Showing papers in "Journal of Pediatric Endocrinology and Metabolism in 2013"
TL;DR: Plasma levels of C18:0, C20:0 and C22:0 ceramide, as well as C24:1 dihydroceramide, were elevated in obese female children and adolescents with T2D, which may be a reflection of tissue insulin resistance and could be a result of low adiponectin levels.
Abstract: Accumulation of ceramides within tissues induces insulin resistance. Moreover, adiponectin exerts its beneficial metabolic effects at least partially through ceramide catabolism. We hypothesized that specific plasma ceramide subspecies are elevated in obese children and adolescents with type 2 diabetes (T2D), and that they inversely correlate with adiponectin and measures of insulin sensitivity. This was a cross-sectional study. Participants included 14 obese female subjects with T2D, ages 10-17, and 14 lean healthy controls of the same age and gender. Fasting plasma ceramide subspecies were measured by quantitative tandem mass spectrometry. Subjects with T2D had higher concentrations of C22:0 and C20:0 ceramides, with a 2-fold increase in C18:0 ceramide and C24:1 dihydroceramide (p<0.05). C22:0, C20:0 and C18:0 ceramide correlated with decreased adiponectin concentrations, increased HOMA-IR, BMI Z-score, triglyceride and fasting blood glucose concentrations (p<0.05). Plasma levels of C18:0, C20:0 and C22:0 ceramide, as well as C24:1 dihydroceramide, were elevated in obese female children and adolescents with T2D. This may be a reflection of tissue insulin resistance and could be a result of low adiponectin levels.
90 citations
TL;DR: Exercise improved metabolic and cardiorespiratory fitness in obese children and recreational programs are also effective and may encourage children to participate in physical activity and limit initial drop-out.
Abstract: Physical activity may protect from the adverse effects of obesity. In obese children, an increased adherence and a decreased drop-out rate during exercise could be achieved with adapted activities. We studied a recreational 12-week controlled training program for sedentary obese children, including interactive video games. We enrolled 22 obese subjects (13.23±1.76 years) in an exercise program, implemented twice a week for a 12-week period. The program consisted of a combination of circuit-based aerobics, strength and resistance exercises; specifically soccer, rugby, volleyball and basketball and interactive video game exercises. Outcome measurements included body composition, metabolic profile and cardiorespiratory fitness. During the 12-week training program there was a significant decrease in body mass index (BMI) (p=0.002), SDS-BMI (p=0.003), waist circumference (p=0.004), waist circumference/height ratio (p=0.001),% fat mass (p=0.001), blood glucose (p=0.001), homeostasis model assessment for insulin resistance (HOMA-IR) (p=0.04), triglycerides (p=0.03) and systolic pressure (p=0.04) before and after exercise. Improvement in estimated maximum oxygen consumption (VO2max) (p<0.001) correlated with a decrease in fat mass (p=0.01), triglycerides (p=0.04) and insulin resistance (p=0.02). Exercise improved metabolic and cardiorespiratory fitness in obese children. Exercise training does not necessarily need to be vigorous, recreational programs are also effective and may encourage children to participate in physical activity and limit initial drop-out.
53 citations
TL;DR: It is suggested that obese children have higher serum TSH and fT3 levels even within the normal range, and that an increase in TSH is associated with dyslipidemia and higher systolic blood pressure.
Abstract: OBJECTIVE In recent years, there has been increasing focus on thyroid function in pediatric obese patients. Our aims were to investigate whether there is an association between serum thyroid-stimulating hormone (TSH) within the normal range and body mass index (BMI), and to determine if TSH levels correlate with metabolic risk factors in children. METHODS A retrospective cross-sectional analysis was carried out on 528 euthyroid, age- and sex-matched lean, overweight, or obese children. Anthropometric indices, blood pressure, fasting blood glucose, hepatic enzymes, lipid profiles, TSH, free triiodothyronine (fT3), and free thyroxine (fT4) were assessed from medical records and compared among groups. Subjects with known presence of diabetes, using medications altering blood pressure and glucose or lipid metabolism, with TSH levels >97.5 or <2.5 percentile, or with autoimmune thyroid disease were excluded. RESULTS Hypertension, dyslipidemia, and elevated levels of hepatic enzymes were found to be more common in overweight and obese children (p<0.001), and those metabolic changes were significantly correlated with the increase in BMI (p<0.05). Serum concentrations of TSH and fT3 within the normal range were higher in overweight and obese children (p<0.01), and TSH was positively correlated with total cholesterol, triglycerides, and systolic blood pressure (p<0.05). CONCLUSION Our findings suggest that obese children have higher serum TSH and fT3 levels even within the normal range, and that an increase in TSH is associated with dyslipidemia and higher systolic blood pressure. It remains to be seen whether TSH might serve as a potential marker of metabolic risk factors in obese pediatric patients.
44 citations
TL;DR: In this article, the efficacy of therapeutic/loading doses of vitamin D supplementation on serum 25-hydroxy vitamin D (25OHD) levels in vitamin D deficient adolescents was evaluated.
