Abstracts for the Pediatric Obesity Conference, 2nd Edition

abstracts for the Pediatric Obesity Conference, 2^nd Edition

Metabolic footprint beyond the 90^th percentile: differentiating macrosomia
from large-for-gestational-age newborns in the epigenetic management
of pediatric obesity

Mihaela-Maria Celsie¹, Manuela-Camelia Cucerea^2,3

1. Department of Neonatology, County Emergency Clinical Hospital Bistrița, Romania

2. Department of Neonatology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu-Mureş, Romania

3. Department of Neonatology, County Emergency Clinical Hospital Târgu-Mureş, Romania

Corresponding author: Mihaela-Maria Celsie, e-mail: celsie.mihaela@yahoo.com
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Introduction. Macrosomia (weight above 4000 g) and large for gestational age (LGA; above the 90^th percentile) are distinct biological entities. While macrosomia primarily indicates mechanical birth risks, LGA status reflects pathological overgrowth driven by fetal hyperinsulinism. This distinction is vital: a preterm infant can be LGA without being macrosomic, yet still bear an epigenetic predisposition to early-onset obesity and metabolic syndrome. Objective. This study aims to conduct a comprehensive review of current literature (2020-2026) to delineate the metabolic and epigenetic distinctions between constitutional macrosomia and large for gestational age (LGA) status. We specifically investigated the role of intrauterine hyperinsulinism as a primary mediator of epigenetic programming, assessing its impact on the predisposition of both term and preterm LGA neonates to early-onset pediatric obesity and metabolic dysfunction. Materials and method. A comprehensive narrative review was conducted, synthesizing evidence from 2020-2026 regarding the metabolic and epigenetic differentiation between fetal macrosomia and LGA status. Databases including PubMed/MEDLINE, Cochrane Library, Google Scholar and Web of Science were searched using MeSH terms such as “fetal macrosomia”, “epigenetic programming”, “DNA methylation” and “intrauterine hyperinsulinism”. The inclusion was restricted to peer-reviewed articles, meta-analyses and systematic reviews focusing on umbilical cord biomarkers (insulin, leptin, adiponectin) and epigenetic signatures (IGF2, LEP genes); case reports and studies limited to mechanical birth trauma were excluded. Data synthesis followed three thematic pillars: the divergence between anthropometric and metabolic definitions, the mechanisms of epigenetic “metabolic imprinting”, and long-term outcomes for term and preterm LGA neonates. Results. Literature shows that constitutionally large infants often present normal metabolic profiles, whereas LGA status – especially in preterm neonates – is strongly linked to fetal hyperinsulinism and visceral adiposity. Intrauterine hyperglycemia correlates with IGF2 DNA hypomethylation and altered LEP promoter patterns, tripling the risk of childhood obesity. Preterm LGA infants exhibit a more aggressive phenotype, characterized by impaired glucose tolerance and rapid, fat-dominant catch-up growth. Conclusions. The metabolic footprint, rather than absolute birth weight, is the primary determinant of pediatric obesity risk. Differentiating constitutional macrosomia from pathological LGA is critical for identifying neonates with adverse epigenetic programming. The clinical management must prioritize personalized nutritional interventions to stabilize metabolic trajectories from early infancy.

Keywords: macrosomia, large for gestational age (LGA), epigenetics

From macrosomic fetus to healthy child: the intrauterine origins of pediatric obesity

