Obesity is multifactorial dissease. Genetics factors participate in its origin of 40-70% (Barsh et al., 2000). Incidence of obesity is associated with a number of complications, which affect quality of life and abbreviate its length. It is projected in constantly younger age and its prevalence in the world grows. Even though several hundred genetics markers associated with obesity have been described, we still do not know all causes, which complicates efficiancy of treatment. Subject of this study was research of selected genes and their polymorphisms: FABP2 (rs1799883) and PLIN (rs1052700 and rs894160). The aim was to establish association between genotypes and antropometric and biochemical parameters related to obesity in group of 299 children and adolescents aged 7-18 years. Next goal was to establish whether these polymorphisms affect success of reduction therapy. SNP associations with antropometric and/or biochemical parameters were evaluated for boys and girls separately. Observed genotype frequencies between sex did not differ and they were in accordance with those explored in other populations. In rs1799883 polymorphism neither association with measured anthropometric and biochemical parameters nor effect on weight loss during reduction therapy have been found. The TT homozygote subjects of...

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A obesidade na infância e adolescência tem aumentado de forma bastante acentuada, e quando observada nos primeiros anos de vida leva um maior risco para hipercolesterolemia, hipertrigliceridemia e alterações cardiovasculares na vida adulta. Uma correlação positiva tem sido observada entre a BMI (Body Mass Index, ou índice de massa corporal) e alterações metabólicas e hematológicas, implicando em alterações na capacidade de cicatrização, na defesa imunológica e celular e no desenvolvimento de diferentes patologias. O objetivo deste estudo foi avaliar os efeitos das fases iniciais da hipercolesterolemia, ou seja, nas idades infantil e juvenil e com pequeno aumento de colesterol, sobre os tecidos bucais e a capacidade de cicatrização. A Ratos Wistar (40g de peso) foi oferecido uma ração preparada com 1% de aumento (em peso) de colesterol + 20% de gordura (óleo de soja) por um período de 2 e 6 semanas para avaliação dos tecidos bucais. Após 2 semanas do uso da ração enriquecida com colesterol foram realizadas feridas cirúrgicas no dorso dos animais para avaliação da cicatrização. Ao final dos tratamentos propostos, os animais foram sacrificados, e colhidas as peças utilizadas (sangue, pele, língua, palatos e região gengival). O sangue coletado foi centrifugado e o soro foi utilizado para avaliação das lipoproteínas - colesterol total, HDL, LDL, VLDL e triglicérides em espectrofotômetro de absorbância. As peças colhidas foram levadas para fixação e descalcificação de acordo com a necessidade, processadas para inclusão em parafina, cortadas com 6 µm de espessura, montadas em lâminas de vidro e coradas com hematoxilina e eosina. Essas peças foram utilizadas para avaliação histológica dos tecidos e do processo de cicatrização, por meio de técnicas morfométricas. Os dados colhidos foram apresentados em valores médios, e as diferenças analisadas por testes estatísticos adequados para a comparação entre as amostras. Nossos resultados mostram que a hipercolesterolemia provocou alterações em tecidos epiteliais e que esses efeitos parecem ser progressivos, ou seja, se tornam mais expressivos com o uso continuado de alimentação com índice de colesterol aumentado, e que existe um aparente atraso no processo de cicatrização nos indivíduos que utilizam dieta hipercolesterolêmica. Consideramos que essas alterações podem tornar esses indivíduos mais suscetíveis a alterações bucais e prejudicar as reações teciduais frente a injúrias, o que pode ser preocupante durante um tratamento odontológico, principalmente cirúrgico mas também em situações de reabilitação oral ou em tratamentos odontológicos de rotina. / Obesity in childhood has becoming a concern. Obesityy is associated with increased triglycerides, decreased high-density lipoprotein cholesterol levels, and increased low-density lipoprotein cholesterol and may lead to increased risk for hypercholesterolemia and cardiovascular complications in adult life. Clinical symptoms and signs of elevated cholesterol levels do not occur until adulthood, but subclinical aspects may be observed in children and adoslecentes. There are no studies on the effects of hypercholesterolemia in children, adolescents or in adults on oral tissues. We propose to study the influence of early age hypercolesterolemia in epithelial oral tissues and on wound healing. Male albino Wistar rats (40g) received enriched cholesterol diet (1%) for 2 and six weeks for epithelial evaluation. After 2 weeks, one control group (receiving standard pellet diet) and treated (hypercholesterolemic diet) received surgical wounds at the dorsum. Animals were sacrifed 1, 3 and 7 days after surgery. At the end of both periods (2 and 6 weeks) animals were sacrificed for epithelial evaluation. At the sacrifice time, serum were collected for evaluation of triglycerides, total cholesterol, HDL, LDL and VLDL. Were collected skin, tongue, palate and gingival tissues. Skin samples were also used for evaluation of the wound healing. All the observation were made at light microscopy. Data were statistically analysed by Mann Whitney U test for comparison between two samples. P[U] ≤0.05 were considered statistically significant. The enriched cholesterol diet significantly increased the total cholesterol, triglycerides, LDL and VLDL plasma content, and the study provide support for the hypothesis that hypercholesterolemia may be associated with deficiencies in the wound healing process. An important clinical implication of this study is the identification of alterations epithelium on oral tissues and in early phases of wound healing associated with subclinical but important alterations in cholesterol levels.