Abstract: Aim: Vitamin D deficiency (VDD) among adolescents is a major health problem in India. The aim of this study was to assess the efficacy of therapeutic/loading doses of vitamin D supplementation on serum 25-hydroxy vitamin D (25OHD) levels in vitamin D deficient adolescents. Methods: A total of 482 out of the 511 subjects recruited for the study were divided into three groups, each group receiving 60,000 IU of vitamin D3 weekly for 4, 6 and 8 weeks followed by 600 IU daily for 12 weeks, respectively. Clinical evaluation was followed by estimation of biochemical markers and serum 25OHD levels. Results: VDD was observed in 94.8 % of adolescents. All three vitamin D loading doses were equally efficacious in achieving vitamin D sufficiency > 75 nmol/L ( > 30 ng/mL) in more than 90 % subjects in the three groups. Mean 25OHD levels in groups 2 and 3 following maintenance therapy were 67.5 ± 16.5 nmol/L (27.0 ± 6.6 ng/mL) and 70.0 ± 21.8 nmol/L (28.0 ± 8.7 ng/mL), respectively. Conclusion: Supplementing 60,000 IU of vitamin D3 per week for 4 – 8 weeks, followed by 600 IU daily through fortified milk, is an effective strategy for achieving vitamin D sufficiency in Indian adolescents.
43 citations
TL;DR: Very advanced BA is common in PA, and patients were significantly taller and more overweight than their peers, and the impact of advanced BA on PAH appears to be minor.
Abstract: BACKGROUND Premature adrenarche (PA) is often associated with bone age (BA) advanced by ≥2 years, which increases the concern for underlying pathology, but the frequency and clinical significance of this is unknown. Our objective was to identify the proportion of PA patients with very advanced BA and normal BA and compare the clinical characteristics of the two groups. METHODS Charts of 427 patients aged 5-9 years, referred for early puberty over a 2-year period, were reviewed for clinical diagnosis, growth, parental heights, hormone levels and BA. We divided the PA patients into three separate groups based on degree of BA advancement. Predicted adult heights (PAH) were calculated and compared to mid-parental target height (TH). RESULTS Of 427 patients, 266 (62%) had PA (82% female). Of the 121 with BA, 30.6% had very advanced BA (≥2 years) and this group was taller (Ht SD+1.72 vs. +0.72, p<0.00001) and had higher BMI (SD+1.70 vs. +0.99, p<0.001) than patients with BA advanced by <1 year, but hormone levels were quite similar. Mean PAH was slightly less than TH for patients with very advanced BA, but there were no girls with PAH <60 inches 152.4 cm or boys with PAH <65 inches 165.1 cm in height. CONCLUSIONS Very advanced BA is common in PA, and patients were significantly taller and more overweight than their peers. The impact of advanced BA on PAH appears to be minor. We question the need for ordering a BA in patients with PA, and suggest that extensive testing is unnecessary simply because of advanced BA.
35 citations
TL;DR: Metabolic syndrome is common in urban Indian overweight and obese adolescents and its identification provides an opportunity to intervene with lifestyle changes to prevent disease progression into adulthood.
Abstract: Aim: To assess prevalence of metabolic syndrome (MS) in urban Indian adolescents. MS in adolescents is a forerunner of diabetes mellitus and cardiovascular disease in adults, therefore, its identification provides an opportunity to intervene with lifestyle changes to prevent disease progression into adulthood. We randomly selected 900 adolescents (300 for each group) to participate in the study from a total of 15,101 adolescents (10–18 years) who were grouped as normal, overweight, and obese (total population). Methods: From the 900 adolescents, 695 consented to participate in the study and underwent a detailed anthropometric and biochemical evaluation, therefore, these adolescents constituted the study population. MS was defined by criteria proposed by the International Diabetes Federation (MS-IDF) and the Adult Treatment Panel (MS-ATP). The prevalence of MS in the study population was used to calculate the prevalence of MS in the total population based on the distribution of the different BMI categories in this larger sample (n = 15,101). Results: Calculated prevalence of MS in urban Indian adolescents was 4.3% and 3.0% in the total population using MS-ATP and MS-IDF criteria, respectively. Among the study population, MS was higher in girls than boys (MS-ATP, G: 22.3% vs. B: 16.6%, p = 0.03; MS-IDF, G: 20.5% vs. B: 13.5%, p = 0.006). The most common component of MS- ATP and MS-IDF was central obesity (89.8% vs. 100.0%, p < 0.00001), followed by hypertriglyceridemia (83.0% vs. 82.2%, p = 0.35), low high density lipoproteincholesterol (71.1% vs. 71.2%, p = 0.48), hypertension (44.4% vs. 44.9%, p = 0.025), and dysglycemia (40.0% vs. 34.7%, p = 0.94). The mean serum insulin levels and HOMA-IR progressively increased with the increasing number of components present in an individual. Conclusions: Metabolic syndrome is common in urban Indian overweight and obese adolescents.
33 citations
TL;DR: Tamoxifen may be effective for the treatment of pubertal gynecomastia, and it seems safe to use, and Randomized controlled studies are necessary to confirm this indication.
