The effect of Helicobacter pylori and economic status on growth parameters and leptin, ghrelin, and insulin-like growth factor (IGF)-I concentrations in children.

BACKGROUND: It was suggested that gastric colonization with Helicobacter pylori (H. pylori) was associated with suboptimal nutrition and growth in childhood. Furthermore, several studies indicated a relationship between H. pylori colonization and alterations in the circulating levels of growth-related molecules (GRM). Accordingly, in this study, we investigate the effect of H. pylori infection on GRMs and on the growth of healthy school children, taking into consideration the effect of their economic status (ES) and anthropometric indices of their parents. METHODS: To acquire sociodemographic and anthropometric nutritional parameters and to detect H. pylori-specific serum IgG antibodies and growth-related molecules, we evaluated a total of 473 children attending four different primary and secondary schools in Istanbul. Subsequently, we assessed the effect of H. pylori on growth-related parameters (weight for age SDS, height for age SDS, BMI SDS, TSF, and waist-to-hip ratio) and on GRMs (leptin, ghrelin, and insulin-like growth factor-1 (IGF-1)), controlling for age, gender, family income, household crowding (HC), breastfeeding, maternal and paternal BMI SDS, and midparental height SDS with complex statistical models. RESULTS: Of the 473 children (275 F/198 M, age 6-15 years; mean: 10.3 ± 0.1 years), 161 (34%) were H. pylori-positive. The prevalence of H. pylori was significantly higher in lower economic status (ES) groups, in children living in crowded houses, and in older age groups. Using simple statistical models, we did not find any significant associations between H. pylori infection and the growth parameters. However, in complex models for height for age SDS and for weight for age SDS, there was a significant interaction between H. pylori infection status and ES. Whereas in H. pylori-positive subjects, mid-income family children were both taller and heavier than the low-income group, there was no such an association in H. pylori-negative subjects. Among biochemical parameters, only ghrelin levels were associated with H. pylori infection in all models. Leptin levels were associated with HC in girls, whereas none of the parameters was significantly associated with leptin levels in boys. For IGF-1 levels, for boys, age and maternal BMI, and for girls, age and HC were significantly associated with IGF-1 levels. CONCLUSION: We suggest that H. pylori may impair growth significantly only in susceptible children where unfavorable socioeconomic conditions facilitate its action, probably through mechanisms, at least in part, involving growth-related molecules.

The relation of serum ghrelin, leptin and insulin levels to the growth patterns and feeding characteristics in breast-fed versus formula-fed infants.

The differences in growth patterns in breast-fed (BF) and formula-fed (FF) infants remain poorly understood. The aim of this study was to examine the relation of serum ghrelin and leptin concentrations to the different growth patterns between the formula-fed and breast-fed babies. Feeding behaviors and anthropometric data were noted at the 3rd and 6th months of age. Serum ghrelin and leptin levels in both groups and breast-milk ghrelin and leptin levels in the mothers of the BF group were determined at the 3rd month of age. Body weight, length, TSF (triceps skin fold thickness), postnatal weight gain, and serum ghrelin levels were higher in BF babies than in the FF group. In BF babies, serum ghrelin was correlated to TSF, and serum leptin was correlated to weight, TSF and weight gain at three months of age. As the serum leptin increased, energy intake from supplemental foods decreased in the BF group at the 6th month. Higher serum ghrelin in BF babies might have played a role in their faster growth rate during the first three months of age. On the other hand, lower energy intake from supplemental foods in correlation with higher serum leptin in BF babies may explain why these babies show marked decline in growth rate compared to FF babies after three months of age.

Developmental characteristics of children aged 1-6 years with food refusal.

OBJECTIVE: The aim of this study was to compare the sociodemographic and developmental characteristics of children with food refusal and children with no history of feeding problems. DESIGN: Cross-sectional case-control study. SAMPLE: 30 children aged 1-6 years who were seen in the outpatient clinics for food refusal formed the case group, and 30 healthy children matched for age, sex, and socioeconomic status formed the control group. METHODS: Anthropometric indices and early developmental characteristics of all the children in the study were evaluated and also their developmental levels were determined using the Ankara Developmental Screening Inventory. RESULTS: The mean age of children with food refusal was 42.4+/-17.6 months, and the male/female ratio was 12/18. Children with food refusal had shorter mean breastfeeding durations and lower mean birth weights, body mass index, percentage height for age, and percentage weight for height values than those of the controls. There were no significant differences between the 2 groups in developmental delays. CONCLUSIONS: These results suggest that food refusal may be related to lower birth weight and shorter breastfeeding duration. Further research with larger samples is needed to clarify these relationships and the effects of feeding problems on the growth and development of children.

