obesity (n = 63, 52.5%), obesity (n = 21, 17.5%), overweight (n = 22, 18.33%), or normal BMIs (n = 14, 11.67%), based on the International Obesity Task Force (IOTF) cut-off points. Following the 1-year lifestyle intervention program, a significant improvement in anthropometric measurements (BMI, BMI-z score, diastolic blood pressure, WHR, and WHtR), body-composition parameters, hepatic enzymes, lipid profile, inflammation markers, and the insulin-sensitivity profile (HbA1C, HOMA index) was observed in all subjects. Sfrp5 decreased in subjects with obesity (p < 0.01); however, it increased significantly (p < 0.05) in patients with morbid obesity. Linear regression analysis indicates that TNF-α and systolic blood pressure were the best positive predictors and hs-CRP was the best negative predictor for Sfpr5 concentration at initial assessment and glucose concentration for ΔSfrp5, while TNF-α and TAS were the best positive predictors for Sfpr5 concentration at annual assessment. Conclusions: These results indicate that Sfrp5 is associated with severe obesity and is increased following weight loss in children and adolescents with morbid obesity. It is also related to metabolic homeostasis, as well as inflammation and oxidative status.

Background/Objectives: The prevalence of childhood obesity has recently increased, particularly during the COVID-19 pandemic, owing to lifestyle changes as a result of public health regulations and guidelines introduced by governments worldwide. The aim of our study was to evaluate the impact of novel e-Health applications in addressing childhood obesity prior to and during the COVID-19 pandemic. Methods: The study was conducted as part of the four-year European project BigO (Horizon2020, No.727688). A total of 86 children and adolescents with overweight and obesity (mean age ± standard error of the mean: 11.82 ± 0.25 years; 49 males, 37 females; 31 prepubertal, 55 pubertal) were studied prospectively for 1 year prior to the pandemic (non-COVID-19 group, n = 50) and during the pandemic (COVID-19 group, n = 36). Based on the body mass index (BMI), subjects were classified as having morbid obesity (n = 40, 46,51%) obesity (n = 21, 24.42%), overweight (n = 22, 25.58%), and normal ΒΜΙ (n = 3, 3.49%) according to the International Obesity Task Force cut-off points. The data collection system utilized the BigO technology platform, which connects to a smartphone and smartwatch to objectively record each patient’s diet, sleep, and physical activity. Participants used the BigO system continuously for 4 weeks and wore the smartwatch for specific periods during the week. Subsequently, they entered a personalized, multidisciplinary lifestyle intervention program for 4 months and used the system again for 4 weeks. Results: The key finding was a significantly higher improvement rate in BMI category among children and adolescents during the COVID-19 pandemic (58.3%) compared to before the pandemic (36%). Both groups showed significant reductions in BMI, BMI z-score, insulin resistance indices (homeostatic model assessment and quantitative insulin sensitivity check index), blood pressure, gamma-glutamyl transferase, and insulin concentrations, alongside increases in high-density lipoprotein cholesterol (p < 0.01). Notably, the COVID-19 group experienced a significantly greater reduction in BMI z-score at 12 months compared to the non-COVID-19 group (p < 0.05). Conclusions: Our results reveal that the COVID-19 group demonstrated better compliance with lifestyle interventions and experienced more significant improvements in cardiometabolic risk factors. This suggests that the innovative e-Health applications were successful in managing childhood obesity despite the challenges caused by the COVID-19 pandemic.

Background: Overweight and obesity in childhood and adolescence represent one of the most significant public health challenges of our century. Affected children and adolescents often face psychosocial maladaptation, including low self-esteem, depressive and anxiety symptoms, and behavioral problems, many of which may persist till later in life. The aim of our study was to evaluate the impact of a multidisciplinary, personalized lifestyle intervention program on psychosocial and behavioral symptoms, assessed through standardized psychometric questionnaires, and to investigate their relation with cardiometabolic parameters in children and adolescents with overweight and obesity. Methods: In this prospective cohort study, 537 children and adolescents (6–18 years; females: 52.9%; pubertal: 43.6%) with obesity (n = 44.3%), overweight (n = 33.7%), or normal BMI (n = 22%) participated in a personalized lifestyle intervention program for one year. Clinical and laboratory evaluations, including anthropometric, cardiometabolic, and endocrinologic parameters, as well as psychosocial functioning assessed by the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR), were performed at the beginning and the end of the study. Linear regression analyses identified predictors of psychometric change. Results: At initial evaluation, children and adolescents with obesity displayed a less favorable cardiometabolic profile and greater emotional/conduct difficulties compared to their overweight and normal-BMI counterparts. Following the intervention, significant improvements were observed in BMI, anthropometric and cardiometabolic parameters, as well as reductions in internalizing, externalizing, and total problem scores across multiple CBCL and YSR domains (p < 0.05). The improvements in psychosocial functioning were partly independent of BMI reduction. Linear regression analyses identified cardiometabolic and endocrine markers as significant predictors of psychometric change (p < 0.05), highlighting interactions between metabolic recovery, pubertal hormones, and stress physiology. Conclusions: A personalized, multidisciplinary lifestyle intervention program implemented for 1 year led to parallel improvements in psychosocial and cardiometabolic health in children and adolescents with overweight and obesity. Identification of specific metabolic and endocrine predictors provides novel insights into potential biological mechanisms associated with adiposity, emotional well-being, and neurodevelopment.