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  1. Article ; Online: Childhood Obesity and Cardiovascular Disease Risk.

    Chung, Stephanie T / Krenek, Andrea / Magge, Sheela N

    Current atherosclerosis reports

    2023  Volume 25, Issue 7, Page(s) 405–415

    Abstract: Purpose of review: The global epidemic of youth-onset obesity is tightly linked to the rising burden of cardiometabolic disease across the lifespan. While the link between childhood obesity and cardiovascular disease is established, this contemporary ... ...

    Abstract Purpose of review: The global epidemic of youth-onset obesity is tightly linked to the rising burden of cardiometabolic disease across the lifespan. While the link between childhood obesity and cardiovascular disease is established, this contemporary review summarizes recent and novel advances in this field that elucidate the mechanisms and impact of this public health issue.
    Recent findings: The review highlights the emerging data supporting the relationship between childhood adverse events, social determinants of health, and systemic and institutional systems as etiological factors. We also provide updates on new screening and treatment approaches including updated nutrition and dietary guidelines and benchmarks for pediatric obesity screening, novel pharmacological agents for pediatric obesity and type 2 diabetes such as glucagon-like 1 peptide receptor agonists, and we discuss the long-term safety and efficacy data on surgical management of pediatric obesity. The global burden of pediatric obesity continues to rise and is associated with accelerated and early vascular aging especially in youth with obesity and type 2 diabetes. Socio-ecological determinants of risk mediate and moderate the relationship of childhood obesity with cardiometabolic disease. Recognizing the importance of neighborhood level influences as etiological factors in the development of cardiovascular disease is critical for designing effective policies and interventions. Novel surgical and pharmacological interventions are effective pediatric weight-loss interventions, but future research is needed to assess whether these agents, within a socio-ecological framework, will be associated with abatement of the pediatric obesity epidemic and related increased cardiovascular disease risk.
    MeSH term(s) Adolescent ; Child ; Humans ; Pediatric Obesity/complications ; Pediatric Obesity/epidemiology ; Diabetes Mellitus, Type 2/complications ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/prevention & control ; Weight Loss
    Language English
    Publishing date 2023-05-31
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2057369-8
    ISSN 1534-6242 ; 1523-3804
    ISSN (online) 1534-6242
    ISSN 1523-3804
    DOI 10.1007/s11883-023-01111-4
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  2. Article ; Online: Dietary sugar restriction reduces hepatic de novo lipogenesis in boys with fatty liver disease.

    Chung, Stephanie T / Magge, Sheela N

    The Journal of clinical investigation

    2021  Volume 131, Issue 24

    Abstract: Nonalcoholic fatty liver disease (NAFLD) in children resulting from the obesity epidemic is widespread and increasing. Although the complexities of pediatric NAFLD are recognized, screening and therapies in children remain limited. Moreover, pediatric ... ...

    Abstract Nonalcoholic fatty liver disease (NAFLD) in children resulting from the obesity epidemic is widespread and increasing. Although the complexities of pediatric NAFLD are recognized, screening and therapies in children remain limited. Moreover, pediatric NAFLD diagnosis fails to consider insulin resistance and metabolic dysfunction as important determinants. In this issue of the JCI, Cohen et al. explored the contribution of dietary factors to the pathogenesis of NAFLD in adolescent boys with biopsy-proven NAFLD and control participants. Notably, dietary sugar restriction over 8 weeks decreased de novo lipogenesis (DNL) and hepatic fat. The change in DNL correlated with changes in insulin and weight, but not with changes in hepatic fat, supporting the relevance of metabolic dysfunction to NAFLD. These results confirm the pathological link between excessive dietary sugar intake and NAFLD in children and support recent recommendations to change the nomenclature of NAFLD to metabolic associated fatty liver disease (MAFLD).
    MeSH term(s) Adolescent ; Child ; Dietary Sugars/metabolism ; Humans ; Lipogenesis ; Liver/metabolism ; Male ; Non-alcoholic Fatty Liver Disease/metabolism ; Sugars/metabolism
    Chemical Substances Dietary Sugars ; Sugars
    Language English
    Publishing date 2021-09-06
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 3067-3
    ISSN 1558-8238 ; 0021-9738
    ISSN (online) 1558-8238
    ISSN 0021-9738
    DOI 10.1172/JCI154645
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  3. Article ; Online: Commentary on the Impact of Obesity and Puberty on Insulin Sensitivity.