Abstract: Objective: A systematic review to assess the efficacy of tamoxifen in the management of idiopathic pubertal gynecomastia. Data sources: Searches were conducted using the data- bases of Medline (search engine PubMed) and Web of Science ® . Study selection: Studies reporting the use of Tamoxifen for the treatment of gynecomastia in adolescents. Outcome measure: Resolution of gynecomastia. Results: A total of 164 publications were found; 59 were selected for retrieval and six were included in the review. There were no randomized controlled studies; the studies found have methodological flaws but show promising results. No clinical side-effects were reported or observed. Conclusion: Tamoxifen may be effective for the treatment of pubertal gynecomastia, and it seems safe to use. Ran- domized controlled studies are necessary to confirm this indication. Most cases of GM are idiopathic. Because breast growth is known to be stimulated by estrogens, an absolute or rela- tive hormonal imbalance is considered by many to be the main etiology (3). However, pathological etiologies need to be ruled out; these include congenital and endocrine dis- orders, tumors and drugs. In the majority of cases GM does not require treatment. In cases of idiopathic pubertal GM, reassurance and an explanation about the natural course of GM is usually sufficient (3). In all ages, if a specific cause of the GM is diagnosed and treatment is commenced during the initial phase, the breast enlargement may regress. If GM lasts for over a year, medical treatment will be unlikely to achieve regression, and surgery may be performed if the patient requires correction of the GM (4, 5). It has been suggested that GM may be treated using pharmacological agents. The rationale behind such therapy is that if GM is caused by a hormonal imbalance, this may be altered, resulting in regression of the GM. The approaches used are the administration of exogenous androgens or use of estrogen-receptor blockers that can mitigate the effect of the surplus of estrogens. The phar- macological agents used from the first category include testosterone analogues. The drugs of the latter category include tamoxifen (TMX), an anti-estrogenic non-steroi- dal drug, and raloxifene. The use of TMX has received the most attention in the medical literature and was reported for the treatment of GM as early as 1977 (6). The use of TMX for GM caused by the treatment of prostate cancer has been reviewed (7, 8). However, one cannot extrapolate from these studies to pubertal GM. We therefore performed a systematic review in order to assess whether TMX is effec- tive in the management of idiopathic pubertal GM.
32 citations
TL;DR: Continuous subcutaneous glucagon infusion was successful in restoring normoglycaemia and attenuating weight gain, with concomitant improvement of developmental milestones in a patient with atypical diffuse CHI caused by mosaic ABCC8 mutation inheritance.
Abstract: Congenital hyperinsulinism (CHI) results from inappropriate excessive insulin secretion by the beta cells in the pancreas. A wide clinical spectrum of disease exists and a genetic diagnosis is now possible for approximately 50% of affected children. We describe a patient with atypical diffuse CHI caused by mosaic ABCC8 mutation inheritance, unmasked by paternal uniparental disomy. Hypoglycaemia persisted despite two subtotal pancreatectomies and trials of diazoxide and nifedipine were unsuccessful. Octreotide resulted in anaphylaxis, precluding its use. Continuous subcutaneous glucagon infusion was successful in restoring normoglycaemia and attenuating weight gain, with concomitant improvement of developmental milestones. No adverse effects have been encountered after >12 months of therapy. Administration problems (e.g., line crystallisation) may complicate continuous glucagon therapy; hence a practical description of infusion constitution is included. We recommend consideration of continuous subcutaneous glucagon infusion as a therapeutic option for persistent refractory hypoglycaemia in CHI.
32 citations
TL;DR: It is suggested that adequate vitamin D intake in growing children is crucial to maintain an optimal vitamin D level to prevent obesity and obesity-related health problems later in life.
Abstract: BACKGROUND AND OBJECTIVE We aimed to investigate the association between serum 25-hydroxyvitamin D (25(OH)D) and anthropometric indicators of adiposity among Korean preadolescent children aged 7-9 years. SUBJECTS AND METHODS Children aged 7 to 9 from the Ewha Birth & Growth Cohort were followed up from July to August 2011. Serum 25(OH)D concentration was measured using radio immunoassay. We assessed the magnitude of cross-sectional association with vitamin D concentrations and indicators of adiposity [body mass index (BMI), waist circumference (WC), mid-arm circumference (MAC), body fat mass (BFM), percent body fat (PBF), and triceps skinfold thickness (TSF)] using multiple linear and logistic regression analyses adjusted for sex, age, birth order, maternal education, and fruit/fruit juice intake. RESULTS Thirty-two (16%) out of a total of 205 children showed an optimal level of serum 25(OH)D, but most children did not reach a sufficient level (<30 ng/mL) even in summer. The level of 25(OH)D was inversely associated with BMI (β=-0.10, p<0.01), WC (β=-0.28, p<0.01), and BFM (β=-0.12, p=0.02) after adjusting for confounding factors and showed marginal boundary with PBF (β=-0.20, p=0.06) and TSF (β=-0.11, p=0.08). Regarding the risk of overweight, a 13% protective effect per 1 ng/mL increase of 25(OH)D was shown even after adjusting for relevant confounding factors (adjusted odds ratio=0.87, 95% confidence interval 0.78-0.98). CONCLUSIONS We found that the 25(OH)D concentrations were inversely associated with adiposity indices in preadolescent children. This study suggests that adequate vitamin D intake in growing children is crucial to maintain an optimal vitamin D level to prevent obesity and obesity-related health problems later in life.
29 citations
TL;DR: Considering age, race/ethnicity, diet, and season may help identify young obese children needing vitamin D management and in these children, 25-OHD was not associated with insulin resistance or cardiovascular risks.
