Congenital hypothyroidism (CH) may have major detrimental effects on growth and neurological development, but early intervention leads to excellent outcomes. CH is classified as transient or permanent, primary or secondary, with primary CH being the most common neonatal endocrine disorder. Most patients with CH do not present any typical signs and symptoms of hypothyroidism shortly after birth, partly due to transplacental maternal thyroid hormone transfer and residual neonatal thyroid function. This paper reports on two CH cases. During the initial Neonatal Intensive Care Unit (NICU) admission phase, CH was not suspected due to nonspecific signs. The distinct characteristics of our cases are as follows: both infants were admitted to the NICU for respiratory distress syndrome, requiring invasive mechanical ventilation, and both were born to diabetic mothers. Following extubation, they both showed similar neurological issues, including reduced muscle tone and feeding difficulties. Initially, those symptoms were attributed to delayed clearance of analgesic and sedative medication. However, symptoms progressively worsened over time. Subsequent tests revealed both meeting CH diagnostic criteria: an unusual ultrasound indicating thyroid agenesis and abnormal hormone levels. Guided by the pediatric endocrinology team, prompt hormonal treatment was started with improvements in neurocognitive function and feeding. Usually, CH screening involves blood samples from healthy newborns at 2–3 days of life. Abnormal results require confirmation, prompting treatment within two weeks. Certain NICU-admitted infants face higher diagnosis delays, as seen in those two cases where CH screening was postponed. Thus, for all neonates with persistent pathologies unresponsive to standard etiological treatment, conducting a comprehensive anamnestic evaluation of the medical history, along with maternal preconceptional and prenatal nutrition, is recommended.

Background and Objectives: Childhood obesity has been increasing at a worrisome pace and emerging as a non-infectious pandemic in the pediatric population in recent years. Raising awareness on this problem is of utmost importance, in order to take action to control body weight from an early age. Materials and Methods: We performed a retrospective study among overweight or obese children evaluated on an outpatient basis in the Department of Pediatric Endocrinology of a tertiary care hospital in Bucharest Romania in 2021 in order to identify laboratory changes occurring according to age and sex. Results: A total of 268 children were included in the analysis, with a median age of 10.9 years (IQR: 8.3, 13.3 years); 61.8% were obese and 38.2% overweight. We identified a subclinical pro-inflammatory status characterized by increased neutrophil count (12.7%) and increased C-reactive protein (16.4%). Biochemically, we identified the highest increases for uric acid (35.4%). More than half of the children included in the study had dyslipidemia-specific changes: high low-density lipoprotein cholesterol (LDL) (50.0%), low high-density lipoprotein cholesterol (HDL) (58.9%) and increased triglyceride levels (12.7%), especially children with a body mass-index (BMI) percentile above 95%. Increased thyroid stimulating hormone (TSH) was identified in 20.3% and low thyroxine (T4) level in 13.4%, especially in females. Conclusions: Early measures to control excess body weight are needed since preventing obesity is easier than treating it. However, this is often difficult to do in our country because parents frequently do not recognize the problem until it is advanced. Furthermore, doctors are not always adequately prepared and sometimes they do not have the support of the health systems to provide children in need with the adequate care. Educational strategies and awareness of issue should be revisited in current post-pandemic context that facilitates increase of obesity prevalence in children. Increase of efficient communication could be achieved by pointing to these objective findings.

Background/Objectives: Childhood obesity is associated with early metabolic complications, particularly insulin resistance (IR), which significantly elevates the long-term risk for type 2 diabetes and cardiovascular disease. Standard measures such as BMI may inadequately capture metabolic risk, particularly in children with atypical phenotypes such as TOFI (Thin Outside, Fat Inside). This study aimed to evaluate the prevalence and predictors of IR in a pediatric population with overweight and obesity, using both conventional biomarkers and bioelectrical impedance analysis (BIA). We also examined the predictive value of lipid ratios and fasting glucose and applied Principal Component Analysis (PCA) to identify underlying body composition dimensions. Methods: A retrospective cohort of 210 children aged 1–18 years, assessed in a tertiary pediatric endocrinology center in Romania, was analyzed. Clinical data included anthropometric measures, fasting laboratory results, and body composition parameters obtained via Tanita PRO DC430 MA BIA. Insulin resistance was defined as HOMA-IR > 2. ROC analysis assessed the predictive performance of triglyceride-to-HDL (Tg/HDL) ratio, fasting glucose, and BIA metrics. PCA was applied to BIA variables to explore dimensional structure. Results: Insulin resistance was present in 54.8% of the cohort. It was significantly associated with higher age, pubertal status, ALT, LDL-cholesterol, triglycerides, and BIA-derived fat-free mass (FFM), TBW, and PMM. ROC analyses showed moderate predictive power for Tg/HDL (AUROC = 0.645) and triglycerides (AUROC = 0.656) in identifying IR. BIA metrics had comparable discriminatory performance (AUROC~0.61). PCA reduced eight BIA parameters into two components: a fat-free mass axis (TBW, FFM, PMM, WATERM) and an adiposity axis (BMI, FATP, FATM, WATERP). Conclusions: This study highlights the high burden of insulin resistance among children with excess weight and supports the integration of BIA and composite biomarkers into early screening protocols. PCA-derived components may improve metabolic phenotyping in pediatric obesity.