Claudia Kosztelnik, Irina Bachiş

Department of Neonatology, County Emergency Clinical Hospital Bistrița, Romania

Corresponding author: Claudia Kosztelnik, e-mail: claudia_isip@yahoo.com
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Introduction. Fetal macrosomia, defined as a birth weight above 4000 g or above the 90^th percentile for gestational age, represents an important public health concern, being associated with obstetric and neonatal complications, as well as with an increased risk of metabolic disorders later in life. Within the concept of the Developmental Origins of Health and Disease (DOHaD), the intrauterine environment and fetal metabolic programming play a key role in shaping long-term health outcomes. Macrosomia frequently occurs in the presence of maternal factors such as gestational diabetes, pregestational obesity and excessive gestational weight gain. Recent research also highlights the contribution of paternal factors and epigenetic mechanisms transmitted through sperm, as well as the influence of environmental exposures on fetal development. Materials and method. This review provides a narrative analysis of the literature regarding the factors involved in the development of fetal macrosomia and its association with the subsequent risk of pediatric obesity. Studies addressing maternal metabolic factors, paternal influences, epigenetic mechanisms and environmental exposures, such as air pollution and endocrine-disrupting chemicals, were analyzed. Results. Fetal macrosomia results from the complex interaction of metabolic, genetic and environmental factors. Maternal hyperglycemia leads to fetal hyperinsulinism and increased adipose tissue deposition. Parental obesity, intrauterine inflammation, oxidative stress and environmental pollutants may influence gene expression involved in adipogenesis through epigenetic mechanisms. In addition, paternal obesity may alter the epigenetic profile of sperm, contributing to metabolic programming in the offspring and increasing the risk of macrosomia and pediatric obesity. Conclusions. Fetal macrosomia represents an early marker of metabolic risk and an important link in the etiopathogenesis of pediatric obesity. Prevention strategies should begin before conception and include optimization of parental metabolic health, appropriate pregnancy monitoring and reduction of harmful environmental exposures.

Keywords: fetal macrosomia, pediatric obesity, epigenetics, paternal obesity, Developmental Origins of Health and Disease (DOHaD)

The gastroenterologist’s role in the management of childhood obesity

Ioana Marchiş

County Emergency Clinical Hospital Bistrița, Romania

Corresponding author: Ioana Marchiș, e-mail: pioana_m@yahoo.com
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Obesity is a multifactorial chronic disease with a major impact on public health globally. Early and correct assessment of future overweight adults is essential for the early detection of comorbidities and the prevention of their evolution. Lifestyle interventions along with modern therapies (GLP1 and GIP agonists, bariatric surgery and endoscopy) can significantly reduce the risks and improve the prognosis. It is worth emphasizing the need for effective complex political and sociomedical strategies for the prevention and management of obesity. The etiopathogenesis of associated diseases consists of the connection between the obesogenic-exposome environment, alterations of the own microbiome, individual susceptibility resulting in proinflammatory and mutagenic intestinal products (interleukins) that cross the enterohepatic barrier and become systemic, along with hormonal syntheses given by adipose tissue (insulin, leptin). The gastroenterologist has the role of quantifying – in front of each overweight or obese patient – the risks of associated diseases and their complications. Obesity and gallbladder lithiasis are associated with complications such as biliary colic, angiocholitis and acute pancreatitis. These conditions may increase the risk of developing chronic pancreatitis, and when chronic pancreatitis is associated with diabetes mellitus, the risk of pancreatic cancer may further increase in these patients. Colorectal cancer, which is associated with an increased frequency of obesity, also requires early screening, depending on its own risk factors. Thus, obesity is one of the risk factors that has increased the incidence of gastrointestinal cancers with early onset, especially when this condition is established since childhood. The gastroenterologist has also a role in the treatment of obesity by prescribing treatments with GLP1 and GIP analogues, but also by performing endoscopic sleeve treatment, which is less invasive and with fewer complications compared to laparoscopic bariatric surgery.

