Decreased high-density lipoprotein cholesterol and insulin resistance were the most common criteria in 12- to 19-year-old adolescents.

BACKGROUND: Metabolic syndrome (MetS) is characterized by a group of metabolic risk factors leading to an increase in diabetes mellitus and cardiovascular diseases. It is known that the pathologic processes such as hyperinsulinemia and atherogenic risk profile associated with the development of MetS begin during childhood and adolescence. AIM OF THE STUDY: To determine the prevalence of MetS and assess the association between MetS and certain demographic and lifestyle factors in a representative adolescent population. METHODS: The study was carried out in central and ten districts located around Kayseri Province, Central Anatolia. A total of 790 adolescents aged from 12 to 19 years were selected systematically from the schools. Criteria of MetS were modified from Adult Treatment Panel III: (1) waist circumference > 90th percentile (aged between 12 and 17 years) and >102 cm in male, >88 cm in female (for aged 18 and 19 years), (2) serum triglycerides [>or=136 mg/dl (aged between 12 and 16 years) and >or=150 mg/dl (for 17 and 19 years)], (3) high-density lipoprotein cholesterol [or= 95th percentile for gender, age and height, (5) insulin resistance HOMA index < 3.16. Multivariate regression model was performed to search for the association between MetS and demographic and lifestyle factors including gender, age, body mass index, settlement, socioeconomic class, smoking habit, physical activity and family history for diseases (cardiovascular diseases and diabetes mellitus). RESULTS: The overall prevalence of MetS was found as 10.8%. The prevalence was significantly higher in males than in females (13.5 and 8.6%, respectively). Low high-density lipoprotein cholesterol and insulin resistance were the most common criteria of the syndrome. According to the analysis, only gender and high socioeconomic class were weak-positive related factors with MetS. CONCLUSIONS: High prevalence of MetS especially among overweight and obese adolescents is a serious health problem. Early identification of the syndrome would contribute greatly to the prevention of diabetes and cardiovascular diseases in youth.

Obesity risk factors in Turkish children.

On the basis of the knowledge that the prevalence of obesity in children has increased steadily in recent years, this study aimed to assess the association between obesity and certain risk factors in a group of 6- to 14-year-old children living in Istanbul. The study was carried out at the Istanbul University School of Medicine Hospital. Data were collected from 592 children aged between 6 and 14 years who were examined in general pediatrics clinics. Weight and height measurements were performed on the children and their parents. The children were classified as obese and nonobese in accordance with the body mass index reference values for Turkish children. Energy intake of children was estimated with a 3-day food consumption recording form. A structured questionnaire was used to collect the information from the parents on possible risk factors causing obesity. The physical activity state of the children was assessed. A logistic regression model was developed to examine the relationships between obesity and possible risk factors. Almost 32% (n = 184) and 69% (n = 408) of children were assessed as obese and nonobese, respectively. Although there was no difference in daily energy intakes of obese and nonobese children, 13.6% of obese and 40.9% of nonobese children were reported to do physical activity regularly. Obesity was strongly associated with parental obesity. Furthermore, energy intake; having regular physical activity; presence of obesity in the mother, the father, and the mother's family; and having a mother working out of home were also significantly associated with obesity. Creating awareness in mothers on the importance of a healthy nutrition and encouraging families to participate in physical activities are important points in the prevention of childhood obesity.

Is plasma homocysteine level associated with metabolic syndrome components in adolescents?