A obesidade é um excesso de tecido gorduroso e estudos em várias áreas têm apontado sua origem como multifatorial. O índice de obesidade tem aumentado, tanto na população adulta, como infantil. Considerada como um dos fatores de risco à saúde, seu tratamento têm sido sugerido no sentido de cercar todos os aspectos envolvidos na sua origem, visando a modificação de hábitos alimentares e estilo de vida. O objetivo desta pesquisa foi o de realizar uma caracterização das famílias de crianças diagnosticadas como obesas, buscando investigar qual o seu papel na obesidade infantil e conhecer a percepção que essas famílias e a própria criança possuíam em relação ao seu corpo. Participaram do estudo quinze crianças obesas de ambos os sexos, com idades entre 8 e 14 anos, e seus familiares. Foi realizada uma entrevista com a criança e com a família e aplicada a técnica gráfica do Desenho da Figura Humana. Observou-se que a maioria das crianças eram do sexo masculino e a maioria delas tinha idade entre 12 e 14 anos. Em relação aos familiares, observou-se que a maior parte dos pais eram casados e a maioria deles estudou até primeiro grau. Constatou-se que, tanto os familiares quanto as crianças, reconheciam seu excesso de peso e as consequências que este poderia trazer à sua saúde física, nos relacionamentos sociais e à auto-estima. No entanto, alguns familiares apresentavam dificuldades em atuar no controle alimentar devido a sentimentos conflitantes e distorção na percepção da criança e de suas reais necessidades. Observou-se que o excesso de peso trouxe consequências para a auto-imagem da criança e que os hábitos alimentares e estilo de vida de algumas crianças permaneciam inadequados após as orientações do tratamento. Assim, sugere-se um trabalho multidisciplinar com as crianças e, principalmente, com as famílias. / Many studies describe obesity is an excess of fat tissue with multi-factorial causes. Obesity rates have increased in adults as well as in children populations. Considered as one of the risk factors to the health, current treatments tend to take into account all the aspects related to its origin, as for change of feeding habits and lifestyle. The objective of this study is to characterize the families of children diagnosed obese in order to investigate their role in children obesity and know the perception that these families and children have of their own body. Fifteen obese children aged 8 to 14 years old and their families were interviewed and submitted to the human figure drawing test. It was observed that the most of the children was of the masculine sex and the most of them aged 12 and 14 years old. In relation to the relatives, the most of the parents was married and attended elementary schools. It was verified that the relatives as well as children recognized your weights excess and the consequences that it could bring to your physical health, in the social relationships and self-steem. However, the relatives presented difficulties in act in the feeding control due contradictory feelings and distortion in the childs perception and their real needs. The weight excess brought consequences for the childs self-image. Their feeding habits and lifestyle continued inadequate after the treatments orientations. Like this, it is suggested a multi-disciplinary work with the children and mainly the families.

