Luxury Brands in India Essay

A luxury brand is a brand for which most of products offered are luxury goods. Luxury goods in general refer to products or services which are not fundamental and can be described as affluence. The three words which compliment luxury brands are high price, high quality and prestige. These brands create and set the seasonal trends and are also capable to pulling all of their consumers with them wherever they go. India being the second-fastest growing economy is believed to be one of the most sought after market by the luxury brands. Designers around the world have been taking inspiration from India’s rich fashion history with bright Bollywood colours, exotic saris, elegant embroidery and stunning jewellery. The growing number of Indians in the billionaire’s club coupled with a evident rise of the urban elite class has seen many international luxury giants queue up to woo the Indian customer who has a peculiar culture of â€Å"status†. A big brand like Chanel launched its 2012 Paris-Bombay Collection. in December of 2011 and Hermes put out a limited-edition line of saris, which instantly drew the world’s attention to the glamour and glitz of India. Luxury brands have thoroughly considered the significance of understanding India’s spending power and rituals as there are definite times when luxury spending isn’t welcome, but other times like weddings and festivals which are prime times for offering high-end, luxury items. As per Millward Brown Optimor consulting company the top 10 luxury brands are: 1. Louis Vuitton- $25. 9 billion, 2. Hermes- $19. 1 billion 3. Rolex- $7. 2 billion 4. Chanel- $6. 7 billion 5. Gucci- $6. 4 billion 6. Prada- $5. 7 billion 7. Cartier- $4. 8 billion. 8. Hennessy- $4. 6 billion. 9. Moet & Chandon- $4. 2 billion. 10. Burberry- $4. 09 billion. Features of Luxury market in India: ? India is the second fastest growing region in Asia Pacific for Luxury Products. ? The Indian market is expected to grow at the rate 25% over next 5 years. ? At $4. 8 billion, the luxury retail market has place for everyone. ? Apparel, jewelry & personal care are the biggest sells in the luxury market. ? Indian Luxury Market is worth $4. 9 Billion, it forms only 2% of global share thus there is a huge scope for expansion. ? There are 103,000 millionaires in India, 16,000 are added each year. ? Luxury and prestige brands such as Rolex, Louis Vuitton and Cartier represent the highest form of craftsmanship and command a staunch consumer loyalty that is not affected by trends. Now that India has emerged as a hot market for Luxury Brands it is important for these brands to market themselves well to the Indian consumer. Most of the Luxury Brands attract a new consumer by indicating high brand worth. With introduction of several Luxury brands in India, Luxury Brand marketing has emerged as a significant ancillary service. Luxury marketing strategies are developed in a unique way which ensures success; some of the strategies are listed below: ? Brand needs to be â€Å"expansive†- it needs to be full of modernization opportunities for the marketer for satisfying the divergent needs of the luxury consumer ? Brand must always tell a majestic story heritage & performance or other aspects that goes on to build the aura of a brand over time. The story always accentuates the identity of the brand. ? Brand needs to be relevant to the needs of consumers-Depending upon the mindset of the luxury class, it is imperative for a brand to satisfy those needs, whether they be catering to recognition or functional use etc. ? Brand must always align itself with consumers’ values-A brand that does not concur with the basic values of a consumer’s society has a small chance of succeeding because luxury items are forms of expression or identification for a luxury consumer. ? Brand needs to perform-Irrespective of which category the brand belongs to, a performance assurance is a must. For all the above mentioned strategies to work there is a strong need for specialized marketing & PR function. These two services have become backbone of the Luxury Brands in India. Through my research I shall try to find out the role played by these agencies and also the activities under taken by various Luxury brands to establish themselves in India. A RESEARCH ON Fashion shows [pic] Assignment on research problem INTRODUCTION Research can be defined as a formalized curiosity. It is â€Å"The systematic investigation into and study of materials, sources, etc., in order to establish facts and reach new conclusions† Oxford English dictionary. In other words it can also be defined as â€Å"A process of finding out information and investigating the unknown to solve a problem† according to Maylor and Blackmon (2005). The topic of my research problem is FASHION SHOWS. My research shall revolve around answering questions like: 1. What brings about the success of these shows? 2. How it affects the fashion trends in a society? 3. How it affects the sales of a country? A fashion show is an event put on by a fashion designer to showcase his or her upcoming line of clothing during a Fashion Week. Fashion shows are fun and creative way of highlighting some of the ethical issues surrounding the fashion industry. There is a lot to be considered so it is well worth planning ahead. This is where the latest fashion trends are introduced to the people at large. In a typical fashion show models walk down the ramp dressed in the clothing created by the designer. Fashions shows enjoy a good amount of media coverage which is essential for spreading trends across the globe. History In the 1800s â€Å"fashion parades† periodically took place in Paris couture salons. American retailers imported the concept of the fashion show in the early 1900s. The first American fashion show likely took place in 1903 in the New York City store Ehrlich Brothers. By 1910, large department stores such as Wanamaker’s in New York City and Philadelphia were also staging fashion shows. These events showed couture gowns from Paris or the store’s copies of them; they aimed to demonstrate the owners’ good taste and capture the attention of female shoppers. Magazines like Vogue and Harper’s bazaar, whose editors were obsessed with French fashion began to feature more work by American designers. American designs became the new modern trends and made their place in the industry. Many designers began to hold their own shows in private functions but some shows turned out to be mishaps. Some locations were hazardous like that of Michael Kors show where a part of the ceiling began falling on the models. Mishaps like these made the designers to send the collection to Bryant Park and Fashion Week as we know it today was born. Advantages:- †¢ Fashion shows gave many aspiring designers a platform to show their collection. †¢ It gave opportunity to see the best garments and meet the best international designers. †¢ It helps in introducing new trends and make people aware of them. †¢ It amalgamates different trends and presents an overview of seasonal trend. What brings out the success of these shows? †¢ Careful selection of the theme of fashion show. It should be in sync with the collection that the designer shows. Theme along with collection leaves an important impact on its audience. †¢ Venue that can accommodate many people and one which can efficiently handle a fashion show. It should have good lighting system, backstage area, adequate parking and also easy to find. †¢ Proper display of Collection. It should be appealing and attractive. †¢ Models that effectively and beautifully carry the designs. †¢ Proper advertisement by creating a media buzz. . World’s most talked about & influential Fashion Shows: †¢ Berlin Fashion Week – Berlin, Germany †¢ Haute Couture- Paris, France †¢ Sao Paulo Fashion Week- Sao Paulo, Brazil †¢ Copenhagen Fashion Week- Copenhagen, Denmark †¢ New York Fashion Week- New York, US †¢ London Fashion Week A/W- London, UK †¢ Tokyo Fashion Week A/W- Tokyo, Japan †¢ Milan Fashion Week S/S- Milan, Italy †¢ Paris Fashion Week S/S- Paris, France.

Case Study †Problem Employee

We often hear about the employers that don’t treat employees well; but you know, it sometimes works the other way as well. I had a call from a gentleman who was at his wits end as to what he could do with an employee that he has had on his payroll now for 5 years. This employee is running the entire show! He’s a bully and the employer is to the point that he is actually afraid of him – not in a physical sense – but in the sense that he’s afraid to stand up to him because – oh no – heaven forbid – he may quit! The employer has completely lost control of this fellow because he never had the courage to set any boundaries or expectations from the start and his leadership has been extremely inconsistent. So, how did this happen, you may ask? The background: The business owner has a small restaurant. He and his wife and brother-in-law opened the restaurant about 7 years ago. The business started to grow and he brought in the employee in question to help them out. At first, the employee was really good and the owner gave him more and more responsibilities, to the point that he felt fairly comfortable in leaving him to open up on occasion and actually assist with the business decisions, etc. The business continued to grow and he hired a few more people, mostly part time, to work during lunch and dinner times. After a few more employees were hired, the original employee (we’ll call him Joe), started to exhibit some less than desirable behaviours by coming in late; opening the doors and then within 15 minutes, he would go out back to have a smoke break (virtually leaving the business open without anyone inside, which the owner found out by coming in a couple of mornings right after Joe and finding the place empty); talking on his cell phone right in front of customers (putting the customers on ignore while he chatted away on the phone); and when the owner tried to speak with him, Joe just held his hand up right in the owner’s face shutting him down. On occasion, when Joe decided he’d made enough tips for the night – he would just leave – an hour – sometimes two hours before his shift actually ended! To heck with the schedule†¦ he’d had enough†¦too bad†¦so sad. Oh – and he didn’t like the owner’s wife – so he told the owner to keep her out of the restaurant – and he did! It has now gotten to the point (according to the employer) that Joe comes and goes as he pleases and in fact, he has told the employer that he can’t do anything about it because he’d have to pay him to terminate him. The employer, unfortunately, does not know his rights in this case – and he has let it go on for so long now that he is getting treated this way by all of his employees. The example has been set! The saddest part of all is that the employee tells the employer what he will and will not do and the employer has no one else that can step into this fellow’s shoes because everyone else is part time and does not have the same level of restaurant business experience. At least, that’s what the owner believes at this time. So; how did we go about finding a solution to this problem when up to this point in time nothing was documented?Case Study – Problem Employee – Part 2 Published: November 1, 2010 The first thing we recommended to this employer was to take a good look at his current employees and consider which ones he could provide more training and development to so that if this problem employee did walk out; he could still manage his business. We also advised him that allowing others to develop their skills would not only increase his ability to provide a better quality business for his customers, it would also provide learning opportunities for his employees that would encourage them to stay. The next thing we did for this employer was to give him information around the basic employment standards act that he needed. He was allowing an employee to tell him what was required by law, and in fact; most of what he was being told was inaccurate. Ignorance is definitely not bliss for a business owner who employs others. We gave him â€Å"fact sheets† with the main areas that he should make himself familiar with so that it was easy to understand and didn’t have a lot of unfamiliar language to interpret. The next thing we recommended is that he considers doing is allowing us to develop an employee handbook and some basic policies that would help him in communicating to his employees moving forward. We recommended that he have a staff meeting prior to the construction of the handbook to allow the employees to have some input or suggestions. We offered to provide support at the staff meeting if he wished; but certainly this is something that he could do on his own as well. We offered to present the handbook to the employees with him so that we could respond to any questions and he didn’t have to feel concerned about how to respond (particularly because he believes the problem employee is going to challenge the implementation of a handbook and policies). We next suggested that he implement a performance management system that aligned with the handbook and policies and we will assist him through coaching sessions as to how he can manage the process. While this is a lot of work for him and it will not be an overnight solution; he has unfortunately allowed his employee to gain control of his business – and not in a good way. Due to the fact that he has not managed the whole relationship well and it has deteriorated to this stage, it will be a long process to repair the damage. The good thing is that he did seek help and he will learn how to retain employees through the provision of learning opportunities; he will have some ‘standards of operation and behavioural expectations’; and he will have a performance management system to ensure a more fair and just working environment. Last, but not least; we are also going to provide some ‘culture coaching’ sessions so he can develop a strong and healthy workplace that fits within his mission and values. As this project is not yet complete, we will report back on occasion to let you know how we move through the recommended processes.