    Haymond, Morey W / Chung, Stephanie T

    The Journal of clinical endocrinology and metabolism

    2020  Volume 105, Issue 5

    MeSH term(s) Bariatric Surgery ; Bodily Secretions ; Humans ; Insulin Resistance ; Longitudinal Studies ; Obesity/complications ; Obesity/epidemiology ; Puberty
    Language English
    Publishing date 2020-03-10
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 3029-6
    ISSN 1945-7197 ; 0021-972X
    ISSN (online) 1945-7197
    ISSN 0021-972X
    DOI 10.1210/clinem/dgaa104
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  4. Article ; Online: Diet and Fat Metabolism-Uncovering Key Determinants of Diabetes Risk Prediction in Populations of African Descent.

    Courville, Amber B / Chung, Stephanie T

    The Journal of clinical endocrinology and metabolism

    2020  Volume 106, Issue 4, Page(s) e1900–e1901

    MeSH term(s) Diabetes Mellitus/epidemiology ; Diet ; Humans ; Lipogenesis
    Language English
    Publishing date 2020-12-31
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 3029-6
    ISSN 1945-7197 ; 0021-972X
    ISSN (online) 1945-7197
    ISSN 0021-972X
    DOI 10.1210/clinem/dgaa914
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  5. Article ; Online: Reevaluating First-line Therapies in Youth-Onset Type 2 Diabetes.

    Chung, Stephanie T / Davis, Faith / Patel, Tejal / Mabundo, Lilian / Estrada, Doris E

    The Journal of clinical endocrinology and metabolism

    2023  Volume 109, Issue 2, Page(s) e870–e872

    Abstract: The prevalence of youth-onset type 2 diabetes is growing worldwide and current first-line treatment with metformin and intensive behavior and lifestyle changes are suboptimal in over 50% of youth within 2 years of diagnosis. This perspective article is a ...

    Abstract The prevalence of youth-onset type 2 diabetes is growing worldwide and current first-line treatment with metformin and intensive behavior and lifestyle changes are suboptimal in over 50% of youth within 2 years of diagnosis. This perspective article is a call to action for reevaluation of existing strategies and critical appraisal of metformin as first-line therapy in youth-onset type 2 diabetes. Increased attention should be given to novel therapeutics approved in youth, including glucagon-like 1 receptor agonists, sodium glucose cotransporter-2, and sociocultural interventions that will promote diabetes self-management.
    MeSH term(s) Humans ; Adolescent ; Hypoglycemic Agents/therapeutic use ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/epidemiology ; Metformin/therapeutic use ; Health Behavior ; Life Style
    Chemical Substances Hypoglycemic Agents ; Metformin (9100L32L2N)
    Language English
    Publishing date 2023-08-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3029-6
    ISSN 1945-7197 ; 0021-972X
    ISSN (online) 1945-7197
    ISSN 0021-972X
    DOI 10.1210/clinem/dgad508
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  6. Article ; Online: One-hour glucose is an earlier marker of dysglycemia than two-hour glucose.

    Ha, Joon / Chung, Stephanie T / Bogardus, Clifton / Jagannathan, Ram / Bergman, Michael / Sherman, Arthur S

    Diabetes research and clinical practice

    2023  Volume 203, Page(s) 110839

    Abstract: Aims: The timing of increase in 1-hour PG and its utility as an earlier predictor of both prediabetes (PreDM) and type 2 diabetes (T2D) compared to 2-hour PG (2 h-PG) are unknown. To evaluate the timing of crossing of the 1 h-PG ≥ 155 mg/dl (8.6 mmol/L) ...