Background and Objectives: Childhood obesity is associated with alterations in body composition that may impair muscular strength and functional capacity. While higher body mass is often accompanied by greater absolute strength, the independent effect of adiposity on muscle strength after accounting for lean mass remains insufficiently understood. This study aimed to evaluate the associations between adiposity and muscle strength in children and adolescents, while accounting for growth and maturation, and to examine differences according to weight status. Materials and Methods: This retrospective cross-sectional study included 84 children and adolescents aged 5–18 years. Anthropometric measurements were used to calculate body mass index (BMI), waist-to-hip ratio, and waist-to-height ratio, with weight status classified according to CDC BMI-for-age percentiles. Body composition was assessed using bioelectrical impedance analysis (Tanita). Pubertal stage was evaluated using Tanner classification. Muscle strength was assessed using dominant handgrip strength. Associations between adiposity-related parameters and muscle strength were analyzed using correlation and multivariable linear regression models adjusted for age, sex, pubertal stage, physical activity, and body composition. Results: Body mass index was positively correlated with absolute handgrip strength (r = 0.561, p < 0.001). Body fat percentage was negatively associated with relative handgrip strength (r = −0.381, p < 0.001). In multivariable regression analyses, body fat percentage remained an independent negative predictor of handgrip strength (β = −0.203, p = 0.0046), whereas fat-free mass and fat-free mass index were positive predictors in respective models (p < 0.001). Conclusions: Increased adiposity is associated with reduced muscle strength in children and adolescents when strength is evaluated relative to body size or adjusted for lean mass. These findings support the concept of impaired muscle performance in pediatric populations with excess adiposity and highlight the importance of integrating body composition and functional assessments in clinical evaluation.

Background/Objectives: Childhood obesity is associated with early metabolic complications, particularly insulin resistance (IR), which significantly elevates the long-term risk for type 2 diabetes and cardiovascular disease. Standard measures such as BMI may inadequately capture metabolic risk, particularly in children with atypical phenotypes such as TOFI (Thin Outside, Fat Inside). This study aimed to evaluate the prevalence and predictors of IR in a pediatric population with overweight and obesity, using both conventional biomarkers and bioelectrical impedance analysis (BIA). We also examined the predictive value of lipid ratios and fasting glucose and applied Principal Component Analysis (PCA) to identify underlying body composition dimensions. Methods: A retrospective cohort of 210 children aged 1–18 years, assessed in a tertiary pediatric endocrinology center in Romania, was analyzed. Clinical data included anthropometric measures, fasting laboratory results, and body composition parameters obtained via Tanita PRO DC430 MA BIA. Insulin resistance was defined as HOMA-IR >2. ROC analysis assessed the predictive performance of triglyceride-to-HDL (TG/HDL) ratio, fasting glucose, and BIA metrics. PCA was applied to BIA variables to explore dimensional structure. Results: Insulin resistance was present in 54.8% of the cohort. It was significantly associated with higher age, pubertal status, ALT, LDL-cholesterol, triglycerides, and BIA-derived fat-free mass (FFM), TBW, and PMM. ROC analyses showed moderate predictive power for TG/HDL (AUROC = 0.645) and triglycerides (AUROC = 0.656) in identifying IR. BIA metrics had comparable discriminatory performance (AUROC ~0.61). PCA reduced eight BIA parameters into two components: a fat-free mass axis (TBW, FFM, PMM, WATERM) and an adiposity axis (BMI, FATP, FATM, WATERP). Conclusions: This study highlights the high burden of insulin resistance among children with excess weight and supports the integration of BIA and composite biomarkers into early screening protocols. PCA-derived components may improve metabolic phenotyping in pediatric obesity.

Background and Objectives: GLP-1 receptor agonists (GLP-1 RAs) are effective weight-loss therapies, but data on body composition changes in pediatric obesity remain scarce. The primary objective was to evaluate the effects of GLP-1 RAs on body composition in children with obesity. Materials and Methods: We conducted a retrospective study of children with obesity evaluated at the National Institute for Mother and Child Health “Alessandrescu-Rusescu”, Bucharest, Romania, who initiated weekly injectable GLP-1 RA therapy (semaglutide) between January and December 2025. Patients were assessed at baseline and after a median follow-up of 5 months. Eight of ten participants with complete paired data were included in the final analysis; two were excluded because one was non-responder with weight gain and suspected non-compliance, while one responder could not maintain the standing position for bioimpedance measurement. Bioimpedance analysis and anthropometry were performed at both visits. Paired data were analyzed using Wilcoxon signed-rank tests. Results: Eight children (4 boys, 4 girls; mean age 14.9±1.8 years) completed the study. Significant Body Mass Index (BMI) Z-score improvements were observed (CDC: -0.14, p=0.012; WHO: -0.37, p=0.012), with median weight reduction of 4.75 kg (p=0.036). While absolute muscle mass showed non-significant change (-1.3 kg, p=0.362), predicted muscle mass percentage increased significantly (+1.9%, p=0.012), suggesting selective fat loss. Fat-free mass percentage increased (+2.0%, p=0.012) with reciprocal fat mass reduction (absolute: -3.85 kg, p=0.017; percentage: -2.0%, p=0.012). Fat-free mass index remained stable (-0.67 kg/m², p=0.161). No serious adverse events occurred. Sensitivity analysis (n=10) confirmed the robustness of the results, with BMI Z-score improvements remaining significant. Conclusions: GLP-1 RA therapy in children with obesity leads to notable improvements in BMI Z-scores and beneficial body composition changes, suggesting muscle mass preservation along with weight loss, even at submaximal doses. These findings support conducting a larger prospective study with body composition as the primary endpoint.