Dataset Information

Autonomic Function in Obese Children and Adolescents: Systematic Review and Meta-Analysis.

ABSTRACT: Background: Obesity is invariably accompanied by autonomic dysfunction, although data in pediatric populations are conflicting. Methods: We conducted a systematic review and meta-analysis of 12 studies (totaling 1102 participants) comparing obese and normal-weight subjects (5-18 years of age), defined as body mass index >95th or <85th percentile, respectively. Using a random-effects model, we report the standardized mean differences (SMD) of sympathetic and vagal indices of heart rate variability. Results: Autonomic dysfunction was present in the obesity group, based on the average SMD in the standard deviation of sinus intervals (at -0.5340), and on the ratio of low (LF)- to high (HF)-frequency spectra (at 0.5735). There was no difference in sympathetic activity, but the heterogeneity among the relevant studies weakens this result. SMD in HF (at 0.5876), in the root mean square of successive differences between intervals (at -0.6333), and in the number of times successive intervals exceeded 50 ms divided by the total number of intervals (at -0.5867) indicated lower vagal activity in the obesity group. Conclusions: Autonomic dysfunction is present in obese children and adolescents, attributed to lower vagal activity. Further studies are needed in various pediatric cohorts, placing emphasis on sympathetic activity.

SUBMITTER: Papadopoulos GE

PROVIDER: S-EPMC11012290 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

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Autonomic Function in Obese Children and Adolescents: Systematic Review and Meta-Analysis.

Papadopoulos Georgios E GE Balomenou Foteini F Sakellariou Xenofon M XM Tassopoulos Christos C Nikas Dimitrios N DN Giapros Vasileios V Kolettis Theofilos M TM

Journal of clinical medicine 20240323 7

<b>Background:</b> Obesity is invariably accompanied by autonomic dysfunction, although data in pediatric populations are conflicting. <b>Methods:</b> We conducted a systematic review and meta-analysis of 12 studies (totaling 1102 participants) comparing obese and normal-weight subjects (5-18 years of age), defined as body mass index >95th or <85th percentile, respectively. Using a random-effects model, we report the standardized mean differences (SMD) of sympathetic and vagal indices of heart r ...[more]

PMID: 38610619

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Project description:PurposeThis study [PROSPERO CRD42023416272] systematically analysed the effects of a physical activity intervention on cardiorespiratory fitness in obese children and adolescents and elucidated the factors that influenced those effects.MethodsA systematic review of the literature on physical activity interventions for improving cardiopulmonary fitness in obese children and adolescents from January 1, 2011, to March 1, 2023, was conducted. The search was performed on the Web of Science and PubMed databases, and the selected literature was first screened and then assessed for quality. Finally, a systematic review was conducted.ResultsOut of the initially identified 1424 search records, 28 studies were eventually included in the systematic review. These studies encompassed a total of 2724 participants aged 5 to 18 years, with the publication dates of the literature primarily ranging from 2011 to 2023. Physical activity was found to effectively improve the following parameters in obese children and adolescents: weight [mean difference (MD), -2.03 (95% confidence interval, -2.59 to -1.47), p < 0.00001], maximal oxygen consumption [MD, -1.95 (95% CI, -1.06 to -2.84), p < 0.0001], heart rate [MD, -2.77 (95% CI, -4.88 to -0.67), p = 0.010], systolic blood pressure [MD, -8.11 (95% CI, -11.41 to -4.81), p < 0.00001], and diastolic blood pressure [MD, -4.18 (95% CI, -5.32 to -3.03), p < 0.00001]. High-intensity exercise was found to yield greater improvements than low- to moderate-intensity exercise in maximal oxygen consumption [MD, 1.43 (95% CI, 0.04 to 2.82), p = 0.04] and diastolic blood pressure [MD, -6.94 (95% CI, -10.61 to -3.26), p = 0.0002] in obese children and adolescents.ConclusionPhysical activity can effectively improve the body weight, maximal oxygen consumption, heart rate, systolic blood pressure, and diastolic blood pressure of obese children and adolescents. The type of physical activity directly influences the participation interest of obese children and adolescents, with moderate- to high-intensity physical activity showing the most significant impact on intervention outcomes. High-frequency, long-term interventions yield better results than short-term interventions.