Abstract: OBJECTIVE To examine the relationships of 25-hydroxyvitamin D (25-OHD) levels with the measures of insulin resistance and cardiovascular risk, and identify the clinical factors associated with low 25-OHD in young obese children. DESIGN AND METHODS Data from 83 children ages 2-6 years seen for obesity care (clinic latitude 42°N) were analyzed. Insulin resistance [homeostasis model assessment of insulin resistance (HOMA-IR)] and cardiovascular risks were examined in relationship to 25-OHD levels using correlation statistics. χ2 and logistic regression models were applied to identify the factors associated with vitamin D deficiency (25-OHD levels <20 ng/mL) and insufficiency (<30 ng/mL). RESULTS Children's mean age was mean 4.9 years and they were predominantly Hispanic. Mean body mass index (BMI) Z-score was 3.2 and mean HOMA-IR was 2.8. Mean 25-OHD was 30.9 ng/mL (6% <20 ng/mL and 46% 20-29 ng/mL). There were no significant correlations between 25-OHD and BMI (Spearman's ρ=-0.096, p=0.389), BMI Z-score (Spearman's ρ=0.104, p=0.350), HOMA-IR (Spearman's ρ=-0.144, p=0.269), total cholesterol (Spearman's ρ=-0.028, p=0.833), or triglycerides (Spearman's ρ=-0.026, p=0.846). Vitamin D deficiency was significantly associated with older age, lower milk intake, and testing in winter months. 25-OHD level <30 ng/mL was associated with older age, African-American and Hispanic race/ethnicity, and testing in winter months. All factors retained significance in a multivariate logistic regression model, with African-American (odds ratio=14.4) and Hispanic (odds ratio=7.2) race/ethnicity being the strongest predictors of 25-OHD levels <30 ng/mL. CONCLUSIONS In these children, 25-OHD was not associated with insulin resistance or cardiovascular risks. Considering age, race/ethnicity, diet, and season may help identify young obese children needing vitamin D management.
29 citations
TL;DR: Thyroid function and morphology may be affected in obese and overweight children and adolescents with elevated TSH, FT3 and thyroid volume, and Alterations in thyroidfunction and morphology cannot be completely explained by local autoimmune responses.
Abstract: Objective To investigate the changes in thyroid function and morphology in overweight and obese school-aged children and adolescents in Chinese population. Methods Altogether, 880 children and adolescents were enrolled in a cross-sectional survey in Anhui Province and we assessed thyroid function, thyroid ultrasound, metabolic indicators and high-sensitivity C-reactive protein (hs-CRP) levels in 781 subjects, which were divided into obesity (n=327), overweight (n=242), and normal-weight (n=212) groups. Overweight and obese subjects were further divided into four subgroups according to thyroid peroxidase antibody and ultrasound pattern to compare thyroid function and morphology with or without thyroid autoimmune evidence. Results Thyroid-stimulating hormone (TSH) and free 3,5,3'-triiodothyronine (FT3), as well as thyroid volume, were found to be positively associated with body mass index Z-score, waist/hip ratio, waist/height ratio and/or waist circumference (WC). Conversely, free thyroxine was negatively associated with WC. The detection rates of thyroid nodules among these groups were not significantly different (p=0.828). Among the four subgroups in 569 overweight or obese subjects, the changes in thyroid function and volume were more obvious in group D which showed no autoimmune evidence. The levels of hs-CRP were also higher in the overweight and obese groups with or without autoimmune evidence than in the normal-weight group (p Conclusion Thyroid function and morphology may be affected in obese and overweight children and adolescents with elevated TSH, FT3 and thyroid volume. The detection rates of thyroid nodules may not be affected by obesity. Alterations in thyroid function and morphology cannot be completely explained by local autoimmune responses. Low-grade inflammation may be involved in the changes in thyroid function and morphology in obesity.
TL;DR: In this paper, a 12-year-old diabetic patient with insulin-dependent diabetes mellitus (PHID) and H syndromes presented with shortness of breath, hepatosplenomegaly, and raised erythrocyte sedimentation rate and C-reactive protein.
Abstract: Mutations in SLC29A3 lead to pigmentary hypertrichosis and non-autoimmune insulin-dependent diabetes mellitus (PHID) and H syndromes, familial Rosai-Dorfman disease, and histiocytosis-lymphadenopathy plus syndrome. We report a new association of PHID syndrome with severe systemic inflammation, scleroderma-like changes, and cardiomyopathy. A 12-year-old girl with PHID syndrome presented with shortness of breath, hepatosplenomegaly, and raised erythrocyte sedimentation rate and C-reactive protein. An echocardiogram showed biventricular myocardial hypertrophy, and cardiac magnetic resonance imaging showed circumferential late gadolinium enhancement of the myocardium. No systemic amyloid deposits were observed on a whole-body serum amyloid P scintigraphy scan. Abdominal ultrasound revealed intra-abdominal fat surrounding the solid organs, suggesting a possibility of evolving lipodystrophy with visceral adiposity. PHID syndrome is a novel monogenic autoinflammatory syndrome (AIS) associated with severe elevation of serum amyloid. Lipodystrophy, cutaneous sclerodermatous changes, and cardiomyopathy were also present in this case. In contrast to other AIS, blockade of interleukin-1 and tumor necrosis-α was ineffective.
TL;DR: The case of a girl with PWS who was diagnosed with idiopathic precocious puberty and was treated with gonadotropin-releasing hormone analog is reported.
Abstract: Prader-Willi syndrome (PWS) is characterized by infantile lethargy and hypotonia causing poor feeding and failure to thrive, childhood obesity, short stature, and hypogonadism. The complex phenotype is most probably caused by a hypothalamic dysfunction that is responsible for the hormonal dysfunction. The resulting hypogonadism in PWS causes incomplete, delayed, and sometimes disordered pubertal development. Precocious puberty is very rare in PWS. We report the case of a girl with PWS who was diagnosed with idiopathic precocious puberty and was treated with gonadotropin-releasing hormone analog.
TL;DR: Normal stretched penile length and prevalence of male genital anomalies in full-term neonates and whether they are influenced by prenatal parental exposure to endocrine-disrupting chemicals are established.