Domestic Violence Essay Example | Topics and Well Written Essays - 500 words

Domestic Violence - Essay Example de in changing laws and creating laws to eradicate domestic violence with penalties that include financial fines and jail sentences; domestic violence continues to be a problem in America (Bullock, 2007). For a long time in America, domestic violence was considered a matter between the husband and wife, mother and father, or romantic couple. That has changed, and with this change the courts are looking at ways to apply sentencing guidelines that serves the people involved and the public at large in the best and safest ways. One of the aspects of sentencing is whether or not a man (or woman) should be sentenced to time in jail. That is a disruption of the family life, including employment, and putting the man away from the family, when in fact keeping the family in tact and rehabilitating the offender with therapy and education might be a better solution. The ways in which violators in domestic violence cases were categorized and were perceived long determined how they were treated. The treatment, in most cases, and prior to recent laws that force the justice system to deal with perpetrators legally; was to make excuses for the perpetrator, to blame it on finances, or some other personal emotional response to an outside precipitator ( Bullock, 2007, p. 34). While some called this making excuses and placing blame, there is perhaps some degree of usefulness to these â€Å"excuses.† That is that it may be more useful to rehabilitate the perpetrator, than to incarcerate the perpetrator. If these outside issues, precipitating factors, or even if the source of the perpetrator’s dysfunction and abuse is one of learned behavior from his or hr own family upbringing; then it makes sense that rehabilitation and therapeutic services would be an even greater deterrent to domestic violence than would be incarceration. To get the courts to support rehabilitation over incarceration, the question as to whether or not the domestic abuser can be rehabilitated must be

BBA Communication 2 Essay Example | Topics and Well Written Essays - 1500 words

BBA Communication 2 - Essay Example It is beautiful and it’s wonderful if it’s a product of a careful planning. Today’s life is full of opportunities, covering everyone from shoe menders to business investors. If one has some sort of skill it is easier to market them on sale, provided one knows where to and how to. However, there stands a difference between living a life and living it beautifully. Life becomes beautiful only when one could live up to see their dreams come true. Those dreams only come true if one acts to turn them into realities. I had always dream to study and practice my religion with grounds of inner beliefs considering no better profession other than this as purification of one’s soul. However, my family especially my parents had it altogether planned differently since the very beginning. Brief Background As a child, I had always been a quite friendly kid although I always had groups of kids to play with at school; I never had any one at home to share my feelings with. My mother was a drama actress; she had inculcated such profession even before marrying dad. She met dad who was one of the stage show organizer whom she later felt in love with and got married. I therefore belong to a family of showbiz people. This basically was the root cause of me and my sister’s subjects had nothing but arts in it. I watched time and noticed that my grandmother had already sign up her mom’s older sister for many extracurricular activities that she however subsequently dropped out of. As, mom became of age to sign up and was then willing to join such groups, her demands were refuse with statements by her parents, such as, â€Å"No, we don’t want to spend more funds to go wasted just the way your sister did.† My mother tried convincing her parents, but they didn’t agree. She always felt cheated for a chance to participate and an opportunity for lifetime. The consequences of this are what I today have to live up with such as pressuri ze over choosing any career but in the field of arts, music or drama. There was no freedom of choice what I wanted to do. No one ever felt the need to inquire my subject area of interest. Earlier Education – Age 4 and onwards Ever since I was a baby, I was made to listen to music and to catch the beat or copy the dance moves. There was a weekly dance contest between my sister and I, which I always used to lose. My sister used to imitate the best dancers; I would witness her pre-planning the dance routines with her friend or cousin and putting them then at family gatherings on a dance show. As was evident sooner my sister became one of leading artist of school plays. When I was finally old enough to sign up for dance and drama lessons, my mom jumped over, certain that I would love to be a part of it and perform like a star pupil due to her obvious budding talent and enthusiasm. The first class I burst into tears when the time came to go into the studio, I didn’t wanted to. The second class I braved going in but tried leaving room for a variety of reasons. Wishing that mom would sense my desire not to attain this education. But, nothing seems to work and the classes continued over a month and although I tried to show much lack of enthusiasm and interest I was still forced to join the group and participate. Parents Role –

Room 4 Moms Ideas Article Example | Topics and Well Written Essays - 500 words

Room 4 Moms Ideas - Article Example The researcher states that nurses have to ensure that there is; respect for human dignity, the good relationship between nurses and patients respect for the nature of health problems of the patients, privacy, and confidentiality of the patients is maintained, and more so, there is a good healthy environment. Nurses cannot achieve all of this attributes unless they have a good philosophy that guides them. It is good to appreciate the efforts put in place by room 4 moms. â€Å"Thank you for the efforts that you have put in place to offer the best services to your patients.† Jean Watson in his notes about human caring highlights some factors that can help one in caring for their patients. This factors are; ‘formation of humanistic-altruistic system of value, instillation of faith-hope, cultivation of sensitivity to one’s self and to others, development of a help and trust, human caring relationship, promotion and acceptance of the expression of positive attitude, neg ative feelings, systematic use of a creative problem and solving caring process, promotion of transpersonal teaching and learning, provision for a supportive, protective, or corrective mental, Physical, societal, and spiritual environment, assistance with gratification of human needs and allowance for existential-phenomenological-spiritual forces’. With all this in place then nursing becomes more philosophical, ethical and intellectually outlined. The room 4 moms come in with the issue of involving one's family in their nursing fields. This gives both the patient and the nurse to have a caring moment with each other. They both come together and share their unique life histories. The coming together at any given moment becomes an inclination point in space and time. During this time, experience and perception take place, but the moment shared together has a significant impact on the patient. They feel encouraged, and they feel both loved and wanted in the society rather than c onsidering them as the liability. The mom`s in rooms 4 believes in Watson`s theory about human caring. Watson at one point in his theory names ‘caring or healing for consciousnesses.

Ethics Essay Example | Topics and Well Written Essays - 1000 words - 5

Ethics - Essay Example In a society, this is applied to adopting policies which should serve the greatest number of people or the majority of the population and the course of action that would be untaken should have a net effect of increasing happiness.   Advocates of libertarian principles, by contrast generally criticize any distributive ideal that requires the pursuit of economic ‘patterns’, such as maximization or equality of welfare or of material goods. They argue that the pursuit of such patterns conflicts with the more important moral demands of liberty or self-ownership (Stanford Encyclopedia of Philosophy). I am more inclined to side with utilitarian justice because it is more applicable in today’s modern society that any act, policy or idea should serve the greatest number of people. It has also practical applications which in fact is even used today such the concept of progressive taxation which is really Rawl’s idea of distributive justice because this taxation tak es more from the rich and gives them more to the one who has less. 2. Explain as fully as you can John Rawls â€Å"Theory of Justice† Do you agree with theory of justice? Why or why not?   In Rawl’s theory of justice, he advance two kinds of justice which is the merit theory which as the title suggests, rewards the person depending upon one’s contribution to society. The other which is more applicable to this case is the need theory which posits that society has an obligation to help other members of society who are in need which will â€Å"balance† their disadvantaged position. In his Theory of Justice, Rawl envisions a â€Å"society of free citizens holding equal basic rights cooperating within an egalitarian economic system† (STandford Encyclopedia of Philosophy).   Thus, the issue of redistributive justice follows this principle that our government ought to redistribute wealth for the purposes of making the distribution of goods more equal. This principle of redistributive justice is not only ideal but also has practical implications. Ideal because the inequalities of society will be addressed through government mechanisms such as collecting more taxes from those who earns more so that it can give more to those who have less. I agree with Rawl’s theory of justice because of its practical implication that it minimizes or blunts the cause of social upheavals which is inequality, injustice and poverty. We all know that the chaotic countries in the Third Worlds are all caused by these elements; widespread poverty, injustice and inequality. By removing or minimizing the ill effect of widespread inequity through the government’s intervention, society will become more stable and less prone to social upheavals because those who have less, will also have less reason to complain and protest against the government. Elements in society who want to sow discontent, chaos or terror will not also prosper because the peo ple are sympathetic to the government and they cannot be agitated to go against the government because they do not feel the injustice and poverty of which chaos, anarchy and terror breeds. The other practical implication of this redistributive justice is that there will be greater social mobility in society where people has equal chance to succeed even if they have less because the government will fill in the social equation where their poverty will not

Choose one of the following Assignment Example | Topics and Well Written Essays - 1750 words