A obesidade na infância e adolescência tem aumentado de forma bastante acentuada, e quando observada nos primeiros anos de vida leva um maior risco para hipercolesterolemia, hipertrigliceridemia e alterações cardiovasculares na vida adulta. Uma correlação positiva tem sido observada entre a BMI (Body Mass Index, ou índice de massa corporal) e alterações metabólicas e hematológicas, implicando em alterações na capacidade de cicatrização, na defesa imunológica e celular e no desenvolvimento de diferentes patologias. O objetivo deste estudo foi avaliar os efeitos das fases iniciais da hipercolesterolemia, ou seja, nas idades infantil e juvenil e com pequeno aumento de colesterol, sobre os tecidos bucais e a capacidade de cicatrização. A Ratos Wistar (40g de peso) foi oferecido uma ração preparada com 1% de aumento (em peso) de colesterol + 20% de gordura (óleo de soja) por um período de 2 e 6 semanas para avaliação dos tecidos bucais. Após 2 semanas do uso da ração enriquecida com colesterol foram realizadas feridas cirúrgicas no dorso dos animais para avaliação da cicatrização. Ao final dos tratamentos propostos, os animais foram sacrificados, e colhidas as peças utilizadas (sangue, pele, língua, palatos e região gengival). O sangue coletado foi centrifugado e o soro foi utilizado para avaliação das lipoproteínas - colesterol total, HDL, LDL, VLDL e triglicérides em espectrofotômetro de absorbância. As peças colhidas foram levadas para fixação e descalcificação de acordo com a necessidade, processadas para inclusão em parafina, cortadas com 6 µm de espessura, montadas em lâminas de vidro e coradas com hematoxilina e eosina. Essas peças foram utilizadas para avaliação histológica dos tecidos e do processo de cicatrização, por meio de técnicas morfométricas. Os dados colhidos foram apresentados em valores médios, e as diferenças analisadas por testes estatísticos adequados para a comparação entre as amostras. Nossos resultados mostram que a hipercolesterolemia provocou alterações em tecidos epiteliais e que esses efeitos parecem ser progressivos, ou seja, se tornam mais expressivos com o uso continuado de alimentação com índice de colesterol aumentado, e que existe um aparente atraso no processo de cicatrização nos indivíduos que utilizam dieta hipercolesterolêmica. Consideramos que essas alterações podem tornar esses indivíduos mais suscetíveis a alterações bucais e prejudicar as reações teciduais frente a injúrias, o que pode ser preocupante durante um tratamento odontológico, principalmente cirúrgico mas também em situações de reabilitação oral ou em tratamentos odontológicos de rotina. / Obesity in childhood has becoming a concern. Obesityy is associated with increased triglycerides, decreased high-density lipoprotein cholesterol levels, and increased low-density lipoprotein cholesterol and may lead to increased risk for hypercholesterolemia and cardiovascular complications in adult life. Clinical symptoms and signs of elevated cholesterol levels do not occur until adulthood, but subclinical aspects may be observed in children and adoslecentes. There are no studies on the effects of hypercholesterolemia in children, adolescents or in adults on oral tissues. We propose to study the influence of early age hypercolesterolemia in epithelial oral tissues and on wound healing. Male albino Wistar rats (40g) received enriched cholesterol diet (1%) for 2 and six weeks for epithelial evaluation. After 2 weeks, one control group (receiving standard pellet diet) and treated (hypercholesterolemic diet) received surgical wounds at the dorsum. Animals were sacrifed 1, 3 and 7 days after surgery. At the end of both periods (2 and 6 weeks) animals were sacrificed for epithelial evaluation. At the sacrifice time, serum were collected for evaluation of triglycerides, total cholesterol, HDL, LDL and VLDL. Were collected skin, tongue, palate and gingival tissues. Skin samples were also used for evaluation of the wound healing. All the observation were made at light microscopy. Data were statistically analysed by Mann Whitney U test for comparison between two samples. P[U] ≤0.05 were considered statistically significant. The enriched cholesterol diet significantly increased the total cholesterol, triglycerides, LDL and VLDL plasma content, and the study provide support for the hypothesis that hypercholesterolemia may be associated with deficiencies in the wound healing process. An important clinical implication of this study is the identification of alterations epithelium on oral tissues and in early phases of wound healing associated with subclinical but important alterations in cholesterol levels.