Keywords: childhood obesity, systemic inflammation, MAFLD, liver cancer, esophagus, colorectal, gallstones, bariatric endoscopy

Bariatric surgery among adolescents

Flavius Mocian

Department of Surgery, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu-Mureş, Romania

Corresponding author: Flavius Mocian, e-mail: flavius.mocian@umfst.ro
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Adolescent metabolic and bariatric surgery (MBS) has evolved from a controversial option to an evidence-supported intervention in specialized, multidisciplinary centers for youth with severe obesity. This manuscript synthesizes contemporary evidence on indications, program structure, procedures and outcomes, equity of access, ethical and psychosocial considerations, along with future directions. We highlight the central role of multidisciplinary pathways, the predominance of sleeve gastrectomy as the current standard in many programs, and the robust but still evolving data on safety, weight loss and comorbidity resolution in adolescents. Laparoscopic sleeve gastrectomy (LSG) has emerged as the predominant procedure in many adolescent programs due to safety and feasibility considerations, while Roux-en-Y gastric bypass (RYGB) remains common in early cohorts and in contexts where malabsorption is deemed advantageous. LSG is associated with favorable short- to mid-term weight loss and may have fewer nutritional deficiencies relative to some malabsorptive procedures, though deficiencies (iron, B12, folate, vitamin D) require lifelong monitoring and supplementation. Postoperative micronutrient monitoring is critical due to risks of iron, B12, copper, vitamin D, calcium and folate deficiencies. Guideline-oriented nutrition stra­te­gies underscore preoperative education, structured postoperative progression and lifelong monitoring to support growth and development during adolescence. As a general conclusion, metabolic and bariatric surgery for adolescents is now established as a viable treatment option within specialized, multidisciplinary programs for carefully selected individuals with severe obesity and related comorbidities. However, essential gaps remain in long-term safety data, equity of access and standardized follow-up. Addressing these gaps will require coordinated policy initiatives, centralized adolescent obesity programs and rigorous, long-term research to optimize outcomes for this vulnerable population.

Keywords: adolescent metabolic and bariatric surgery, sleeve gastrectomy, multidisciplinary programs, international consensus, pediatric populations, ethical considerations

Body Mass Index as a model of health assessment

Narcisa-Patricia Borca¹, Maria-Magdalena Șmadici¹, Remus-Sebastian Șipoș²

1. Student, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu-Mureş, Romania

2. “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu-Mureş, Romania

Corresponding author: Remus-Sebastian Șipoș, e-mail: remus.sipos@umfst.ro
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Introduction. Weight gain has become an increasingly widespread global issue, and the way students training for medical professions manage their lifestyle may reflect how future specialists will approach this problem. The study analyzes the weight status of second-year students enrolled in the General Medicine and Nutrition-Dietetics programs at the “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu-Mureş, Romania. Materials and method. During the routine medical checkup performed for second-year students, Body Mass Index (BMI) was calculated according to the World Health Organization criteria for a total of 498 students. Of these, 441 were enrolled in the General Medicine program and 57 in the Nutrition-Dietetics program. BMI values were compared both between the two study programs and according to sex. Results. Most of the participants were female (72.29%). Overall, 65.66% of the students had a normal weight status, with a higher proportion among females (71.67%). Students from the Nutrition-Dietetics program appeared to be more concerned about their weight status, with normal BMI values recorded in 83.33% of males and in 80.30% of females. In comparison, among General Medicine students, normal BMI values were found in 48.48% of males and in 70.23% of females. Conclusions. The majority of students fell within the normal weight range, although differences were observed depending on sex and study program. Underweight status was more frequently observed among women, while excess weight was more common among men.

Keywords: lifestyle, weight status, obesity

Association between methyl donor nutrients intake with cardiovascular structure
and function abnormalities in obese adolescents

