Ghrelin and leptin modulate immunity and liver function in overweight children.

BACKGROUND: The rising prevalence of obesity represents a growing worldwide public health problem. Interactions of adipocytokines and low-grade systemic inflammation presently are considered important in the development of obesity, as well as associated chronic disease including bronchial asthma, obesity-related liver disease and type 2 diabetes mellitus. The purpose of the present study was to investigate metabolic, hormonal, immunologic and inflammatory factors in overweight children and to further clarify possible immunomodulatory effects of obesity-related hormones and cytokines. METHODS: Forty-nine prepubertal overweight children and 49 age-matched controls of normal weight without underlying disease were enrolled. Levels of plasma ghrelin and serum leptin, cytokines (interleukin [IL]-4, IL-10, IL-12, 1L-13), C-reactive protein, immunoglobulin, and insulin were measured, and liver function tests were done to better understand their status in the setting of obesity. RESULTS: Overweight subjects had significantly higher measures of adiposity (body mass indexI, % body fat) and had significantly higher serum levels of IgG, IgA and IgE than non-obese children (P = 0.038, 0.0043, 0.0034, respectively); the opposite was true for IgM (P = 0.025). The incidence of presumed non-alcoholic fatty liver disease was 28.6% in overweight children. In overweight children, serum leptin levels were associated with liver function index (aspartate aminotransferase/alanine aminotransferase ratio) and serum insulin levels. Some elevated immunoglobulin levels significantly correlated with plasma ghrelin levels and liver function index. CONCLUSIONS: It is possible that appetite-regulating hormones modulate both humoral immunity and liver function. Further studies with a larger number of subjects are needed to clarify the precise mechanisms of this association.

Extended-stay hospitalization for childhood asthma in Japan.

BACKGROUND: While recent advances in asthma management have enabled adequate control to be frequently achieved in outpatient settings, children whose asthma remains poorly controlled despite outpatient treatment are often referred to extended-stay hospitals. The aim of the present study was to examine trends concerning extended-stay hospitalization and to evaluate the present status of this approach. METHODS: A retrospective study was conducted to assess changes in the number of admissions among 408 children with extended stays at Kamiamakusa General Hospital between 1989 and 2005. Medical and laboratory data of 236 patients admitted since 1994 were obtained from clinical records. RESULTS: The number of children with extended-stay hospitalizations since 2000 declined dramatically compared with the early 1990s, while the percentage of patients with complications of childhood asthma, such as severe atopic dermatitis, school absenteeism, and obesity, have increased significantly in the recent past. Practical benefits of extended-stay hospitalization were demonstrated by significant improvement of exercise performance and measurement of pulmonary function parameters and serum IgE concentrations by time of discharge. In addition to improvement in asthmatic symptoms, maintenance drug requirements and frequency of school absenteeism were reduced. CONCLUSIONS: The medical mission of extended-stay hospitalizations is currently limited due to the availability of improved pharmacotherapy. Some patients, however, with exceptionally severe asthma or psychological problems that interact with their medical condition still fare poorly under outpatient care and could benefit from group care. Further study is needed to identify the components of long-term programs essential to produce change.