Body composition and bone health in adolescents after Roux-en-Y gastric bypass for severe obesity.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGB) causes changes in body composition and bone metabolism, yet little is known about effects in adolescents. OBJECTIVES: The objective of this study was to report dual-energy X-ray absorptiometry measures and serum bone markers, hypothesizing that bone turnover increases after surgery. METHODS: Inclusion criteria included the following: age 13-18 years and body mass index (BMI) >35 kg/m2 . Seventy-two adolescents (22 boys; mean age 16.5 years; BMI 44.8 kg/m2 ) undergoing RYGB underwent dual-energy X-ray absorptiometry and serum bone marker analyses preoperatively and annually for 2 years. RESULTS: Mean BMI reduction at 2 years was 15.1 kg/m2 . Body composition changes included a reduction in fat mass (51.8% to 39.6%, p < 0.001) and relative increase in lean mass (47.0% to 58.1%, p < 0.001). In contrast to previous studies in adults, adolescent boys lost a greater percentage of their body fat than girls (-17.3% vs. -9.5%, p < 0.001). Individual bone mineral density Z-scores (BMD-Z) at baseline were within or above the normal range. The mean (SD) BMD-Z was 2.02 (1.2) at baseline, decreasing to 0.52 (1.19) at 2 years. Higher concentrations of serum CTX (p < 0.001) and osteocalcin (p < 0.001) were observed in boys throughout the study period. Levels rose in the first year, before decreasing modestly in the second. Levels of serum markers of bone synthesis and resorption were higher in boys, whose skeletal maturity occurs later than girls'. CONCLUSIONS: Differences in body fat and lean mass proportions were observed according to sex following RYGB. Bone turnover increased, and BMD decreased to levels approaching a norm for age. Long-term outcome will determine the clinical relevance.

Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS).

CONTEXT: The prevalence of obesity among adolescents has increased and we lack effective treatments. OBJECTIVE: To determine if gastric bypass is safe and effective for an unselected cohort of adolescents with morbid obesity in specialized health care. DESIGN, SETTING AND PATIENTS: Intervention study for 81 adolescents (13-18 years) with a body mass index (BMI) range 36-69 kg m(-2) undergoing laparoscopic gastric bypass surgery in a university hospital setting in Sweden between April 2006 and May 2009. For weight change comparisons, we identified an adult group undergoing gastric bypass surgery (n=81) and an adolescent group (n=81) receiving conventional care. MAIN OUTCOME MEASUREMENTS: Two-year outcome regarding BMI in all groups, and metabolic risk factors and quality of life in the adolescent surgery group. RESULTS: Two-year follow-up rate was 100% in both surgery groups and 73% in the adolescent comparison group. In adolescents undergoing surgery, BMI was 45.5 ± 6.1 (mean ± s.d.) at baseline and 30.2 (confidence interval 29.1-31.3) after 2 years (P<0.001) corresponding to a 32% weight loss and a 76% loss of excess BMI. The 2-year weight loss was 31% in adult surgery patients, whereas 3% weight gain was seen in conventionally treated adolescents. At baseline, hyperinsulinemia (>20 mU l(-1)) was present in 70% of the adolescent surgery patients, which was reduced to 0% at 1 year and 3% at 2 years. Other cardiovascular risk factors were also improved. Two-thirds of adolescents undergoing surgery had a history of psychopathology. Nevertheless, the treatment was generally well tolerated and, overall, quality of life increased significantly. Adverse events were seen in 33% of patients. CONCLUSIONS: Adolescents with severe obesity demonstrated similar weight loss as adults following gastric bypass surgery yet demonstrating high prevalence of psychopathology at baseline. There were associated benefits for health and quality of life. Surgical and psychological challenges during follow-up require careful attention.

A comparison of different definitions of growth response in short prepubertal children treated with growth hormone.

