The relationship between hyperthyrotropinemia and metabolic and cardiovascular risk factors in a large group of overweight and obese children and adolescents.

PURPOSE: Mild TSH elevations are frequently observed in obese patients, in the absence of any detectable thyroid disease. Our objective is to evaluate the relationship between the raised TSH levels and the biochemical and clinical consequences of obesity. METHODS: This is a retrospective cross-sectional study of a large population of obese children and adolescents. We evaluated 833 subjects (340 m, 493 f), aged 14.4 ± 2.5 (range 5.2-18.5) years, height SDS 0.27 ± 1.04 (-3.49-4.35), and BMI SDS 2.94 ± 0.59 (1.60-4.68). Body composition, free T4, TSH, anti-TPO antibodies, anti-TG antibodies, inflammation markers (total WBC and the subtypes, ultrasensitive C-reactive protein), and metabolic parameters [AST, ALT, γGT, ALP, glycaemia, insulin, total cholesterol (TC), HDL-cholesterol (HDL-C), and LDL-cholesterol (LDL-C), triglycerides (TG)] were measured, and oral disposition index (ODI) and cardiovascular risk factors (TC/HDL-C and TG/HDL-C) were calculated. After exclusion of the subjects showing anti-thyroid antibodies, the remaining 779 (325 m, 454 f) were then subdivided into two subgroups according to a TSH value below (group A) or above (group B) 4.5 mU/L. RESULTS: Clinical characteristics and hematological markers of patients with and without positive anti-thyroid antibodies were similar, with the exception of higher TSH levels in the latter group. Using analysis of covariance, the subjects of group B had significantly higher values of TC (170.3 ± 28.7 vs 163.3 ± 32.9 mg/dL; p < 0.05), systolic (125.8 ± 13.5 vs 124.5 ± 13.1 mm/Hg), and diastolic blood pressure (79.2 ± 8.0 vs 77.9 ± 8.2 mm/Hg) than subjects of group A. No difference was observed in body composition, ODI, and the cardiovascular risk factors between these two groups. CONCLUSION: TSH elevation in overweight and obese children and adolescents, being associated with a higher TC and blood pressure, might negatively influence the cardiac status. Longitudinal studies are requested, however, to confirm this hypothesis and, therefore, to conclude whether a substitutive treatment with l-thyroxine is really needed in these patients.

Prematurity and low birth weight lead to altered bone geometry, strength, and quality in children.

PURPOSE: Prematurity and low birth weight are associated with a decrease in bone mass. Aim of the study was to investigate bone geometry, strength, and quality in children born at term small for gestational age (term SGA), premature appropriate for gestational age (prem AGA), and premature SGA (prem SGA). METHODS: 91 patients (46 f, 45 m), mean age 11.28 years, height SDS 0.03 ± 0.21, and BMI SDS -0.31 ± 0.19. 20 were term SGA, 22 prem SGA, and 49 prem AGA. Bone geometry was assessed on the 2nd metacarpal bone, by evaluating the outer and inner diameter, the cortical area, medullary area, metacarpal index, cross-sectional area, and bone strength. Bone quality was evaluated by ultrasound and expressed as amplitude-dependent speed of sound and bone transmission time (BTT). RESULTS: Term SGA, prem SGA, and prem AGA had values of bone geometry, strength, and quality significantly lower than our reference range (p < 0.05). Findings in the three groups were similar, apart from BTT, which was significantly reduced in prem SGA (p < 0.05). Fat percentage was the main determinant of BTT. CONCLUSIONS: Children born either prematurely or SGA seem to have smaller and weaker bones. Those born both premature and SGA were the most affected.

A national study of iodine status in Albania.

OBJECTIVE: The aim of the study was to determine the iodine status in Albania following 11 yr of iodine prophylaxis and to evaluate factors influencing the outcome. DESIGN: Eight hundred and forty children, aged 6-13 yr, living in 4 different regions and 365 pregnant women living in the same areas, were enrolled for the study. The prevalence of goiter was assessed by palpation and ultrasound imaging and the urinary iodine and the iodine concentration in the salt of different commercial brands were evaluated. Presence of goiter in the family and their eating habits were also investigated as well as the use of iodized salt in the household. MAIN OUTCOME: In children, the prevalence of goiter was 57.6% by palpation and 24.4% by ultrasound imaging. Median urinary iodine was 86.2 microg/l, with pronounced geographical variations (range 3.52-1079 microg/l). In particular, 29.1% of the children had urinary iodine <50 microg/l and 57.1% <100 microg/l. In pregnant women, the median urinary iodine was 85 microg/l. Median iodine concentration in household iodized salt was 21.2 mg/kg, with 60.3% of the brands being adequately and 39.7% non-adequately iodized. Almost all families (99.6%) claimed to use iodized salt. CONCLUSION: Despite the introduction of iodine prophylaxis, there is still a mild iodine deficiency in Albania, particularly in the inner mountainous areas.

[Peripheral arterial disease in a population of type 2 diabetic patients: its correlation with diabetic microangiopathy and laboratory parameters]. / L'arteriopatia obliterante periferica in una popolazione di diabetici di tipo 2: correlazione con la microangiopatia diabetica e parametri laboratoristici.

BACKGROUND: The aim of this study was to evaluate the incidence of peripheral arterial disease (PAD) in a population of type 2 diabetic patients (NIDDM) and its possible correlation with diabetic nephropathy (DN), diabetic retinopathy (DR) and also with some biochemical parameters of glomerular and tubular renal function. METHODS: The study included a total of 150 NIDDM patients, randomly selected, who have been followed-up at the Metabolic Center of our Division. All patients underwent assessment of the ankle/brachial pressure index (ABI) and Doppler ultrasound of the lower extremities. They were then divided into 2 groups: Group 0 without PAD and Group 1 with PAD. They also underwent a echo color-Doppler study of the renal interlobar arteries in order to evaluate the resistive index (RI), while the retinal vessels were assessed by biomicroscopy and fluorangiography. RESULTS: The incidence of PAD in this study was 30.6%, occurring on average 14 years from the onset of diabetes, and affecting particularly patients with nephropathy. The presence of both albuminuria and retinopathy in the same patient increases by 8.9 times the risk of cardiovascular disease. CONCLUSIONS: The RI, measured at the level of the intrarenal arteries, is of great interest as a marker not only of renal vascular damage in NIDDM patients, but also of a generalized vascular involvement.

[Renal Doppler color ultrasonography in the study of diabetic nephropathy]. / Eco-color Doppler renale nello studio della nefropatia diabetica.

The traditional ultrasound approach in the field of diabetic nephropathy provides only partial clinical information; moreover, the data obtained are merely descriptive, in particular regarding the involvement of the intrarenal arteries, which is however the area mainly involved. The aim of our study was to assess the data provided by Doppler ultrasound and in particular the role of the Resistive Index (RI) in a population of 160 type 2 diabetics (NIDDM), divided into 4 groups according to the severity of diabetic nephropathy. The assessment of RI has enabled us to detect among patients in the early stages of diabetic nephropathy (64 patients of group 1), a subgroup of 28 subjects (43.8%) showing RI values equal to or above the threshold value of 0.7. The determination of renal size and of renal parenchyma echogenicity proved to be of little value. The most relevant clinical information is provided by the RI, a parameter that will allow the early detection of patients affected by NIDDM, who show renal vascular involvement without however any other alterations of the traditional ultrasound parameters.