**3. Diet and weight loss**

Clinical studies have demonstrated that the berry and the ethanol fraction from Sea-buckthorn

Experimental studies done in diabetic rats demonstrated that flavonoids present in water extracts of Sea-buckthorn seeds have hypoglycemic and triglyceride-lowering effect [84].

The fibers and polyphenols in Sea-buckthorn (Hippophaë rhamnoides) extraction residues

Quercetin, as an important flavonoid in the Sea-buckthorn, has also hypolipidemic effect [86].

In vitro studies demonstrated that quercetin and isorhamnetin have protective effects against oxidized LDL-induced endothelial cell injuries. The flavonoids' beneficial effects might derive from their antioxidant activity and from their capability in modulating the expression of eNOS

There are some molecules that are (currently known to be) unique to Sea-buckthorn named

High-fat diet obese C57BL/6J mice treated with 70% ethanolic extract of Sea-buckthorn at 500– 1,000 mg/kg bodyweight over 13 weeks had lower hepatic and serum total cholesterol, lower hepatic triglycerides and serum leptin level versus non-treated mice. Triglyceridemia and insulinemia were similar in the studied group. The study demonstrated that the Sea-buckthorn intervention was effective in preventing body weight gain and fat accumulation in the liver. The molecular mechanism of this effect is the increase of the hepatic mRNA expression of peroxisome proliferator-activated receptor (PPAR) α and PPAR-γ while the level of the hepatic

Many compounds from Sea-buckthorn help lose extra weight. Omega-7 in Sea-buckthorn sends messages to the brain, telling it to stop storing calories as excess fat. Sea-buckthorn oil stimulates healthy bowel moves, thereby protecting cell membranes from oxidative and

In overweight or obese women, the intake of different berries and berry fractions for 33 days with washout periods of 30–39 days have resulted in positive effects such as a significantly decrease in the waist circumference and in the level of vascular cell adhesion and intercellular

**2.3. Association of the atherogenic indexes with antropometric, inflammatory, oxidative**

It was demonstrated that in obese children with metabolic syndrome, there is a positive association between the high waist circumference and the atherogenic index (total cholesterol/

Endothelial dysfunction, inflammation, and oxidative stress are present in childhood obesity. Especially during puberty, there are some pro-inflammatory and pro-oxidative changes

**stress and endothelial dysfunctional markers in childhood obesity**

pulp has beneficial effects on postprandial glucose and insulin levels [83].

Quercetin inhibits fatty acid and triacylglycerol synthesis in rat liver cells [87].

(endothelial nitric oxide synthase) and LOX-1(lipooxygenase-1) [66].

flavonoid glycosides [88] and they have antioxidant activity.

key enzyme in the fatty acid synthase was decreased [89].

physical stress.

HDL-c) [91].

adhesion molecules [90].

delay also the postprandial lipemia [85].

68 Lipoproteins - From Bench to Bedside

A comparative study between severely obese children versus moderately obese children demonstrated a markedly more unfavorable cardio-metabolic risk profile in the first group. The study highlights that severely obese children need to receive particular attention regarding obesity treatment [98].

A recent study demonstrated that the strongest negative predictor of weight loss is waist circumference. The study underscores that obese children with abdominal fat distribution need more intensive interventions [99].

In a review about the impact of dietary and physical activity in obese children, including the studies that have been done in the last 35 years, demonstrated that diet-only and diet-plusexercise interventions resulted in weight loss and metabolic profile improvement. Diet-only intervention reduced triglycerides and LDL levels, while diet-plus-exercise interventions reduced fasting glycaemia and insulinemia and increased HDL-c concentration [100].

In obese children and adolescents, weight loss improved the values of the parameters included in the metabolic syndrome criteria with the exception of HDL-c concentration. The reduction in fasting triglycerides concentration (but not waist circumference) was the only significant predictor of metabolic syndrome change [101].

Diet modifications and physical activity have been included in obesity management, but have shown relatively limited success among severely obese children and adolescents. However, the parents of obese children should know that a healthy lifestyle is important for better physical and mental health no matter how much or how little weight is lost. The physician should help patients to cope obesity for psychosocial functioning and must motivate them to make use of the available healthcare resources.

Pharmacotherapy for obesity has side effects (growth problems, lessened self-esteem, unheal‐ thy weight-control mechanisms) and frequently fails to be efficacious because obesity is a multifactorial, polygenic disease [102,103].
