Impact of percent body fat on oral glucose tolerance testing: a cross-sectional study in 1512 obese children.

BACKGROUND: Although an association between insulin resistance (IR) and body adiposity has been reported in obese children, this relationship has not been studied as thoroughly as in adults. AIM: We evaluated the association between oral glucose tolerance testing (OGTT) and percent body fat (PBF) in a sample of 1512 obese children followed at a Pediatric Obesity Clinic. SUBJECTS AND METHODS: Six hundred and twenty-eight male and 884 female obese children aged 6 to 18 yr were consecutively enrolled into the study. OGTT was performed with administration of 1.75 g of glucose per kg of body weight (up to 75 g). PBF was estimated through bioelectrical impedance analysis (BIA) using a population- specific formula recently published by our group. Multivariable median regression was used to evaluate the association between 4 outcomes [glucose area under the curve (AUC), insulin AUC, insulin sensitivity index (ISI), and insulinogenic index (IGI)] and gender, age or pubertal status and PBF. RESULTS: Median PBF was 52% (range 26 to 70%). After correction for age and gender, a 10% increase of PBF was associated with a decrease of -0.50 [95% confidence interval (CI): -0.65 to -0.35] units of ISI and an increase of 0.15 units of IGI (95%CI 0.07 to 0.24). CONCLUSIONS: In obese children, PBF is inversely associated with IR and directly associated to ß-cell response as detected by OGTT.

Metabolic responses to submaximal treadmill walking and cycle ergometer pedalling in obese adolescents.

Physical activity is essential in obesity management because of the impact of exercise-related energy expenditure (EE) and fat oxidation (Fox) rate on a daily balance, but the specific physiological effects of different exercise modalities are scarcely known in obese individuals. The objective of the study was to compare the metabolic responses to treadmill (TM) and cycle ergometer (CE) exercise in obese adolescents. Gas exchange, heart rate (HR), blood lactate (LA) concentration, EE and Fox were determined at different intensity levels (up to about 85% of maximal oxygen uptake) during TM and CE in 14 pubertal (Tanner stage: >3) obese (BMI SDS: 2.15-3.86) male adolescents (age: 13-18 years). At comparable HR, oxygen uptake, EE and Fox were higher, and LA lower, during TM than CE (P<0.05-0.001), suggesting that cycling imposes a metabolic involvement at the level of the single active muscles greater than walking. Therefore, due to different physiological responses to TM and CE, walking was more convenient than cycling in obese adolescents, permitting to attain the same EE at lower HR, with lower blood LA concentration and with greater Fox. These conclusions seem clinically relevant when using exercise as a part of multidisciplinary treatment for juvenile obesity and amelioration of related metabolic disturbances.

Sympathoadrenergic and metabolic factors are involved in ambulatory blood pressure rise in childhood obesity.

We investigated in a young Italian obese population, the relationship between ambulatory BP (ABP) and several pathophysiological factors linking obesity to hypertension. A total of 89 obese children and adolescents underwent a 24-h ambulatory BP monitoring (ABPM) and an oral glucose tolerance test. The circulating levels of insulin, lipids, uric acid, C-reactive protein, interleukin-6, renin and aldosterone and the 24-h urinary levels of epinephrine, norepinephrine and albumin excretion rate were measured. Nine percent of subjects had daytime sustained hypertension (SH), 26% night-time hypertension and 11% a non-dipping pattern. SH subjects compared to those with sustained normotension (SN) were more obese (P<0.05), with a more frequent family history of hypertension (P<0.05), higher urinary catecholamine (P<0.05) and heart rate values (P<0.05) after adjustment for standard deviation score (SDS) of body mass index (BMI) and sex. Subjects with night-time hypertension compared to those with night-time normotension were more obese (P<0.0001), with a higher prevalence of impaired glucose tolerance (P<0.05) and metabolic syndrome (P<0.05) and higher 2-h glucose (P<0.05), uric acid (P<0.05) and triglycerides (P<0.05). In multivariate regression analysis, daytime systolic BP (SBP) remained independently correlated with urinary norepinephrine and SDS-BMI (P<0.05 for both), daytime diastolic BP (DBP) with waist circumference (P<0.05) and night-time SBP and DBP with SDS-BMI (P<0.01 for both). The risk of having systolic and diastolic hypertension increased with the increase in SDS-BMI and waist circumference, respectively. In conclusion, in our cohort of obese children and adolescents, daytime and night-time hypertension were associated with activation of the sympathoadrenal system and worst metabolic conditions, respectively.