BACKGROUND: How to define poor growth response in the management of short growth hormone (GH)-treated children is controversial. AIM: Assess various criteria of poor response. SUBJECTS AND METHODS: Short GH-treated prepubertal children [n = 456; height (Ht) SD score (SDS) ≤-2] with idiopathic GH deficiency (IGHD, n = 173), idiopathic short stature (ISS, n = 37), small for gestational age (SGA, n = 54), organic GHD (OGHD, n = 40), Turner syndrome (TS, n = 43), skeletal dysplasia (n = 15), other diseases (n = 46) or syndromes (n = 48) were evaluated in this retrospective multicenter study. Median age at GH start was 6.3 years and Ht SDS -3.2. RESULTS: Median [25-75 percentile] first-year gain in Ht SDS was 0.65 (0.40-0.90) and height velocity (HtV) 8.67 (7.51-9.90) cm/year. Almost 50% of IGHD children fulfilled at least one criterion for poor responders. In 28% of IGHD children, Ht SDS gain was <0.5 and they had lower increases in median IGF-I SDS than those with Ht SDS >0.5. Only IGHD patients with peak stimulated growth hormone level <3 µg/l responded better than those with ISS. A higher proportion of children with TS, skeletal dysplasia or born SGA had Ht SDS gain <0.5. CONCLUSION: Many children respond poorly to GH therapy. Recommendations defining a criterion may help in managing short stature patients.

Elevated serum levels of estradiol, dihydrotestosterone, and inhibin B in adult males born small for gestational age.

CONTEXT: Prenatal growth restriction may affect future fertility in both females and males. Studies have shown that growth-retarded male rats have different sexual behavior and disturbed steroidogenesis. OBJECTIVE: We hypothesized that adult human males born small for gestational age (SGA) have an altered sex hormone profile. DESIGN, SETTING, AND PATIENTS: Twenty-five adult males born SGA with median birth weight -2.2 sd scores (SDS) and birth length -2.4 SDS were studied. Median age was 23.1 yr and final height -0.5 SDS. They were compared with 44 male controls with median age 20.5 yr and final height 0.4 SDS. MAIN OUTCOME MEASURE: The primary outcome before the study started was 17beta-estradiol (E(2)) levels in SGA males. RESULTS: The SGA group showed significantly higher median levels of E(2), 17.9 pg/ml (P < 0.001), and dihydrotestosterone (DHT), 0.543 ng/ml (P < 0.05), compared with controls, 12.6 pg/ml and 0.423 ng/ml, respectively. Testosterone (T) levels did not differ between groups. E(2) to T ratio correlated negatively to birth weight (r = -0.40, P < 0.01) and birth length (r = -0.44, P < 0.001). DHT to T ratio correlated negatively to birth weight (r = -0.51, P < 0.001) and birth length (r = -0.38, P < 0.01). Males born SGA also had significantly higher median levels of inhibin B, 164 pg/ml (P < 0.05), compared with controls, 137 pg/ml. Inhibin B correlated negatively to birth length (r = -0.34, P < 0.01). CONCLUSION: SGA males of normal stature have higher levels of E(2), DHT, and inhibin B than controls, indicating a disturbed steroid synthesis or metabolism. Aromatase activity, calculated as E(2) to T ratio, and 5alpha-reductase activity, calculated as DHT to T ratio, is negatively correlated to size at birth.

Cluster of Hodgkin's lymphoma in residents near a non-operational petroleum refinery.

This report examines the prevalence rate of Hodgkin's disease in an American mid-west town located directly south of a non-operational oil refinery. The refinery has a history of benzene-containing gasoline leaks dating back to the early 1900s. Exposure data were assessed through the Toxic Release Inventory (TRI) data as published by the Environmental Protection Agency (EPA) and supplemented by exposure simulations using variations of residential exposure times and odour levels and the benzene content of the gasoline. Prevalence rates depended on the size of the population in question. The population size varied greatly between sources, with the more conservative and consistent estimates being reported by the local government and United States Census Bureau and the highest population figure being reported by the Agency for Toxic Substances Disease Registry. The prevalence of Hodgkin's disease for the residents within 1 mile from the refinery was found to be elevated for every population figure, ranging from 72.11 cases per 100,000 using the ATSDR's population to 182.34 per 100,000, whereas the prevalence for Hodgkin's disease in all the United States is only 22 cases of Hodgkin's disease per 100,000 people. The prevalence value reported in this report should be given greater weight than what would have been calculated using data from the ATSDR. Because of its significantly increased value compared with the rest of the United States, it provides evidence of benzene's role as a causative agent in the etiology of Hodgkin's disease.

