[Insulin Resistance and Abnormalities in Blood Values of Icelandic Children Receiving Obesity Treatment].

INTRODUCTION: Worldwide, the rates of childhood obesity have risen dramatically in recent decades. Obesity may cause serious sequelae during childhood and throughout adulthood. Insulin resistance is prevalent metabolic abnormality in pediatric obesity. The Pediatric Obesity Clinic was established in 2011 at the Children's Medical Center, Landspítali University Hospital. This study aimed to observe metabolic abnormalities and insulin resistance in blood values of children receiving obesity treatment. METHODS: The study included all children (n = 180) who received obesity treatment at The Pediatric Obesity Clinic between 2016 and 2020 and had at least eight out of the nine following serum values analyzed while fasting: HbA1c, glucose, insulin, ALAT, total cholesterol, HDL-cholesterol, triglycerides, TSH and free T4. HOMA-IR value was calculated from insulin and glucose values. Decreased insulin sensitivity was defined as HOMA-IR > 3.42. RESULTS: 84% of the children had at least one abnormality in their tested blood values. 50% had abnormal insulin values and 44% had abnormal ALAT values. 78% had decreased insulin sensitivity, and their mean HOMA-IR was 7.3 (± 5.0), surpassing twice the normal value. CONCLUSION: A large majority of the children undergoing obesity treatment already exhibited signs of metabolic sequelae during their treatment. The prevalence of affected children has increased compared to a similar study conducted in 2013. Of particular concern is the growing number of children with decreased insulin sensitivity. Proper measures must be taken to combat this alarming trend.

Obesity in adolescents does not influence early immune responses to influenza vaccination.

BACKGROUND: Obesity has been linked to reduced vaccine responses against tetanus, hepatitis B and influenza. Data on the influence of paediatric obesity on influenza vaccine response is still lacking and this study aims to fill the gap. METHODS: A total of 30 children with obesity and 30 children with normal weight, aged 12-18 years, were recruited. Participants were vaccinated with a tetravalent influenza vaccine. Blood was collected prior to the vaccination and again four weeks later. The humoral response was assessed with haemagglutinin inhibition assay. The cellular response was assessed with T-cell stimulation assays measuring TNF-α, IFN-γ, IL-2 and IL-13. RESULTS: Of the 29/30 from the study group and 30/30 from the control group finished both visits. Seroconversion occurred for > 90% of participants in both groups for the A/H1N1, A/H3N2 and B/Victoria strains, but the B/Yamagata strain had lower seroconversion rates (93% in the study group and 80% in the control group). 97-100% of participants from both groups had adequate serological responses following vaccination. Cellular responses were similar between the two groups post-vaccination. CONCLUSIONS: Early humoral and cellular immune responses to influenza vaccinations are similar among adolescents with obesity and normal weight.

[Importance of waist circumference measurements when following children with obesity: Serious abnormalities in blood values of Iceandic children with obesity]. / Mikilvægi mittismáls við eftirlit barna með offitu. Alvarleg frávik í blóðgildum hjá íslenskum börnum með offitu.

INTRODUCTION: Childhood obesity is a growing health problem worldwide. Body mass index (BMI) has been used as the main measurement of obesity for years but its quality for children has been questioned. In 2011 the Health School was formed at the Childrens Medical Center at Landspitali University Hospital for treatment of obese children and their families. The aim of this study was to find the best predictor of blood test abnormalities and to get a clear picture of abnormalities in blood values in the group of obese children referred to the Health School. METHODS: All children referred to the Health School from January 1st 2011 until March 15th 2013 were retrospectively studied (n=181). Information was gathered on height, weight, BMI, waist circumference and available blood variables. RESULTS: Abnormal blood values were found in 54 cases (47%). Of the children where information was available, four (4%) had Non-Alchoholic Fatty Liver Disease (NAFLD) and 28 (28%) had a raised fasting insulin levels whereof 8 (8%) needed treatment. One child had both NAFLD and raised fasting insulin. CONCLUSION: Abnormal blood values are common in obese children. Waist circumference appears to have a better predictive value of these abnormalities than BMI-SDS. Waist circumference could be used to screen for children who need physician supervision because of risk of metabolic disorders. Waist circumference adds important information to the risk assessment of obese children. This study emphasises the importance of care givers measuring waist circumference in obese children.