Predictors of non-alcoholic fatty liver disease in obese children.

OBJECTIVE: To evaluate predictors of non-alcoholic fatty liver disease (NAFLD) in obese children. DESIGN: Cross-sectional study. SUBJECTS: Two hundred and sixty-eight obese children not consuming alcohol and without hepatitis B or C were consecutively studied at an auxology clinic. MEASUREMENTS: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl-transferase (GGT), cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, triglycerides, uric acid, glucose, glucose during oral glucose tolerance testing (OGTT), insulin, insulin during OGTT, insulin resistance as estimated by homeostasis model assessment (HOMA), C-reactive protein (CRP), and systolic and diastolic blood pressure were measured. Fatty liver was diagnosed by ultrasonography using standard criteria. Univariable and multivariable logistic regression was used to evaluate predictors of NAFLD. All predictors except gender and pubertal status were modeled as continuous variables. RESULTS: NAFLD was detected in 44% of obese children. At univariable analysis, male gender, Z-score of body mass index (BMI) (Z-BMI), ALT, AST, GGT, triglycerides, uric acid, glucose, glucose during OGTT, insulin, insulin during OGTT, HOMA, CRP and systolic blood pressure were predictors of NAFLD, whereas HDL-cholesterol and late-pubertal status were predictors of the normal liver. At multivariable analysis, however, only Z-BMI, ALT, uric acid, glucose during OGTT and insulin during OGTT were independent predictors of NAFLD. CONCLUSION: Z-BMI, ALT, uric acid, glucose during OGTT and insulin during OGTT are independent predictors of NAFLD in Italian obese children, with most of the prediction explained by ALT and Z-BMI.

[The TRH test in Turner syndrome]. / TRH-test nella sindrome di Turner.

In order to evaluate the functionality of the hypothalamic-hypophyseal-thyroid axis in Turner's syndrome (TS), 27 subjects, aged between 5.1 and 16.1 years old, were studied, 14 of whom were karyotype 45,XO and 13 affected by mosaicism. The TRH test (200 mcg i.v.) was performed in all subjects using a single bolus. TRH titers were assayed in serum samples collected at 0, 15, 30, 60 and 90 minutes, and anti-microsome and anti-thyroglobulin, T4 and T3, were assayed in the basal sample; the latter were also assayed in the blood sample collected at 120 minutes. These results were compared with those obtained using the same test in a group of age- and sex-matched controls. Anti-thyroid antibodies and basal levels of T3 and T4 were within the norm in 26 subjects; a high basal value of TSH was only found in one patient with chromosomic mosaicism with an elevated response to TRH and a high titer of anti-microsomic antibodies. Apart from this no statistically significant differences were found in patients compared to control subjects in relation to TSH values at all stages of the test and between the two groups of TS; no significant results were found in the comparison between the areas below the curves (AUC). On the basis of these results the Authors conclude that it is not possible to reveal alterations in thyroid function attributable to hypothalamic and hypophyseal anomalies in this group of patients either with karyotype 45,XO and mosaicism.

[The effect of GH on erythropoiesis in vivo]. / Effetto, in vivo, del GH sull'eritropoiesi.

