الفهرس 
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Abstract
Childhood obesity continues to be a highly prevalent and a worldwide intractable problem.
Obesity is primarily due to positive energy balance characterized by increase daily calorie intake above calorie expenditure, with extra calories from the diet are deposited as triacylglycerols in white adipose tissue (WAT). Adipocyte hypertrophy or adipocyte hyperplasia are the two processes that can cause an increase in fat mass.
Early diagnosis and intervention are extremely important as children with obesity are at higher risk for several medical conditions such as metabolic syndrome, insulin resistance (IR), hypertension, nonalcoholic fatty liver disease, obstructive sleep apnea, irregular menstruation and polycystic ovary syndrome (PCOS).
Insulin resistance (IR) is an impaired biologic response to insulin stimulation of target tissues, primarily the liver, muscle, and adipose tissue. IR impairs glucose disposal, resulting in a compensatory increase in beta-cell insulin production and hyperinsulinemia. The metabolic effects of IR include hyperglycemia, high blood pressure, dyslipidemia, visceral obesity, chronic inflammation, endothelial function impairment, and disruption of the hemostatic balance.
The search for novel, informative biomarkers involved in key biological pathways remains the most challenging issue in modern science because it has the potential to influence accurate diagnosis and the subsequent decision on a treatment plan. Within this framework, follistatin-like proteins (FSTL) seem to be interesting biomolecules. It can be argued that FSTLs are promising targets and novel biomarkers in the medical practice. The highest concentration of FSTL1 is achieved in the heart, lungs, and subcutaneous white adipose tissue under physiological conditions.
In this study, we aimed to evaluate the serum level of FSTL1 in overweight/obese children as compared to normal healthy subjects and correlate serum FSTL1 level with insulin resistance and inflammation in overweight/obese children.
We studied 50 children, 25 obese and 25 normal age- and sex-matched subjects. Their ages ranged from 6 to 17 years, selected from the outpatient clinic of Pediatrics Department of Ain Shams University Hospitals from April 2022 to August 2022.
These patients were assigned randomly into 2 groups, group 1 that included 25 overweight/obese children aged 6-17 years and group 2 that included 25 normal weight subjects with matched age and sex served as control group.
All selected children were subjected (after written informed consent) to complete history taking, thorough physical examination, anthropometric and body composition measurements, and laboratory investigations (measurement of serum FSTL1, fasting blood glucose, fasting serum insulin, fasting serum lipids, serum hs-CRP, and HOMA-IR calculation).
Regarding the anthropometric measures there was statistically significant increase in the weight, BMI, waist circumference, body fat% and fat body mass, and MAC in overweight/obese group than control group.
There was no statistically significant difference found between both groups regarding vital data.
Regarding WHtR, there were high significant values in 64% of overweight/obese group than in control group with normal WHtR with cut-off value of 0.5 used in all age groups in children.
Regarding IR, there was significant higher levels of fasting serum insulin level and HOMA-IR in overweight/obese group than the control group. While there was no significant difference in fasting blood glucose level in overweight/obese group.
Regarding serum lipid profile (total cholesterol, LDL, HDL, and TGL) There was no significant difference found between the two groups.
Regarding twenty-four-hour recall food analysis, there was statistically significant increase of total caloric intake, sodium intake, carbohydrates intake (g/d), potassium intake (mg/d), fat intake (g/d), water in food (g/d), zinc intake (mg/d), iron intake (mg/d), fiber intake (g/d), and protein intake (g/d) in overweight/obese group than normal group. While there was no statistically significant difference found between both groups regarding Carbohydrate % in diet, Carb intake level according to RDA, Fat % in diet, Fat intake according to RDA, Protein intake according to RDA, phosphorus intake (mg/d), and calcium intake (mg/d).
Regarding questions answered by mothers, there was statistically significant decrease in child participation in physical activity, meal components usually include vegetables and fruits in overweight/obese group than normal group, while there was no statistically significant difference found between both groups regarding watching TV while eating and having snakes between meals of the studied groups.
Regarding mother giving food rewards, there was significantly higher in control group than overweight/obese group.
Regarding the FSTL1, there was statistically significant increase in the serum level of FSTL1 (ng/ml) in overweight/obese group than normal group.
Regarding FSTL1, the ROC curve shows that the best cutoff point for serum FSTL1 level to differentiate between normal and overweight/obese groups was found >2 ng/ml with sensitivity of 100.0%, specificity of 100.0% and area under curve (AUC) 100.0%.
There was no statistically significant difference in serum FSTL1 level between the obese and overweight subgroups.
There was statistically significant increase in the level of serum hs-CRP in obese subgroup than overweight subgroup.
There was a positive correlation found between serum FSTL1 level and BMI, waist/height ratio, body fat %, MAC, fat body mass(kg), total caloric intake, fasting serum insulin, serum hs-CRP, and HOMA-IR.
Regarding twenty-four-hour recall There was a positive correlation found between serum FSTL1 level and carbohydrate intake, protein % in diet, fat intake (g/d), water in diet, iron intake, and fiber intake. There was a negative correlation between serum FSTL1 level and protein % in diet.
Regarding the questions answered by the mother, there was a statistically significant relation between low serum FSTL1 level and children who participated in physical activity or exercise, in meal served usually include vegetables and fruits, and also with using food to reward child. There was also a statistically significant relation between high serum FSTL1 level in children spent (30-60) minutes than those who spent more than 60 minutes doing physical activity and in children watching TV while eating.