Pediatric Obesity: Endocrinologic and Genetic Etiologies and Management

We describe these rare conditions and the dysregulation of neuropathways in obesity and review successes and failures in treatments in both syndromic and nonsyndromic obesity.Recent FindingsThe best-described form of syndromic obesity is Prader –Willi Syndrome (PWS). While recent pharmacotherapies (specifically beloranib) demonstrated improvements in weight in PWS, the unfortunate adverse effect of deep vein thrombosis and pulmonary embolism necessitated the halting of its further development. Additional treatments are in development whi ch target the signaling of ghrelin and other hypothalamic targets known to be dysregulated in PWS. For nonsyndromic obesity, lifestyle modifications remain the mainstay of treatment. However, recent large-scale interventions have had disappointing results. Bariatric surgery in children holds some pr omise, though complications and reoperations are common. Pharmacotherapies have been developed that treat rare monogenic forms of obesity, including MC4R agonists, which hold promise for these uncommon explanations for early childhood weight gain. There is evidence that methylation patterns in key g enes in the neuroregulation of appetite are altered in individuals with obesity. Interestingly, this altered methylation is evident in sperm, which may have an impact on the heritability of gene expression across generations.SummaryPediatric obesity is complex and multifactorial. Efforts in rare monogenic and syndromic obesity may give rise to po...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research

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In this study, mature DCs (mDCs), generated from the GM-CSF and IL-4 induced bone marrow cells, were intravenously injected into wild-type mice. Three days later, assays showed that the mDCs were indeed able to return to the thymus. Homing DCs have been mainly reported to deplete thymocytes and induce tolerance. However, medullary TECs (mTECs) play a crucial role in inducing immune tolerance. Thus, we evaluated whether the mDCs homing into the thymus led to TECs depletion. We cocultured mDCs with mTEC1 cells and found that the mDCs induced the apoptosis and inhibited the proliferation of mTEC1 cells. These effects were onl...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
CONCLUSIONS: Bariatric surgery has been safely performed in patients who made a full recovery from COVID-19 without increased complications due to cardiovascular, pulmonary, venous thromboembolism, or increased mortality rates.PMID:34446386 | DOI:10.1016/j.soard.2021.07.018
Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery - Category: Surgery Authors: Source Type: research
AbstractPurposeThe aim was to evaluate the complication rate after abdominoplasty procedures performed in a high volume post-bariatric center and to identify predictors of complications.Material and MethodsA retrospective analysis was performed and included all abdominoplasty procedures performed between January 2011 and December 2019. Complications classified according to the Clavien-Dindo classification were documented and potential risk factors were statistically evaluated.ResultsA total of 898 patients were included. Overall complication rate was 29.8%. Type I complications (minor wound problems) occurred in 15.8% (n =...
Source: Obesity Surgery - Category: Surgery Source Type: research
ConclusionComplex bariatric operations and patients who require post-discharge extended care are associated with early readmissions. Such readmissions are due to early post-discharge complications. However, late readmissions are driven by interrelated risk factors and complications. These findings suggest that targeting patients at risk for delayed rehospitalization is the most efficient approach to minimize readmissions after bariatric surgery.
Source: Obesity Surgery - Category: Surgery Source Type: research
Despite thromboprophylaxis, postoperative deep vein thrombosis and pulmonary embolism (PE) occur after bariatric surgery, perhaps due to failure to achieve optimal prophylactic levels in the obese population.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Tags: Original articles Source Type: research
Authors: Tromeur C, Le Mao R, Leven C, Couturaud F, Théreaux J, Lacut K Abstract Despite the high proportion of obese patients this population remains understudied in the field of venous thromboembolic disease (VTE). Obesity is a risk factor for pulmonary embolism and/or deep vein thrombosis, especially when it is associated with other risk factors for VTE. Currently there is no validated diagnostic algorithm for VTE in the population of obese patients. Moreover, imaging examinations can be of poor quality and inconclusive. In the prevention of VTE, data concerning obese patients are mainly based on low-leve...
Source: Revue des Maladies Respiratoires - Category: Respiratory Medicine Tags: Rev Mal Respir Source Type: research
AbstractObesity and diabetes can lead to heart failure with preserved ejection fraction (HFpEF), potentially because they both cause expansion and inflammation of epicardial adipose tissue and thus lead to microvascular dysfunction and fibrosis of the underlying left ventricle. The same process also causes an atrial myopathy, which is clinically evident as atrial fibrillation (AF); thus, AF may be the first manifestation of HFpEF. Many patients with apparently isolated AF have latent HFpEF or subsequently develop HFpEF. Most patients with obesity or diabetes who have AF and exercise intolerance have increased left atrial p...
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Review Source Type: research
This study evaluates the incidence of bariatric surgery (BS) before total joint arthroplasty (TJA) in New York State and compares patient comorbidities and 90-day postoperative complications of patients with and without BS before TJA. METHODS: The NY Statewide Planning and Research Cooperative System database between 2005 and 2014 was reviewed and 343,710 patients with TJA were identified. Patients were stratified into the following three cohorts: group 1 (patients who underwent BS
Source: The Journal of the American Academy of Orthopaedic Surgeons - Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research
This study aims to assess the safety of bariatric surgery on these patients.MethodsData was extracted from 2015 to 2017 using the MBSAQIP database. Included patients were those who underwent a primary LSG or LRYGB. A multivariable regression analysis was performed looking at 30-day outcomes for pre-operatively anticoagulated patients. A secondary propensity-matched analysis was performed comparing outcomes among patients undergoing LSG vs LRYGB.ResultsA total of 430,396 patients were analyzed, 11,013 (2.56%) of which were taking anticoagulation medications pre-operatively. Absolute 30-day complication rates (8.73% vs 3.36%,p 
Source: Obesity Surgery - Category: Surgery Source Type: research
Post-operative venous thromboembolism (VTE) remains a considerable complication following bariatric surgery. While earlier studies of bariatric surgery report VTE rates of 3% or higher(1,2), more recent studies and larger database reviews have reported the rates to be about 1% or less(3-6). However, the morbidity and mortality from a VTE event, particularly a pulmonary embolism, in a post-bariatric surgery patient is significant with it being one of the top 3 causes of mortality. In recognition of the importance of this topic, the ASMBS initially issued a position statement on VTE prophylaxis in 2007 and then an updated statement in 2013.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
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