It has been demonstrated that the direct and/or indirect stimulation of hematopoiesis is one of the effects of the growth hormone (GH) in vitro. In order to study the effect of GH on erythropoiesis in vivo, the variation of hemochrome in a group of 8 subjects with GH deficiency (GHD) were monitored during a substitutive therapy with biosynthetic GH (rhGH) at dose of 0.4 U/kg/week. Hemoglobin (Hb), hematocrit (Ht), mean corpuscular volume (MCV), number of red blood cells (RBC) were analysed in all subjects at the beginning and after 9 months of treatment. The effectiveness of therapy was demonstrated by statistically significant variations in height, height SDS, growth velocity, serum levels of IGF-I. After 9 months of rhGH therapy, a significant increase was observed in all values considered with exception of MCV. In conclusion Gh would appear to stimulate erythropoiesis, directly or indirectly, and these results would appear to indicate an in vivo confirmation.

[Leptin and neuropeptide Y serum levls in young obese during weight loss]. / Valori serici di leptina e neuropeptide Y in giovani obesi durante la riduzione ponderale.

BACKGROUND AND AIM: Correlations between serum leptin (LEP) and BMI and the percentage of fat mass (FM), as well as differences between male and female serum levels and their behaviour during weight loss have already been extensively described in adult obesity, whereas few cases have been examined in child and adolescent obesity. There are also few studies of the alterations in NPY in peripheral blood in obese subjects during weight loss. METHODS: This study aimed to evaluate the correlations between LEP and BMI, FM% and NPY in 72 obese subjects, with BMI > 35 (29 males and 43 females) aged between 9.6 and 19.8 years old, during weight loss together with any differences between the sexes. RESULTS: LEP was positively correlated in both sexes with BMI and FM%, whereas no correlation emerged with NPY; LEP levels decreased gradually during weight loss, whereas no changes were observed in NPY except during the first phases of weight loss in males when the decrease was significant. LEP concentrations were significantly higher in females, who also showed a higher FM% with equal BMI. No difference was observed between NPY levels in both sexes. CONCLUSIONS: The authors conclude that: 1) the behaviour of LEP in child-adolescent obesity is broadly comparable to that described in adult obesity; 2) the highest LEP concentrations with equal BMI in females appear to reflect the different body composition of the two sexes given that females have a higher FM%; 3) the control exerted by LEP on hypothalamic NPY cannot be seen in peripheral blood and no differences emerged between the two sexes.

[Relationship between blood insulin and arterial hypertension in obese adults]. / Studio dei rapporti tra insulinemia ed ipertensione arteriosa in adulti obesi.

The well know fact that high blood pressure and impaired glucose tolerance are frequently associated with obesity has suggested that hyperinsulinemia could represent one of the possible pathogenetic connections between obesity and systodiastolic hypertension. With the aim of verifying this hypothesis 67 obese subjects (36 hypertensive and 31 normotensive), males, were admitted to our study. All of the subjects underwent standard OGTT in order to measure their glycemic and insulinemic levels. No differences were found between two groups, as regard age and the degree of obesity; blood pressure values were significantly different (p less than 0.01). No significative differences were detected for glycemic and insulinemic levels between normotensive and hypertensive subjects; basal hyperinsulinemia was detected in a similar percentage (16.6 vs 19.3%) in the two groups. Under these circumstances it is not possible to confirm that hyperinsulinemia is the prominent link between obesity and high blood pressure, as previously observed by others.

[Carotid endarterectomy with placement of a PUR (polyurethane) patch]. / La TEA carotidea con posizionamento di patch in PUR.

In this study, 40 patients who underwent surgery for cerebro-vascular insufficiency were considered. Carotid endarterectomy was the procedure of choice in all of the patients; the arteriotomy was always closed using a PUR patch, a new material that, for its chemical and physical characteristics seems to be a good alternative to PTFE. All of the patients underwent surgery under loco-regional anesthesia, allowing a perioperative monitoring of the neurological status through the patient's active collaboration. During the postoperative period, non local or systemic pathology related to the use of the patch has been observed. During the short and half term follow-up, the patients underwent echo-Doppler of the supra-aortic trunks that didn't show either false aneurysms or thrombosis on the patch surface.