Nutritional stunting.

Nutritional stunting is a common problem of the pediatric population especially in developing countries. Although it is a resolvable problem, it continues to be an important health issue. Stunting can be diagnosed when a child's height falls more than two standard deviations below the mean height for age. Stunting may be caused by genetic, hormonal, pharmaceutical, psychosocial and nutritional factors. Before doing extensive laboratory tests, nutritional factors must be searched for at the time of diagnosis. If the etiology is nutritional deficiency, meticulous dietary regulation must be done. The results of treatment must be assessed for guiding the nutritional rehabilitation during follow up. Here we review the interaction of wasting and nutritional stunting; the prevalence of nutritional stunting; diet components and growth; the pathophysiology of stunting; periods of accelerated growth; the diagnosis and clinical assessment of nutritional stunting; the anthropometric and laboratory nutritional indices that can be used at the time of diagnosis and for follow-up purposes during rehabilitation and also the management of nutritional stunting.

[Family functioning, personality disorders, and depressive and anxiety symptoms in the mothers of children with food refusal]. / Yeme Reddi Olan Cocuklarin Annelerinde Kisilik Bozukluklari, Depresyon ve Anksiyete Belirtileri ve Aile Islevleri.

OBJECTIVE: A review of the literature reveals that feeding problems during early childhood can be related to maternal psychiatric disorders. We aimed to evaluate the personality disorders, levels of depression and anxiety symptoms in the mothers of children with food refusal in addition to family functioning. METHOD: Thirty children aged between 1 and 6 years admitted to the clinic for food refusal and their mothers were included in the study. The control group consisted of 30 healthy children and their mothers. The Beck Depression Inventory, State-Trait Anxiety Inventory, McMaster Family Assessment Device and Structured Clinical Interview for DSM-III-R Personality Disorders were performed in mothers, and the presence of any personality disorders was evaluated with the SCID-II Interview. RESULTS: The depression and anxiety scores of the mothers of patients were higher than those of the controls. Perceived family functioning by mothers of patients was more problematic than that of the controls. Rates of maternal personality disorders were not significantly different between the two groups. CONCLUSION: Food refusal is not only related to characteristics of the child or his/her mother, but also to problems in family functioning. An integrative approach which evaluates the whole family is helpful to assess and treat children with food refusal.

Fatty liver in obese children: prevalence and correlation with anthropometric measurements and hyperlipidemia.

The aim of this study was to evaluate the correlation of ultrasonography-proven fatty liver with liver functions, serum lipid levels and anthropometric measurements in children with exogenous obesity. Three hundred and twenty-two patients (183 girls, 56.8%) with a mean age of 11.4+/-3.2 years (4-18 years) who presented with the complaint of obesity were enrolled. In 38 (11.8%) patients, increased liver echogenicity resembling fatty liver was found (Group 1). The body mass index percentages of group 1 patients were significantly higher than of those without fatty liver (Group 2) (157.7+/-18.0 vs 151.3+/-17.8, p=0.038). Alanine and aspartate aminotransferase levels of group 1 patients were significantly higher than of group 2 (p=0.002 vs p=0.028, respectively). Triglyceride levels were significantly higher in group 1 patients (120.8+/-88.8 vs 100.5+/-58.5 mg/dl, p=0.044). In conclusion, ultrasonography is an easy and noninvasive method for the diagnosis of fatty liver in children with obesity. Body mass index and serum lipids were higher in group 1 patients. The diagnosis and early treatment of obesity in childhood is important for the prevention and better treatment of related complications. Thus, ultrasonography should be a part of the early evaluation of obese children.

Immunohistochemical evaluation of p53 expression and proliferative activity in children with Helicobacter pylori associated gastritis.

OBJECTIVES: The aim of this study was to evaluate the significance of p53 expression and proliferative activity of glandular epithelium and intestinal metaplasia in Helicobacter pylori associated gastritis of pediatric patients. METHODS: The study included endoscopic gastric biopsies of 54 children with dyspeptic complaints. Immunohistochemistry was performed for evaluation of p53 expression and Ki-67 labeling index, an indicator of proliferative activity. Grading of H. pylori density, intestinal metaplasia and inflammatory cell infiltration were performed in histologic tissue sections stained with hematoxylin-eosin, Giemsa and Alcian-blue. RESULTS: Of 54 children, 35 (64%) were infected by H. pylori. Positive immunostaining for p53 was observed in 11 of 54 cases (20.4%). H. pylori infection was found in 10 (91%) of the p53-positive patients. There was a positive correlation between H. pylori density and Ki-67 labeling index in H. pylori infected children. H. pylori density, Ki-67 labeling index and inflammatory cell infiltration in the p53-positive group were significantly higher than in the p53-negative group. Although intestinal metaplasia was more common in H. pylori infected children (n = 11; 31.4%), there was no difference in the rate of intestinal metaplasia between the p53-positive and p53-negative groups. CONCLUSIONS: The present study shows that p53 mutations and higher proliferative activity of glandular epithelium may be related to H. pylori associated gastritis in children. Because p53 mutation does not appear to be associated with intestinal metaplasia, a precursor for gastric cancer in adults, we think that H.pylori associated p53 alterations do not initiate and promote gastric cancer that may occur in adulthood.