Choose one of the following - Assignment Example In other words, this essay attempts to explore how an advertisement in the printed media can illustrate Umberto Eco’s assertion that the medium as well as the message can be â€Å"charged with cultural signification† (Eco, 1976: 267). To add, the analysis of the perfume advert will focus on the photographic imagery that provides iconic representation of the product along with what it is supposed to stand for. It will also center around how the aforementioned imagery produces relevant signified concepts or, in other words, certain emotional overtones that serve to promote the item’s image. First of all, let us define semiotics and discuss concepts related to it. David Chandler, the author of â€Å"Semiotics: The Basics†, defines semiotics as â€Å"the study of signs† (Chandler, 2002: 1). The definition that is broader in scope was given by Umberto Eco, who assumed that â€Å"semiotics is concerned with everything that can be taken as a sign† ( Eco, 1976: 7). Wray (1981: 4) further explained that semiotics is a study of â€Å"the way any sign, whether it is a traffic signal, a thermometer reading of 98.6 F, poetic imagery, musical notation, a prose passage, or a wink of the eye, functions in the mind of an interpreter to convey a specific meaning in a given situation†. ... With reference to signs, two notable theories should be mentioned – that of Ferdinand de Saussure, a famous Swiss linguist, and Charles Pierce, a U.S. philosopher. For Saussure, semiotics was some kind of science that studies signs’ role within social life. For Pierce, semiotics was rather â€Å"a formal doctrine of signs†, inseparable from logic. While both approaches are considered essentially important for the modern understanding of semiotics, there is a major difference between them: as Leeds-Hurwitz points out, Pierce studied logics, while Saussure focused on behaviour (Leedz-Hurwitz, 2012: 6). The theory of semiotics posits that making meaning is a complex process within the text, and encompasses both signification and address. Signification is a word used to describe the overall process of signs’ reading. Semiotics understands ‘signs’ as something that denotes the elements of language, for instance, words. All languages are complex sig n systems. However, there may be found sign systems that are less complex. These are, for instance, colours. Through the use of specific colours, a message may be transmitted, based on their meanings in various cultures. For instance, the red colour is widely used to signify either a warning or passion in the cultures of the western civilization, while green is believed to be a colour of nature and the colour of harmony. Garments and accessories can serve another language that conveys things about individuals. Therefore, meaning gets formed not just by purely linguistic signifiers, e.g. written words, but also through images as well as different non-linguistic sounds. With reference to this, images function as

Nominating a Musician for the Rock and Roll Hall of Fame Essay

Nominating a Musician for the Rock and Roll Hall of Fame - Essay Example ary 20, 1967  Ã¢â‚¬â€œÃ‚  April 5, 1994) an American singer-songwriter, musician and artist of the highest caliber who articulated the angst, anxiety, frustration and untold aspiration of his generation. He was first noticed in the music scene with the anger of "Smells Like Teen Spirit" from its second album  Nevermind  (1991) and departed with the challenge of In Utero (1993). Kurt Cobain belonged to Generation X, the generation who was labeled an X for the utter lack of description that encapsulate that era. This generation however was given a voice, whose language was spoken through the band of Cobain’s Nirvana which was labeled as â€Å"the flagship band† and spokesperson of his generation, the Generation X. The genre of grunge, with its raw deliverance was given an art and emotion by the genius of its spokesperson, Cobain. Kurt Cobain may have suffered the addiction to heroin and committed suicide. But it cannot be denied that his music has a far reaching influence beyond his generation. The genius of his Utero (1993) is a masterpiece that even the generation after him wondered of its genius. He truly lived the life of rock which includes the internal tumult that compels an artist to create. His life, though not openly shared, was communicated through his music not only during his time but also the succeeding generation that followed his. He may have lived short in the music industry, but not short enough to make his

How photography has been affected by Adobe Photoshop Research Paper

How photography has been affected by Adobe Photoshop - Research Paper Example This research paper hereby analyzes the impact of Adobe Photoshop on traditional photography techniques and also highlights its possible consequences. The traditional techniques involved in the process of photograph development in a darkroom are much time consuming, slow and tough in comparison to the fastidious and smooth logging in the Adobe Photoshop, but it is also an undeniable fact that when a real image become visible, out of nowhere, on the plain photo paper provides a sense of accomplishment to any photographer. While on other hand it is true that operating in a color darkroom comes with its very own difficulties as compared to operating in the black & white, which usually accompanies much more details, color disturbance and totality darkness but on the other hand, development of a photograph in Adobe Photoshop comprises of working in a comfortable environment while sipping a coffee and avoids the direct exposure of hazardous chemicals. In old technique, the measures to be taken to attain the desired print are decided post creation of a contact sheet and the exposure testing's which is done via test strips whereas, the Photoshop has replaced this Hit & Try technology with its up to date modern digital technology. The processes of Dodging and burning, which are considered as tiresome processes in the darkroom are completed with use of Photoshop in couple of minutes and that too with equivalent results. For black and white photographers, the darkroom is the site of at least half the action. Operating in a color darkroom entails an immense dedication on the part of the photographer, both in expressions of point in time and money. The operations of a color darkroom are quite costly as compared to the black & white darkroom, not merely in the materials involved but as well in the equipment mandatory to fabricate superior output. The most significant feature about processing color in a darkroom is temperature control, the temperature gauge at all times is ought to be under ' of 100', there are many instances of likewise operations that are needed to be out looked carefully while developing photo in a Darkroom regardless of Black & white or Color where as in Photoshop, the photo development is just few clicks away, with its advanced inbuilt tools it can correct, enhance, crop, enlarge and produce an equivalent quality. The new technology provided by the Adobe Photoshop has replaced the concept of different darkrooms for different photos making photographers work easier. These days, digital techniques which in no way needs temperature control, working with chemicals, expensive machines like enlargers, are getting more popular among amateur as well as professional photographers. A Photographers

Concept of surface area of a cube Essay Example | Topics and Well Written Essays - 500 words

Concept of surface area of a cube - Essay Example When the bottom is joined to the sides, all four edges can be glued at the same time. That is, the bottom counts as one seam. After the bottom and sides are assembled, the top will be attached. Part 1 - The prerequisite skills necessary to complete this problem; Guiding the students so that they can calculate how many sheets of plywood must be used and determine how many solid seams must be made The prerequisites for this task include recognition of the cube and knowledge of its properties, and the concept of surface area in general. This in turn expects that the students have previously dealt with the concept of the square and flat area in earlier classes so that they can now grasp the concept of the surface area of the cube. The skills required are the ability to measure in feet, derive formulae, and perform simple addition and multiplication calculations related to working out areas, the time taken to complete a project, and the cost of materials. Besides this is the simple ability to compare quantities required at the final stage. They must also be familiar with the concept of 3 dimensions as found in objects around us; that there is a third measure of depth/height besides length and breadth of two dimensional objects and drawings. And, appreciate how we can use (apparently) two-dimensional materials (the plywood sheets) to construct three-dimensional objects (the cube shaped bin). Students should recognize that the number of pieces that need to be cut corresponds to the six faces of the cube. To account for the thickness of the sheets and allow the seams of edges to be made, four of these parts will have shorter dimensions than the 3 ft. x 3 ft. dimensions of the first two parts (from the first sheet for the top and bottom sides). Given the information contained in part 2 of the notes, the students should be aware how only 5 seams need to be made. The cube has 12 edges in total and two meet to form a seam except that in some cases more

Justification for funding researches on Biotechnology and genetic engineering Essay Example for Free

Justification for funding researches on Biotechnology and genetic engineering Essay Biotechnology and genetic engineering are technologies that employ biological materials to generate or construct enhanced products. The technologies are extensively used in the field of agriculture for the generation of new plant hybrids which present commercially important traits such as size and sweetness and remove the commercially risky features including drought- and insecticide-resistance. In the field of biomedicine, microbial species are modified through genetic engineering and used as basis for the design and creation of new vaccines which will help the public from acquiring specific infectious diseases. It is of my opinion that these sciences be funded for purposes of food enhancements and vaccine improvements because these provide us with new methods of using modified versions of the basic biological materials. The modification of particular plant species may be helpful to us in terms of food and our daily consumption, and maintaining good health in the society. For example, rice may be genetically modified to grow to maturity in half the time the wild rice grows. This means that we will always have ample supply of rice because we do not have to wait for such a very long time. In term of vaccines, it is important the biotechnology and genetic engineering improve vaccines because the bacterial and viral pathogens that cause diseases are also constantly evolving. Viruses are continuously changing the proteins on their cell membrane so that the cells of their host will not recognize and destroy them based on the host’s current immunity. If we do not improve our vaccines, we will not be able to control emerging infections around the world, and this may result in multiple global outbreaks. Hence, it is important that these technological innovations be used to their maximum potential. References Patel R, Torres RJ and Rosset P (2005): Genetic engineering in agriculture and corporate engineering in public debate: Risk, public relations, and public debate over genetically modified crops. Int. J. Occup. Environ. Health 11:428-436.