Abstract: This is an attempt to establish the normal stretched penile length and prevalence of male genital anomalies in full-term neonates and whether they are influenced by prenatal parental exposure to endocrine-disrupting chemicals. A thousand newborns were included; their mothers were subjected to the following questionnaire: parents' age, residence, occupation, contact with insecticides and pesticides, antenatal exposure to cigarette smoke or drugs, family history of genital anomalies, phytoestrogens intake and history of in vitro fertilization or infertility. Free testosterone was measured in 150 neonates in the first day of life. Mean penile length was 3.4±0.37 cm. A penile length <2.5 cm was considered micropenis. Prevalence of genital anomalies was 1.8% (hypospadias 83.33%). There was a higher rate of anomalies in those exposed to endocrine disruptors (EDs; 7.4%) than in the non-exposed (1.2%; p<0.0001; odds ratio 6, 95% confidence interval 2-16). Mean penile length showed a linear relationship with free testosterone and was lower in neonates exposed to EDs.
TL;DR: It is concluded that this p.G488R missense mutation in the DUOX2 gene of the patients is associated with thyroid dysfunction that presents during the neonatal period and is still euthyroid even after discontinuing thyroid hormone therapy.
Abstract: The dual oxidase 2 (DUOX2) mutation results in an impairment of the hydrogen peroxidase-generating system and is identified as a dyshormonogenic cause of congenital hypothyroidism (CH). Here, we describe two unrelated Japanese girls with CH due to a novel DUOX2 mutation. They had high serum thyrotropin levels and low free thyroxine/thyroxine concentrations during the neonatal period. A novel missense mutation with a transversion of G to A at position 1462 in exon 12 of the DUOX2 gene that caused a replacement of glycine (G) with arginine (R) at codon 488 of the protein (c.1462G>A, p.[G488R]) was identified. One patient was a compound heterozygote for p.[L479SfsX3]+[G488R]. The other was homozygous for p.[G488R]. This p.G488R substitution occurred in a highly conserved glycine residue of the mammalian DUOX2 protein. The two patients had different haplotypes, suggesting that the p.G488R alleles were the result of independent, recurrent mutations. Later in life, both patients were still euthyroid even after discontinuing thyroid hormone therapy. We conclude that this p.G488R missense mutation in the DUOX2 gene of the patients is associated with thyroid dysfunction that presents during the neonatal period.
TL;DR: In this paper, the authors measured serum DPP4 activity and assessed its relationship to metabolic variables in T1DM children using a fluorometric assay in 43 Type 1 diabetes mellitus (T1DM) and 26 control children.
Abstract: BACKGROUND It is poorly understood whether dipeptidyl peptidase 4 (DPP4) activity is altered and how DPP4 contributes to glycemic control in patients with type 1 diabetes mellitus (T1DM). AIM The aim of this study was to measure serum DPP4 activity and to assess its relationships to metabolic variables in T1DM children. METHODS Serum DPP4 activity was determined using a fluorometric assay in 43 T1DM and 26 control children. RESULTS Serum DPP4 activity was significantly higher in T1DM children than in controls (3.57 ± 0.99 vs. 2.67 ± 0.77 U/mL, p<0.001). In the T1DM children, DPP4 activity was not correlated with HbA1c, blood glucose, or diabetes duration. A significant negative correlation was found between DPP4 activity and serum adiponectin levels in the T1DM group (r=-0.35, p<0.05). CONCLUSIONS Serum DPP4 activity was increased in the T1DM children, whereas it was not associated with glycemic control. Given the negative correlation between serum DPP4 and adiponectin levels, further investigations are warranted to elucidate the role of DPP4 on insulin sensitivity in T1DM children.
TL;DR: There is compelling evidence that carbohydrate quality has important influences on cardiovascular disease, the metabolic syndrome, type 2 diabetes, and obesity, and Cohort and interventional studies indicate that dietary fiber is an important determinant of satiation, satiety, and weight gain, and also protects against cardiovascular disease.
Abstract: There is compelling evidence that carbohydrate quality has important influences on cardiovascular disease, the metabolic syndrome, type 2 diabetes, and obesity. Cohort and interventional studies indicate that dietary fiber is an important determinant of satiation, satiety, and weight gain, and also protects against cardiovascular disease. Cohort studies have shown that vegetables and fruits protect against coronary heart disease, whereas whole grains provide protection against cardiovascular disease, type 2 diabetes, and weight gain. Dietary glycemia within the range eaten by most of the population seems not to have a significant influence on body weight, although it may influence waist circumference. There is strong evidence from interventional trials that dietary glycemia does influence insulin resistance and diabetes control. Moreover, replacing saturated fat with high-glycemic carbohydrate may increase cardiovascular risk. Soft drink consumption is a proven cause of weight gain, which may relate to the lack of satiation provided by these drinks. In large amounts, dietary fructose leads to greater adverse metabolic changes than equivalent amounts of glucose, although the extent to which fructose per se is contributing to many of the metabolic changes found in the obese, as distinct from the calories it provides, is still a matter of debate.
TL;DR: The prevalence of IGT and IR was related to severity of obesity, to the association of acanthosis nigricans and was associated with cardiovascular risk.