Pyogenic liver abscesses in a child spreading to pulmonary and subcutaneous tissues: case report.

Pyogenic liver abscess is a rare and life-threatening disease in children. Our case is noteworthy because of the rapid advancement of liver abscesses without any other systemic disorder. A 16-year-old girl was admitted to the hospital with fatigue, pallor, weight loss and high fever. In physical examination a fluctuating mass was observed under the scapular area and hepatosplenomegaly was found. In computed tomography, three septated cystic lesions which looked like abscesses were demonstrated in the liver. The abscess was drained through percutaneous route. Right pleural empyema with clinical features of adult respiratory distress syndrome appeared after the first day of treatment. Bacteroides sp. was isolated from pus. On the twentieth day of the therapy, control abdominal computed tomography revealed two new abscesses in the liver. They were drained and the antibiotic therapy was continued with ticarcillin-clavulanate, fluconazole and levofloxacin. By the end of the first week of the therapy, the fever of the patient had abated. This therapy was continued for four weeks; 15 days after the end of the therapy there was prominent healing of the liver lesions with only one necrotic remnant 2 cm in diameter on abdominal computed tomography.

Serum leptin concentrations in children with mild protein-energy malnutrition and catch-up growth.

BACKGROUND: The aim of the present study was to clarify the relationship between changing nutritional anthropometric data and serum leptin concentrations during the catch-up growth process in children. METHODS: Thirty children with mild protein-energy malnutrition (PEM) were followed for 6 months and their anthropometric measurements and serum leptin concentrations were recorded during follow up. RESULTS: Twenty-two (73.3%) of the 30 children showed catch-up growth. All parameters and serum leptin concentrations increased during the period of catch-up growth. In the remaining eight children, weight for height, percentage standard body mass index, percentage standard body height and mean serum leptin concentrations did not show any significant increase at the 6 month follow-up. Mean serum leptin concentration was higher in children with catch-up growth than in the controls. CONCLUSION: During recovery from malnutrition, leptin concentrations increase in relation to fat mass if the fat mass reaches a critical point, and leptin might trigger catch-up growth with its regulator effects on growth. Although weight gain was noted in both groups, an increase in leptin concentration was observed only in children who showed catch-up growth. More interestingly, the mean leptin concentration was much higher in children with PEM who had catch-up growth compared to the control group and in children who failed to have catch-up growth. In children with catch-up growth, the higher serum leptin concentrations compared to healthy children and to children without catch-up growth despite significant weight gain suggests that leptin affects nutritional status in catch-up growth as a dynamic process, rather than merely being an index of body fat content.

Current therapeutic approaches in childhood chronic hepatitis B infection: a multicenter study.

BACKGROUND AND AIM: The aim of the present study was to compare the therapeutic efficacy of three different regimens in childhood chronic hepatitis B (CHB) infection. METHODS: A total of 182 children with CHB infection were prospectively allocated to three random groups. Sixty-two patients in the first group received high-dose interferon (IFN)-alpha 2b (10 MU/m2) thrice/weekly alone for 6 months. In the second (n = 60) and third groups (n = 60), IFN-alpha was used for 6 months (5 MU/m2) thrice/weekly in combination with lamivudine (LAM) (4 mg/kg, maximum 100 mg/day) for 12 months. Lamivudine was started simultaneously with IFN in the second group, while it was started 2 months prior to IFN injections in the third group. RESULTS: The initial mean alanine aminotransferase (ALT) values for the first, second and third groups were 109 +/- 93 IU/L, 101 +/- 64 IU/L and 92 +/- 42 IU/L, respectively (P > 0.05). At the end of the therapy, ALT values decreased to 82 +/- 111 IU/L, 38 +/- 41 IU/L and 29 +/- 16 IU/L in groups 1, 2 and 3, respectively. The mean ALT value of the first group was significantly different to the second and third groups (P = 0.046 and P = 0.002, respectively) at the end of the therapy and these differences were found to be sustained after 18 months. However, results in the second and third groups were similar (P > 0.05). There were no significant differences in HBeAg clearance and anti-HBe seroconversion at the initial stage, 12 months and 18 months between the three groups (P > 0.05). Hepatitis B virus (HBV) DNA clearance in the first group was different from the second and third groups, while the second and third groups had similar HBV DNA clearance ratios at 12 and 18 months. No significant difference was found in the complete response (normalization of ALT, clearance of HBV DNA and seroconversion of anti HBe) ratios of all groups (at 12 months: 28.8, 45.5, 35.8% and at 18 months 33.3, 49 and 34% in groups 1, 2 and 3, respectively, P > 0.05). CONCLUSIONS: Although the ALT normalization and HBV DNA clearance ratios of IFN plus LAM combination groups were better than the high-dose IFN-alpha monotherapy group, no significant difference was found in the complete response ratios of all three groups.