Project description:the clustering of metabolic syndrome (MetS) risk factors is becoming more prevalent in children, leading to the development of type 2 diabetes (T2D) and cardiovascular diseases in early adulthood. The impact of MetS risk factors on cardiac autonomic modulation (CAM) or vice versa has been noted to track from childhood to pre-adolescence and adolescence. Understating associations in this age group may help to improve the clinical outcomes of the MetS, even when MetS symptoms are not visible. Potential damage from each individual MetS component and the ability to predict early cardiac damage or upcoming cardiovascular events is very important. Therefore, the present systematic review and meta-analysis investigated the associations between CAM and MetS risk factors individually to verify which of the MetS risk components were significantly correlated with heart rate variability (HRV) indices before or at the onset of the MetS among young people. The purpose of this review was to outline the importance of potentially screening HRV indices in young people even with only one MetS risk factor, as a pre-indicator for early cardiovascular risk stratification. cross-sectional studies that examined the relationship of MetS risk factors with HRV indices were searched using four databases including PubMed, the Cochrane clinical trials library, Medline and the Web of Science. Correlation coefficients with 95% confidence intervals (95% CI), and random effects meta-analyses of the association between MetS risk factors with HRV indices were performed. out of 14 cross-sectional studies and one case-control study, 8 studies (10 data sets) provided association data for the meta-analysis. Our results indicated significant positive correlations for systolic blood pressure (SBP) (correlation coefficient 0.13 (95%CI: 0.06; 0.19), I2 = 47.26%) and diastolic blood pressure (DBP) (correlation coefficient 0.09 (95%CI: -0.01; 0.18), I2 = 0%) with a Low Frequency/High Frequency ratio (LF/HF). Significant negative correlations for waist circumference (WC) (correlation coefficient -0.12 (95%CI: -0.19; -0.04), I2 = 51.50%), Triglycerides (TGs) (correlation coefficient -0.09 (95%CI: -0.15; -0.02), I2 = 0%) and ≥2 MetS risk factors (correlation coefficient -0.10 (95%CI: -0.16; -0.03), I2 = 0%); with high frequency (HF) were revealed. Significant positive correlations for high density lipoprotein (HDL) (correlation coefficient 0.08 (95%CI: 0.05; 0.11), I2 = 0%) and significant negative correlations of ≥2 MetS risk (correlation coefficient -0.04 (95%CI: -0.12; 0.03), I2 = 0.0%) with low frequency (LF) were revealed. Significant negative correlations for TGs (correlation coefficient -0.09 (95%CI: -0.23; 0.05), I2 = 2.01%) with a mean square root of the sum of differences between mean time between two successive intervals (rMSSD) and significant positive correlation of HDL (correlation coefficient 0.09 (95%CI: -0.01; 0.19), I2 = 0.33%) with standard deviation of the time between two successive intervals (SDNN) were also revealed. An Egger's test indicated that there was no obvious publication bias for any of the above relationships except for TGs and rMSSD. The significance level stipulated for the meta-analysis was p < 0.05. lipid profiles (HDL and TGs), WC and BP were associated with CAM in young people up to the age of 19 years. The use of HRV indices to predict future MetS risk, and relationships with individual risk factors including HDL, BP, WC and TGs, were established. Future studies related to young people (up to the age of 19 years) are recommended to explore the associations reported here further.

Project description:BackgroundOverweight and obesity are major public health problems in children and adolescents. The purpose of this study was to conduct a systematic review with meta-analysis to determine the effects of exercise (aerobic, strength or both) on body mass index (BMI) z-score in overweight and obese children and adolescents.MethodsStudies were included if they were randomized controlled exercise intervention trials ≥ 4 weeks in overweight and obese children and adolescents 2 to 18 years of age, published in any language between 1990-2012 and in which data were available for BMI z-score. Studies were retrieved by searching eleven electronic databases, cross-referencing and expert review. Two authors (GAK, KSK) selected and abstracted data. Bias was assessed using the Cochrane Risk of Bias Assessment Instrument. Exercise minus control group changes were calculated from each study and weighted by the inverse of the variance. All results were pooled using a random-effects model with non-overlapping 95% confidence intervals (CI) considered statistically significant. Heterogeneity was assessed using Q and I2 while funnel plots and Egger's regression test were used to assess for small-study effects. Influence and cumulative meta-analysis were performed as well as moderator and meta-regression analyses.ResultsOf the 4,999 citations reviewed, 835 children and adolescents (456 exercise, 379 control) from 10 studies representing 21 groups (11 exercise, 10 control) were included. On average, exercise took place 4 x week for 43 minutes per session over 16 weeks. Overall, a statistically significant reduction equivalent to 3% was found for BMI z-score (Χ¯, -0.06, 95% CI, -0.09 to -0.03; Q = 24.9, p = 0.01; I(2)=59.8%). No small-study effects were observed and results remained statistically significant when each study was deleted from the model once. Based on cumulative meta-analysis, results have been statistically significant since 2009. None of the moderator or meta-regression analyses were statistically significant. The number-needed-to treat was 107 with an estimated 116,822 million obese US children and adolescents and approximately 1 million overweight and obese children and adolescents worldwide potentially improving their BMI z-score by participating in exercise.ConclusionsExercise improves BMI z-score in overweight and obese children and adolescents and should be recommended in this population group. However, a need exists for additional studies on this topic.