A obesidade é um excesso de tecido gorduroso e estudos em várias áreas têm apontado sua origem como multifatorial. O índice de obesidade tem aumentado, tanto na população adulta, como infantil. Considerada como um dos fatores de risco à saúde, seu tratamento têm sido sugerido no sentido de cercar todos os aspectos envolvidos na sua origem, visando a modificação de hábitos alimentares e estilo de vida. O objetivo desta pesquisa foi o de realizar uma caracterização das famílias de crianças diagnosticadas como obesas, buscando investigar qual o seu papel na obesidade infantil e conhecer a percepção que essas famílias e a própria criança possuíam em relação ao seu corpo. Participaram do estudo quinze crianças obesas de ambos os sexos, com idades entre 8 e 14 anos, e seus familiares. Foi realizada uma entrevista com a criança e com a família e aplicada a técnica gráfica do Desenho da Figura Humana. Observou-se que a maioria das crianças eram do sexo masculino e a maioria delas tinha idade entre 12 e 14 anos. Em relação aos familiares, observou-se que a maior parte dos pais eram casados e a maioria deles estudou até primeiro grau. Constatou-se que, tanto os familiares quanto as crianças, reconheciam seu excesso de peso e as consequências que este poderia trazer à sua saúde física, nos relacionamentos sociais e à auto-estima. No entanto, alguns familiares apresentavam dificuldades em atuar no controle alimentar devido a sentimentos conflitantes e distorção na percepção da criança e de suas reais necessidades. Observou-se que o excesso de peso trouxe consequências para a auto-imagem da criança e que os hábitos alimentares e estilo de vida de algumas crianças permaneciam inadequados após as orientações do tratamento. Assim, sugere-se um trabalho multidisciplinar com as crianças e, principalmente, com as famílias. / Many studies describe obesity is an excess of fat tissue with multi-factorial causes. Obesity rates have increased in adults as well as in children populations. Considered as one of the risk factors to the health, current treatments tend to take into account all the aspects related to its origin, as for change of feeding habits and lifestyle. The objective of this study is to characterize the families of children diagnosed obese in order to investigate their role in children obesity and know the perception that these families and children have of their own body. Fifteen obese children aged 8 to 14 years old and their families were interviewed and submitted to the human figure drawing test. It was observed that the most of the children was of the masculine sex and the most of them aged 12 and 14 years old. In relation to the relatives, the most of the parents was married and attended elementary schools. It was verified that the relatives as well as children recognized your weights excess and the consequences that it could bring to your physical health, in the social relationships and self-steem. However, the relatives presented difficulties in act in the feeding control due contradictory feelings and distortion in the childs perception and their real needs. The weight excess brought consequences for the childs self-image. Their feeding habits and lifestyle continued inadequate after the treatments orientations. Like this, it is suggested a multi-disciplinary work with the children and mainly the families.

Übergewicht und Adipositas bei Kindern und Jugendlichen stellen ein weltweit zunehmendes Gesundheitsproblem dar und sind zur häufigsten chronischen Erkrankung des Kindes- und Jugendalters in der entwickelten Welt geworden. Nicht nur die Prävalenz der Adipositas ist in den letzten 25 Jahren gestiegen, sondern auch der absolute BMI. Die kindliche Adipositas stellt nicht nur ein kosmetisches Problem dar, sondern einen Risikofaktor etwa für Herzerkrankungen, Diabetes mellitus oder Störungen des Bewegungsapparates. Voraussetzung für erfolgreiche Präventions- und Interventionsprogramme ist ein Bewusstsein für Übergewicht und der Wille zur Gewichtsreduktion bei den betroffenen Kindern sowie bei deren Eltern. Diese Dissertation hat daher zwei Ziele: Zunächst wird untersucht, wie Kinder sich und ihren Körper im Vergleich zum tatsächlichen Gewichtsstatus einschätzen. Darüber hinaus wird der Frage nachgegangen, ob Eltern das Vorliegen von Übergewicht oder Adipositas bei ihrem Kind erkennen. Die Dissertation besteht aus einem Artikel. Darin wird gezeigt, dass die meisten Kinder und Jugendlichen sowie ihre Eltern die Adipositas als ein Gesundheitsproblem erkennen. Eine Mehrheit der Kinder und Jugendlichen schätzt ihren eigenen Gewichtsstatus realistisch ein. Die Mehrheit der Eltern erkennt zumindest Übergewicht bei ihrem Kind. Das Ausmaß wird jedoch häufig unterschätzt.

Thesis deals eating habits of children from 12 to 15 years of age and possibilities of the treatment are being considered. Over the last year, the children obesity has increased rapidly and caused an individual a lot of health problems. I tis not only a question of the cosmetic imperfection. The obese children suffer mainly from mental, physical and, in adulthood, socioeconomic difficulties. The prevention against obesity and its treatment lies in the increased physical activity and in the principles of healthy eating. The aim of this paper is to refer to the danger of the mass occurence of the obesity in children and adults in the Czech Republic and make the public familiar with a possibility of the rational nutrition and with the connections in the change of life style.