    Abstract Aims: The timing of increase in 1-hour PG and its utility as an earlier predictor of both prediabetes (PreDM) and type 2 diabetes (T2D) compared to 2-hour PG (2 h-PG) are unknown. To evaluate the timing of crossing of the 1 h-PG ≥ 155 mg/dl (8.6 mmol/L) for PreDM and 209 mg/dl (11.6 mmol/L) for T2D and respective current 2 h-PG thresholds of 140 mg/dl (7.8 mmol/L) and 200 mg/dl (11.1 mmol/L).
    Methods: Secondary analysis of 201 Southwest Native Americans who were followed longitudinally for 6-10 years and had at least 3 OGTTs.
    Results: We identified a subset of 43 individuals who first developed PreDM by both 1 h-PG and 2 h-PG criteria during the study. For most (32/43,74%), 1 h-PG ≥ 155 mg/dl was observed before 2 h-PG reached 140 mg/dl (median [IQR]: 1.7 [-0.25, 4.59] y; mean ± SEM: 5.3 ± 1.9 y). We also identified a subset of 33 individuals who first developed T2D during the study. For most (25/33, 75%), 1 h-PG reached 209 mg/dl earlier (median 1.0 [-0.56, 2.02] y; mean ± SEM: 1.6 ± 0.8 y) than 2 h-PG reached 200 mg/dl, diagnostic of T2D.
    Conclusions: 1 h-PG ≥ 155 mg/dl is an earlier marker of elevated risk for PreDM and T2D than 2 h-PG ≥ 140 mg/dl.
    MeSH term(s) Humans ; Glucose ; Blood Glucose ; Diabetes Mellitus, Type 2/diagnosis ; Prediabetic State/diagnosis ; Glucose Tolerance Test
    Chemical Substances Glucose (IY9XDZ35W2) ; Blood Glucose
    Language English
    Publishing date 2023-07-21
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 632523-3
    ISSN 1872-8227 ; 0168-8227
    ISSN (online) 1872-8227
    ISSN 0168-8227
    DOI 10.1016/j.diabres.2023.110839
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    Zs.A 2047: Show issues Location:
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  7. Article ; Online: Virtual Learning and Youth-Onset Type 2 Diabetes During the COVID-19 Pandemic.

    Grundman, Jody B / Chung, Stephanie T / Estrada, Elizabeth / Podolsky, Robert H / Meyers, Abby / Marks, Brynn E

    Hormone research in paediatrics

    2023  

    Abstract: Introduction: Cases and severity of presentation of youth-onset type 2 diabetes (Y-T2D) increased during the COVID-19 pandemic, yet the potential drivers of this rise remain unknown. During this time public health mandates paused in-person education and ...

    Abstract Introduction: Cases and severity of presentation of youth-onset type 2 diabetes (Y-T2D) increased during the COVID-19 pandemic, yet the potential drivers of this rise remain unknown. During this time public health mandates paused in-person education and limited social interactions, resulting in radical lifestyle changes. We hypothesized that the incidence and severity of presentation of Y-T2D increased during virtual learning amidst the COVID-19 pandemic.
    Materials and methods: We conducted a single center retrospective chart review to identify all newly diagnosed cases of Y-T2D (n=387) at a pediatric tertiary care center in Washington, DC during three pre-determined learning periods as defined by learning modality in Washington, DC Public Schools: pre-pandemic in-person learning (3/11/2018-3/13/2020), pandemic virtual learning (3/14/2020-8/29/2021), and pandemic in-person learning (8/30/2021-3/10/2022) periods.
    Results: Incident cases were stable during pre-pandemic in-person learning (3.9 cases/month, 95% CI: 2.8 - 5.4 cases/month), increased to a peak during virtual learning (18.7 cases/month, 95% CI: 15.9 - 22.1 cases/month), and declined with return to in-person learning (4.3 cases/month, 95% CI: 2.8 - 6.8 cases/month). Y-T2D incidence was 16.9 (95% CI: 9.8-29.1, p<0.001) and 5.1-fold higher (95% CI: 2.9-9.1, p<0.001) among non-Hispanic Black and Latinx youth, respectively, throughout the study period. Overall COVID-19 infection rates at diagnosis were low (2.5%) and were not associated with diabetes incidence (p=0.26).
    Discussion/conclusions: This study provides timely insights into an important and modifiable correlate of Y-T2D incidence, its disproportionate impact on underserved communities, and the need to consider the effects on long-term health outcomes and pre-existing healthcare inequities when designing public policy.
    Language English
    Publishing date 2023-06-30
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2537278-6
    ISSN 1663-2826 ; 1663-2818
    ISSN (online) 1663-2826
    ISSN 1663-2818
    DOI 10.1159/000531720
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  8. Article ; Online: Low-carbohydrate diets for the treatment of obesity and type 2 diabetes.