Project description:OBJECTIVES:Determine both the effects and hierarchy of effectiveness for exercise interventions (aerobic, strength training or both) on selected measures of adiposity (body mass index (BMI) in kg/m2, fat mass and per cent body fat) in overweight and obese children and adolescents. DESIGN:Network meta-analysis of randomised exercise intervention trials. SETTING:Any setting where a randomised trial could be conducted. PARTICIPANTS:Overweight and obese male and/or female children and adolescents 2-18 years of age. INTERVENTIONS:Randomised exercise intervention trials>4 weeks, published between 1 January 1973 and 22 August 2018, and which included direct and/or indirect evidence for aerobic, strength training or combined aerobic and strength training. PRIMARY OUTCOMES:Changes in BMI in kg/m2, fat mass and per cent body fat. RESULTS:Fifty-seven studies representing 127 groups (73 exercise, 54 control) and 2792 participants (1667 exercise, 1125 control) met the criteria for inclusion. Length of training ([Formula: see text] ± SD) averaged 14.1±6.2 weeks, frequency, 3.3±1.1 days per week and duration 42.0±21.0 min per session. Significant and clinically important reductions in BMI, fat mass and per cent body fat were observed in aerobic versus control comparisons (BMI, mean, 95% CI -1.0, 1.4 to -0.6; fat mass -2.1, -3.3 to -1.0 kg; per cent fat -1.5, -2.2 to -0.9%) and combined aerobic and strength versus control comparisons (BMI -0.7, -1.4 to -0.1; fat mass -2.5, -4.1 to -1.0 kg; per cent fat, -2.2, -3.2 to -1.2%). A significant reduction in per cent fat was also found for strength vs control comparisons (-1.3,-2.5 to -0.1%). Combined aerobic and strength training was ranked first for improving both fat mass (kg) and per cent body fat while aerobic exercise was ranked first for improving BMI. CONCLUSIONS:Aerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents. PROSPERO REGISTRATION NUMBER:CRD42017073103.

Project description:ObjectiveThis systematic review and meta-analysis aims to systematically analyse the association of overweight and obesity with health service utilisation during childhood.Data sourcesPubMed, MEDLINE, CINAHL, EMBASE and Web of Science.MethodsObservational studies published up to May 2020 that assessed the impact of overweight and obesity on healthcare utilisation in children and adolescents were included. Studies were eligible for inclusion if the included participants were ≤19 years of age. Findings from all included studies were summarised narratively. In addition, rate ratios (RRs) and 95% CIs were calculated in a meta-analysis on a subgroup of eligible studies.Outcome measuresIncluded studies reported association of weight status with healthcare utilisation measures of outpatient visits, emergency department (ED) visits, general practitioner visits, hospital admissions and hospital length of stay.ResultsThirty-three studies were included in the review. When synthesising the findings from all studies narratively, obesity and overweight were found to be positively associated with increased healthcare utilisation in children for all the outcome measures. Six studies reported sufficient data to meta-analyse association of weight with outpatient visits. Five studies were included in a separate meta-analysis for the outcome measure of ED visits. In comparison with normal-weight children, rates of ED (RR 1.34, 95% CI 1.07 to 1.68) and outpatient visits (RR 1.11, 95% CI 1.02 to 1.20) were significantly higher in obese children. The rates of ED and outpatient visits by overweight children were only slightly higher and non-significant compared with normal-weight children.ConclusionsObesity in children is associated with increased healthcare utilisation. Future research should assess the impact of ethnicity and obesity-associated health conditions on increased healthcare utilisation in children with overweight and obesity.Prospero registration numberCRD42018091752.

Project description:BackgroundLower urinary tract symptoms (LUTS) are common in children and adolescents. Non-invasive tests evaluating bladder function are generally preferred over invasive tests, yet few studies have explored the range of normative values for these tests in healthy, asymptomatic children.ObjectiveTo define normative reference ranges for non-invasive tests of bladder function in healthy, asymptomatic girls and adolescents.Study designA comprehensive search strategy was performed in seven electronic databases through October 2019. English-language studies reporting data on voiding frequency, voided and postvoid residual volumes (PVR) and uroflowmetry results in healthy, asymptomatic girls (mean age ≥ 5 years) were included. Two independent reviewers performed study review, data extraction, and quality assessment. Overall mean estimates and 95% confidence intervals for each bladder function parameter were calculated using random effects models, and 95% normative reference values were estimated.ResultsTen studies met eligibility criteria for the meta-analysis (n = 2143 girls, age range: 3-18). Mean estimates of maximum voided volume and PVR were 233.4 ml (95% CI 204.3-262.6; n = 1 study) and 8.6 ml (95% CI 4.8-12.4; n = 2 studies) respectively. Pooled mean estimates for uroflowmetry parameters were: 21.5 ml/s (95% CI 20.5-2.5) for maximum flow rate (n = 6 studies), 12.5 ml/s (95% CI 11.2-13.8) for mean flow rate (n = 6 studies), 6.8 s (95% CI 4.4-9.3) for time to maximum flow (n = 3 studies), 15.7 s (95% CI 13.0-18.5) for flow time (n = 3 studies), and 198.7 ml (95% CI 154.2-234.2) for voided volume (n = 9 studies). No studies reported estimates of voiding frequency. Between-study heterogeneity was high (89.0-99.6%).ConclusionsAlthough we were able to calculate pooled mean estimates for several parameters, the small number of included studies and the wide age ranges of participants preclude generalization of reference values to all healthy girls. Further research is needed to determine normative reference values within specific age groups.

Dataset Information

Autonomic Function in Obese Children and Adolescents: Systematic Review and Meta-Analysis.

Publications

Autonomic Function in Obese Children and Adolescents: Systematic Review and Meta-Analysis.

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