Obesity in childhood increases the risk for early adult cardiovascular disease. However, the underlying mechanism is not fully known. The aims of this study were to measure levels of prothrombotic factors and examine their possible association with obesity and insulin resistance in obese children and adolescents. A total of 313 obese children and adolescents were recruited. In a cross-sectional design, we measured anthropometric parameters, plasminogen activator inhibitor-1-antigen (PAI-1-Ag), von Willebrand factor-antigen (vWF-Ag), fibrinogen (FB), lipids, fasting glucose, and insulin (FI) levels. Insulin resistance was estimated using the homeostasis model assessment for insulin resistance (HOMA-IR) index. Boys presented significantly higher PAI-1-Ag levels than girls (82.6 vs. 71.3 ng/ml, p = 0.01). Higher levels of PAI-1-Ag (96.8 vs. 69 ng/ml, p < 0.001), vWF-Ag (123.5 vs. 107.6%, p = 0.004) but not FB (353.1 vs. 337.6 mg/dl, p = 0.137) were found in insulin-resistant (IR) participants after adjusted for age, gender, and pubertal stage. IR patients were at 2.98 (CI: 1.084–8.193) and 4.86 (CI: 1.119–15.606) times greater risk for high PAI-1-Ag and vWF-Ag levels, respectively. All three prothrombotic factors were positively correlated with body mass index (BMI) and FI levels (p < 0.05), but only PAI-1-Ag and vWF-Ag were significantly correlated with HOMA-IR index (p ≤ 0.001). After adjustment for confounding factors, both BMI and HOMA-IR indices remained significantly associated with PAI-1-Ag (r ² = 0.225, p < 0.001) and vWF-Ag levels (r ² = 0.077, p = 0.003). Conclusion: This study shows that obesity in youngsters, when accompanied with insulin resistance, is associated with at least threefold increased risk for elevated levels of prothrombotic factors, contributing to the early development of atherothrombosis. This impaired prothrombotic state may partially explain the increased risk for developing cardiovascular disease later in adulthood.

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.

The longer-term effects of early high-dose vitamin A to support lung development in preterm infants remain to be clarified. The aim of the NeoVitaA follow-up study was to assess the effects of early postnatal additional high-dose fat-soluble enteral vitamin A supplementation (HD-VitA) vs. placebo (control) for 28 days on respiratory complications and neurodevelopmental outcome in ELBW infants receiving recommended basic vitamin A supplementation, specified as secondary outcome parameters in the NeoVitaA trial. The trial was approved by the ethics committee of Saarland, Saarbruecken, Germany (file number: 70/2011) as well as by all local ethics committees and the Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM, Bonn, Germany). The NeoVitaA trial was registered with EudraCT (2013-001998-24) and DRKS (DRKS00006541). This follow-up covers secondary endpoints at 12 and 24 months as mentioned in the registration. Follow-up took place between September 2019 and June 2024. Follow-up assessment at 12 and 24 months’ corrected age (CA) of infants enrolled in the NeoVitaA-trial included anthropometric data, number of antibiotic treatments, antibiotic treatments for pulmonary infections, hospital admissions, and hospital admissions for pulmonary infections, composite scores of the Bayley Scale of Infant and Toddler Development, second (Bayley-II) or third edition (Baley-III), other medical diagnoses and medical treatments. Follow-up examinations were available for 759 infants (83.0%). HD-VitA had no effect on number of antibiotics needed for pulmonary infections or number of hospital admissions for pulmonary infections at 12 or 24 months' CA. At 24 months’ CA, the median number of antibiotic courses for pulmonary infections was one for both the HD-VitA and control group; the median number of hospital admissions for pulmonary infections per patient was 0 (HD-VitA) and 1 (control). Successful Bayley assessment was completed in 618/759 infants (92 Bayley-II, 526 Bayley-III). The median Mental Development Index score for Bayley-II was 95 vs. 97 (median difference −5.0, 95%-CI [−12.0, 2.0]) and Psychomotor Development Index 96 vs. 92 (median difference 3.0, 95%-CI [−4.0, 8.0]), with intervention and placebo, respectively. The median cognitive composite score for Bayley-III was 95 vs. 95 (median difference 0.0, 95%-CI [−5.0, 0.0]) and motor score was 92 vs. 92 (median difference 0.0, 95%-CI [−4.0, 3.0]), respectively. Early postnatal high-dose enteral fat-soluble vitamin A supplementation in ELBW infants did not affect pulmonary or developmental outcomes at 24 months’ CA. The NeoVitaA trial was funded by the 10.13039/501100001659 Deutsche Forschungsgemeinschaft ME 3827/1-1/2 and European Clinical Research Infrastructures Network.