    Hall, Kevin D / Chung, Stephanie T

    Current opinion in clinical nutrition and metabolic care

    2018  Volume 21, Issue 4, Page(s) 308–312

    Abstract: Purpose of review: Summarize the physiological effects of low-carbohydrate diets as they relate to weight loss, glycemic control, and metabolic health.: Recent findings: Low-carbohydrate diets are at least as effective for weight loss as other diets, ...

    Abstract Purpose of review: Summarize the physiological effects of low-carbohydrate diets as they relate to weight loss, glycemic control, and metabolic health.
    Recent findings: Low-carbohydrate diets are at least as effective for weight loss as other diets, but claims about increased energy expenditure and preferential loss of body fat are unsubstantiated. Glycemic control and hyperinsulinemia are improved by low-carbohydrate diets, but insulin sensitivity and glucose-stimulated insulin secretion may be impaired, especially in the absence of weight loss. Fasting lipid parameters are generally improved, but such improvements may depend on the quality of dietary fat and the carbohydrates they replaced. Postprandial hyperlipemia is a potential concern given the high fat content typical of low-carbohydrate diets.
    Summary: Low-carbohydrate diets have several potential benefits for treatment of obesity and type 2 diabetes, but more research is required to better understand their long-term consequences as well as the variable effects on the endocrine control of glucose, lipids, and metabolism.
    MeSH term(s) Blood Glucose/metabolism ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/diet therapy ; Diet, Carbohydrate-Restricted/adverse effects ; Dietary Carbohydrates/administration & dosage ; Dietary Carbohydrates/metabolism ; Dietary Carbohydrates/pharmacology ; Dietary Fats/administration & dosage ; Dietary Fats/metabolism ; Fasting ; Humans ; Hyperinsulinism/diet therapy ; Hyperlipidemias/etiology ; Insulin/metabolism ; Insulin Resistance ; Lipids/blood ; Obesity/diet therapy ; Obesity/metabolism ; Postprandial Period ; Weight Loss
    Chemical Substances Blood Glucose ; Dietary Carbohydrates ; Dietary Fats ; Insulin ; Lipids
    Language English
    Publishing date 2018-07-17
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Intramural ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1460178-3
    ISSN 1473-6519 ; 1363-1950
    ISSN (online) 1473-6519
    ISSN 1363-1950
    DOI 10.1097/MCO.0000000000000470
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    Zs.A 5586: Show issues Location:
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  9. Article ; Online: Trends in pediatric obesity management, a survey from the Pediatric Endocrine Society Obesity Committee.

    Shoemaker, Ashley H / Chung, Stephanie T / Fleischman, Amy

    Journal of pediatric endocrinology & metabolism : JPEM

    2020  Volume 33, Issue 4, Page(s) 469–472

    Abstract: Background In the United States, 18.5% of children are obese. Dietary and lifestyle modifications are key, but often ineffective. There are limited approved pediatric pharmacotherapies. The objective of this study was to evaluate current treatment ... ...

