Childhood obesity and the associated rise in cardiometabolic complications

Abstract

Childhood obesity is one of the most serious global public-health challenges of the twenty-first century. Over the past four decades, the number of children and adolescents with obesity has risen more than tenfold. Worldwide, an increasing number of youth are facing greater exposure to obesity throughout their lives, and this increase will contribute to the early development of type 2 diabetes, fatty liver and cardiovascular complications. Herein, we provide a brief overview of trends in the global shifts in, and environmental and genetic determinants of, childhood obesity. We then discuss recent progress in the elucidation of the central role of insulin resistance, the key element linking obesity and cardiovascular-risk-factor clustering, and the potential mechanisms through which ectopic lipid accumulation leads to insulin resistance and its associated cardiometabolic complications in obese adolescents. In the absence of effective prevention and intervention programs, childhood obesity will have severe public-health consequences for decades to come.

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Fig. 1: Trends in the number of children and adolescents with obesity and with moderate and severe underweight by region.
Fig. 2: Trends in the prevalence of childhood obesity in the United States from 1963 to 2016.
Fig. 3: Proposed pathophysiological mechanisms linking NAFLD to IR and cardiac dysfunction in obese adolescents.

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Acknowledgements

The authors are grateful to B. Pierpont and M. Savoye for their support and dedication to this work. S.C. is supported by US National Institutes of Health (NIH) grants R01-DK111038 and R01-HD028016. N.S. is supported by NIH grant R01-DK114504. The work of S.C. and N.S. at Yale is also made possible by NIH grant P30DK045735. This publication was also made possible by CTSA grant UL1 TR000142 from the National Center for Advancing Translational Science (NCATS), a component of the NIH. The contents herein are solely the responsibility of the authors and do not necessarily represent the official view of NIH.

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S.C. drafted the following: Abstract, introduction, ‘Epidemiology’, ‘Environmental determinants’, ‘The effects of the FTO genotype on food intake in children’, ‘Future outlook’, ‘Ectopic fat storage in obese youth’ and ‘Halting the epidemic of childhood obesity’. R.W. drafted the following: ‘Bariatric surgery in paediatric obesity’ and ‘Obesity dynamics and CVRF stability in obese adolescents’. N.S. drafted the following: ‘Genetics of childhood obesity’, ‘Syndromic forms of obesity’, ‘Non-alcoholic fatty liver disease in obese youth’ and ‘Pharmacological approaches’. All the authors have read and edited the final version of the manuscript.

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Correspondence to Sonia Caprio or Nicola Santoro or Ram Weiss.

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Caprio, S., Santoro, N. & Weiss, R. Childhood obesity and the associated rise in cardiometabolic complications. Nat Metab 2, 223–232 (2020). https://doi.org/10.1038/s42255-020-0183-z

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