Obesity and the Metabolic Syndrome in Children and Adolescents

Abstract

This multicenter prospective study compared uterine embolization with hysterectomy in the treatment of women with symptomatic leiomyomas. One hundred two patients were treated with embolization and 50 underwent hysterectomy. Clinical and demographic data, menstrual flow, menorrhagia, general health, and quality-of-life assessments were recorded for each patient. Follow up consisted of office visits with 1 to 3 weeks of treatment, at 3 months, and 6 months. Patients were mailed a questionnaire for evaluation at 12 months.Participants were between 30 and 50 years of age. Embolization patients were more often black, more likely to have had prior treatment for leiomyomas, and had more leiomyomas. The mean uterine volume for these patients was nearly twice that of hysterectomy patients.Embolization procedures took an average of 60 minutes. The average hospital stay was less than 1 day (mean 0.83 days), and the time to return to work was an average of 11 days after treatment. For hysterectomy patients, the mean operating time was 97 minutes, mean hospital stay was 2.3 days, and mean time to return to work was 33 days (P Ͻ0.001 for all 3 comparisons).Patients who had embolization had a 55.6% reduction in blood loss at the 3 months follow-up visit and a 58.1% reduction at 6 months (P Ͻ0.001 for change). Menorrhagia scores followed a similar pattern. Three hysterectomy patients had minimal cyclic bleeding after surgery. No other differences in symptoms were seen between the 2 groups at 6 months. At 12 months, 98% of hysterectomy patients had improved pelvic pain compared with 84% of embolization patients. Hysterectomy patients also reported a reduction in pelvic pressure more often than those who had embolization (98% vs. 84%). Urinary symptoms were similar in both groups.No differences were seen between the 2 groups in physical and mental health summaries and patient self-assessments of overall health status, which all showed improvement at 6 months and 12 months. Overall, patients who had the lowest baseline scores for these measures reported the greatest improvement at 6 months.The embolization group experienced a mean decrease in uterine volume of 26% at 3 months and 33.1% at 6 months (P Ͻ0.001 for both). Leiomyomata volume decreased by 45.8% and 54%, respectively (P Ͻ0.001 for both).At 3 and 6 months, 94% of hysterectomy patients expressed at least moderate satisfaction with symptom improvement; by 12 months, 97% were satisfied. Comparable scores for embolization patients were 89%, 88%, and 90%, respectively.Complications from treatment were more frequent among patients who had hysterectomy. Within the follow-up period, febrile morbidity was seen in 24% of hysterectomy patients and 12.7% of embolization patients (P Ͻ0.01). Eight percent and 3%, respectively, were readmitted to the hospital, 8.0% and 2.0% had additional unintended surgery, and 8.0% and 0.0% experienced blood loss requiring 2 or more units of blood (P Ͻ0.01). Overall morbidity was 34% in hysterectomy patients and 15% in embolization patients (P Ͻ0.01)....

Serum levels of omentin‐1 are increased after weight loss and are particularly associated with increases in obese children with metabolic syndrome

“…Visceral obesity plays an extremely important role in metabolic syndrome and it was obvious in this study that the reaction of the visceral adipose tissue was more sensitive to adipose decomposition than the peripheral adipose tissue . Body fat tissue is not just a lipid accumulation organ, but also a huge endocrine organ that produces many kinds of adipocytokines .…”

Diagnostic criteria patterns of U.S. children with Metabolic Syndrome: NHANES 1999–2002

“…MS has been be assessed using varying diagnostic criteria in the pediatric population and there is consensus that the potential development of MS in children is reason for concern [ 21 - 23 ]. Nevertheless, there is an urgent need to establish one uniform set of diagnostic guidelines for the diagnosis of pediatric MS [ 24 - 26 ].…”

Obesity, inflammation and the immune system

“…BMI and skin-fold thickness) in apparently healthy children and adolescents (11) . In overweight pediatric populations, higher circulating levels have been found for several inflammation-related proteins, such as CRP, IL-6, or TNFa (12)(13)(14)(15)(16)(17)(18) ( Table 1). Other inflammatory markers less extensively studied appear to be related to obesity as well.…”