Dalma Béres^1,2, Anna Hajdú¹, Péter Nagy¹, Szilvia Bokor^1,3, Dénes Molnár^1,3

1. Department of Pediatrics, Medical School, University of Pécs, Hungary

2. Individual Pediatrics Practice, Târgu-Mureş, Romania

3. National Laboratory on Human Reproduction, University of Pécs, Hungary

Corresponding author: Dalma Béres, e-mail: dalma.jani@yahoo.com
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Introduction. Subclinical cardiovascular damage, such as increased carotid intima-media thickness (CIMT), left ventricular hypertrophy, endothelial dysfunction and early vascular aging, has already been documented in obese youth. These findings highlight the need to identify modifiable contributors to cardiovascular risk in this population. Materials and method. This study evaluated obese adolescents using anthropometric measurements, blood pressure assessment and laboratory analyses, including selected methyl donor-related parameters. Nutritional intake was assessed with validated dietary questionnaires focusing on folate, vitamin B12, methionine, choline and betaine consumption. Cardiac structure and function were assessed by echocardiography, including left ventricular dimensions and systolic and diastolic parameters, along with carotid intima-media thickness (CIMT) as a marker of subclinical atherosclerosis. Results. Obese adolescents demonstrated early cardiovascular alterations, including increased CIMT and structural cardiac changes, such as increased left ventricular mass, compared to the control group. Lower intake of methyl donor group nutrients was associated with higher markers of cardiovascular risk. Conclusions. The inadequate intake of methyl group donor nutrients, including folate, vitamin B12, methionine, choline and betaine, may impair the endothelial function and promote vascular remodeling. Understanding their potential protective role in cardiovascular health during adolescence is therefore of significant clinical relevance.

Keywords: childhood obesity, cardiovascular risk, increased carotid intima-media thickness, vascular remodeling, methyl donor group nutrients

Prematurity – a risk factor for childhood obesity

Zsuzsánna Simon-Szabó

Pathophysiology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu-Mureş, Romania

Corresponding author: Zsuzsánna Simon-Szabó, e-mail: zsuzsanna.simon-szabo@umfst.ro
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Introduction. Prematurity is a well-known risk factor for childhood obesity, although the relationship is complex and influenced by multiple perinatal and postnatal factors. The American Academy of Pediatrics’ 2023 Clinical Practice Guidelines state that premature infants are more likely to develop childhood obesity due to gene-environment interactions and nutritional habits that promote rapid weight gain. Objective. The aim of this paper was to study the relationship between gestational age and childhood obesity, to identify the mechanisms that may contribute to the development of weight gain later in life, and to uncover the risk factors that could help fight obesity. Materials and method. A thorough search of online databases was conducted using selected keywords in February 2026. Results. A 2020 meta-analysis showed that premature infants have a slightly higher risk of childhood obesity than full-term infants (OR=1.19; 95% CI). Interestingly, no significant difference in childhood obesity was found between small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) preterm infants. However, increased weight gain in the first two years after birth significantly increased the likelihood of obesity in later childhood among premature newborns (OR=1.87; 95% CI). This suggests that the growth trajectory after birth may be more important than birth weight itself. For extremely preterm infants, the risk profile for obesity at the age of 10 is similar to that of full-term children, with the most important risk factors being maternal pre-pregnancy BMI ≥25 and upper quartile weight gain in the first year of life. Premature infants are at greater risk of undiagnosed obesity, with an 8% higher probability of remaining undiagnosed than full-term infants. Conclusions. Prematurity increases childhood obesity risk through complex mechanisms involving maternal factors, feeding practices and accelerated postnatal growth. Establishing optimal growth trajectories and enhanced obesity screening in preterm populations are clinically important preventive strategies.

