Metabolic diseases and their link with lifestyle and gut microbiota: an overview from pediatric age to adults

Obesity and diabetes have become prominent global health concerns in recent decades, characterized by their escalating prevalence worldwide. This surge is predominantly attributed to socio-economic progress. Over the past twenty years, obesity rates have doubled globally and quadrupled among adolescents, underscoring its emergence as one of the most pervasive noncommunicable diseases, even among children. Pediatric obesity heightens the risk and accelerates the onset of various comorbidities: dyslipidemia, insulin resistance, metabolic dysfunctionassociated fatty liver disease (MAFLD), prediabetes, and type 2 diabetes mellitus (T2DM). Prediabetes, characterized by impaired fasting glucose and impaired glucose tolerance, is associated with micro and macrovascular diseases linked to T2DM. The primary strategy for managing prediabetes revolves around lifestyle interventions, including weight management and physical activity, while ongoing research explores preventive measures for high-risk individuals. T2DM, currently the seventh leading cause of death globally, affects 537 million adults worldwide, with projections indicating a rise to 783 million by 2045. In Europe, 61 million adults contend with T2DM, representing the bulk of diabetes cases. The incidence of T2DM exhibits geographical disparities, with 80% of cases concentrated in low- and middle-income countries. Lifestyle factors and familial predispositions have contributed to a surge in T2DM cases, even among children and adolescents, precipitating faster complication development compared to adults. However, treatment options for pediatric T2DM remain limited and largely ineffective. Understanding the burden of obesity and T2DM is crucial for effective prevention and management strategies.