    Abstract Background In the United States, 18.5% of children are obese. Dietary and lifestyle modifications are key, but often ineffective. There are limited approved pediatric pharmacotherapies. The objective of this study was to evaluate current treatment practices for pediatric obesity among members of the Pediatric Endocrine Society (PES, n = 1300) and the Pediatric Obesity Weight Evaluation Registry (POWER, n = 42) consortium. Methods A 10-question online survey on treatment of children with obesity in clinical practice was conducted. Results The response rates were 19% for PES and 20% for POWER members. The majority were female (65%) and board certified in pediatric endocrinology (81%). Most practitioners saw 5-10 patients with obesity/week and 19% prescribed weight-loss medications. POWER participants were more likely to prescribe weight-loss medications than PES participants (46% vs. 18%, p =  0.02). Metformin was the most commonly prescribed medication. Response to medication was poor. Use of dietary non-pharmacological treatment options was uncommon. Over half of the respondents (56%) referred patients for bariatric surgery and 53% had local access to pediatric bariatric surgery. Conclusions Metformin was the most common drug prescribed among respondents, but successful weight-loss responses were uncommon. Among practitioners who are using pharmacological interventions, therapeutic strategies vary widely. Targeted research in pharmacologic and surgical treatment for pediatric obesity is urgently needed.
    MeSH term(s) Bariatric Surgery/methods ; Body Weight ; Child ; Endocrine System ; Female ; Follow-Up Studies ; Humans ; Life Style ; Male ; Obesity Management ; Pediatric Obesity/prevention & control ; Practice Patterns, Physicians'/statistics & numerical data ; Prognosis ; Surveys and Questionnaires ; Weight Loss
    Language English
    Publishing date 2020-02-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1231070-0
    ISSN 2191-0251 ; 0334-018X
    ISSN (online) 2191-0251
    ISSN 0334-018X
    DOI 10.1515/jpem-2019-0546
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  10. Article ; Online: Measuring Insulin Resistance in Humans.

    Sharma, Vandhna R / Matta, Samantha T / Haymond, Morey W / Chung, Stephanie T

    Hormone research in paediatrics

    2021  Volume 93, Issue 11-12, Page(s) 577–588

    Abstract: Background: Insulin resistance is a pathophysiological condition associated with diabetes and cardiometabolic diseases that is characterized by a diminished tissue response to insulin action. Our understanding of this complex phenomenon and its role in ... ...

    Abstract Background: Insulin resistance is a pathophysiological condition associated with diabetes and cardiometabolic diseases that is characterized by a diminished tissue response to insulin action. Our understanding of this complex phenomenon and its role in the pathogenesis of cardiometabolic diseases is rooted in the discovery of insulin, its isolation and purification, and the challenges encountered with its therapeutic use.
    Summary: In this historical perspective, we explore the evolution of the term "insulin resistance" and demonstrate how advances in insulin and glucose analytics contributed to the recognition and validation of this metabolic entity. We identify primary discoveries which were pivotal in expanding our knowledge of insulin resistance, the challenges in measurement and interpretation, contemporary techniques, and areas of future exploration. Key Message: Measurements of insulin resistance are important tools for defining and treating cardiometabolic diseases. Accurate quantification of this pathophysiological entity requires careful consideration of the assumptions and pitfalls of the methodological techniques and the historical and clinical context when interpreting and applying the results.
    MeSH term(s) Animals ; Blood Chemical Analysis/history ; Glucose/analysis ; History, 20th Century ; Humans ; Insulin/analysis ; Insulin Resistance
    Chemical Substances Insulin ; Glucose (IY9XDZ35W2)
    Language English
    Publishing date 2021-04-30
    Publishing country Switzerland
    Document type Historical Article ; Journal Article ; Review
    ZDB-ID 2537278-6
    ISSN 1663-2826 ; 1663-2818
    ISSN (online) 1663-2826
    ISSN 1663-2818
    DOI 10.1159/000515462
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