Keywords: prematurity, childhood obesity, risk factors, weight gain, screening

Incorrect nutritional choices in adolescents

Adela Mititel (Rus)¹, Heidrun Adumitrăchioaiei^1,2

1. “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu-Mureş, Romania

2. County Emergency Clinical Hospital Bistrița, Romania

Corresponding author: Heidrun Adumitrăchioaiei, e-mail: ad.heidi91@gmail.com
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Obesity currently represents a major public health issue globally, being considered a veritable modern “pande­mic”. Its prevalence is continuously increasing, especially among children and adolescents, against the background of exposure to obesogenic environments characterized by easy access to high-calorie foods, sedentary lifestyle and lack of nutritional education. The consequences of obesity are multiple, and include metabolic complications (insulin resistance, type 2 diabetes), cardiovascular, orthopedic, as well as significant psychological impact. The aim of this study was to identify the relationship between adolescents’ food preferences and the occurrence of overweight. The study was based on administering a questionnaire to 300 adolescents aged between 14 and 18 years old. Eating behaviors, physical activity levels, as well as knowledge related to nutrition were evaluated. The results highlighted that only 24.9% of adolescents engaged in daily physical activity, while 16.6% reported that they rarely or never exercised. A concerning aspect is the low level of nutritional education: the majority of respondents did not have basic information about macronutrients and micronutrients. However, 90% of them considered the introduction of courses dedicated to healthy lifestyle in schools to be useful. Regarding the eating habits, 19.3% of adolescents consumed soft drinks daily, and 20% consumed fast-food products daily. Additionally, 39% purchased food daily from the school kiosk, which raises questions about the nutritional quality of these products. In conclusion, poor nutritional choices combined with a sedentary lifestyle and lack of nutritional education significantly contribute to the increasing prevalence of obesity among adolescents, highlighting the need for early educational and public health interventions.

Keywords: obesity, early educational and public health interventions, metabolic complications, obesogenic environment

Adolescent dietary preferences

Ancuța-Ioana Vlădău

Primary Care Physician, Bistriţa, Romania

Corresponding author: Ancuța-Ioana Vlădău, e-mail: ancavladau@yahoo.com
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Clinical importance and epidemiology. Critical period: adolescence is a vital stage for metabolic programming, influencing the long-term risk of obesity, type 2 diabetes and early cardiovascular disease. Global trends: World Health Organization (2022) reports that more than 340 million children and adolescents are overweight or obese, a fourfold increase since 1975. Local data (Romania): in urban areas like Bistrița, recent reports for 12^th-grade students show alarming rates – 16.3% of girls and 19.9% of boys are overweight or obese. Modern “Western diet” profile. Consumption patterns: 60% of adolescents eat fast food at least once a week, while fewer than 30% consume fruits and vegetables daily. Ultra-processed foods: a 10% increase in ultra-processed food intake is linked to a 12% higher obesity risk and to a 13% increase in hypertension. Sweetened beverages: 50% of teens consume sugary drinks daily, which are major sources of “empty calories” and linked to non-alcoholic fatty liver disease (NAFLD). Energy drinks: high doses of caffeine and taurine in these drinks can cause tachycardia, hypertension, insomnia and anxiety. Nutritional risks and eating disorders. “Fad” diets: unsupervised vegan diets or intermittent fasting can lead to vitamin B12 deficiencies (up to 58%), reduced bone mineral density and to growth delays. Micronutrient deficiencies: common gaps include vitamin D, iron (leading to anemia, especially in females), calcium and magnesium. Eating disorders: the prevalence of disorders like anorexia, bulimia and orthorexia stands at 8-12%. Anorexia nervosa carries a high mortality rate of 5-10%. Psychosocial factors. Social influences: peer pressure often leads to conformism in choosing fast food, while online influencers can promote risky dietary trends. Skipping meals: omitting breakfast is correlated with a higher BMI and with a decreased cognitive performance due to reactive hypoglycemia. Recommendations and intervention strategies. Multidisciplinary approach: the management should involve family doctors, nutritionists and psychologists. The “healthy plate” rule: aim for 50% vegetables/fruits, 25% quality protein and 25% whole grains. Key habits: maintain three main meals and 1-2 snacks, limit ultra-processed items, and use water as the primary beverage. Screening: annual nutritional screening is essential to identify risks early and prevent chronic adult diseases. Conclusions. Adolescence is a window of maximum nutritional vulnerability. Early intervention and periodic screening for nutrient deficiencies and eating disorders are vital for long-term health.

Keywords: adolescents, dietary preferences, obesity