Improvement of BMI after Lifestyle Intervention Is Associated with Normalisation of Elevated ELF Score and Liver Stiffness in Obese Children.

BACKGROUND: Noninvasive tools to diagnose nonalcoholic fatty liver disease (NAFLD), including transient elastography (TE) and enhanced liver fibrosis panel (ELF), have only been evaluated in children with biopsy-proven NAFLD. We evaluated the prevalence of ELF and TE abnormalities in obese children without clinical liver disease and examined the effects of BMI stabilization on ELF and TE in a longitudinal approach. METHODS: 39 obese children (17 m, age 12.3 (7.6-17.4) years) who participated in a 12-month lifestyle-intervention program underwent TE and ELF testing at baseline and at completion of the program. Results were compared with data from a nonobese paediatric cohort. RESULTS: TE and ELF at baseline were significantly elevated compared to controls (TE: 5.9 (3.4-8.3) kPa versus 4.45 (2.45-8.85) kPa, P < 0.01; ELF: 9.0 (7.87-9.60) versus 8.6 (7.33-11.52), P = 0.033). All children with elevated TE and ELF results had normal transaminases. After the program, ELF and TE normalized. Reduction of ELF and TE was associated with a decrease in BMI centile. CONCLUSION: Abnormal TE and ELF results in obese children suggest presence of NAFLD even when transaminases are normal. TE and ELF might be used as monitoring tools for NAFLD. BMI stabilisation normalizes TE and ELF, underlining the impact of lifestyle intervention.

Lipoatrophy in children with type 1 diabetes: an increasing incidence?

The objectives were to evaluate the current prevalence of lipoatrophy at insulin injection sites in young patients with type 1 diabetes. Standardized examination of insulin injection sites in all 678 patients with type 1 diabetes treated in 2013 in our outpatient clinic were conducted. In case of lipoatrophy photo documentation and standardized interview with parents and patients were performed. We identified a total of 16 patients (43.8% male) with lipoatrophy (overall prevalence 2.4%). The current mean age (±SD) of the affected patients was 14.4 ± 3.9 years, age and diabetes duration at onset of lipoatrophy were 11.5 ± 3.8 years and 5.4 ± 3.6 years, respectively. All patients were using analogs at the onset of lipoatrophy. In all, 14 of 16 patients (87.5%) were on insulin pump compared with 52% without lipoatrophy (P = .0018). The use of steel needle and Teflon catheter was equal between the pump patients. Concomitant autoimmune diseases were present in 37.5% of the patients (thyroiditis: n = 3, thyroiditis and celiac disease: n = 2, celiac disease: n = 1) compared with 15.0% in those without lipoatrophy (P = .0128). Lipoatrophy was present in young patients treated with modern insulins and pumps; however, the prevalence was relatively low as expected with the use of modern insulins. Our data may support the hypothesis that a constant mechanical element such as a subcutaneous catheter may trigger the development of lipoatrophy, particularly in those patients with more than 1 autoimmune disease.

Dietary intake of nickel and zinc by young children--results from food duplicate portion measurements in comparison to data calculated from dietary records and available data on levels in food groups.

The daily dietary intake of nickel (Ni) and zinc (Zn) by 42 young children, 21 boys and 21 girls, from 4 to 7 years of age, living in urban and rural areas of Germany and having different food consumption behaviour, was determined by the duplicate method with a 7-day sampling period. Dietary records were also kept by the children's parents for the 7-day sampling period. Individual reported food items were identified, assigned to food groups and, together with known Ni and Zn concentrations of foodstuffs, daily intake rates were calculated. The same method was used for calculations of the energy, fat, protein and carbohydrate intake rates. The levels in the food duplicates, determined by atomic absorption spectrometry, were in the range of 69-2000 microg Ni/kg(dry weight) (geometric mean (GM): 348) and 7.1-43 mg Zn/kg(dry weight) (GM: 17.5). Daily intake rates based on the 294 individual food duplicate analyses were 12-560 microgNi/d (GM: 92.3) and 1.5-11 mgZn/d (GM: 4.63). The results from the dietary records were 35-1050 microg Ni/d (GM: 123) and 1.7-15 mg Zn/d (GM: 5.35). The results of the daily intake rates from both methods showed a correlation with regard to Zn (r=0.56), but no correlation was found between either the Ni intake rates determined with both methods or between the Ni intake rates measured by the duplicate method and calculated intake rates from the dietary records of energy, fat, protein, carbohydrates or drinking water. In the case of nickel, the discrepancies between the methods lead one to suppose that the main factors influencing Ni intake by food are not directly caused by easily assessable food ingredients themselves. It is possible that other factors, such as contaminated drinking water or the transition of Ni from kettles or other household utensils made from stainless steel into the food, may be more relevant. In addition there are some foodstuffs with great variations in concentrations, often influenced by the growing area and environmental factors. Further, some food groups naturally high in Nickel like nuts, cocoa or teas might not have been kept sufficient within the records. In summary, the dietary record method gave sufficient results for Zn, but is insufficient for Ni. Based on the food duplicate analysis, children living in urban areas with consumption of food products from a family-owned garden or the surrounding area and/or products from domestic animals of the surrounding area had about one-third higher Ni levels in their food than children either living in an urban area or children consuming products exclusively from the supermarket. Only slight differences were found with regard to Zn. Compared to the recommendations of the German Society of Nutrition (DGE) (25-30 microgNi/d and 5.0 mgZn/d), the participants of the study had a clearly increased Ni and, in view of the geometric mean value, a nearly adequate Zn intake. Health risks are especially given with regard to the influence of nickel intake by food on dermatitis for nickel-sensitive individuals.