Relationship between severe obesity and gut inflammation in children: what's next?

Abstract

BackgroundPreliminary evidence suggests an association between obesity and gut inflammation.AimsTo evaluate the frequency of glucose abnormalities and their correlation with systemic and intestinal inflammation in severely obese children.Patients and MethodsThirty-four children (25 males; median age 10.8 ± 3.4 yrs) with severe obesity (BMI >95%) were screened for diabetes with oral glucose tolerance test (OGTT), systemic inflammation with C-reactive protein (CRP) and gut inflammation with rectal nitric oxide (NO) and faecal calprotectin.ResultsBMI ranged from 23 to 44 kg/m2, and BMI z-score between 2.08 e 4.93 (median 2.69 ± 0.53). Glucose abnormalities were documented in 71% of patients: type 2 diabetes in 29%, impaired fasting glucose (IFG) in 58%, and impaired glucose tolerance (IGT) in 37.5%. Thirty-one patients (91%) were hyperinsulinemic. CRP was increased in 73.5% with a correlation between BMI z-score and CRP (p 0.03). Faecal calprotectin was increased in 47% patients (mean 77 ± 68), and in 50% of children with abnormal glucose metabolism (mean 76 ± 68 μg/g), with a correlation with increasing BMI z-score. NO was pathological in 88%, and in 87.5% of glucose impairment (mean 6.8 ± 5 μM).ConclusionsIn this study, the prevalence of glucose abnormalities in obese children is higher than in other series; furthermore, a correlation is present between markers of systemic and intestinal inflammation and glucose abnormalities.

Serum Calprotectin Level in Children: Marker of Obesity and its Metabolic Complications

“…Inflammation causes endothelial dysfunction that may contribute to increased systemic vascular resistance and lead to the development of hypertension. Moreover, we did not find an association between calprotectin and hypertension, and thus whether inflammation is a cause or effect of hypertension is something that is not yet well understood [33,34].…”

“…Of importance is the fact that we reported a positive correlation between increased serum calprotectin and pathological FBG and insulin resistance in obese children despite the absence of specific intestinal symptoms and of intestinal disorders, confirming a key role of proinflammatory factors in insulin-resistance pathogenesis and supporting the evolving concept that inflammation might be a common denominator linking obesity to many of its pathological sequelae, through the increased expression of some inflammatory cytokines and several signaling pathways activation, interfering with insulin signaling and action [33][34][35].…”

Increased Levels of Calprotectin in Obesity Are Related to Macrophage Content: Impact on Inflammation and Effect of Weight Loss

“…In line with these functions, phagocytes reportedly express S100A8 and S100A9 under multiple inflammatory conditions, i.e., inflammatory bowel disease, rheumatoid arthritis or allograft rejection (8)(9)(10), whereas numerous pathological conditions associated with inflammation in humans are associated with elevated S100A8 and S100A9 levels (11). Furthermore, the inflammatory factors interleukin (IL)-1, interferon (IFN)-γ and tumor necrosis factor (TNF)-α induce the expression and secretion of the S100A8/A9 heterodimer (12)(13)(14).…”

Effects of long-term synbiotic supplementation in addition to lifestyle changes in children with obesity-related non-alcoholic fatty liver disease

“…In a recent study, the levels of pro-inflammatory cytokines and endotoxinrelated parameters were shown to increase in patients with NAFLD, and pro-inflammatory cytokine levels were correlated with the histological severity of NAFLD (18). Fecal calprotectin levels were studied in obese children, and a correlation was found with BMI and abnormal oral glucose tolerance test in children (19).…”