A paradigm shift for the prevention and treatment of individual and global obesity.

The prevalence of obesity and overweight has plateaued in developed countries, although at high levels, but in most parts of the world, it continues to increase. Current recommendations for preventing and treating obesity are based mainly on the notion that overeating results from hedonic eating as a result of unlimited access to palatable foods, particularly those high in sugar and fat, and that hedonic centers are able to "override" the body's homeostatic mechanisms. This article proposes that the homeostatic mechanisms affecting appetite and satiety are more important in chronic overeating, and that sufficient evidence exists for adopting a new paradigm for controlling individual and global obesity based on controlling energy homeostasis via the enteroendocrine and gut microbiota systems.

Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents.

Objectives: The aim of this study is to identify factors accounting for the variation in 25-hydroxyvitamin D levels in a pediatric obese population.

Patients And Methods: One hundred and forty-nine obese children and adolescents (BMI ≥95th percentile) were evaluated in a pediatric endocrine office. Acanthosis nigricans (AN) skin lesions were rated on a 4-point scale.

Increased hunger and speed of eating in obese children and adolescents.

Objectives: This quality improvement program examined self-reported hunger, over-eating, and eating speed in obese and normal-weight children and adolescents prior to an interventional component.

Patients And Methods: Food frequency questionnaires were presented to 127 obese and 42 normal-weight patients, and perceived hunger, food intake and eating speed were rated.

Results: Obese patients reported significantly greater hunger than normal-weight patients (62.

The influence of carbohydrate quality on cardiovascular disease, the metabolic syndrome, type 2 diabetes, and obesity - an overview.

There is compelling evidence that carbohydrate quality has important influences on cardiovascular disease, the metabolic syndrome, type 2 diabetes, and obesity. Cohort and interventional studies indicate that dietary fiber is an important determinant of satiation, satiety, and weight gain, and also protects against cardiovascular disease. Cohort studies have shown that vegetables and fruits protect against coronary heart disease, whereas whole grains provide protection against cardiovascular disease, type 2 diabetes, and weight gain.

A clinically euthyroid child with a large goiter due to a thyroglobulin gene defect: clinical features and genetic studies.

A 10-year old child born to consanguineous parents presented with an extremely large goiter, a low free T4 level and free T4 index, and normal TSH concentration. The findings of undetectable thyroglobulin (TG) and low free T4, and an elevated free T3/free T4 ratio suggested the possibility of a defect in TG synthesis. Noteworthy aspects of this case were the extremely elevated thyroidal radioiodide uptake despite a normal TSH concentration and the fact that the reduction in the size of her goiter only occurred when her TSH was suppressed below the normal range.

The pubertal timing controversy in the USA, and a review of possible causative factors for the advance in timing of onset of puberty.

Previously used standards for the diagnosis of precocious puberty in girls no longer appear to be appropriate in the USA, in that a significant number of girls are being seen in paediatricians' offices with breast budding before 8 years of age. The timing of menarche, however, has changed little over the past few decades. Early maturing girls are more likely to become obese in adolescence and adulthood than normal or late maturing girls.

Effective methimazole dose for childhood Graves' disease and use of free triiodothyronine combined with concurrent thyroid-stimulating hormone level to identify mild hyperthyroidism and delayed pituitary recovery.

Appropriate methimazole dosing for initial treatment of childhood Graves' disease is uncertain. A retrospective chart review was performed on 5 to 17 year-old children treated for Graves' disease. Patients were divided into two groups depending on initial methimazole dosing: low-dose and high-dose regimens using <0.

Atypical presentation of shock from acute adrenal insufficiency in an adolescent male.

Objective: To report an atypical presentation of shock and acute adrenal insufficiency in an adolescent male.

Case Summary: A 14-year-old boy with a history of nocturnal enuresis presented with a clinical picture suggestive of septic shock refractory to aggressive fluid and vasopressor management. History and physical examination were suggestive of shock secondary to an infectious etiology, associated with skin findings of hyperpigmentation.

Clinical review 168: What vascular ultrasound testing has revealed about pediatric atherogenesis, and a potential clinical role for ultrasound in pediatric risk assessment.

Coronary vascular disease is one facet of a generalized disturbance of vascular function present throughout the vascular tree. Dysfunction of the endothelium leads to thickening of the intima and media of the vessel wall of large and medium-sized muscular arteries and large elastic arteries, such as the aorta, carotid, and iliac arteries. Flow-mediated dilatation of the brachial artery is one of several tests used to assess dysfunction of the endothelium using high resolution ultrasound.

The pediatric obesity epidemic: causes and controversies.

Obesity in children and adolescents has reached alarming proportions in the United States. Nutritional surveys do not indicate a significant increase in caloric intake in children and adolescents over the last 3 decades, although caloric intake has increased recently in adolescent females. Dietary fat has also been falling.

Autosomal dominant pseudohypoparathyroidism type Ib is associated with a heterozygous microdeletion that likely disrupts a putative imprinting control element of GNAS.

Patients with pseudohypoparathyroidism type Ib (PHP-Ib) have hypocalcemia and hyperphosphatemia due to renal parathyroid hormone (PTH) resistance, but lack physical features of Albright hereditary osteodystrophy. PHP-Ib is thus distinct from PHP-Ia, which is caused by mutations in the GNAS exons encoding the G protein alpha subunit. However, an imprinted autosomal dominant form of PHP-Ib (AD-PHP-Ib) has been mapped to a region of chromosome 20q13.