[Family-based behavioral treatment for obese children - results and two year follow up]. / Fjölskydumidud atferlismedferd fyrir of feit börn.

INTRODUCTION: Childhood obesity has become a worldwide epidemic and Icelandic children have not been exempt from increasing rates of obesity. Epstein´s family-based behavioral treatment for childhood obesity has demonstrated favorable outcomes in research settings, but research in clinical settings has been called for. The objective of this study was to replicate and confirm the effects observed in the US research setting. MATERIAL AND METHODS: Participants were 84 obese children (age-range: 8-13 years) and a participating parent. Sixty-one families completed a 12 week treatment lasting 18 weeks, and were followed for one and two years post-treatment. Measurements at baseline and end of treatment included height and weight, daily activity, daily fruit and vegetable consumption, blood pressure, blood profiles and measures of psychological well-being. Measurements also included parental height, weight and depression scores. RESULTS: Among treatment completers BMI-SDS (body-mass index standard deviation score) decreased significantly from pre- to post- treatment (F(2.60)=110.31, p<0.001) which was maintained at one-year (F(2.60)=1.33, p=0.253) and two-years (F(2.60)= 3,19, p=0.079) post treatment. There was a significant reduction in blood pressure (upper: t(59)=-2.01, p<0.05, lower: t(59)=-4.00, p<0.001). Among a subsample (n=23) of participants, significant reductions were observed in fasting insulin levels, (t(22)=6.1, p<0.05), triglycerides (t(22)=0.31, p<0.05) and total cholesterol (t(22)=0.35, p<0.05). Significant improvements were observed for measures of psychological well-being (depressive symptoms: (F(1.59)=6.67, p<0.05); anxiety: (F(1,57)= 4.54, p%lt;0.05) and children´s self-concept (F(1.59)=19.2, p<0.001). A significant reduction was observed in parental BMI scores from pre- to post- treatment (F(1.59)= 71.54, p%lt;0.001) but a significant increase was evident at one year post-treatment (F(1.59)=41.87, p%lt;0.001). Improvements were observed for measures of parental depression from pre- to post- treatment (F(1.60)= 12.93, p<0.01). CONCLUSION: Epstein´s family-based behavioural treatment showed promising effects on weight status, and emotional as well as physical markers, both in the short and long term in a clinical sample of obese Icelandic children.

The cryptic chromosomal deletion del(11)(p12p13) as a new activation mechanism of LMO2 in pediatric T-cell acute lymphoblastic leukemia.

To identify new cytogenetic abnormalities associated with leukemogenesis or disease outcome, T-cell acute lymphoblastic leukemia (T-ALL) patient samples were analyzed by means of the array-comparative genome hybridization technique (array-CGH). Here, we report the identification of a new recurrent and cryptic deletion on chromosome 11 (del(11)(p12p13)) in about 4% (6/138) of pediatric T-ALL patients. Detailed molecular-cytogenetic analysis revealed that this deletion activates the LMO2 oncogene in 4 of 6 del(11)(p12p13)-positive T-ALL patients, in the same manner as in patients with an LMO2 translocation (9/138). The LMO2 activation mechanism of this deletion is loss of a negative regulatory region upstream of LMO2, causing activation of the proximal LMO2 promoter. LMO2 rearrangements, including this del(11)(p12p13) and t(11;14) (p13;q11) or t(7;11)(q35;p13), were found in the absence of other recurrent cytogenetic abnormalities involving HOX11L2, HOX11, CALM-AF10, TAL1, MLL, or MYC. LMO2 abnormalities represent about 9% (13/138) of pediatric T-ALL cases and are more frequent in pediatric T-ALL than appreciated until now.