Abstract: BACKGROUND The worldwide epidemic of childhood obesity has been accompanied by an increase in the incidence of carbohydrate metabolism disorders. OBJECTIVE To determine the prevalence of type 2 diabetes mellitus (T2DM) and other carbohydrate metabolism disorders in obese young people in the Basque Country (Spain). DESIGN Prospective observational study. PATIENTS We studied 136 obese Caucasian children and adolescents (body mass index ≥2 SDS above the mean). MEASUREMENTS Their severity of obesity was classified as mild <3 SDS or moderate-to-severe ≥3 SDS. Data were collected on clinical and metabolic parameters; insulin resistance (IR) was calculated using the homeostasis model assessment, and an oral glucose tolerance test (OGTT) was carried out. RESULTS T2DM was not found. Impaired glucose tolerance (IGT) was found in 9.6% of patients being higher in moderate-to-severe obesity (12.8% vs. 2.4%; p=0.048) and in patients with acanthosis nigricans (27.8% vs. 6.8%; p=0.016). No differences were detected by sex or pubertal development in metabolic results as a function of OGTT's response. IR (13.5%) was higher among those with moderate-to-severe obesity, in patients with acanthosis nigricans and was associated with other cardiovascular disease risk factors. CONCLUSIONS We found no children with T2DM. The prevalence of IGT and IR was related to severity of obesity, to the association of acanthosis nigricans and was associated with cardiovascular risk.
TL;DR: A significant increase in adiponectin concentration and a reduction in body weight, BMI, total fat mass, visceral and subcutaneous fat are shown in obese adolescent girls, providing a novel physiologically concept that may shed light on the etiology of osteoporosis and help to identify new therapeutic targets.
Abstract: Obesity is a chronic inflammatory condition with numerous metabolic consequences to the organism, high- lighting its influence on bone mass. Therefore, the aim of this study was to verify the role of visceral fat, leptin, adiponectin and ghrelin on bone mineral density in obese post-puberty adolescents girls, submitted to an interdis- ciplinary therapy. The study involved 20 post-puberty obese adolescent girls: 16 ± 1.5 years of age, 98.9 ± 15.8 kg (weight), 1.60 ± 0.72 m (height) and 37.2 ± 4.8 kg/m 2 (body mass index (BMI)). Anthropometric measurements, body composition, visceral fat, subcutaneous fat, bone mineral density and content were determined. Ghrelin, leptin and adiponectin were analyzed and the leptin/adiponectin ratio was calculated. Our findings showed a significant increase in adiponectin concentration and a reduction in body weight, BMI, total fat mass, visceral and subcutane- ous fat. In addition, ghrelin (r 2 = - 0.53; p = 0.02) visceral fat (r 2 = - 0.46, p = 0.04) (r 2 - 0.66, p = 0.001) and leptin/adi- ponectin ratio (r 2 - 0.56, p = 0.01) were negative predictors for bone mineral density and content in obese adolescent girls, respectively. It provides a novel physiologically con- cept that may shed light on the etiology of osteoporosis and help to identify new therapeutic targets. However this should be confirmed in a large cohort study.
TL;DR: The prevalence of MetS has decreased since 2005 mainly because of changes in the prevalence of low levels of HDL cholesterol, which increased most over the 1998–2005 period and decreased over the 2005–2008 period.
Abstract: BACKGROUND Although the metabolic syndrome (MetS) in childhood is increasing worldwide and becoming a significant public health problem, some countries report trends for stabilization. After 2005, the Health Plan 2010 of the Korean Ministry of Health and Welfare has carried out the standardization of school lunch provisions for all students and reinforced nutritional and physical education in schools. Thus, an investigation of changes in the prevalence of MetS in Korean children and adolescents is important and intriguing in the aspect of evaluating the national public health intervention. METHODS We investigated trends in the prevalence of MetS among a nationally representative sample of 5652 children and adolescents aged 10-18 years from the Korean National Health and Nutrition Examination Surveys (KNHANES) I (1998), II (2001), III (2005), and IV (2008). RESULTS Prevalence trends in MetS were 7.5%, 9.8%, 10.9%, and 6.7% in the KNHANES I through IV, respectively (p<0.001). Among the five components of MetS, the prevalence of low high-density lipoprotein (HDL) cholesterol increased most over the 1998-2005 period and decreased over the 2005-2008 period. CONCLUSION The prevalence of MetS has decreased since 2005 mainly because of changes in the prevalence of low levels of HDL cholesterol.
TL;DR: The main objectives of treatment are normalization of prolactin level, adenoma shrinkage, and recovery from clinical signs related to hyperprolactinemia, and dopamine agonists are the first-line treatment in patients with microadenoma, invasive or non-invasive macroadenoma, and even in patientswith visual field defects.
Abstract: Pituitary adenoma is the most common cause of hyperprolactinemia, which is a rare endocrine disorder encountered in pediatric patient care. Epidemiological and clinical information about hyperprolactinemia in childhood and adolescence is limited. Clinical signs of hyperprolactinemia are very heterogeneous. In girls, disturbances in menstrual function and galactorrhea may be seen, whereas in boys, headache, visual disturbances, delayed pubertal development and hypogonadism are often present. Owing to the ease of ordering a serum prolactin measurement, an evidence-based, cost-effective approach to the management of this endocrine disorder is required. Before a diagnosis of hyperprolactinemia is made, drug use, renal insufficiency, hypothyroidism, and parasellar tumors should be excluded. The main objectives of treatment are normalization of prolactin level, adenoma shrinkage, and recovery from clinical signs related to hyperprolactinemia. In patients with microadenoma, invasive or non-invasive macroadenoma, and even in patients with visual field defects, dopamine agonists are the first-line treatment. Surgical treatment is indicated in patients who are unresponsive or intolerant to medical treatment or who have persistent neurological signs. Radiotherapy should be considered as a supportive treatment for patients in whom surgery fails or medical response is not achieved.
