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Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics.
Valerio, G, Maffeis, C, Saggese, G, Ambruzzi, MA, Balsamo, A, Bellone, S, Bergamini, M, Bernasconi, S, Bona, G, Calcaterra, V, et al
Italian journal of pediatrics. 2018;(1):88
Abstract
The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.
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Systematic review of ghrelin response to food intake in pediatric age, from neonates to adolescents.
Prodam, F, Monzani, A, Ricotti, R, Marolda, A, Bellone, S, Aimaretti, G, Roccio, M, Bona, G
The Journal of clinical endocrinology and metabolism. 2014;(5):1556-68
Abstract
OBJECTIVE Food intake and energy balance are regulated during the lifespan with critical changes in each specific period (infancy, adulthood, aging). Some of ghrelin's changes may contribute to the regulation of food intake and weight in children. We aimed to analyze the ghrelin response to feeding in lean or obese subjects from birth to adolescence. METHODS We searched PubMed, Scopus, Google Scholar, Cochrane, and EMBASE (December 1999 to February 2013) and identified 62 relevant articles, of which 29 were suitable to be included. RESULTS AND CONCLUSIONS Total ghrelin response to meals is particular, with refractoriness in neonates and lean children and an inhibition that starts from puberty. Total ghrelin levels are decreased after meals, irrespective of pubertal stages in obese children and adolescents. Conversely, total ghrelin is decreased after an oral glucose tolerance test in all ages, with the exception of neonates. Data on unacylated ghrelin response are scant but resemble those of total ghrelin. The acylated ghrelin response to meals or oral glucose tolerance test is discordant, although a precocious inhibition followed by a rise back is present in both lean and obese children. The post-feeding profile in children with Prader-Willi syndrome is also peculiar, with a conserved and deeper inhibition of all ghrelin forms.
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3.
Role of ghrelin in the regulation of appetite in children.
Savastio, S, Bellone, S, Baldelli, R, Ferraris, M, Lapidari, A, Zanetta, F, Sogni, S, Petri, A, Bona, G
Minerva pediatrica. 2006;(1):21-6
Abstract
Ghrelin, the new recently discovered hormone, is a 28 amino-acid acylated peptide predominantly produced by the stomach characterized by a strong GH-releasing activity mediated by the hypothalamic-pituitary GH secretagogues (GHSs) receptors. Ghrelin and GHSs, acting on central and peripheral receptors, exert other actions such as stimulation of ACTH and prolactin secretion, influence on insulin secretion and glucose metabolism, orexigenic effect and modulatory activity on the neuroendocrine and metabolic response to starvation, influence on exocrine gastro-entero-pancreatic functions, cardiovascular activities and modulation of cell proliferation and apoptosis. The wide spectrum of ghrelin action requires further studies to provide critical information on the role of ghrelin and the potential perspectives of its analogues in the clinical practice. This point is of particular interest in the field of pediatric endocrinology and metabolism because the ghrelin story started focusing on GH deficiency and is now extending to aspects that once again are of major relevance such as obesity and eating disorders, regulation of the hypothalamus-pituitary-adrenal and gonadal axis. More studies are needed to evaluate the real impact of ghrelin in different non endocrine processes and the possible use of ghrelin analogues in different diseases condition.
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4.
Ghrelin: a new hormone with endocrine and non-endocrine activities.
Baldelli, R, Bellone, S, Broglio, F, Ghigo, E, Bona, G
Pediatric endocrinology reviews : PER. 2004;(1):8-14
Abstract
Ghrelin, the new and recently discovered hormone, is a 28 amino-acid acylated peptide predominantly produced by the stomach, characterized by a strong GH-releasing activity mediated by the hypothalamic-pituitary GH Secretagogues (GHSs) receptors. Ghrelin and GHSs, acting on central and peripheral receptors, exert other actions such as: stimulation of ACTH and prolactin secretion; influence insulin secretion and glucose metabolism; have an orexigenic effect and modulatory activity on the neuroendocrine and metabolic response to starvation; influencing exocrine gastro-entero-pancreatic functions; influencing cardiovascular activities and modulation of cell proliferation and apoptosis. With the discovery of ghrelin and the characterization of these GH-independent biological activities, we have to pay more attention to these molecules as candidate drugs for the treatment of pathophysiological conditions including those unrelated to GH secretion disorders.