Human digestion Essay Example for Free

Human digestion Essay The salivary glands are the first to react in the digestive process, which are usually triggered by either the sight or the smell of food. Food enters the digestive tract through the mouth where the teeth, tongue, and salivary glands help moisten and break down the food within minutes. The food then becomes something called a bolus, which will travel through the pharynx, then through the esophagus, and into the stomach. As the food travels through the pharynx the epiglottis is in place to prevent food from entering the lungs. Once the bolus enters the stomach it is broken down with acid secretions. The food is partially digested within the stomach. The bolus then becomes chyme (a semiliquid food). Chyme usually leaves the stomach during a time frame of 2-6 hours. The small intestine is where most of the digestion and nutrient absorption takes place with the help of secretions from the liver, gallbladder, and pancreas. The small intestine consists of three parts: the duodenum, the jejunum, and the ileum. Anything that is not absorbed in the small intestine then enters the large intestine travelling through the sphincter. The sphincter prevents any of the remaining food from re-entering the small intestine. The large intestine is made up of two major parts: the colon and the rectum. The colon aids in the absorption of leftover water, vitamins, or minerals. Anything left over after this process is considered waste product (feces) and is then excreted from the body via the anus, which is attached to the colon. Reference Human Digestion Activity. Retrieved August 21, 2009 from http://corptrain.phoenix.edu/axia/sci241/sci241-digestivetract.html

