Translational Research on
Overweight Children
Research Collaborative on
Pediatric Overweight
Definition of overweight
 CDC: term ‘obesity’ is not used for children
 In children, body mass index (BMI) is charted by
age and gender.
 The normal range of weight for a given height
varies with age.
 In general, children younger than 3 years and
older than 11 years have proportionately more
weight for height than do school-aged children.
 In children, body
mass index (BMI) is
charted by age and
gender.
 The normal range of
weight for a given
height varies with age.
 Children younger
than 4 and older than
9 years have
proportionately more
weight for height than
do school-aged
children.
Definition of overweight
 BMI above 95th percentile =
overweight
~ corresponds to ‘obese’ label in adults
 BMIs 85th to 95th percentile =
at risk for overweight
~ corresponds to ‘overweight’ label in adults
Definition of overweight
In our research, the term, ‘overweight’
often is used to refer BMIs above the 85th
percentile for age and gender.
~ highest 15% of weight for height among US
children
Our Approach
 Study childhood overweight with recognition of
its complexity.
 Compose teams of clinical researchers and
basic scientists to study metabolic and
physiologic bases of overweight in children.
 A group of WCMC, HSS, and RU faculty have
been working together for over two years to
formulate a coordinated program of research on
childhood overweight.
Clinical Pathway
CORE LAB SET LEVEL 1 (fasting) Fast of 8-12 hours for lipids; fast of 3-4 hours for insulin/glucose
Glucose (fluorinated [green] tube)
Fasting: if 100-125 mg/dL: Level 2 refer to Endo
Fasting: if > 126 mg/dL and confirmed fasting by history: page Endo STAT for possible diabetes
Non- Fasting: if > 140 mg/dL: Level 2 refer to Endo
Non- Fasting: if > 200 mg/dL: page Endo STAT for possible diabetes
HgbA1C  if > 5.9% : Level 2 refer to Endo
Insulin  Fasting: if > 14 uIU/: Level 2 refer to Endo
Lipid Profile 
if LDL 130-199 or HDL 21-40 or TG 150-300:  repeat studies within 3 months
if values abnl at 3 mo  Level 2: refer to Dr. Hudgins
if LDL >200 or HDL <20 or TG >300:  Level 2: refer to Dr. Hudgins
Vitamin D, 25-Hydroxy 
if < 30 ng/mL: prescribe 1,000 IU Vitamin D q day
if 10-20 ng/mL: prescribe 2,000 IU Vitamin D q day”
if <10 ng/mL: prescribe 2,000 IU Vitamin D q day” : Level 2 refer to Endo
LFT’s  if ALT or AST >60:  Level 2 Liver US refer to Dr. Solomon (liver US)
LEVEL 1a: hypertension:
–If BP > 95th% for age & height (per Harriet Lane)  repeat BP during visit.
–If both values >95th% for age & height:  Level 2 serum electrolytes, plasma renin activity, urine microalbumin, urine Na, U/A
–If results normal  F/U w/in 3 mo  if repeat BP >95th%:
–If results abnormal   Level 2 refer to Renal, Peds Cardiology
LEVEL 1b: short stature (height < 5th% or decline in growth velocity):
–TSH, free T4, IGF-1, IGFBP-3, cortisol
–Refer to Endo (bone age will be done)
LEVEL 1c:joint malalignment/musculo-skeletal pain:
PE/screening for genu varum/genu valgum: if clinical concern  refer to Peds Ortho
PE/screening: if SCFE suspected  emergent X-ray of hip/thigh/knee/groin
Research Teams
1. Immunological Function in Nonalcoholic Fatty Liver
Disease in Overweight Children
2. Vitamin D Deficiency and Atypical Glucose
Metabolism in Overweight Children
3. Atypical Lipid Metabolism and Endothelial
Dysfunction in Overweight Children
4. Angiogenic Markers in Overweight Children
5. Lower Extremity Alignment, Gait, and Joint
Pathophysiology in Overweight Children
6. Health for Life Primary Care Intervention
Immunological Function
in NAFLD
 Susanna Cunningham-Rundles
 Arzu Kovanlikaya
 Ruben Cooper
 Aliza Solomon
Immunological Function
in NAFLD
 NAFLD involves accumulation of fatty deposits
on the liver.
 Examine the associations among oxidative
stress markers, anti oxidant reserve and
inflammatory markers in children.
 Introduce MRI to provide precise calculation of
fat levels in the liver.
Vitamin D Deficiency and
Atypical Glucose Metabolism
 Maria Vogiatzi
 Roja Motaghedi
 Sunita Cheruvu
Vitamin D Deficiency and
Atypical Glucose Metabolism
 Vitamin D insufficiency is associated with insulin
resistance, the metabolic syndrome and Types I
and II diabetes.
(1) prospective randomized trial of vitamin D
supplementation in obese, insulin resistant, vitamin
D deficient adolescents
(2) basic science studies on insulin signaling and
glucose transport as a function of varying levels of
vitamin D concentrations in fat and muscle.
Angiogenic and Vasculogenic
Markers in Overweight Children
 David C. Lyden
 Snezana M. Osorio
 Rosandra Kaplan
Angiogenic and Vasculogenic
Markers in Overweight Children
 Sprouting of new blood vessels from pre-existing
ones is termed angiogenesis.
 Angiogenesis is tightly controlled by a balance
between factors that stimulate endothelial cell
growth and movement and anti-angiogenic
factors, which inhibit these processes.
 Angiogenic factors are elevated in overweight and
obese adults. These factors have not yet been
studied in children.
Atypical Lipid Metabolism and
Endothelial Dysfunction
 Ruben Cooper
 Lisa Hudgins
 Abraham Bornstein
 Arzu Kovanlikaya
 Maura Frank
 Susanna Cunningham-Rundles
 Mary J. Ward
Atypical Lipid Metabolism and
Endothelial Dysfunction in
Overweight Children
 EndoPAT is a novel, non-invasive method
for assessing endothelial function.
 Endothelium is affected by overweight, as
well as elevated lipids and dysregulated
insulin.
Lower Extremity Alignment, Gait,
and Joint Pathophysiology
In Overweight Children
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Howard Hillstrom
Peter Torzilli
Christopher Chen
Daniel Green
Siobhan Doyle
Mary J. Ward
Maria Vogiatzi
Lower Extremity Alignment, Gait,
and Joint Pathophysiology
In Overweight Children
 Understand the role of joint malalignment
and BMI in joint mechanics, joint
physiology, and risk of osteoarthritis among
overweight children.
 Motion analysis methodology, assessment
of Vitamin D metabolism, and laboratory
assessment of joint physiology
Health for Life Primary Care
Intervention
 Maura Frank
 Weill-Cornell Resident Group Practice staff
Health for Life Primary Care
Intervention
 Evidence-based program for 8-18 year-olds with
BMI ≥ 85th %ile
 Staff includes dietitians, physicians, physical
therapists, social workers, nurses, and medical
students
 Individual sessions: medical, nutritional,
psychosocial and physical fitness evaluations
 10 weekly group sessions on nutrition/behavior
and physical activity
Wish List
 What more should we know?
 Researchers interested in collaboration?