Prenatal cytokine exposure results in obesity and gender-specific programming.

Prenatal events appear to program hormonal homeostasis, contributing to the development of somatic disorders at an adult age. The aim of this study was to examine whether maternal exposure to cytokines or to dexamethasone (Dxm) would be followed by hormonal consequences in the offspring at adult age. Pregnant rats were injected on days 8, 10, and 12 of gestation with either human interleukin-6 (IL-6) or tumor necrosis factor-alpha (TNF-alpha) or with Dxm. Control dams were injected with vehicle. All exposed offspring developed increased body weight (P < 0.05--0.001), apparently due to an increase of 30--40% in adipose tissue weight (P < 0.05--0.01). Corticosterone response to stress was increased in the IL-6 group (P < 0.05-0.01). Dxm-treated male rats exhibited blunted Dexamethasone suppression test results. In male rats, insulin sensitivity was decreased after IL-6 exposure (P < 0.01), whereas basal insulin was elevated in the TNF-alpha group (P < 0.01). In female rats, plasma testosterone levels were higher in all exposed groups compared with controls (P < 0.01--0.001), with the exception of Dxm-exposed offspring. Males in the TNF-alpha group showed decreased locomotor activity (P < 0.05), and females in the IL-6 group showed increased locomotor activity (P < 0.05). These results indicate that prenatal exposure to cytokines or Dxm leads to increased fat depots in both genders. In females, cytokine exposure was followed by a state of hyperandrogenicity. The results suggest that prenatal exposure to cytokines or Dxm can induce gender-specific programming of neuroendocrine regulation with consequences in adult life.

Leptin levels show diurnal variation throughout puberty in healthy children, and follow a gender-specific pattern.

OBJECTIVE: To investigate the levels and diurnal rhythm of serum leptin in healthy children, and to investigate the association between leptin levels and sex steroids. METHODS: Four girls and four boys, all healthy volunteers, were followed longitudinally throughout puberty. Their chronological ages ranged from 8.7 to 19.5 years, and body composition, expressed as weight-for-height standard deviation scores (SDS), ranged between -1.7 and +2.4. Serum leptin, oestradiol and testosterone concentrations were measured by radioimmunoassay at 1000, 1400, 1800, 2200, 0200 and 0600 h. RESULTS: In all girls and boys, both prepubertally and during pubertal development, serum leptin levels increased during the night, with no difference in relative peak amplitude. In boys, the leptin concentrations increased until the initiation of puberty and then declined, whereas in girls, the concentrations increased throughout puberty. The inter-individual variation in mean leptin levels among girls decreased to 11% at the time of menarche. A positive correlation was found for both oestradiol and testosterone versus leptin in girls throughout puberty (r=0.64 and r=0.71 respectively, P<0.001). A negative correlation was found between leptin and testosterone in boys in mid- and late puberty (r=-0.66, P<0.01). No correlation was found between oestradiol and leptin in boys or between testosterone and leptin in pre- and early pubertal boys. CONCLUSION: Serum leptin concentrations show diurnal variation throughout pubertal development in both girls and boys. The changes in leptin levels during puberty follow a gender-specific pattern, probably due to an influence of sex steroids on leptin production.

Red-wine polyphenols and inhibition of platelet aggregation: possible mechanisms, and potential use in health promotion and disease prevention.

