Childhood Obesity, Endothelial Cell Activation, and Critical Illness

Radman, Monique; McGuire, John J.; Zimmerman, Jerry J.

doi:10.3389/fped.2020.00441

Cited by 7 publications

(8 citation statements)

References 117 publications

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“…Endothelial activation may lead to vasoconstriction, prothrombotic states and the release of anti-mitogenic mediators [ 16 – 22 ]. The association between obesity and the severity of endothelial activation and dysfunction in critically ill children is widely studied, particularly with the more significant oxidative stress and insulin resistance which may occur in these patients [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)

et al. 2021

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Background The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. Methods An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. Results There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). Conclusions Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.

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Section: Discussionmentioning

confidence: 99%

Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)

et al. 2021

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“…Rates of obesity in pediatric populations remain high in developed countries such as the United States and Canada, with prevalence rates of 18.5% and 13.1%, respectively (1). This is of particular importance because of the association of pediatric obesity with metabolic syndrome, inflammation, and a variety of other comorbidities (2). Current weight‐management treatments for pediatric patients include behavioral therapy, pharmacotherapy, and bariatric surgery (3).…”

Section: Introductionmentioning

confidence: 99%

A systematic review of binge eating, loss of control eating, and weight loss in children and adolescents

Moustafa

Quigley

Wadden

et al. 2021

Obesity

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Pediatric obesity is a global health concern. Rates of obesity in pediatric populations remain high in developed countries such as the United States and Canada, with prevalence rates of 18.5% and 13.1%, respectively (1). This is of particular importance because of the association of pediatric obesity with metabolic syndrome, inflammation, and a variety of other comorbidities (2). Current weightmanagement treatments for pediatric patients include behavioral therapy, pharmacotherapy, and bariatric surgery (3). These treatments can help patients lose weight. However, there has been concern that, in children and adolescents, they may promote or worsen disordered eating behaviors, such as binge eating (BE) and loss of control eating (LOC) (4). Several mechanisms have been proposed that may underlie this relationship (5). High levels of rigid dietary restraint have been identified as a central risk and maintaining factor of BE. Dieting may result in hunger and associated physiological responses, which may contribute to BE. In some individuals, externally or self-imposed dietary rules may be strict and increasingly difficult to sustain over the long term. The inevitable breaking of these rules may induce an all-or-none reaction, resulting in BE (i.e., the abstinence violation effect).BE is reported by 20% to 35% of youth seeking weight loss (6). BE is defined as "the subjective experience of loss of control while eating a reportedly objectively large amount of food" (7).In 2013, the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) added binge eating disorder (BED) as an independent diagnosis for those who have recurrent BE episodes while

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“…Endothelial activation may lead to vasoconstriction, prothrombotic states and the release of anti-mitogenic mediators (19)(20)(21)(22)(23)(24)(25). The association between obesity and the severity of endothelial activation and dysfunction in critically ill children is widely studied, particularly the more significant oxidative stress and insulin resistance which may occur in these patients (26,27).…”

Section: Discussionmentioning

confidence: 99%

Mortality and Clinical Characteristics of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 in critically ill patients: an observational multicenter study (MISCO STUDY)

Acevedo

Piñeres-Olave²,

Niño-Serna

et al. 2021

Preprint

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Background The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 is widespread and presents a very low mortality rate in highincome countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries compared to described series in high-income countries along with the factors associated with mortality and worse outcomes. Methods An observational cohort study was conducted in 14 PICUs in Colombia between April 01, 2020 and January 31, 2021. Patient´s age ranged between one month and 18 years and they met the requirements set forth by WHO for MIS-C. Results There were seventy-eight children in this study. The median age was seven years (IQR 1- 11), 18% (14/78) were under one year old, and 56% were male. Thirty-five percent (29/78) were obese or overweight. The PICU stay was six days (IQR 4-7), and 100% had a fever on admission lasting five days (IQR 3.7-6). Seventy percent (55/78) had diarrhea, and 87% (68/78) had shock or myocardial dysfunction (78%). Compared to the United Kingdom (UK) study, there were more children under the age of five (37% vs. 10%; p=0.004), and there was a higher frequency of obesity (29.5% vs. 10%; p=0.008). With regard to the US study, there was more lymphadenopathy (23% vs. 13%; p=0.02), diarrhea (70.5% vs. 53%; p=0.001), lymphopenia (64% vs. 35%; p=0.001), shock (87% vs. 35%; p=0.001), elevated troponin (51% vs. 31%; p=0.006) and elevated proBNP (82% vs 43%; p=0.001), as well as greater mortality (9% vs 1.8%; p=0.001). The group that did not survive had a longer duration of the disease until admission to the PICU (6 days vs. 5 days; p = 0.003), more frequency of ferritin above 500 ngr/mL (100% vs. 45%; p = 0.012) and more cardiovascular complications (100% vs. 54%; p = 0.019) compared to the group that survived. Conclusions Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. It was observed inflammatory response, and cardiovascular involvement were conditions that, added to the difficulties in accessing healthcare systems in countries with limited resources, may explain the higher mortality seen in these children.

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Childhood Obesity, Endothelial Cell Activation, and Critical Illness

Cited by 7 publications

References 117 publications

Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)

Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study)

A systematic review of binge eating, loss of control eating, and weight loss in children and adolescents

Mortality and Clinical Characteristics of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 in critically ill patients: an observational multicenter study (MISCO STUDY)

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