[Chemodectomas of the glomus caroticum]. / I chemodectomi del glomo carotideo.

The authors review the nature, biological evolution, diagnosis and treatment of carotid body tumors both on the basis of data reported in the literature and in the light of their own experience with a population of 11 carotid body chemodectomas. All patients (except one) were subjected to total resection of the neoplasm. In one case, surgery was confined to a partial resection. Operative mortality was nil, and complications consisted in one case of Claude-Bernard-Horner syndrome, one lesion of the XII cranial nerve and one lesion of the X cranial nerve. Follow-up of the patients (min. 6 months, max. 10 years) has shown no recurrences or metastases.

[Surgical treatment of caval obstructions]. / Il trattamento chirurgico delle ostruzioni cavali.

The vena cava is the seat of obstructive disorders for which direct reparative surgery may sometimes become necessary. S.C.S. is mainly caused by neoplastic invasions or, in the case of the inferior vena cava, by progression of phlebothrombosis of the lower limbs. Prosthesis or autologous substitution and thrombointimectomy are specifically indicated in the two cases respectively. The two methods are described in detail and exemplified through the authors' personal cases consisting in an inferior caval thrombointimectomy and four superior caval by passes. It is concluded that surgical procedures are effective when the primitive disorder can be dominated and the thrombosis is not excessively extensive.

[Aneurysms of the gluteal artery (description of a clinical case and review of the literature)]. / Gli aneurismi dell'arteria glutea (Descrizione di un caso clinico e revisione della letteratura).

The authors show a case of superior gluteal artery aneurysm they operated successfully. Starting from this case the Authors review the literature about the etiology, the clinical characteristics, the diagnosis and the various methods of treatment of this lesion.

[Subclavian and innominate steal syndrome (our experience with 29 patients)]. / Il furto della succlavia e dell'anonima (nostra esperienza in 29 pazienti).

Subclavian steal syndrome and innominate steal syndrome are well-known reasons of cerebral vascular insufficiency. Today this pathology can be corrected by extra-anatomic by-passes. In our experience in recent years (1980-1986) these by-pass (in our patients carotid-subclavian and subclavian-subclavian by-pass) gave very good outcomes. These are simple and poor-risk operations. Their patent after many years is very good.

[Arterial aneurysms of the upper limbs (our experience and review of the literature)]. / Gli aneurismi delle arterie degli arti superiori (nostra esperienza e revisione della letteratura).

The authors discuss about the very low incidence of the upper extremities aneurysms and about their post-traumatic etiology. They show their experience in 6 cases with a Follow up from 2 to 17 years. All the patients were operated on; in 2 cases the authors performed aneurysmectomy only and in 4 cases an axillo-brachial by-pass. The results are very good in every patient.

[Rare colonic occlusions: volvulus of the splenic flexure]. / Occlusioni coliche rare: il volvolo della flessura splenica.

Authors report a case of perforated splenic flexure volvulus, treated with resection, end colostomy and closure of the distal stump. From the revision of literature it comes out the case reported is the 30th recorded till now, the 6th with ischemic complications, and the only one with perforation. Actual pathogenetic trends and various therapeutic options are reported.

[Evaluation of noise-induced injury: consideration of a group of exposed cement workers]. / La valutazione del danno da rumore: considerazioni su una casistica di esposti addetti alla produzione del cemento.