BACKGROUND: This study investigated whether serum homocysteine (Hcy) level is associated with metabolic syndrome components, including high waist circumference (WC), hypertriglyceridemia, low high-density lipoprotein-cholesterol (HDL-C), elevated systolic blood pressure (SBP), and insulin resistance (IR) in adolescents living in Central Anatolia, Turkey. METHODS: The data of The Prevalence of Metabolic Syndrome Among Adolescents Study, a cross-sectional study carried out in two of the central and ten outlying districts of Kayseri was used. Components of metabolic syndrome were modified from the Adult Treatment Panel III (ATP III). A multivariate regression model was developed to examine the relationships between the homocysteine (Hcy) level and metabolic syndrome components. Hyperhomocysteinemia (HH) was defined as level of Hcy > or = 15 micromol/L. RESULTS: Mean plasma Hcy level of adolescents with metabolic syndrome was found to be 11.8 +/- 5.0 micromol/L. Although the Hcy level of females (11.4 +/- 5.5 micromol/L) was lower than that of males (12.0 +/- 4.7 micromol/L), the difference was not statistically significant (P > 0.05). In all, 40.5% of adolescents had Hcy levels between 10 and 15 micromol/L (mild HH) and 17.7% of adolescents had Hcy levels of > or = 15 micromol/L. The Hcy level was negative and weakly correlated with insulin resistance in females (r = -0.319, P = 0.058) and negative strongly correlated with SBP in males (r = - 0.385, P = 0.011). There were no associations between Hcy level and other components of metabolic syndrome. CONCLUSIONS: An elevated plasma Hcy level is not considered to be related to components of metabolic syndrome. But HH may be an independent risk factor, especially for diabetic adolescents or those who have cardiovascular events as in adults.

Cross-sectional reference values for mid-upper arm circumference, triceps skinfold thickness and arm fat area of Turkish children and adolescents.

The aim of the study was to establish cross-sectional reference values for the mid-upper arm circumference (MUAC), triceps skinfold thickness (TSF) and arm fat area (AFA) of Turkish children and adolescents. In total 5,553 students aged between 6 and 17 years were selected by a multistage sampling method from schools representing city centre, rural and urban areas of Kayseri, Central Anatolia. The MUAC and TSF were measured, and the arm muscle area, arm area, AFA and fat percentage (%) were calculated. The LMS method was employed to calculate the MUAC, TSF and AFA curve parameters. The MUAC, TSF, AFA and fat percentage in each age group were significantly higher in girls than in boys. In boys, the TSF 50th percentile ranged from 7.6 mm at 17 years to 9.0 mm at 11 years; whereas in girls this ranged from 9.4 mm at 6 years to 14.6 mm at 17 years. The MUAC 50th percentile ranged from 17.0 to 23.6 cm in boys, and from 15.6 cm to 20.9 cm in girls. The AFA 50th percentile measurements ranged from 4.5 cm at 6 years to 5.8 cm at 12-14 years in boys; and ranged from 7.2 cm at 6 years to 14.8 cm at 17 years in girls. The percentile distribution was more disperse towards higher TSF and AFA values in boys than in girls.

Reference body mass index curves for Turkish children 6 to 18 years of age.

AIM: To determine reference body mass index (BMI) curves for Turkish children 6 to 18 years old and to compare with BMI in other countries. METHODS: A cross-sectional study conducted in Kayseri, Turkey. A total of 5,727 children (2,942 girls, 2,785 boys) aged between 6 and 18 years were selected to construct a reference curve using LMS method. RESULTS: BMI age reference charts of Turkish children were constructed. The 50th percentile curve of Turkish girls is lower than Italian and Turkish girls in The Netherlands but higher than Iranian girls. The 50th percentile curve of Turkish boys is lower than Italian and Turkish boys in The Netherlands and similar to Iranian boys after 13 years of age. CONCLUSION: BMI references of Turkish children are lower than in South East Europe, UK and North American populations, but higher than in Central European and Scandinavian countries.

Food types in the diet and the nutrient intake of obese and non-obese children.