Sarcoidosis with an uncommon presentation: apropos of a case.

A 17-year-old male presenting with chronic renal failure whose supporting clinical manifestations of the disease had appeared independently over a four-year period is reported. The renal biopsy specimen of the patient revealed tubulointerstitial nephritis and membranous glomerulonephritis. He never had hilar adenopathy, but maculopapular rashes, erythema nodosum, arthritis, chronic lymphocytopenia, hepatomegaly, splenomegaly, and lymphadenomegaly had been observed at different periods over four years. The presence of non-caseating granulomatous lesions in the liver biopsy accompanying uveitis verified the diagnosis of sarcoidosis. Low dose steroid was applied to this hepatitis-C carrier, and uveitis was suppressed. No recurrence has been observed in two-year follow-up.

A rare cause of protein-losing enteropathy and growth retardation in infancy: infantile systemic hyalinosis.

Infantile systemic hyalinosis is a rare, progressive, fatal condition with a presumably autosomal recessive mode of inheritance. It is characterized by widespread deposition of hyaline material in many tissues. We present a three-month-old girl with hypoproteinemia, growth retardation, and generalized stiff and edematous skin, who was diagnosed as protein-losing enteropathy. A final diagnosis of systemic hyalinosis was made. In this report, we present a very rare entity of infantile systemic hyalinosis, which is a cause of protein-losing enteropathy and growth retardation in infancy, and review the relevant literature.

Serum leptin concentrations in children with mild-to-moderate protein-energy malnutrition.

BACKGROUND: The aim of the present study was to clarify the relationship between nutritional anthropometric parameters and serum leptin concentrations in otherwise healthy children with mild-to-moderate protein-energy malnutrition (PEM) secondary to inadequate energy intake. METHODS: Eighty-one otherwise healthy children with poor appetite and inadequate energy intake were enrolled in the study. The anthropometric values were evaluated in all subjects. Fasting serum leptin concentrations were assessed. RESULTS: Of the 81 otherwise healthy children, 30 were found to have mild-to-moderate PEM. The control group consisted of 51 healthy children who had normal anthropometric values, even though they had inadequate energy intake. There was a significant difference in serum leptin concentrations between the two groups (P < 0.01). Furthermore, there was a positive correlation between mean serum leptin concentrations and percentage of standard weight for height in the patient and the control group (P < 0.05). Multiple linear regression analysis indicated that percentage of standard BMI was the best predictor for serum leptin concentrations (P < 0.05). CONCLUSION: In addition to BMI, percentage of standard weight for height is a valuable nutritional anthropometric parameter for serum leptin concentrations in PEM and inadequate energy intake. However in the present study, percentage of standard BMI was the best predictor for serum leptin concentrations. Serum leptin concentrations are low not only in severe PEM, but also in children with mild-to-moderate PEM without chronic disease.

Effects of hospital stay on nutritional anthropometric data in Turkish children.

We evaluated the effects of hospital stay on nutritional anthropometric data in children of various age groups and investigated the effects of admission undernutrition on nutritional anthropometric data in children who were hospitalized in our university hospital in Turkey. The adverse effect of hospitalization on nutritional status was shown to be most obvious on the 2-6-year age group with undernourished children. We also found reduced anthropometric parameters in all patients with mild malnutrition at admission (p < 0.05). A significant number of pediatric patients in Turkey are at nutritional risk at the time of hospital admission (31.8 per cent). The well-nourished children do not carry nutritional risk due to hospitalization for other medical reasons. Since undernutrition has an adverse effect on morbidity and mortality, careful nutritional evaluation of children on admission is essential. Special attention should be given to patients who had mild malnutrition on admission since this population of patients seem to be at higher risk of adverse effect of hospitalization.