The study covered 1334 workers employed in 12 cement factories located in southern Italy. They were submitted to audiometric screening consisting of a questionnaire containing questions on past otologic complaints, metabolic diseases, use of ototoxic drugs and past occupational or non-occupational exposure to noise, plus otoscopic examination and full audiometric examination. The results revealed a statistically significant relationship between duration of exposure to noise and elevation in the hearing threshold. The highest noise levels were found in the "crude/baked mills" department; however, the highest frequency of occupational hearing loss was observed in the "mine and crushing installations", maintenance and "hodmen" departments. On the question of assessment of the audiometric tracings for preventive and insurance purposes, attention is drawn to the fact that there is a need for a method that will enable an evaluation for prevention to be transformed into an evaluation for insurance. This method should in any case allow for deduction of the portion of hearing loss regarding presbycusis and socioacusis and take due account of the 3 KHz frequency. The attention of industry and public administration is drawn to the urgent need for prevention programs to protect against noise-induced hearing loss in both occupational and non-occupational settings.

Metabolic syndrome in obese Caucasian children: prevalence using WHO-derived criteria and association with nontraditional cardiovascular risk factors.

OBJECTIVE: Studies on the prevalence of metabolic syndrome (MS) in European obese children using child-based criteria are scanty. Moreover, it is unknown if nontraditional cardiovascular disease (CVD) risk factors are associated with the MS at this early age in these subjects. DESIGN AND SUBJECTS: We studied the prevalence of the MS in 588 Caucasian obese children and adolescents by devising a World Health Organization derived definition and child-specific criteria, whose deviation from normalcy was based on an age, sex, and ethnically comparable control group of 1363 subjects. In a subgroup of 206 obese children, we investigated the association of the MS with nontraditional CVD risk factors. MEASUREMENTS: Fasting blood samples for glucose and lipids measurements were taken in both control and obese children. In addition, the obese children underwent an oral glucose tolerance test. In the subgroup of 206 obese children, albumin excretion rate , plasma uric acid, fibrinogen, plasminogen activator inhibitor type 1(PAI-1), C-reactive protein, interleukin 6 and white blood cells were also measured. RESULTS: The prevalence of MS was 23.3%. A similar prevalence of 23% of MS was recorded in the subgroup of 206 obese children in whom measurements of nontraditional CVD risk factors were available. After adjustment for the degree of obesity, subjects with MS had significantly higher uric acid (6.6+/-0.23 vs 6.1+/-0.12 mg/dl, P<0.0001) and PAI-1 plasma concentrations (231.4+/-25.50 vs 214.3+/-12.96 ng/ml, P<0.05) and a higher frequency of microalbuminuria (37 vs 20%, P<0.05) than those without MS. Microalbuminuria, uric acid and PAI-1 explained 10.6% of the variance of MS. CONCLUSION: Approximately, a quarter of Caucasian obese children have the MS. The association of MS with several nontraditional risk factors for CVD early in life suggests a heightened CVD risk in these individuals.

[Social integration in adulthood in a group of subjects with Turner syndrome]. / Condizioni sociali in età adulta in un gruppo di soggetti affetti da sindrome di Turner.

The aim of the present study was to evaluate social integration in adulthood in a group of 48 subjects with Turner's syndrome. This was done by asking subjects to fill in a multi-choice questionnaire concerning their personal, social and working situation. The mean age (+/- SD) of the group was 24.8 +/- 1 and the reported stature was 142.2 +/- 1.4. The results obtained were compared with those formulated by ISTAT in 1990 for the entire Italian population. As far as regards education it was seen that 100% of subjects had completed primary school, 52% had attended secondary school, 29% had been to high school and 6% had attended university. It was therefore concluded that educational status, at least in this group, was higher than that of the Italian population in general. The cultural level of these subjects meant that most had found appropriate employment and only 6% were unemployed. 90% of the subjects were unmarried and only 5 were married (10%); the majority of those unmarried lived with their parents (83%). This underlines a prolonged dependence on the family nucleus and probable disorders regarding the subjects' own sexual identity and affective capacities. Among the parameters examined no substantial differences were found between subjects with a 45,X karyotype and those with chromosomic mosaicism. In the light of these findings it is apparent that efficacious medical and psychological strategies should be developed to enable a greater realization of interpersonal relations in the familial and social field.