BACKGROUND: Childhood obesity has reached epidemic proportions world-wide. OBJECTIVE: To compare the types of food in the diet and the nutrient intake of obese children with those of non-obese children. METHODS: A total of 95 obese and 592 non-obese children aged between 6 and 10 years participated in the study. A body mass index (BMI) value exceeding the 95th percentile for age and gender was taken as the criterion for obesity. Three-day food consumption was recorded and evaluated according to standard international recommendations. RESULTS: Macronutrient intake was adequate in both obese and non-obese children. Energy intake of the obese children was significantly higher than that of the non-obese children. Micronutrient intake except fiber of both groups, calcium intake of obese children and vitamin A intake of non-obese children were higher than recommended amounts. The obese children consumed excessive fat and sugar, but less fruit and vegetables as compared to the non-obese children, and less than the recommendations of the food guide pyramid as adopted by the US Department of Food and Agriculture and the Department of Health and Human Services. CONCLUSION: The implementation of educational programs on nutrition may be important for promoting knowledge about healthy eating among obese children.

Congenital pulmonary lymphangiectasia in a newborn: a response to autologous blood therapy.

Congenital pulmonary lymphangiectasia is a rare condition that may present antenatally with pleural effusions and hydrops, and the prognosis is reported to be very poor. Treatments for lymphangiectasia have included corticosteroids for patients with primary inflammatory conditions, dietary modifications, surgical resection for isolated lesions, octreotide, antiplasmin therapy and fibrin glue pleurodesis. However, there is no experience with pleurodesis by autologous blood therapy in the literature. We present a newborn with primary pulmonary lymphangiectasis who developed progressively profuse chylous pleural effusions after enteral full feeding from the 8th day of life and improved with pleurodesis by autologous blood therapy.

The relationship between birthweight, 25-hydroxyvitamin D concentrations and bone mineral status in neonates.

BACKGROUND: Calcium (Ca), phosphorus (P) and 25-hydroxyvitamin D (25-OHD) are the major micronutrients for fetal skeletal development. AIMS: To compare whole body bone mineral density (WB BMD) and bone mineral content (WB BMC) in different birthweights of term neonates and to determine correlations of biological criteria of bone health between neonates and their mothers. SUBJECTS AND METHODS: Serum Ca, P, alkaline phosphatase (ALP) and 25-OHD levels were measured in 30 small-for-gestational-age (SGA, group 1), 40 appropriate-for-gestational-age (AGA, group 2) and 30 large-for-gestational-age (LGA, group 3) neonates and their mothers in winter. WB BMD and WB BMC of neonates were estimated by dual-energy X-ray absorptiometry (DEXA) in the 1st 24 hrs after delivery. RESULTS: Mean (SD) serum 25-OHD levels in the mothers [8.7 (3.0), 8.6 (3.0) and 7.7 (2.8) microg/L, respectively] and their infants [6.3 (2.5), 6.0 (2.2) and 5.7 (1.8) microg/L, respectively] in groups 1, 2 and 3 were similar. Compared with the mothers, the mean 25-OHD levels of the neonates in all groups were significantly lower (p<0.05), and they were highly correlated (r=0.755, p<0.05). Ninety-three per cent of the neonates and 82% of their mothers had 25-OHD levels <10 microg/L, the lowest limit of normal. Mean (SD) WB BMD and WB BMC were higher in LGA infants [0.442 (0.025) g/cm(2), 71.6 (9.0) g, p<0.01, p<0.001, respectively] but lower in SGA [0.381 (0.027) g/cm(2), 29.1 (9.1) g, p<0.001, p<0.001, respectively] than in AGA infants [0.426 (0.022) g/cm(2), 53.7 (9.6) g, respectively]. The percentage of WB BMC was lower in SGA than in AGA and LGA infants. WB BMC and WB BMD were positively correlated with birthweight (r=0.910, p<0.05) and gestational age (r=0.707, p<0.05) but not with serum 25-OHD. CONCLUSIONS: The neonates' bone indices increased significantly with gestational age and birthweight but this was not related to serum 25-OHD levels in the infants and their mothers.

Iodine status remains critical in mother and infant in Central Anatolia (Kayseri) of Turkey.