Made available in DSpace on 2015-09-25T12:21:38Z (GMT). No. of bitstreams: 1 PDF - Anajas da Silva Cardoso.pdf: 1585856 bytes, checksum: c737ca16e407637d9e687c79ca5a7785 (MD5) Previous issue date: 2012-12-14 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / BACKGROUND: Childhood obesity is alarming and is associated with major metabolic and cardiovascular diseases and has even joined a subclinical inflammatory process. OBJECTIVE: Article 1: To investigate the relationship between PCR, MS and cardiovascular risk factors in children and adolescents overweight or obese. Article 2: To investigate the relationship between CRP and cardiometabolic risk factors in children and adolescents overweight.METHODS: Article 1: This is a systematic review, conducted from May to June 2011 in the databases PubMed, Virtual Health Library - VHL, SciELO and Scopus through the descriptors: "C-reactive protein" and "metabolic syndrome x "and" cardiovascular diseases " were included manuscripts published between 2006 to 2011. Of the 18 articles retrieved, seven were repeated in Scopus, so that the sample consisted of 11 articles of interest to the study. Article 2: Cross-sectional study in Central Childhood Obesity in the period from April/2009 to April/2010, involving 185 overweight children and adolescents aged 2 to 18 years. We compared the values of CRP us according to age, nutritional status, sex, race, cardiometabolic risk factors (waist circumference, lipid profile and impaired fasting glucose, blood pressure and presence of insulin resistance) through the test chi-square, analysis of variance and Pearson correlation. All analyzes were performed with SPSS version 17.0 program, adopting a significance level of 5%. RESULTS: Article 1: Of the 11 works selected three involved the general population, five obese and normal weight, one involved only participants overweight. The design was the most frequent cross-age and evaluated ranged between 1 and 19 years. Most of the studies aimed to verify the relationship between inflammatory markers and development of metabolic syndrome (MS) or cardiovascular disease, only one study looked at whether the patterns of adiponectin are related to the phenotype of obesity. Article 2: The CRP us was altered in 31,4% of the population studied and the HDL-cholesterol changed was cardiometabolic risk factor more frequent, and there was a significant association between CRP us levels changed with severe obesity (p = 0.005), waist circumference (WC) amended (p = 0.000) and insulin resistance (p = 0.002) as well as significantly higher values of BMI, WC, insulin and index of glucose homeostasis (HOMA-IR). We observed a significant correlation of CRP us with most cardiometabolic risk factors, except for diastolic blood pressure, total cholesterol and LDL-cholesterol. CONCLUSIONS: Most studies evaluated suggested a relation of CRP with the appearance of MS and cardiovascular disease. There was a high prevalence of CRP changed and a significant association of CRP with severe obesity, WC and IR, in the population studied, this marker may be used to identify children and adolescents at higher risk for developing cardiovascular disease. / INTRODUÇÃO: A obesidade infantil é preocupante e está relacionada com as principais doenças metabólicas e cardiovasculares e ainda tem se associado a um processo inflamatório subclínico. OBJETIVO: Artigo 1: Verificar a relação entre o PCR, SM e fatores de risco cardiovasculares em crianças e adolescentes obesos ou com sobrepeso. Artigo 2: Verificar a relação existente entre a PCR e fatores de risco cardiometabólicos em crianças e adolescentes com excesso de peso. OBJETIVO: Verificar a frequência dos fatores de risco cardiometabólicos e sua relação com a Proteína C-Reativa ultrassensível (PCR us) em crianças e adolescentes com excesso de peso. MÉTODOS: Artigo 1: Trata-se de uma revisão sistemática, nas bases de dados PubMed, Biblioteca Virtual de Saúde BVS, Scielo e Scopus através dos descritores: "C-reactive protein" and "metabolic syndrome x" and "cardiovascular diseases . Foram incluídos manuscritos publicados no período de 2006 a 2011. Dos 18 artigos encontrados, sete se repetiam na Scopus, de forma que a amostra foi composta