Biochemical and Hormonal Changes in Childhood Obesity

Biochemical and Hormonal Changes in Childhood Obesity The prevalence of chronic or non communicable disease is escalating much more rapidly in developing countries than in industrialized countries. According to World Health Organization (WHO) estimates, by the 2020, non communicable diseases will account for approximately three quarter of all deaths in the developing countries (WHO. Global Strategy for non communicable disease prevention, 1997). In this regard, a potential emerging public health issue for the developing countries may be increasing incidence of childhood obesity with associated complications, which in turn is likely to create public health burden for poorer nations in the near future (Freedman et al, 2001). Lower to middle income nations face the double burden of having both malnourished and over nourished population, with most overweight and obese children being concentrated in urban areas. Rapid urbanization is associated with unhealthy lifestyle or New World Syndrome. In addition, in such communities, childhood obesit y is still considered a sign of healthiness and high social class. There is no universal consensus on a cut off points for defining overweight and obesity in children and adolescents, usually, for clinical practice and epidemiological studies, child overweight and obesity are assessed by means of indicators based on weight and height measurements, such as weight for height measures or body mass index (weight (kg)/height (m2))(WHO. Report series no.847, 1995).The US Centers for Disease Control and Prevention (CDC) defines obese as being at or above 95th percentile of body mass index for age (Kuczmarsk RJ et al, 2000). History of obesity is both interesting and gives details of its progression. Obesity is an age-old health condition. Through out the history of obesity, its reputation varies from appreciation and opposite among cultures and in time. Ancient Egyptians are said to consider obesity as disease. Perhaps the most famous and earliest evidence of obesity is the Venus figurines, Statuettes of an obese female torso that probably had a major role in rituals. Ancient China has also been aware of obesity and dangers that come with it. They always were a believer of prevention as a key to longevity. The Aztecs believed that obesity was supernatural, an affliction of the gods. Hippocrates, the father of medicines was aware of sudden deaths being more common among obese men than lean ones as stated in his writings. In certain cultures and areas where food is scarce and poverty is prevalent, is viewed as symbol of wealth and social status. To date, an African tribe purposely plumps up a bride to pre pare her for child bearing. Before a wedding can be set, a slim bride is pampered to gain weight until she reaches the suitable weight. Through out the history of obesity, the publics view and status of obesity changed considerably in the 1900s. It was regarded as unfashionable by the French designer, Paul Poi ret who designed skin-revealing clothes for women. About the same time, the incidence of obesity began to increase and become wide spread. Later in 1940s, Metropolitan life insurance published a chart of ideal weight for various heights. They also advocated that weight gain parallel to age is unhealthy. The government and medical society become more hands-on with obesity by imitating campaign against it. This was preceded by a study of risk factors for cardiovascular disease revealing obesity in the high ranks. Since then various diets and exercise programs have emerged. In 1996, the Body Mass Index (BMI) was published. This statistical calculation and index determined that a person is obese or not. At this time ,obesity incidence have soared, led by children and adolescent obesity, tripling in just a few short years, greater than any number in the history of obesity. This increase in the incidence of childhood obesity with associated cardiovascular risks, type 2 diabetes mellitus and stroke is supported by a considerable body of evidence. The prevalence of overweight and obesity in childhood and adolescents has been increasing throughout much of the developed and developing world for the past few decades. It has become increasingly clear that excess adiposity in childhood predisposes individual not only to increased risk of adiposity and its sequaele as adults (Freedman et al, 2001), but also to increased risk of multiple chronic diseases in childhood and adolescence (Rosen bloom et al, 1999). Though mechanism not clearly delineated, excess body weight and adiposity is associated with type 2 diabetes mellitus and its complications, cardiovascular disease risk factors, non alcoholic fatty liver disease and asthma in youth. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity and Economic Growth 1930-1983 Childhood obesity was related to the economic growth during the 50 years of economic growth in the industrialized world especially in Denmark. Annual measurements of height and weight were available for all children born between 1930 and 1983 attending primary schools in Copenhagen Municipality. 165,389 boys and 163,609 girls from the age of 7 through 13 years were included in this study. After computerization SBMI (kg/m2) were calculated and the prevalence of overweight and obesity according to international age and gender–specific criteria. Economics growth was indicated by the Gross National Product and the overall consumption per capita, adjusted for inflation. Prevalence of overweight and obesity among Danish children rose in phases, which were not paralleled by trends in economic growth. The microeconomics growth indicators seem inappropriate as proxies for the environmental exposures that have elicited the obesity epidemic. Childhood obesity and television viewing Children spend a substantial portion of their lives watching television (TV). Investigators have hypothesized that TV viewing causes obesity by one or more than three mechanisms: Displacement of physical activity. Increased calorie consumption while watching or caused by the effects of advertising. Reduced resting metabolism. The relationship between TV viewing and obesity has been examined in a relatively large number of cross sectional epidemiological but few longitudinal studies. Many of them have found relatively weak, positive association or mixed results. Many experimental studies have found that reducing TV viewing may help to reduce the risk of obesity. One school based experimental study was designed specifically to test directly the casual relationship between TV viewing behaviors and body fatness. The results of this randomized controlled trial provide evidence that TV viewing is a cause of increased body fatness and that reducing the TV viewing is a promising strategy for preventing childhood obesity (Robinson; 2001). The objective of another study (Utter J et al, 2006), was to explore how time spent watching television (TV) is associated with the dietary behavior of New Zealand children and young adolescents. Total number of participants was 3275 children aged 5-17 years. The findings suggest that longer duration of TV watching (thus more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks and some fast foods among children and young adolescents. Efforts to control the time spent watching TV may result in better dietary habits and weight control for children and adolescents. Childhood Obesity US- A decade of progress, 1990-1999 Current data suggest that 20% of US children are overweight .An analysis of the secular trends suggest that 20% of US children are overweight, and a clear up ward trend in body weight in children of 0.2 Kg between 1973 and 1994. In addition, childhood obesity is more prevalent among minority sub groups such as African Americans. Obesity that begins early in life persists into adulthood and increases the risk of obesity related conditions later in life. There has been tremendous increase in the number of studies examining the etiology and health effects of obesity in children (Goran MI, 1990-1999).1980 (boys 0.2% girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). Ten years trends of childhood obesity in Israel 1990-2000 Cross sectional data was collected from 13284 second and fifth class school; children between 1990-2000. Prevalence of obesity was determined using Israeli and US reference values. BMI values at 95th percentile increased overtime in all ages and sex categories. Between 1990 and 2000, 95th centile values were increased by 12.7%and 11.8% among second grade boys and girls respectively. Among fifth graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference values. The proportion of obese children increased over time using both Israeli and US reference values (Huerta Michael et al, 2008). Netherlands. Overweight, Obesity in 2003: V.1980-97. Data on 90,071 children, aged 4-16 years were routinely collected by 11 Community Heath Services during 2002-2004. International cut -off points for BMI to determine overweight and obesity. On average, 14.5% of boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9% and girls 6.9%) and 1997 (boys 9.7% and girls 13%). Similarly 2.6% of the boys and 3.3% 0f the girls aged 4-16 years were obese, which is much higher than in 1980 (boys 0.2% and girls 0.5%) and 1997 (boys 1.2% and girls 2.0%), (KatjaVan Den Husk, 2007). Obesity trends in US. 2003-2006 Height and weight measurements were obtained from 8164 children and adolescents as apart of the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Because no statistically significant differences in the prevalence of high BMI for age were found between the estimates for 2003-2004 and 2005-2006, data for four years were combined to provide more stable estimates for the most recent time period. Over all, in 2003-2006, 11.3% of children and adolescents aged 2 through years were at or above 97th percentile of the 2000 BMI- for- age growth charts, 16.3% were at or above 95th percentile. Prevalence estimates vary by age and by racial/ethnic group. Analysis of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999-2000, 2001-2002, 2003-2004, and 2005-2006) for either boys or girls (Cynthia l.Ogden et al, 2008). 11-March 2005. Public Release Date: Consensus on Childhood Obesity, Recommends classification as disease A common statement on childhood obesity was published to day in the journal of Chemical Endocrinology and Metabolism (one of the journals of Endocrine Society). The consensus statement reflects the conclusions from an international summit held in Israel last year (2004) and includes a controversial recommendation to classify obesity as a disease. This decision was based upon the available research on the diagnosis, prevalence, causes (including endocrine disorders), risks, prevention and treatment of childhood obesity. Pediatric obesity is now recognized as a major health problem all over the world. Researcher have found that children who are obese have a higher risks adult obesity, which is strongly associated with many serious medical complications that impair quality of life and lead to additional increased risks. The statement also noted the prevalence of overweight/obesity among children 6-11 years (in the US) doubled between the years 1980-2000. By classifying obesity as legiti mate disease, public funding and in user sreimbursement for obesity treatment becomes legalized (consensus on childhood obesity, 2005). Serious health risks will likely to begin to appear in obese children and adolescents as they grow older. These may include diabetes mellitus, metabolic syndrome, hyperandrogenism, heart disease, hypertension, respiratory factors, and sleep disorders. Obese children are also at greater risk of anxiety and depression. It also recommended a number of measures that can be implemented by parents; schools, health providers and government and regulatory agencies to help to prevent the onset of childhood obesity Endocrine Regulation of Energy Metabolism Adipocytokines and Obesity The mechanism underlying obesity was further explained by the discovery of adipocytokines, the role of peripheral thyroid hormones (T4, T3), thyroid stimulating hormone and insulin the regulation of energy metabolism. The levels of some of the adipocytokines were shown to be related to visceral obesity, type 2 diabetes mellitus and coronary artery disease. Plasma levels of all the adipocytokines increase with the obesity except adiponectin (Yuji Matsuzawa et al, 2003). Recent studies point out to the adipose tissue as a highly active organ secreting a range of hormones, Leptin, Adiponectin, and Resistin. They are considered to take part in the regulation of energy metabolism. Leptin, Adiponectin and Resistin are produced by the adipose tissue. Leptin and Adiponectin are insulin sensitizing while Resistin increase the insulin resistance. Leptin The notion that genetic abnormalities contribute to obesity gained important support with the identification of the Ob gene and its protein product in 1994 (Zhangy et al, 1996). The Ob gene termed Leptin from the Greek Leptos, meaning thin, is produced in adipose tissue and is thought to act as an afferent satiety signal in a feed back loop that affects the appetite and satiety centre in the hypothalamus of brain. The ultimate effect of this loop is to regulate body-fat mass. In human, as noted by Considine et al, 1996; caloric restriction reduces leptin concentrations and Ob mRNA levels in adipose tissue, and refeeding increases these levels. One fundamental mechanism of obesity is insensitivity to the action of Leptin, presumably in the hypothalamus. The Leptins primary physiological function is to provide a signal to suppress body fat by decreasing food intake or increasing energy expenditure. Serum leptin concentrations change more during weight loss than during weight gain (Rose nbaum M et al, 1997). Adiponectin Adiponectin or Adipo Q, an adipocyte specific secreted protein with roles in glucose and lipid homeostasis (Insulin stimulates the secretion of adiponectin). Circulating adiponectin concentrations are high 500-30,000 Â µg/l (5-30mg/ml) accounting for 0.01% of total plasma proteins (Berget et al, 2002). Adiponectin was discovered in the mid 1990s by four different groups of researchers (Hu E et al, 1996). Adiponectin has various biological functions including insulin sensitizing (Hotta K et al, 2000), antiatherogenic (Yamauchi T et al, 2003), anti-inflammatory (Ouchi N et al, 2003), antiangiogenic and anti tumor functions (Brakenhielm E et al, 2004). Adiponectin acts through Adiponectin receptors, Adipo R1 and Adipo R2. Adipo R1 is mostly expressed