TL;DR: Thyroid dysfunction is common among preterm infants, and with the exception of persistent hyperthyrotropinemia, it generally does not affect neurodevelopmental outcomes, however, the beneficial effects of thyroid hormone therapy in patients with persistent hyper thyroxine medication merits further study.
Abstract: BACKGROUND Thyroid dysfunction is very common and is associated with neurodevelopmental impairments in preterm infants. OBJECTIVES This study was conducted to determine the incidence and natural course of various thyroid dysfunctions and their impacts on neurodevelopmental outcomes among premature infants. METHODS A total of 177 infants were enrolled who were born at <34 weeks or whose birth weight was <1500 g and who underwent repeat thyroid function tests. We analyzed how various thyroid dysfunctions affected neurodevelopmental outcomes at 18 months of corrected age. RESULTS Thyroid dysfunction was noted in 88 infants. Hypothyroxinemia was observed in 23 infants, and their thyroid function was influenced by variable clinical factors. Free T4 levels were all normalized without thyroxine medication, and neurodevelopmental outcomes were not affected. In contrast, hyperthyrotropinemia was not associated with other clinical factors. Among 58 subjects who had hyperthyrotropinemia, only 31 infants showed normal thyroid-stimulating hormone (TSH) levels at follow-up tests. The remaining 27 infants had persistently high TSH levels, which significantly and poorly influenced the neurodevelopmental outcomes. CONCLUSIONS Thyroid dysfunction is common among preterm infants. With the exception of persistent hyperthyrotropinemia, it generally does not affect neurodevelopmental outcomes. However, the beneficial effects of thyroid hormone therapy in patients with persistent hyperthyrotropinemia merits further study.
TL;DR: In contrast to previous studies showing a high prevalence of neurodevelopmental difficulties in children with congenital hyperinsulinism, this study showed normal cognitive achievements in most children.
Abstract: Background Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infants. Its management can be extremely complicated, and may involve medical therapy and surgery. The mainstay of the treatment is to maintain normoglycemia, since hypoglycemia during infancy can have severe neurological consequences. Objective To assess the cognitive and developmental levels and the adaptive skills achieved by children with CHI who were treated medically over the past decade. Subjects and methods Fourteen children with CHI, under the age of 10 years, who received medical treatment only, underwent a physical and neurological examination and standardized assessments that included the Bayley Scale of Infant and Toddler Development, 3rd Edition, or Kaufman Assessment Battery for Children, the Vineland Adaptive Behavior Scales and the Achenbach Child Behavior Checklist (CBCL) parent questionnaire form. Results Twelve children (86%) achieved normal range scores in the cognitive and development assessments (Bayley Scale of Infant and Toddler Development or Kaufman Assessment Battery for Children). Only two showed cognitive achievements below the normal range. The Vineland questionnaire, which was based on parental report, showed below normal adaptive skills in eight patients (57%). Conclusions In contrast to previous studies showing a high prevalence of neurodevelopmental difficulties in children with congenital hyperinsulinism, our study showed normal cognitive achievements in most children. This may be attributed to the earlier recognition and better management of the disease in the past decade.
TL;DR: Investigating the association between TSH, free T4 (fT4) and cardiometabolic risk factors in euthyroid obese children and adolescents found increasing TSH was associated with impaired glucose metabolism and dyslipidemia.
Abstract: Background Contrasting data exist regarding the relationship between thyroid-stimulating hormone (TSH) and obesity-related risk factors in children. In the present study, we investigated the association between TSH, free T4 (fT4) and cardiometabolic risk factors in euthyroid obese children and adolescents. Methods A retrospective analysis of patient records was performed on data from 703 multi-ethnic obese children and adolescents who visited an obesity-outpatient clinic. We performed anthropometric measurements, an oral glucose tolerance test, and measured serum TSH, fT4 and lipid levels. Results A positive association between TSH and the standard deviation score of the body mass index (BMI-Z) was found. After adjustment for ethnicity, sex, pubertal stage and BMI-Z, logistic regression analysis showed significant associations between TSH levels and impaired fasting glucose, impaired glucose tolerance, high total cholesterol, high low-density lipoprotein cholesterol and high triglycerides. No significant associations between fT4 levels and cardiometabolic risk factors were found in linear/logistic regression analysis. Conclusion In our multi-ethnic cohort of euthyroid obese children and adolescents increasing TSH was associated with impaired glucose metabolism and dyslipidemia.
TL;DR: The role of cannabis and steroid abuse that induce strokes in the absence of arteriopathy, cardioembolism or thrombophilia is highlighted.
Abstract: We report on a 16-year-old body builder who suffered from an acute ischemic stroke. In the urine, cannabis metabolites as well as metabolites of the oral androgenic-anabolic steroid methandrostenolone were detected, both known to be associated with stroke events. This report highlights the role of cannabis and steroid abuse that induce strokes in the absence of arteriopathy, cardioembolism or thrombophilia. Owing to new upcoming socio-behavioral aspects of late childhood and early adolescent life, this formally rare abuse of cannabis and/or anabolic steroids as well as their associations with strokes becomes more current than ever.
TL;DR: Female TS patients face a high prevalence of autoimmunity and associated AID, and there was a non-significant association between the 45,X karyotype and overall prevalence ofAutoantibodies.