por 11 artigos de interesse para o estudo. Artigo 2: Estudo transversal, realizado no Centro de Obesidade Infantil no período de abril/2009 a abril/2010, envolvendo 185 crianças e adolescentes entre 2 e 18 anos com excesso de peso. Foram comparados os valores de PCR us de acordo com faixa etária, estado nutricional, sexo, raça, fatores de risco cardiometabólicos [circunferência abdominal (CA), perfil lipídico e glicemia de jejum alterada, pressão arterial elevada e presença de resistência insulínica (RI)] através do teste do qui-quadrado, da análise de variância e da correlação de Pearson. Todas as análises foram realizadas com a versão 17.0 do programa SPSS, adotando-se o nível de significância de 5%. RESULTADOS: Artigo 1: Dos 11 trabalhos selecionados três envolviam a população geral, cinco obesos e eutróficos, um envolvia apenas participantes com excesso de peso. O delineamento mais frequente foi o transversal e a idade dos avaliados variou entre 1 e 19 anos. A maioria dos estudos objetivou verificar a relação entre os marcadores inflamatórios e o desenvolvimento da síndrome metabólica (SM) ou de doenças cardiovasculares, apenas em um dos estudos observou-se que os padrões de adiponectinas se relacionaram com o fenótipo de obesidade. Artigo 2: A PCR us esteve alterado em 31,4% da população estudada e o HDL-colesterol alterado foi o fator de risco cardiometabólico mais frequente; houve uma associação significativa entre os valores da PCR us alterada com obesidade acentuada (p=0,005), CA alterada (p=0,000) e RI (p=0,002), bem como valores significativamente mais elevados do IMC, CA, insulina e do índice da homeostase glicêmica (HOMA-RI). Foi observada correlação significativa da PCR us com a maioria dos fatores de risco cardiometabólicos, exceto com pressão arterial diastólica, colesterol total e LDLcolesterol. CONCLUSÕES: A maioria dos estudos avaliados sugeriu haver relação da PCR us com o aparecimento da SM e doenças cardiovasculares. Observou-se uma alta prevalência da PCR alterada e uma associação significativa da PCR com obesidade acentuada, CA e RI, na população estudada, podendo este marcador ser utilizado para identificar crianças e adolescentes com maior risco para o desenvolvimento de doenças cardiovasculares.

Übergewichtige Personen, die keine fettleibigkeitsbedingten metabolischen Komplikationen zeigen, wurden als 'metabolisch gesund fettleibig' (MHO, Metabolically healthy obesity) definiert. Im Gegensatz zu metabolisch ungesunden fettleibigen (MUO, Metabolically unhealthy obesity) Individuen zeigen MHOs keine metabolischen Störungen wie Bluthochdruck, Dyslipidämie, Insulinresistenz und Entzündung [50]. Aufgrund des Mangels an allgemein akzeptierten Kriterien ist die genaue Definition des MHO-Status jedoch immer noch umstritten. Es wird allgemein angenommen, dass die MHO-Definition von der Einführung zusätzlicher Biomarker profitieren könnte, welche wiederum zur Klärung der zugrunde liegenden Mechanismen metabolischer Komplikationen herangezogen werden können [24]. Darüber hinaus hat sich die klinische Forschung hauptsächlich auf Erwachsene konzentriert, und es liegen nur wenige Studien zu MHO bei jungen Menschen vor. Daher wird die Untersuchung des MHO-Status in der jungen Bevölkerung unter Verwendung gut etablierter und potentiell neuer Indikatoren als wesentlich angesehen, um einen positiven Beitrag zur Prävention und/oder Behandlung von zukünftigen fettleibigkeitsbezogenen Krankheiten zu leisten. Unter den möglichen neuen Biomarkern wurde festgestellt, dass Serumharnsäure (Serum-UA) eine wichtige Rolle als kardiometabolischer Risikofaktor [22] für Adipositas-assoziierte Komorbiditäten bei Kindern und Jugendlichen spielt. Dennoch haben nur wenige Studien den Zusammenhang zwischen dieser biochemischen Variablen und MHO in der jungen Bevölkerung untersucht. Der Schwerpunkt der vorliegenden Studie lag auf der Identifizierung potenzieller klinischer und metabolischer Indikatoren, die zur Unterscheidung zwischen MHO- und MUO-Phänotypen beitragen können. Die anthropometrischen, klinischen und biochemischen Merkmale von 458 Kindern und Jugendlichen wurden analysiert und diskutiert. MHO- und MUO-Individuen repräsentieren 38% bzw. 16% der dieser Grupe. Der