in skeletal muscles and Adipo R2 is abundant in liver. These receptors are also expressed by the pancreatic ß cells (Kharroubi et al, 2003), macrophages and atherosclerotic lesions (Chinetti et al, 2004) as well as in brain (Yamauchi et al, 2003). Circulating Adiponectin levels display diurnal variation with a nocturnal decline and maximum levels in the late morning (Gavrila et al, 2003). Adiponectin is also found in breast milk, which in turn is implicated in childhood obesity prevention (Savino et al, 2008). Among the various adipocytokines, adiponectin, which is an abundant circulating protein (247 amino acids) synthesized purely in adipose tissue, appears to play a very important role in carbohydrates, lipid metabolism and vascular biology. Adiponectin appears to be a major modulator of insulin action and its levels are reduced in type 2 diabetes mellitus, which could contribute to peripheral insulin resistance in this condition. It has significant insulin sensitizing as well as anti inflammatory properties that include suppression of macrophage phagocytosis and TNF-a secretion and blockage of monocytes adhesion to endothelial cells in vitro. Although further investigations are required, Adiponectin administration, as well as regulation of the pathway controlling its production, represents a promising target for managing obesity, hyperlipidemia, insulin resistance, type 2 diabetes mellitus, and vascular inflammation (Manju Chandran et al, 2003). Resistin Human resistin is 108 amino acids prepeptide and is cleaved before its secretion from the Adipose tissue. Resistin circulates in the blood as dimeric protein consisting of 92 amino acids polypeptides that are linked by a disulfide bridge. Holcomb et al, 2000 first described the gene family and its tissue specific distribution. Originally described as lung specific, is also produced by the adipose tissue and peripheral blood monocytes. It is also present in dividing epithelia of the intestine. Resistin increase blood glucose and insulin concentration in the mice and impairs hypoglycemic response to insulin infusion. In addition, anti resistin antibodies decrease blood glucose and insulin sensitivity in obese mice (Ukkalo O, 2002). The physiological role of resistin in human remains controversial. There more resistin protein in obese than lean individuals, with a significant positive correlation between resistin and BMI. BMI is a significant predictor of insulin resistance, but resisti n adjusted for BMI is not. These data demonstrate that resistin protein is present in human adipose tissue and blood and that there is significantly more resistin in serum of obese individuals. Serum resistin is not a significant predictor of insulin resistance in human (Youn et al, 2003, Rear R and Donnelly R, 2004). Tumor Necrosis Factor-a It will be unreasonable not to mention the Tumor Necrosis Factor a and its role in vascular inflammation related to atherosclerosis especially in obesity. It is a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction. The primary role of TNF is in the regulation of immune cells. TNF is able to induce apoptotic cell death, to induce inflammation and to inhibit tumourgenesis and viral replication. Dysregulation and, in particular, over production of TNF have been implicated in a variety of human diseases, as well as cancer (Locksley et al, 2001). The theory of antitumoural response of the immune system in vivo was recognized by the physician William B in 1968. Dr A Granger reported a cytotoxic factor produced by lymphocytes and named it Lymphotoxin (Kalli WB and Granger GA, 1968). Dr L Loyal old, in 1975 reported another cytotoxic factor produced by macrophages and named it Tumor Necrosis Factor (TNF) (Cars well et al, 1975). Interleukin – 6 (IL-6) Chronic inflammation is linked to endothelial dysfunction, atherosclerosis, and insulin resistance (Fernandez-Real JM and Ricart W, 2003 and Fernandez-Real JM, Ricart W, 2005). Plasma concentrations of proinflammatory cytokines, such as interleukin (IL) 18, IL-6, and tumor necrosis factor (TNF)-a, and of several other inflammatory markers are increased in patients with ischemic heart disease (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2002, Engstrom G et al, 2004, Ridker PM et al, 1997, Pradham AD et al, 2002). Circulating cytokines also are elevated in type 2 diabetes, obesity, and insulin resistance syndrome and play a central role in the pathogenesis of these disorders (Fernandez-Real JM and Ricart W, 2003). IL-6 is a mediator of the inflammatory response, and it is linked to dyslipidemia, type 2 diabetes, and risk of myocardial infarction (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2000, Esteve E et al, 2005, Yudkin JS et al, 2000). IL-6 is secreted by a variety of different cell types, including lymphoid and endothelial cells, fibroblasts, skeletal muscle, and adipose tissue. Circulating IL-6 levels correlate with obesity and insulin resistance and may predict the development of type 2 diabetes mellitus (Yudkin JS et al, 2000, Pradhan AD et al, 2001, Akira S et al, 1993, Mohamed-Ali V et al, 1997). Endothelial dysfunction is regarded as a causal factor in the development of atherosclerosis (Hansson GK, 2005). It is one of the earliest abnormalities that can be detected in people at risk for cardiovascular events, and it is linked to insulin resistance and type 2 diabetes (Steinberg HO and Baron AD, 2002, Natali A et al, 2006). Cytokines have an important role in the endothelial injury induced by inflammation. The vascular endothelium is involved in the inflammatory response to atherosclerosis (Hansson GK, 2005, Steinberg HO and Baron AD, 2002, Natali A et al, 2006, Widlansky ME et al, 2003), and changes in endothelium function could underlie the association between cardiovascular disease and inflammation. Obesity Related Insulin Resistance: Definition and Pathogenesis Insulin resistance is a state in which a given amount of insulin produces a subnormal biological response (Kahn CR, 1978). In particular, it is characterized by a decrease in the ability of insulin to stimulate the use of glucose by muscles and adipose tissue and to suppress hepatic glucose production and output (Matthaei et al, 2000). Furthermore, it accounts a resistance to insulin action on protein and lipid metabolism and on vascular endothelial function and genes expression (Bajaj M and Defronzo RA, 2003). Several defects in the insulin signaling cascade have been implicated in the pathogenesis of insulin resistance, Insulin resistance is believed to have both genetic and environmental factors implicated in its etiology (Matthaei et al, 2000 and Liu et al, 2004). The genetic component seems to be polygenic in nature, and several genes have been suggested as potential candidates (Matthaei et al, 2000). However, several other factors can influence insulin sensitivity, such as obesity, ethnicity, gender, perinatal factors, puberty, sedentary lifestyle and diet (Liu et al, 2004). The Role of Fatty Acids and Adipocytokines Obesity represents the major risk factor for the development of insulin resistance in children and adolescents (Caprio S, 2002), and insulin resistance/hyperinsulinemia is believed to be an important link between obesity and the associated metabolic abnormalities and cardiovascular risk (Weiss R and Kaufman FR, 2008). Approximately, 55% of the variance in insulin sensitivity in children can be explained by total adiposity, after adjusting for other confounders, such as age, gender, ethnicity and pubertal stage (Caprio S, 2002). Obese children have hyperinsulinemia and peripheral insulin resistance with an ~40% lower insulin-stimulated glucose metabolism than non-obese children (Caprio S et al, 19996). Adipose tissue seems to play a key role in the pathogenesis of insulin resistance through several released metabolites, hormones and adipocytokines that can affect different steps in insulin action (Matsuzawa Y, 2005) (Fig. 1). Adipocytes produce non-esterified fatty acids, which inhibit carbohydrate metabolism via substrate competition and impaired intracellular insulin signaling (Matsuzawa Y, 2005, Griffin ME et al 1999 and Randle PJ, 1998). In children, as in adults, several adipocytokines have been related to adiposity indexes as well as to insulin resistance. Adiponectin is one of the most common cytokines produced by adipose tissue, with an important insulin sensitizing effect associated with anti-atherogenetic properties (Despres JP, 2006 and Gil-Campos M et al, 2004). Whereas obesity is generally associated with an increased release of metabolites by adipose tissue, levels of Adiponectin are inversely related to adiposity (Matsuzawa Y, 2005). Therefore, reduced levels of this adipocytokine have been implicated in the pathogenesis of insulin resistance and metabolic syndrome (Matsuzawa Y, 2005). Decreased levels of Adiponectin have been detected across tertiles of insulin resistance in children and adolescents (Weiss R et al, 2004), where it is a good predictor of insulin sensitivity, independently of adiposity (Lee S et al, 2006). Adipose tissue also produces tumour necrosis factor-a, an inflammatory factor, which can alter insulin action at different levels in the intracellular pathway (Matsuzawa Y, 2005). Interleukin-6 (IL-6) is ano ther inflammatory cytokine released by adipose tissue and its levels are increased in obesity (Matsuzawa Y, 2005). IL-6 stimulates the hepatic production of C-reactive protein and this can explain the state of inflammation associated with obesity, and could mediate, at least partially, obesity-related insulin resistance (Matsuzawa Y, 2005). Data based mainly on animal studies also suggest that increased levels of resistin, another molecule produced by adipose tissue, could impair insulin sensitivity (Matsuzawa Y, 2005). The close relationship between Leptin levels and insulin resistance in children has also been suggested by the data (Chu NF et al, 2000). Serum levels of retinol-binding protein 4 (RBP4) correlate with insulin resistance in subjects with obesity as well as in those with impaired glucose tolerance (IGT) or type 2 diabetes mellitus, therefore suggesting that it could be useful in assessing insulin resistance and the associated risk for complications (Graham TE et al, 2006). Serum RBP4 is independently related to obesity as well as to components of the metabolic syndrome in normal weight and overweight children (Aeberli I et al, 2007). Diet composition in obese children might be an additional factor promoting and/or worsening insulin resistance. Animal and human studies suggest that a high energy intake as well as a diet rich in fat and carbohydrates and low in fiber could increase the risk of developing insulin resistance (Canete R et al, 2007). The Role of Fat Distribution An altered partitioning of fat between subcutaneous and visceral or ectopic sites has been associated with insulin resistance (Weiss R and Kaufman FR, 2008). Visceral fat has a better correlation with insulin sensitivity than subcutaneous or total body fat (Caprio S et al, 1995), in both obese adults and children. Visceral fat has higher lipolytic activity compared with subcutaneous fat, therefore a greater amount of free fatty acids and glycerol gain entry or carried out to the liver (Matthaei et al, 2000). Visceral fat in girls is directly correlated to the glucose-stimulated insulin levels and inversely correlated with insulin sensitivity and the rate of glucose uptake. No correlation was found between abdominal subcutaneous fat (Caprio S et al, 1995). Ectopic deposition of fat in the liver or muscle can also be responsible for insulin resistance in obese subjects, as the accumulation of fat in these sites impairs insulin signaling, with a reduced glucose uptake in the muscle and a decreased insulin-mediated suppression of hepatic glucose production (Weiss R and Kaufman FR, 2008). Intramyocellular lipid (IMCL) accumulation has been shown as a factor related to decreased insulin sensitivity (Jacob S et al, 1999 and Thamer C et al, 2003). Obese insulin sensitive children and adolescents present lower levels of visceral fat and IMCL when compared with obese insulin resistant children (Weiss R et al, 2005). Accumulation of fat in the liver has also been associated with insulin resistance, independently of adiposity (Kelley DE et al, 2003). It has also been suggested that deposits of fat around blood vessels can produce several cytokines and therefore contribute to the development of insulin resistance, through a so-called vasocrine effect (Yudkin JS et al, 2005). Insulin Resistance and Associated Complications Insulin resistance in obesity is strictly related to the development of hypertension (Marcovecchio ML et al, 2006 and Cruz ML et al, 2002), dyslipidemia (Howard BV and Howard WJ, 1994), impaired glucose tolerance (IGT) (Sinha R et al, 2002), hepatic steatosis (DAdamo E et al, 2008), as well as to the combination of these factors, also known as metabolic syndrome (Eckel RH et al, 2005). Furthermore, insulin resistance is associated with systemic inflammation, endothelial dysfunction, early atherosclerosis and disordered fibrinolysis (Dan Dona P et al, 2002). It is alarming that these metabolic and cardiovascular complications are already found in obese children and adolescents (Dietz WH, 2004). The presence of these alterations in prepubertal children is then particularly worrying, as insulin resistance and related complications might be further exacerbated by the influence of puberty, due to the physiological decrease in insulin sensitivity associated with normal pubertal development (Caprio S et al, 1989). Insulin resistance in childhood can track in adult life (Sinaiko AR et al, 2006). Insulin resistance at the age of 13 years predicts insulin resistance at age 19 years, independently of BMI, and is also associated with cardiovascular risk in adulthood (Sinaiko AR et al, 2006). The fundamental role of insulin resistance in human disease was already recognized in 1988 by Reaven (Reaven GM, 1988) who emphasized its role in the development of a grouping of metabolic abnormalities, which he defined as syndrome X. Later studies strengthened the concept of insulin resistance as a key component of the metabolic syndrome, a cluster of impaired glucose tolerance (IGT), dyslipidemia, hypertension, hyperinsulinemia, associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease (Eckel RH et al, 2005). Insulin resistance represents a serious and common complication of obesity during childhood and adolescence. A timely diagnosis and an appropriated prevention and treatment of obesity and insulin resistance are required in order to reduce the