Balagopal, Babu

Introduction: Adolescent obesity is linked to significantly increased risk of cardiovascular and metabolic comorbidities. Exercise outcomes are often impaired in adolescents with obesity (AO), but it remains unclear whether this reflects compromised cardiovascular reserve or non-cardiovascular factors. This study aimed to characterize mechanisms of reduced exercise performance in AO using cardiopulmonary exercise testing (CPET). The secondary aim was to assess the contribution of excess weight burden by correcting for extra fat mass in AO through estimated standard body mass (eSBM). Methods: We retrospectively analyzed CPET data from asymptomatic AO, defined as BMI ≥ 30 (n = 94), and age-matched, normal-weight controls without obesity (n = 139). In a subset of AO (n = 47), % body fat was measured by bioelectric impedance analysis, and eSBM was calculated as if they have comparable % body fat to controls using median values by sex and age in US adolescents. CPET was performed with a cycle ergometer following a ramp protocol. Results: Both male and female AO exhibited higher resting HR (p < 0.001) while peak HR remained comparable to controls. Absolute peak oxygen consumption (VO2) was higher in female AO (p < 0.001), while males showed no difference. Absolute ventilatory anaerobic threshold (VAT) was elevated in AO in both sexes (p < 0.001). When indexed by total body weight, peak VO2, peak work rate (WR), and VAT were lower in both male and female AO (p < 0.001). Peak respiratory exchange ratio (RER), peak VO2/VAT, and peak WR/peak VO2 were also significantly reduced in AO (p < 0.001). When indexed by eSBM, peak VO2 normalized only in female AO; peak WR remained lower, but VAT normalized in AO of both sexes with overcorrection in females, suggesting comparable submaximal exercise performance to controls. Conclusion: Reduced exercise performance in AO appears characterized by elevated resting HR, early exhaustion near peak exercise (lower peak RER and peak VO2/VAT), and decreased work efficiency (lower peak WR/peak VO2). Indexing CPET parameters by eSBM revealed relatively normal cardiopulmonary performance in AO during submaximal exercise, suggesting that reduced performance primarily reflects premature, fatigue-driven termination of exercise due to excess weight burden rather than true cardiopulmonary compromise. Further study is needed to clarify factors contributing to the observed sex-specific differences in AO exercise performance.

Background Traumatic brain injury (TBI) is a leading cause of morbidity and mortality among children in the United States (US), with severity and outcomes linked to social determinants of health (SDOH) and regional differences. Data on the impact of SDOH including race, sex, and Child Opportunity Index (COI) level on TBI severity in southeastern US are sparse in children. Methods We analyzed data retrospectively in 1063 children with TBI, admitted at a Level I Pediatric Trauma Center in the Southeast US between January 2017-June 2023. TBI severity was categorized using the Glasgow Coma Scale (GCS). Outcomes were length of hospital stay (LOHS), intensive care unit stay (LOICUS), and craniotomy frequency. Patients were classified by race ( white , Black , non-Black people of color [ NBPOC ]), COI (low, moderate, high), and sex (male, female). Statistical analyses included chi-square tests, one-way analysis of variance (ANOVA), and post-hoc comparisons. Results Significant disparities were observed by race and COI. Black children and children with low COI had lower GCS scores ( P < 0.01), longer LOHS and LOICUS ( P < 0.01) compared to white children and those with high COI. Additionally, Black and NBPOC children were more likely to undergo craniotomies than white children ( P < 0.05). No sex-based differences in TBI severity or outcomes were found. Discussion This study highlights the significant impact of SDOH, particularly race and COI, on pediatric TBI severity, surgical interventions, and outcomes. These findings underscore the need for targeted interventions to address health care disparities in vulnerable pediatric populations.

Abstract This mini-review aims to briefly summarize the pathophysiology of childhood obesity, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD) risk in children and adolescents. Recent data on efficacy of lifestyle interventions, medications, and metabolic surgery for obesity, T2DM, and CVD risk factors are also reviewed. We conducted a PubMed search of English-language original and review articles relevant to childhood obesity, T2DM, and CVD risk factors, and biomarkers in children with an emphasis on recent publications. Childhood obesity arises from an intricate interaction between genetic, physiologic, environmental, and socioeconomic factors. The rise in the prevalence of childhood obesity is associated with the development of comorbidities including T2DM and CVD at an early age. A multipronged approach is central to the detection, monitoring, and management of childhood obesity and associated adverse metabolic consequences.

This study compared the effects of self-selected exercise intensity (SEI) versus predetermined exercise intensity (PEI) on blood pressure (BP) and arterial stiffness in adolescents with obesity. A total of 37 adolescents, 14.7 (1.6) years old, body mass index ≥95th percentile were randomly allocated into SEI (n = 18; 12 boys) or PEI (n = 19; 13 boys). Both groups exercised for 35 minutes on a treadmill, 3 times per week, for 12 weeks. The SEI could set the speed at the beginning of the sessions and make changes every 5 minutes. The PEI adolescents were trained at an intensity set at 60% to 70% of heart rate reserve. Brachial and central BP, pulse pressure, augmentation index, and carotid–femoral pulse wave were determined at baseline and after 12 weeks. Both groups reduced brachial systolic BP (SEI, Δ = −9 mm Hg; PEI, Δ = −4 mm Hg; P < .01), central systolic BP (SEI, Δ = −4 mm Hg; PEI, Δ = −4 mm Hg; P = .01), and central pulse pressure (SEI, Δ = −4 mm Hg; PEI, Δ = −3 mm Hg; P = .02) without differences between groups. No changes in the augmentation index and carotid–femoral pulse wave were observed in either group. The SEI induced similar changes in various cardiovascular outcomes compared with PEI in adolescents with obesity.