häufigste kardiovaskuläre Risikofaktor bei MUO-Patienten war Hypertriglyceridämie (54,2%), gefolgt von niedrigem Serum-HDL-C (45,8%), Hypertonie (19,5%) und gestörter Glukosetoleranz (14,7%). Zusammenfassend deuten diese Ergebnisse darauf hin, dass eine frühzeitige Identifizierung von MUO in der Jugend möglich ist, wodurch eine frühzeitige Erkennung möglicher metabolischer Komplikationen gewährleistet ist. Verglichen mit der MUO-Gruppe zeigten MHO-Individuen niedrigere Nüchterninsulinwerte, Triglyceride, Blutdruck, Nüchternglucose und höhere Insulinsensitivität sowie niedrigere Serumharnsäure-, hs-CRP-, Albumin- und C-Peptidspiegel. Interessanterweise wurden im Gegensatz zu früheren Studien in den MHO- und MUO-Gruppen ähnlich hohe Werte für die Marker der Leberfunktion, einschließlich der zirkulierenden Konzentrationen von ALT, AST und alkalischer Phosphatase, festgestellt. Dieses Ergebnis legt nahe, dass niedrigere Leberenzyme zu dem günstigen metabolischen Profil von MHO-Individuen beitragen könnten. Darüber hinaus fördert diese Forschung ein besseres Verständnis der Wirkung potenzieller Indikatoren, die verwendet werden können, um MHO von MUO zu unterscheiden, insbesondere mit dem Fokus auf Serum-UA. Die Ergebnisse dieser Arbeit zeigen, dass Serum-UA mit mehreren kardiometabolischen Risikofaktoren assoziiert ist, die normalerweise mit Fettleibigkeit in Verbindung gebracht werden, wie Serumtriglycerid SDS, systolischer Blutdruck, C-Peptid und Cystatin C. Keine signifikante Beziehung zwischen Glukose-SDS und Serum-UA-Spiegeln wurde gefunden. Höhere Serumspiegel von UA erwiesen sich als signifikanter Indikator für den MUO-Phänotyp. Höhere C-Peptid-Spiegel, Taillenumfangs-SDS und Pubertätstadium sind mit einer höheren Wahrscheinlichkeit des MUO-Status assoziiert. Umgekehrt zeigte das Geschlecht der Person keine signifikante Wirkung. Hs-CRP und Albumin waren keine signifikanten MUO-Indikatoren, wenn sie nach Alter, Geschlecht, Pubertät und BMI-SDS kontrolliert wurden. Die in dieser Arbeit präsentierten Ergebnisse könnten für eine bessere Unterscheidung zwischen MUO- und MHO-Phänotypen nützlich sein und adipositasbedingte Komorbiditäten frühzeitig im Leben behandeln. Längsschnittstudien in größeren Kohorten mit jüngeren Individuen werden als ein vernünftiger nächster Schritt angesehen, um das Ergebnis dieser Arbeit zu bestätigen und zu erweitern. Mögliche zukünftige Untersuchungen könnten zusätzliche Eigenschaften und Wirkungen von MHO/MUO-Indikatoren betreffen. Zum Beispiel, wie der Serum-UA-Spiegel durch Konsum zuckergesüßter Erfrischungsgetränke und Alkohol beeinfluss wird.:LIST OF ABBREVIATIONS III I. BIBLIOGRAPHISCHE BESCHREIBUNG IV 1 INTRODUCTION 1.1 Obesity and associated diseases, a world health threat 1.1.1 Definitions and classifications of overweight and obesity 1.2 A ‘metabolic healthy’ type of obesity 1.2.1 Distinguishing characteristics of healthy obesity 1.3 Physiology of uric acid (UA) 1.3.1 Serum UA and cardiometabolic risk factors 1.3.2 Serum UA and type 2 diabetes 1.3.3 Serum UA and hypertension 1.3.4 Serum UA and kidney-related complications 1.3.5 Connection between Serum UA levels and metabolic health status THE PROJECT RESEARCH 1.4 Research question and hypotheses 1.5 The LIFE-Child study 2 PUBLICATION MANUSCRIPT REFERENCES 3 ZUSAMMENFASSUNG DER ARBEIT REFERENCES ANLAGEN II. Supplement Material III. Erklärung über die eigenständige Abfassung der Arbeit IV. Curriculum Vitae V. List of publications and conference participations VI. Acknowledgments / Obese individuals that do not show obesity-related metabolic complications have been defined as “metabolically healthy obese” (MHO). Unlike metabolic unhealthy obese (MUO) individuals, MHO do not show several metabolic disorders, such as hypertension, dyslipidemia, insulin resistance and inflammation. However, due to the lack of universally accepted criteria, the precise definition of the MHO status is still controversial. It is widely believed that the MHO definition might benefit from the introduction of additional biomarkers, which in turn can be used to clarify the underlying mechanisms of metabolic complications. Futhermore, clinical research has mostly focused on adults and few studies addressing MHO