Biochemical and Hormonal Changes in Childhood Obesity Biochemical and Hormonal Changes in Childhood Obesity The prevalence of chronic or non communicable disease is escalating much more rapidly in developing countries than in industrialized countries. According to World Health Organization (WHO) estimates, by the 2020, non communicable diseases will account for approximately three quarter of all deaths in the developing countries (WHO. Global Strategy for non communicable disease prevention, 1997). In this regard, a potential emerging public health issue for the developing countries may be increasing incidence of childhood obesity with associated complications, which in turn is likely to create public health burden for poorer nations in the near future (Freedman et al, 2001). Lower to middle income nations face the double burden of having both malnourished and over nourished population, with most overweight and obese children being concentrated in urban areas. Rapid urbanization is associated with unhealthy lifestyle or New World Syndrome. In addition, in such communities, childhood obesit y is still considered a sign of healthiness and high social class. There is no universal consensus on a cut off points for defining overweight and obesity in children and adolescents, usually, for clinical practice and epidemiological studies, child overweight and obesity are assessed by means of indicators based on weight and height measurements, such as weight for height measures or body mass index (weight (kg)/height (m2))(WHO. Report series no.847, 1995).The US Centers for Disease Control and Prevention (CDC) defines obese as being at or above 95th percentile of body mass index for age (Kuczmarsk RJ et al, 2000). History of obesity is both interesting and gives details of its progression. Obesity is an age-old health condition. Through out the history of obesity, its reputation varies from appreciation and opposite among cultures and in time. Ancient Egyptians are said to consider obesity as disease. Perhaps the most famous and earliest evidence of obesity is the Venus figurines, Statuettes of an obese female torso that probably had a major role in rituals. Ancient China has also been aware of obesity and dangers that come with it. They always were a believer of prevention as a key to longevity. The Aztecs believed that obesity was supernatural, an affliction of the gods. Hippocrates, the father of medicines was aware of sudden deaths being more common among obese men than lean ones as stated in his writings. In certain cultures and areas where food is scarce and poverty is prevalent, is viewed as symbol of wealth and social status. To date, an African tribe purposely plumps up a bride to pre pare her for child bearing. Before a wedding can be set, a slim bride is pampered to gain weight until she reaches the suitable weight. Through out the history of obesity, the publics view and status of obesity changed considerably in the 1900s. It was regarded as unfashionable by the French designer, Paul Poi ret who designed skin-revealing clothes for women. About the same time, the incidence of obesity began to increase and become wide spread. Later in 1940s, Metropolitan life insurance published a chart of ideal weight for various heights. They also advocated that weight gain parallel to age is unhealthy. The government and medical society become more hands-on with obesity by imitating campaign against it. This was preceded by a study of risk factors for cardiovascular disease revealing obesity in the high ranks. Since then various diets and exercise programs have emerged. In 1996, the Body Mass Index (BMI) was published. This statistical calculation and index determined that a person is obese or not. At this time ,obesity incidence have soared, led by children and adolescent obesity, tripling in just a few short years, greater than any number in the history of obesity. This increase in the incidence of childhood obesity with associated cardiovascular risks, type 2 diabetes mellitus and stroke is supported by a considerable body of evidence. The prevalence of overweight and obesity in childhood and adolescents has been increasing throughout much of the developed and developing world for the past few decades. It has become increasingly clear that excess adiposity in childhood predisposes individual not only to increased risk of adiposity and its sequaele as adults (Freedman et al, 2001), but also to increased risk of multiple chronic diseases in childhood and adolescence (Rosen bloom et al, 1999). Though mechanism not clearly delineated, excess body weight and adiposity is associated with type 2 diabetes mellitus and its complications, cardiovascular disease risk factors, non alcoholic fatty liver disease and asthma in youth. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity and Economic Growth 1930-1983 Childhood obesity was related to the economic growth during the 50 years of economic growth in the industrialized world especially in Denmark. Annual measurements of height and weight were available for all children born between 1930 and 1983 attending primary schools in Copenhagen Municipality. 165,389 boys and 163,609 girls from the age of 7 through 13 years were included in this study. After computerization SBMI (kg/m2) were calculated and the prevalence of overweight and obesity according to international age and gender–specific criteria. Economics growth was indicated by the Gross National Product and the overall consumption per capita, adjusted for inflation. Prevalence of overweight and obesity among Danish children rose in phases, which were not paralleled by trends in economic growth. The microeconomics growth indicators seem inappropriate as proxies for the environmental exposures that have elicited the obesity epidemic. Childhood obesity and television viewing Children spend a substantial portion of their lives watching television (TV). Investigators have hypothesized that TV viewing causes obesity by one or more than three mechanisms: Displacement of physical activity. Increased calorie consumption while watching or caused by the effects of advertising. Reduced resting metabolism. The relationship between TV viewing and obesity has been examined in a relatively large number of cross sectional epidemiological but few longitudinal studies. Many of them have found relatively weak, positive association or mixed results. Many experimental studies have found that reducing TV viewing may help to reduce the risk of obesity. One school based experimental study was designed specifically to test directly the casual relationship between TV viewing behaviors and body fatness. The results of this randomized controlled trial provide evidence that TV viewing is a cause of increased body fatness and that reducing the TV viewing is a promising strategy for preventing childhood obesity (Robinson; 2001). The objective of another study (Utter J et al, 2006), was to explore how time spent watching television (TV) is associated with the dietary behavior of New Zealand children and young adolescents. Total number of participants was 3275 children aged 5-17 years. The findings suggest that longer duration of TV watching (thus more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks and some fast foods among children and young adolescents. Efforts to control the time spent watching TV may result in better dietary habits and weight control for children and adolescents. Childhood Obesity US- A decade of progress, 1990-1999 Current data suggest that 20% of US children are overweight .An analysis of the secular trends suggest that 20% of US children are overweight, and a clear up ward trend in body weight in children of 0.2 Kg between 1973 and 1994. In addition, childhood obesity is more prevalent among minority sub groups such as African Americans. Obesity that begins early in life persists into adulthood and increases the risk of obesity related conditions later in life. There has been tremendous increase in the number of studies examining the etiology and health effects of obesity in children (Goran MI, 1990-1999).1980 (boys 0.2% girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). Ten years trends of childhood obesity in Israel 1990-2000 Cross sectional data was collected from 13284 second and fifth class school; children between 1990-2000. Prevalence of obesity was determined using Israeli and US reference values. BMI values at 95th percentile increased overtime in all ages and sex categories. Between 1990 and 2000, 95th centile values were increased by 12.7%and 11.8% among second grade boys and girls respectively. Among fifth graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference values. The proportion of obese children increased over time using both Israeli and US reference values (Huerta Michael et al, 2008). Netherlands. Overweight, Obesity in 2003: V.1980-97. Data on 90,071 children, aged 4-16 years were routinely collected by 11 Community Heath Services during 2002-2004. International cut -off points for BMI to determine overweight and obesity. On average, 14.5% of boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9% and girls 6.9%) and 1997 (boys 9.7% and girls 13%). Similarly 2.6% of the boys and 3.3% 0f the girls aged 4-16 years were obese, which is much higher than in 1980 (boys 0.2% and girls 0.5%) and 1997 (boys 1.2% and girls 2.0%), (KatjaVan Den Husk, 2007). Obesity trends in US. 2003-2006 Height and weight measurements were obtained from 8164 children and adolescents as apart of the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Because no statistically significant differences in the prevalence of high BMI for age were found between the estimates for 2003-2004 and 2005-2006, data for four years were combined to provide more stable estimates for the most recent time period. Over all, in 2003-2006, 11.3% of children and adolescents aged 2 through years were at or above 97th percentile of the 2000 BMI- for- age growth charts, 16.3% were at or above 95th percentile. Prevalence estimates vary by age and by racial/ethnic group. Analysis of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999-2000, 2001-2002, 2003-2004, and 2005-2006) for either boys or girls (Cynthia l.Ogden et al, 2008). 11-March 2005. Public Release Date: Consensus on Childhood Obesity, Recommends classification as disease A common statement on childhood obesity was published to day in the journal of Chemical Endocrinology and Metabolism (one of the journals of Endocrine Society). The consensus statement reflects the conclusions from an international summit held in Israel last year (2004) and includes a controversial recommendation to classify obesity as a disease. This decision was based upon the available research on the diagnosis, prevalence, causes (including endocrine disorders), risks, prevention and treatment of childhood obesity. Pediatric obesity is now recognized as a major health problem all over the world. Researcher have found that children who are obese have a higher risks adult obesity, which is strongly associated with many serious medical complications that impair quality of life and lead to additional increased risks. The statement also noted the prevalence of overweight/obesity among children 6-11 years (in the US) doubled between the years 1980-2000. By classifying obesity as legiti mate disease, public funding and in user sreimbursement for obesity treatment becomes legalized (consensus on childhood obesity, 2005). Serious health risks will likely to begin to appear in obese children and adolescents as they grow older. These may include diabetes mellitus, metabolic syndrome, hyperandrogenism, heart disease, hypertension, respiratory factors, and sleep disorders. Obese children are also at greater risk of anxiety and depression. It also recommended a number of measures that can be implemented by parents; schools, health providers and government and regulatory agencies to help to prevent the onset of childhood obesity Endocrine Regulation of Energy Metabolism Adipocytokines and Obesity The mechanism underlying obesity was further explained by the discovery of adipocytokines, the role of peripheral thyroid hormones (T4, T3), thyroid stimulating hormone and insulin the regulation of energy metabolism. The levels of some of the adipocytokines were shown to be related to visceral obesity, type 2 diabetes mellitus and coronary artery disease. Plasma levels of all the adipocytokines increase with the obesity except adiponectin (Yuji Matsuzawa et al, 2003). Recent studies point out to the adipose tissue as a highly active organ secreting a range of hormones, Leptin, Adiponectin, and Resistin. They are considered to take part in the regulation of energy metabolism. Leptin, Adiponectin and Resistin are produced by the adipose tissue. Leptin and Adiponectin are insulin sensitizing while Resistin increase the insulin resistance. Leptin The notion that genetic abnormalities contribute to obesity gained important support with the identification of the Ob gene and its protein product in 1994 (Zhangy et al, 1996). The Ob gene termed Leptin from the Greek Leptos, meaning thin, is produced in adipose tissue and is thought to act as an afferent satiety signal in a feed back loop that affects the appetite and satiety centre in the hypothalamus of brain. The ultimate effect of this loop is to regulate body-fat mass. In human, as noted by Considine et al, 1996; caloric restriction reduces leptin concentrations and Ob mRNA levels in adipose tissue, and refeeding increases these levels. One fundamental mechanism of obesity is insensitivity to the action of Leptin, presumably in the hypothalamus. The Leptins primary physiological function is to provide a signal to suppress body fat by decreasing food intake or increasing energy expenditure. Serum leptin concentrations change more during weight loss than during weight gain (Rose nbaum M et al, 1997). Adiponectin Adiponectin or Adipo Q, an adipocyte specific secreted protein with roles in glucose and lipid homeostasis (Insulin stimulates the secretion of adiponectin). Circulating adiponectin concentrations are high 500-30,000 Â µg/l (5-30mg/ml) accounting for 0.01% of total plasma proteins (Berget et al, 2002). Adiponectin was discovered in the mid 1990s by four different groups of researchers (Hu E et al, 1996). Adiponectin has various biological functions including insulin sensitizing (Hotta K et al, 2000), antiatherogenic (Yamauchi T et al, 2003), anti-inflammatory (Ouchi N et al, 2003), antiangiogenic and anti tumor functions (Brakenhielm E et al, 2004). Adiponectin acts through Adiponectin receptors, Adipo R1 and Adipo R2. Adipo R1 is mostly expressed