BACKGROUND: Severe iodine deficiency disorders have been eradicated in many parts of the world, but milder forms still exist and may escape detection. Turkey has long been known to be a mild to moderate iodine deficiency area. AIM OF THE STUDY: The aim of this study was to assess the iodine nutritional status and the thyroid function of pregnant women and their neonates in the region of Kayseri (central Anatolia of Turkey) that appeared to be iodine deficient in previous studies performed before the introduction of mandatory salt iodization. METHODS: A cross-sectional voluntary screening study was performed in the Maternity Unit of a university hospital. A total of 70 mothers and their healthy full-term neonates were included in this study. Urinary iodine concentration was estimated in spot urine samples obtained from mothers and their neonates on day 5. All the neonates were breastfed. The iodine content was determined in the breast milk of all mothers on day 5. Serum concentrations of TSH, thyroglobulin (Tg), free triiodothyronine (FT3) and free thyroxine (FT4) were investigated in the cord serum of neonates and compared to those of mothers immediately after parturition RESULTS: The median urinary iodine on day 5 in mothers and their babies were 30.20 and 23.80 microg/l, respectively. These figures are much lower than normal for these age groups (150-200 microg/l). The median iodine content of breast-milk was 73 microg/l. It is again much lower than in iodine sufficient areas, indicating that the status of iodine nutrition of pregnant and lactating women is clearly insufficient. The median concentrations (and ranges) of neonatal TSH, Tg, FT3 and FT4 were 7.44 mU/l, 71.62 ng/ml, 1.30 pg/ml and 1.34 ng/dl respectively. The corresponding levels for the mothers during labor were 2.19 mU/l, 25.65 ng/ml, 1.31 pg/ml and 1.23 ng/dl respectively. The median neonatal serum concentrations of TSH and Tg were significantly higher than the corresponding maternal levels (P < 0.0001, P < 0.0001, respectively) and 27.1% of the neonates had serum TSH concentrations above 10 mU/l and 57.1 % had cord blood serum Tg concentrations above 54 ng/ml. None of the mothers showed TSH concentrations above 5 mU/l and 41.4% had serum Tg concentrations above 30 ng/ml. CONCLUSION: Iodine deficiency with low urinary iodine excretion and high serum Tg and TSH concentrations were recognized among pregnant women and their babies in Kayseri in spite of the program of salt iodization. National measures are urgently required for improving the correction of iodine deficiency in Turkey. This includes regular supplementation with iodine, starting at preconception or in early pregnancy and continuing during the period of nursing in this region.

Bone mineral density and serum 25-hydroxyvitamin D level: is there any difference according to the dressing style of the female university students.

Nutrition plays a role in the etiology of osteoporosis. Two of the most important nutrients for bone health are calcium and vitamin D. Plasma 25-hydroxyvitamin D [25-(OH)D] is the most sensitive clinical index of vitamin D status and has been found to be positively related to bone mineral density (BMD) in middle-aged and elderly women, and positive relations exist between the BMD of adult women and their calcium consumption throughout life. The aim of the present study was to determine relationships between BMD, serum vitamin D levels and dietary calcium intake of female young adult students who dressed in different styles. We studied two groups of volunteer female students (total = 67). Students in the first group dressed in a style that exposed the skin to sunlight, students in the second group wore dresses completely covering the skin except for the face and hands. Serum 25-(OH)D levels were measured by radioimmunoassay, BMDs were determined at the lumbar spine and femoral neck by dual-energy X-ray absorptiometry, and calcium intakes were estimated with a 3-day food recording questionnaire. The serum 25-(OH)D level was significantly lower in the second group. There was no significant difference in BMD between the two groups. The dietary calcium intake of the two groups were lower than the adequate intake of 1000 mg daily for this age. There was a correlation between the serum 25-(OH)D level and BMD at the femoral neck in the first group. Our results indicate that vitamin D and calcium requirements for normal bone mineral accrual in young adults may advance until a certain age, and the covered dressing style causes vitamin D insufficiency and most of the students were under risk for osteoporosis in later life.