An extract from red-wine grape fermentation, ANOX has been developed as a source of red-wine polyphenols, which are thought to inhibit several of the pathogenic pathways that lead to cardiovascular disease. New data indicate that this extract has a significantly greater effect than either red wine or red-wine powder on the inhibition of platelet aggregation in vitro. Based on this data, about 300 - 500 mg of the extract is equivalent to the daily dose of red-wine polyphenols that appears to protect against cardiovascular disease. The possible synergistic effect of red-wine polyphenols with vitamin C, their vasorelaxing activity and their possible role in preventing over-crosslinking of connective tissues (premature ageing) are considered. The extract contains standardized amounts of the whole spectrum of polyphenolic compounds found in red wine and may provide a valuable reference substance in clinical investigations of the physiological actions of plant polyphenols; its potential use in functional nutrition and preventive medicine is also discussed.

Radiographic and spirometric findings in diatomaceous earth workers.

Diatomaceous earth is a noncrystalline form of silica; in processing, calcining leads to formation of cristobalite, a form of crystalline silica. Four hundred ninety-two currently employed diatomaceous earth workers in a large mine and processing facility had chest radiographs performed and interpreted by the International Labour Office (ILO) system. Two hundred sixty-seven subjects underwent spirometry testing. Exposure indices for total dust (largely diatomaceous earth) and cristobalite were reconstructed for each individual based upon personnel records. Analysis demonstrated the following prevalences of radiographic findings: 5% had ILO scores > or = 1/0, and 25% had scores of 0/1 or higher. Regression analyses showed that there was a relationship between both total cristobalite exposure and total dust (largely diatomaceous earth) exposure and the ILO score. Radiographic patterns are not typical of those of classic silicosis. Linear regression analyses for forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio did not demonstrate a relationship between cumulative exposure and lung function. Such analyses were performed using all subjects and stratified by smoking status. There were differences in spirometric data according to radiographic ILO category, but the results were inconsistent and did not permit determining if physiologic changes are associated with radiographic change or if this is due to confounding. Overall, the study suggests that diatomaceous earth pneumoconiosis (radiographically defined) is an entity distinct from silicosis. Recent exposure levels may produce radiographic abnormalities but do not lead to demonstrable physiologic effect. The prevalence of the disorder has diminished markedly in response to modern dust control measures. Ongoing medical surveillance is recommended in workers with potential exposure to significant quantity of material.

Hypogonadism in chronically lead-poisoned men.

PIP: The hypothalamic-pituitary-testicular axis was evaluated in 10 men with occupational lead exposure, 9 of whom had noted a decrease in libido and frequency of intercourse following this exposure. 6 of these men had clinically apparent lead poisoning while 4 were classified as being only lead-exposed. Results of the endocrine evaluation of these patients were compared to those obtained on 9 age and socioeconomically matched control patients. Both lead poisoned and lead-exposed patients had reduced basal serum testosterone levels and normal basal serum testosterone-estradiol-binding globulin capacity, estradiol, LH, FSH, and prolactin levels. Both groups demonstrated an appropriate rise in serum testosterone following hCG stimulation and a normal increment in serum FSH in response to clomiphene citrate and gonadotropin-releasing hormone in comparison to the control group. The lead poisoned patients demonstrated a significantly reduced increment in serum LH after clomiphene citrate and gonadotropin-releasing hormone administration while the lead-exposed patients had normal LH dynamics. Testicular biopsies carried out on the 2 most severely lead-poisoned men showed peritubular fibrosis, oligospermia, and vacuolization of the Sertoli cells. These results suggest that lead poisoning may lead to a pituitary-hypothalamic defect in LH secretion and may also result in direct testicular seminiferous tubular injury.^ieng

Pyogenic vertebral osteomyelitis in heroin addicts.

The diagnosis of pyogenic vertebral osteomyelitis was made in seven narcotic addicts between 1967 and 1972. Vertebrae involved were either cervical or lumbar. Bacteriologic diagnosis was made in each case by percutaneous needle biopsy and aspiration. Staphylococcus aureus was cultured in two patients. Five patients had infections due to Gram-negative bacteria, including Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterobacter. All patients were cured by treatment with antibiotics and immobilization.