in skeletal muscles and Adipo R2 is abundant in liver. These receptors are also expressed by the pancreatic ß cells (Kharroubi et al, 2003), macrophages and atherosclerotic lesions (Chinetti et al, 2004) as well as in brain (Yamauchi et al, 2003). Circulating Adiponectin levels display diurnal variation with a nocturnal decline and maximum levels in the late morning (Gavrila et al, 2003). Adiponectin is also found in breast milk, which in turn is implicated in childhood obesity prevention (Savino et al, 2008). Among the various adipocytokines, adiponectin, which is an abundant circulating protein (247 amino acids) synthesized purely in adipose tissue, appears to play a very important role in carbohydrates, lipid metabolism and vascular biology. Adiponectin appears to be a major modulator of insulin action and its levels are reduced in type 2 diabetes mellitus, which could contribute to peripheral insulin resistance in this condition. It has significant insulin sensitizing as well as anti inflammatory properties that include suppression of macrophage phagocytosis and TNF-a secretion and blockage of monocytes adhesion to endothelial cells in vitro. Although further investigations are required, Adiponectin administration, as well as regulation of the pathway controlling its production, represents a promising target for managing obesity, hyperlipidemia, insulin resistance, type 2 diabetes mellitus, and vascular inflammation (Manju Chandran et al, 2003). Resistin Human resistin is 108 amino acids prepeptide and is cleaved before its secretion from the Adipose tissue. Resistin circulates in the blood as dimeric protein consisting of 92 amino acids polypeptides that are linked by a disulfide bridge. Holcomb et al, 2000 first described the gene family and its tissue specific distribution. Originally described as lung specific, is also produced by the adipose tissue and peripheral blood monocytes. It is also present in dividing epithelia of the intestine. Resistin increase blood glucose and insulin concentration in the mice and impairs hypoglycemic response to insulin infusion. In addition, anti resistin antibodies decrease blood glucose and insulin sensitivity in obese mice (Ukkalo O, 2002). The physiological role of resistin in human remains controversial. There more resistin protein in obese than lean individuals, with a significant positive correlation between resistin and BMI. BMI is a significant predictor of insulin resistance, but resisti n adjusted for BMI is not. These data demonstrate that resistin protein is present in human adipose tissue and blood and that there is significantly more resistin in serum of obese individuals. Serum resistin is not a significant predictor of insulin resistance in human (Youn et al, 2003, Rear R and Donnelly R, 2004). Tumor Necrosis Factor-a It will be unreasonable not to mention the Tumor Necrosis Factor a and its role in vascular inflammation related to atherosclerosis especially in obesity. It is a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction. The primary role of TNF is in the regulation of immune cells. TNF is able to induce apoptotic cell death, to induce inflammation and to inhibit tumourgenesis and viral replication. Dysregulation and, in particular, over production of TNF have been implicated in a variety of human diseases, as well as cancer (Locksley et al, 2001). The theory of antitumoural response of the immune system in vivo was recognized by the physician William B in 1968. Dr A Granger reported a cytotoxic factor produced by lymphocytes and named it Lymphotoxin (Kalli WB and Granger GA, 1968). Dr L Loyal old, in 1975 reported another cytotoxic factor produced by macrophages and named it Tumor Necrosis Factor (TNF) (Cars well et al, 1975). Interleukin – 6 (IL-6) Chronic inflammation is linked to endothelial dysfunction, atherosclerosis, and insulin resistance (Fernandez-Real JM and Ricart W, 2003 and Fernandez-Real JM, Ricart W, 2005). Plasma concentrations of proinflammatory cytokines, such as interleukin (IL) 18, IL-6, and tumor necrosis factor (TNF)-a, and of several other inflammatory markers are increased in patients with ischemic heart disease (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2002, Engstrom G et al, 2004, Ridker PM et al, 1997, Pradham AD et al, 2002). Circulating cytokines also are elevated in type 2 diabetes, obesity, and insulin resistance syndrome and play a central role in the pathogenesis of these disorders (Fernandez-Real JM and Ricart W, 2003). IL-6 is a mediator of the inflammatory response, and it is linked to dyslipidemia, type 2 diabetes, and risk of myocardial infarction (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2000, Esteve E et al, 2005, Yudkin JS et al, 2000). IL-6 is secreted by a variety of different cell types, including lymphoid and endothelial cells, fibroblasts, skeletal muscle, and adipose tissue. Circulating IL-6 levels correlate with obesity and insulin resistance and may predict the development of type 2 diabetes mellitus (Yudkin JS et al, 2000, Pradhan AD et al, 2001, Akira S et al, 1993, Mohamed-Ali V et al, 1997). Endothelial dysfunction is regarded as a causal factor in the development of atherosclerosis (Hansson GK, 2005). It is one of the earliest abnormalities that can be detected in people at risk for cardiovascular events, and it is linked to insulin resistance and type 2 diabetes (Steinberg HO and Baron AD, 2002, Natali A et al, 2006). Cytokines have an important role in the endothelial injury induced by inflammation. The vascular endothelium is involved in the inflammatory response to atherosclerosis (Hansson GK, 2005, Steinberg HO and Baron AD, 2002, Natali A et al, 2006, Widlansky ME et al, 2003), and changes in endothelium function could underlie the association between cardiovascular disease and inflammation. Obesity Related Insulin Resistance: Definition and Pathogenesis Insulin resistance is a state in which a given amount of insulin produces a subnormal biological response (Kahn CR, 1978). In particular, it is characterized by a decrease in the ability of insulin to stimulate the use of glucose by muscles and adipose tissue and to suppress hepatic glucose production and output (Matthaei et al, 2000). Furthermore, it accounts a resistance to insulin action on protein and lipid metabolism and on vascular endothelial function and genes expression (Bajaj M and Defronzo RA, 2003). Several defects in the insulin signaling cascade have been implicated in the pathogenesis of insulin resistance, Insulin resistance is believed to have both genetic and environmental factors implicated in its etiology (Matthaei et al, 2000 and Liu et al, 2004). The genetic component seems to be polygenic in nature, and several genes have been suggested as potential candidates (Matthaei et al, 2000). However, several other factors can influence insulin sensitivity, such as obesity, ethnicity, gender, perinatal factors, puberty, sedentary lifestyle and diet (Liu et al, 2004). The Role of Fatty Acids and Adipocytokines Obesity represents the major risk factor for the development of insulin resistance in children and adolescents (Caprio S, 2002), and insulin resistance/hyperinsulinemia is believed to be an important link between obesity and the associated metabolic abnormalities and cardiovascular risk (Weiss R and Kaufman FR, 2008). Approximately, 55% of the variance in insulin sensitivity in children can be explained by total adiposity, after adjusting for other confounders, such as age, gender, ethnicity and pubertal stage (Caprio S, 2002). Obese children have hyperinsulinemia and peripheral insulin resistance with an ~40% lower insulin-stimulated glucose metabolism than non-obese children (Caprio S et al, 19996). Adipose tissue seems to play a key role in the pathogenesis of insulin resistance through several released metabolites, hormones and adipocytokines that can affect different steps in insulin action (Matsuzawa Y, 2005) (Fig. 1). Adipocytes produce non-esterified fatty acids, which inhibit carbohydrate metabolism via substrate competition and impaired intracellular insulin signaling (Matsuzawa Y, 2005, Griffin ME et al 1999 and Randle PJ, 1998). In children, as in adults, several adipocytokines have been related to adiposity indexes as well as to insulin resistance. Adiponectin is one of the most common cytokines produced by adipose tissue, with an important insulin sensitizing effect associated with anti-atherogenetic properties (Despres JP, 2006 and Gil-Campos M et al, 2004). Whereas obesity is generally associated with an increased release of metabolites by adipose tissue, levels of Adiponectin are inversely related to adiposity (Matsuzawa Y, 2005). Therefore, reduced levels of this adipocytokine have been implicated in the pathogenesis of insulin resistance and metabolic syndrome (Matsuzawa Y, 2005). Decreased levels of Adiponectin have been detected across tertiles of insulin resistance in children and adolescents (Weiss R et al, 2004), where it is a good predictor of insulin sensitivity, independently of adiposity (Lee S et al, 2006). Adipose tissue also produces tumour necrosis factor-a, an inflammatory factor, which can alter insulin action at different levels in the intracellular pathway (Matsuzawa Y, 2005). Interleukin-6 (IL-6) is ano ther inflammatory cytokine released by adipose tissue and its levels are increased in obesity (Matsuzawa Y, 2005). IL-6 stimulates the hepatic production of C-reactive protein and this can explain the state of inflammation associated with obesity, and could mediate, at least partially, obesity-related insulin resistance (Matsuzawa Y, 2005). Data based mainly on animal studies also suggest that increased levels of resistin, another molecule produced by adipose tissue, could impair insulin sensitivity (Matsuzawa Y, 2005). The close relationship between Leptin levels and insulin resistance in children has also been suggested by the data (Chu NF et al, 2000). Serum levels of retinol-binding protein 4 (RBP4) correlate with insulin resistance in subjects with obesity as well as in those with impaired glucose tolerance (IGT) or type 2 diabetes mellitus, therefore suggesting that it could be useful in assessing insulin resistance and the associated risk for complications (Graham TE et al, 2006). Serum RBP4 is independently related to obesity as well as to components of the metabolic syndrome in normal weight and overweight children (Aeberli I et al, 2007). Diet composition in obese children might be an additional factor promoting and/or worsening insulin resistance. Animal and human studies suggest that a high energy intake as well as a diet rich in fat and carbohydrates and low in fiber could increase the risk of developing insulin resistance (Canete R et al, 2007). The Role of Fat Distribution An altered partitioning of fat between subcutaneous and visceral or ectopic sites has been associated with insulin resistance (Weiss R and Kaufman FR, 2008). Visceral fat has a better correlation with insulin sensitivity than subcutaneous or total body fat (Caprio S et al, 1995), in both obese adults and children. Visceral fat has higher lipolytic activity compared with subcutaneous fat, therefore a greater amount of free fatty acids and glycerol gain entry or carried out to the liver (Matthaei et al, 2000). Visceral fat in girls is directly correlated to the glucose-stimulated insulin levels and inversely correlated with insulin sensitivity and the rate of glucose uptake. No correlation was found between abdominal subcutaneous fat (Caprio S et al, 1995). Ectopic deposition of fat in the liver or muscle can also be responsible for insulin resistance in obese subjects, as the accumulation of fat in these sites impairs insulin signaling, with a reduced glucose uptake in the muscle and a decreased insulin-mediated suppression of hepatic glucose production (Weiss R and Kaufman FR, 2008). Intramyocellular lipid (IMCL) accumulation has been shown as a factor related to decreased insulin sensitivity (Jacob S et al, 1999 and Thamer C et al, 2003). Obese insulin sensitive children and adolescents present lower levels of visceral fat and IMCL when compared with obese insulin resistant children (Weiss R et al, 2005). Accumulation of fat in the liver has also been associated with insulin resistance, independently of adiposity (Kelley DE et al, 2003). It has also been suggested that deposits of fat around blood vessels can produce several cytokines and therefore contribute to the development of insulin resistance, through a so-called vasocrine effect (Yudkin JS et al, 2005). Insulin Resistance and Associated Complications Insulin resistance in obesity is strictly related to the development of hypertension (Marcovecchio ML et al, 2006 and Cruz ML et al, 2002), dyslipidemia (Howard BV and Howard WJ, 1994), impaired glucose tolerance (IGT) (Sinha R et al, 2002), hepatic steatosis (DAdamo E et al, 2008), as well as to the combination of these factors, also known as metabolic syndrome (Eckel RH et al, 2005). Furthermore, insulin resistance is associated with systemic inflammation, endothelial dysfunction, early atherosclerosis and disordered fibrinolysis (Dan Dona P et al, 2002). It is alarming that these metabolic and cardiovascular complications are already found in obese children and adolescents (Dietz WH, 2004). The presence of these alterations in prepubertal children is then particularly worrying, as insulin resistance and related complications might be further exacerbated by the influence of puberty, due to the physiological decrease in insulin sensitivity associated with normal pubertal development (Caprio S et al, 1989). Insulin resistance in childhood can track in adult life (Sinaiko AR et al, 2006). Insulin resistance at the age of 13 years predicts insulin resistance at age 19 years, independently of BMI, and is also associated with cardiovascular risk in adulthood (Sinaiko AR et al, 2006). The fundamental role of insulin resistance in human disease was already recognized in 1988 by Reaven (Reaven GM, 1988) who emphasized its role in the development of a grouping of metabolic abnormalities, which he defined as syndrome X. Later studies strengthened the concept of insulin resistance as a key component of the metabolic syndrome, a cluster of impaired glucose tolerance (IGT), dyslipidemia, hypertension, hyperinsulinemia, associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease (Eckel RH et al, 2005). Insulin resistance represents a serious and common complication of obesity during childhood and adolescence. A timely diagnosis and an appropriated prevention and treatment of obesity and insulin resistance are required in order to reduce the