BACKGROUND/OBJECTIVES:The alarming increase in obesity worldwide is of concern, owing to the associations of obesity with metabolic syndrome (MetS), which has been associated with a proinflammatory state characterized by elevated plasma concentrations of several markers of inflammation. The aim of this study was to assess levels of inflammatory markers and their association with MetS among adolescents. SUBJECTS/METHODS: A random sample of adolescents (n ¼ 362, 143 boys and 219 girls, 12-17 years) was interviewed, anthropometrically measured and provided a fasting blood sample. Circulating levels of adiponectin, leptin, tumour necrosis factor-alpha, plasminogen activator inhibitor 1 (PAI-1), interleukin-6 and high-sensitivity C-reactive protein were measured. The association between inflammatory markers and sex, age, body mass index (BMI) status, MetS, physical activity and blood pressure was also calculated. RESULTS: Adiponectin levels are inversely associated and leptin levels are directly associated with MetS and BMI, but directly with gender (females show higher levels than boys), and PAI-1 levels are directly associated with MetS, among adolescents.

(1) Objective: to establish practical guidance for the design of future clinical trials in MS (metabolic syndrome) patients aged 18 and older, based on a systematic review of randomized clinical trials connecting diet, physical exercise and changes in body composition. (2) Method: this systematic review of randomized clinical trials (RCT) is based on the guidelines recommended by PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Criteria of selection: ≥18 years of age; patients diagnosed with MS; intervention programs including diet, physical exercise and/or modifications in the style of life as treatment, as well as the magnitude of changes in body composition (BC); randomized clinical trial published between 2004 and 2018. (3) Results: the multidisciplinary interventions describe major changes in BC, and the recurring pattern in these clinical trials is an energy reduction and control in the percentage of intake of macronutrients along with the performance of regularly structured exercise; the most analyzed parameter was waist circumference (88.9% of the trials), followed by body weight (85.2%), BMI (77.8%) and body fat (55.6%). (4) Conclusions: The analysis of the information here reported sheds light for the design of future clinical trials in adults with MS. The best anthropometric parameters and units of measurement to monitor the interventions are related to dietary and physical exercise interventions. A list of practical advice that is easy to implement in daily practice in consultation is here proposed in order to guarantee the best results in changes of body composition.

Objective: Bariatric surgery has emerged as effective treatment for obesity not only for the substantial and durable weight loss, but also by improving several obesity-related comorbidities, including hypertension. Extracellular vesicles (EVs; membrane nanoparticles released by cells) and their cargo reflect endothelial dysfunction and inflammation, and may be used as indicators of post-surgical outcomes in these patients. The aim of the present study was to exploit an EV signature to assess cardiovascular (CV) risk, metabolic profile, and inflammatory fingerprint before and after bariatric surgery. Design and method: The study cohort was composed by 62 patients (age 39 years; 21% males); for each subject, clinical and biochemical parameters, disease status (including diabetes, dyslipidemia, and hypertension), medications, and EV profiling were evaluated at baseline (T0) and 1-/3-years (T1 and T2, respectively), after surgery (sleeve gastrectomy or Roux-en-Y gastric bypass). EVs were isolated from serum by beads-based immuno-capture and analyzed for the expression of 37 membrane-associated antigens. Results: After bariatric surgery, patients gradually lost weight from a median of 110 Kg at T0 down to 80 Kg at T2 (cumulative weight loss 31 Kg; 29.9% BMI reduction). Accordingly, the overall CV risk and metabolic-inflammatory profile of patients improved: systolic blood pressure, HbA1c, total cholesterol, triglycerides, LDL, uric acid, white blood cells, and C-reactive protein decreased, while HDL and renal function (expressed as eGFR) increased at follow-up (p < 0.05 for all comparisons); prevalence of hypertension, dyslipidemia, and diabetes decreased together with the number of assumed drugs (anti-hypertensives, statins, hypoglycemic, and anti-platelets agents). Consistently, levels of expression of EV specific markers (CD9-CD63-CD81) and 11 out of the 37 evaluated antigens (mainly from endothelium, platelets, and inflammatory cells) decreased at T1/T2, reflecting changes of main CV risk indicators. Interestingly, lower baseline levels of CD4, CD31, CD40, CD42a, and CD62P were associated to a complete post-surgical outcome, defined as no residual disease without medications, with a BMI at T2 lower than 30 Kg/sqm. Conclusions: EV-derived biomarkers reflect the improvement of CV profile in patients who underwent bariatric surgery and may become a new tool to predict post-surgical outcome.