in young individuals are available. Therefore, the investigation of the MHO status in the young population, by using well-established and potential new indicators, is considered essential to positively contribute to prevention and/or treatment of future obese-related diseases. Among the possible potential new biomarker, serum uric acid (serum UA) has been found to play an important role as a cardiometabolic risk factor44 for obesity-related comorbidities in children and adolescents. Nonetheless, very few studies have investigated the association between this biochemical variable and MHO in the young population. The focus of the present study was to identify potential clinical and metabolic indicators that may help to distinguish between MHO and MUO phenotypes. The anthropometric, clinical and biochemical characteristics of 458 children and adolescents were analyzed and discussed. MHO and MUO individuals represent 38% and 16% of the overweight/obese population, respectively. The most frequent cardiovascular risk factor found in MUO individuals was hypertriglyceridemia (54.2%), followed by low serum HDL-C (45.8%), hypertension (19.5%) and impaired glucose tolerance (14.7%). Altogether, these findings suggest that early identification of MUO is possible during youth, thereby ensuring the early addressing of potential metabolic complications. Compared to the MUO group, MHO individuals showed lower fasting insulin values, triglycerides, blood pressure, fasting glucose and higher insulin sensitivity, as well as lower serum uric acid, hs-CRP, albumin and C-peptide levels. Interestingly, in contrast to previous studies, markers of liver function, including circulating concentrations of ALT, AST and alkaline phosphatase, were found to be similarly high in MHO and MUO groups. This finding suggests that lower levels of hepatic enzymes could contribute to the favorable metabolic profile of MHO individuals. In addition, the research promotes a better understanding of the action of potential indicators that can be used to distinguish MHO from MUO, especially focusing on serum UA. The results of this thesis revealed that serum UA is associated with several cardiometabolic risk factors usually linked with obesity, such as serum triglyceride SDS, systolic blood pressure, C-peptide and Cystatin C. No significant relationship between glucose-SDS and serum UA levels has been found. Higher levels of serum UA were found to be a significant indicator of the MUO phenotype. Higher levels of C-peptide, waist circumference SDS and pubertal stage are associated to higher likelihood of MUO status. Conversely, the individual’s gender showed no significant effect. Hs-CRP and albumin were non-significant MUO indicators when controlled for age, gender, pubertal stage and BMI-SDS. The results presented in this thesis might be valuable for a better distinction between MUO and MHO phenotypes and to properly address obesity-related comorbidities early in life. Longitudinal studies in larger cohorts with younger individuals are seen as a sensible next step to confirm and expand the outcome of this work. Possible future investigations might address additional properties and effects of MHO/MUO indicators, for instance by studying how serum UA levels are affected by alcohol consumption and sugar-sweetened soft drinks.:LIST OF ABBREVIATIONS III I. BIBLIOGRAPHISCHE BESCHREIBUNG IV 1 INTRODUCTION 1.1 Obesity and associated diseases, a world health threat 1.1.1 Definitions and classifications of overweight and obesity 1.2 A ‘metabolic healthy’ type of obesity 1.2.1 Distinguishing characteristics of healthy obesity 1.3 Physiology of uric acid (UA) 1.3.1 Serum UA and cardiometabolic risk factors 1.3.2 Serum UA and type 2 diabetes 1.3.3 Serum UA and hypertension 1.3.4 Serum UA and kidney-related complications 1.3.5 Connection between Serum UA levels and metabolic health status THE PROJECT RESEARCH 1.4 Research question and hypotheses 1.5 The LIFE-Child study 2 PUBLICATION MANUSCRIPT REFERENCES 3 ZUSAMMENFASSUNG DER ARBEIT REFERENCES ANLAGEN II. Supplement Material III. Erklärung über die eigenständige Abfassung der Arbeit IV. Curriculum Vitae V. List of publications and conference participations VI. Acknowledgments