Abstract: Our study aimed to investigate: the prevalence of autoantibodies related to organ-specific disease; the prevalence of some autoimmune diseases (AID) in Egyptian Turner syndrome (TS) patients; and the association of autoimmunity with patients' karyotypes. Eighty TS patients were subjected to history, auxological assessment and measurement of antithyroid peroxidase antibody (ATPOAb), antithyroglobulin antibody (ATGAb), anti-tissue transglutaminase IgA antibodies (ATTIgAAb), anti-glutamic acid decarboxylase-65 antibodies (GAD-65-Ab) and anti-adrenal cortex antibodies (AACAb). Of the 80 TS patients, 54 (67.5%) were seropositive for one or more autoantibodies. Thirty-five percent were positive for ATPOAb, 15% for ATGAb, 12.5% for ATTIgAAb, 3.75% for Anti-GAD-65Ab and 1.25% for AACAb. There was a non-significant association between the 45,X karyotype and overall prevalence of autoantibodies (p=0.20), while IsoXq was associated with increased prevalence of ATPOAb (p<0.01), ATGAb (p=0.01) and anti-GAD-65Ab (p=0.02). Thus, female TS patients face a high prevalence of autoimmunity and associated AID.
TL;DR: A case with duplication of the X chromosome segment within the region of Xp21 resulting in 46 XY sex reversal and a literature review on DAX1 and dosage sensitive sex reversal (DSS).
Abstract: Background The sex chromosome composition of the primordial gonad, either 46XX or 46XY, determines its differentiation as ovaries or testes. Local hormones secreted by developing gonads and tissue specific transcription factors influence the differentiation of external and internal genital structures. Dosage sensitive sex reversal adrenal hypoplasia congenita critical region (DAX1) on Xp21 is a gene which is expressed in the developing adrenals, gonads, hypothalamus and pituitary gland. Duplication of this area causes dosage sensitive male-to-female sex reversal while mutation or deletion leads to adrenal hypoplasia congenita with hypogonadotropic hypogonadism in affected males. Aim To report a case with duplication of the X chromosome segment within the region of Xp21.1-22.2 resulting in 46 XY sex reversal and a literature review on DAX1 and dosage sensitive sex reversal (DSS). Methods and results We present the clinical history, physical findings, laboratory, and imaging study results in a newborn baby. This infant was sex assigned as female at birth and had normal female external genitalia. Chromosome analysis was done due to multiple minor malformations and showed a karyotype of 46 Xp+Y. Fluorescent in situ hybridization analysis revealed the duplication in the DSS area. Conclusion Duplication of the DAX1 gene on the X chromosome with normal sex determining region of Y (SRY) results in 46 XY sex reversal. This was inherited from the mother who had normal ovarian function. Additional problems include growth failure, mental retardation and multiple congenital anomalies. The baby did not have a mutation or deletion of DAX1, which would have caused adrenal insufficiency and hypogonadism.
TL;DR: A 9-month-old infant treated with octreotide developed anicteric hepatitis with no other proven cause after the discontinuation of this drug, the liver enzymes declined rapidly.
Abstract: Congenital hyperinsulinism is characterized by hypoglycemia caused by several genetic disorders of inappropriate insulin secretion. Octreotide, an analogue of somatostatin, plays a major role in the pharmaceutical treatment of this condition. A 9-month-old infant treated with octreotide developed anicteric hepatitis with no other proven cause. After the discontinuation of this drug, the liver enzymes declined rapidly. Liver function tests should be followed in patients receiving octreotide.
TL;DR: This case highlights a very early presentation of bilateral GB in DDS and the consideration of early prophylactic gonadectomy at the time of diagnosis with DDS.
Abstract: Mutation of the Wilms tumor gene (WT1) is associated with two well-described syndromes called Denys-Drash (DDS) and Frasier (FS). Both are associated with nephropathy and ambiguous genitalia and have overlapping clinical and molecular features. The known risk of Wilms tumor in DDS and gonadoblastoma (GB) in FS patients requires tumor surveillance. The literature reports the occurrence of GB in DDS as lower than FS. This case highlights a very early presentation of bilateral GB in DDS and the consideration of early prophylactic gonadectomy at the time of diagnosis with DDS.
TL;DR: The frequency of a DKA event at onset of T1D is still high in Istanbul children despite a decreasing trend in the last decade, and NDAP may significantly contribute to the reduction in rate of DKA.
Abstract: AIMS To assess the frequency and severity of diabetic ketoacidosis (DKA) at disease onset in children newly diagnosed with autoimmune type 1 diabetes (T1D) in Istanbul in the last decade. Also, to evaluate the potential contribution of the national diabetes awareness programme (NDAP) initiated in 2010. METHODS Four hundred and one consecutive children (mean ± standard deviation, age 8.1 ± 4.1 years) with a diagnosis of autoimmune T1D were evaluated retrospectively with respect to demographic, clinical, and laboratory data in relation to DKA at disease onset. The possible impact of NDAP on the rate of DKA at disease onset in the last 2 years was also evaluated by comparing the data related to the time intervals before and after the onset of the programme. The results were evaluated at 95% confidence interval and significance was granted for p ≤ 0.05. RESULTS The overall frequency of DKA at disease onset was 44.2%, with a significant trend for decline in rate of DKA at disease onset in the last decade (p=0.0001). There were no significant differences in proportions of newly diagnosed T1D patients with severe or moderate DKA over time. Mean body mass index standard deviation score tended to increase in the last decade, but not significantly (p=0.09). When the time intervals before and after the onset of NDAP were evaluated, there was a more than two-fold decrease in rate of DKA (from 49.3% to 23.9%) (p<0.0001). CONCLUSIONS The frequency of a DKA event at onset of T1D is still high in Istanbul children despite a decreasing trend in the last decade. NDAP may significantly contribute to the reduction in rate of DKA.