Subclinical cardiovascular system changes in obese patients with juvenile idiopathic arthritis.

OBJECTIVE: We aimed to determine the prevalence of excess body mass in juvenile idiopathic arthritis (JIA) children and to investigate the influence of obesity into the early, subclinical changes in cardiovascular system in these patients. METHODS: Fifty-eight JIA patients, aged median 13 years, were compared to 36 healthy controls. Traditional cardiovascular risk factors and inflammatory markers (hsCRP, IL-6, TNF α, adiponectin) were studied together with IMT (intima-media thickness), FMD (flow mediated dilation), and LVMi (left ventricle mass index) as surrogate markers of subclinical atherosclerosis. RESULTS: Thirteen JIA children (22%) were obese and had increased systolic blood pressure, cholesterol, triglycerides, insulin, HOMA, hsCRP, and IL-6 compared to nonobese JIA and controls. FMD was decreased compared to nonobese JIA and controls, whereas IMT and LVMi were increased. In multivariate regression analysis, TNF α, SDS-BMI, and systolic blood pressure were independent predictors of early CV changes in JIA. CONCLUSIONS: Coincident obesity is common in JIA children and is associated with insulin resistance, dyslipidemia, and increased levels of inflammatory markers leading to early changes in cardiovascular system. Thus, medical care of children with JIA should include strategies preventing cardiovascular disease by maintenance of adequate body weight.

Cardiac function in survivors of acute lymphoblastic leukaemia and Hodgkin's lymphoma.

AIM: The study objective was to assess plasma N-terminal-pro-brain natriuretic peptide (BNP) levels and to evaluate left ventricular mass as well as left ventricular systolic and diastolic functions in 44 children who had undergone treatment for acute lymphoblastic leukaemia and Hodgkin's lymphoma, with regard to gender, age at disease onset, time that had passed since therapy completion, cumulative dose of antracyclines and mediastinal radiotherapy applied. METHODS: The median levels of pro-BNP were found to be higher in the whole study group as compared with the control (55.9 ± 53.1 ng/mL vs. 38.5 ± 47.7 ng/mL, P= 0.059). The pro-BNP values >80.0 ng/mL (standard deviation score (SDS)) were noted in 11/44 patients, including those exceeding 115.0 ng/mL (2 SDS) - in 6/44 patients. RESULTS: No correlation was observed of pro-BNP levels with the accumulated dose of antracyclines (r=-0.42, P= 0.79) or mediastinal radiotherapy (r= 0.197, P= 0.2). However, negative correlation was found between pro-BNP and the time that had passed since therapy completion (r=-0.378, P= 0.009). In echocardiography, shortening and ejection fractions remained normal, whereas the indexed stroke volume was below 40 mL/m(2) in 16/44 patients. The E/A index below 1.5 was found in 6/44 cases. The left ventricular systolic mass remained within the normal range. Negative correlation was noted between isovolumetric diastolic time and pro-BNP level. CONCLUSIONS: Increased levels of pro-BNP after anti-cancer treatment with the involvement of cardiotoxic substances may indicate the first symptoms of myocardial dysfunction, despite the lack of major echocardiographic disorders.

Endothelin-1 plasma concentration in children and adolescents with atherogenic risk factors.

BACKGROUND: Endothelial injury is the main stimulus for endothelin-1 (ET-1) secretion - a strong vasoconstricting agent. The role of endothelial dysfunction in the pathogenesis of hypertension and atherosclerosis which already develops in childhood, has been recently underlined. AIM: To asses plasma ET-1 concentration in children and adolescents with such atherogenic risk factors as hypertension, obesity or diabetes. METHODS: The study group consisted of 105 children and adolescents in the mean age of 15.3+/-2.4 years who were divided into 5 groups: (1) hypertension, (2) obesity and hypertension, (3) obesity, (4) diabetes and (5) diabetes with hypertension. The control group was composed of 32 healthy subjects of appropriate weight, aged 14.7+/-2.9 years. Plasma concentration of ET-1 was measured using the enzymatic method ELISA (R and D Systems). RESULTS: ET-1 plasma concentration was significantly higher in the whole study group than in controls (0.71 vs 0.40 pg/mL; p<0.05) as well as in each studied subgroup compared with healthy subjects (0.63 pg/mL, p<0.05; 0.88 pg/mL p<0.05; 0.96 pg/mL, p<0.05, 0.60 pg/mL, p<0.05, and 0.63, p<0.05, respectively). There was a significant correlation between ET-1 concentration and body mass index in the whole study group (p=0.001) as well as cholesterol (p=0.018) and triglyceride (p=0.001) levels. In the group of patients with hypertension, ET-1 correlated with body mass index (p=0.023) and systolic blood pressure (p=0.02). CONCLUSIONS: Children and adolescents with hypertension, obesity or diabetes have higher ET-1 plasma concentration than healthy subjects. ET-1 level correlates with body mass index, lipid parameters and systolic blood pressure.

Relationship between circulating endothelial progenitor cells and endothelial dysfunction in children with type 1 diabetes: a novel paradigm of early atherosclerosis in high-risk young patients.

OBJECTIVE: The low number of circulating endothelial progenitor cells (EPCs) has emerged as a biomarker of cardiovascular (CV) risk in adults. Data regarding EPCs in paediatric populations with CV risk factors are limited. The aim of the study was to estimate the EPC number and its relationship with vascular function and structure in children with type 1 diabetes mellitus (T1DM). DESIGN AND METHODS: We performed a comparative analysis of 52 children with T1DM (mean age 14.5 years; diabetes duration, 6.0 years; HbA1c level, 8.5%) and 36 healthy age- and gender-matched control children. EPCs were identified and analysed by flow cytometry with the use of MABs directed against CD34, CD144 (VE-cadherin) and CD309 (VEGFR-2). sICAM-1, hsCRP, thrombomodulin and adiponectin levels were also assessed. We evaluated vascular function (flow-mediated dilation (FMD)) and structure (carotid intima-media thickness (IMT)) ultrasonographically. RESULTS: Frequencies of CD34+ cells were similar in both groups (P=0.30). In contrast, frequencies of CD34+VE-cadherin+ cells were significantly higher in diabetic children compared with the healthy group (P=0.003). Similarly, diabetic patients tended to present with higher frequencies of CD34+VEGFR+ cells (P=0.06). FMD was lower (6.9 vs 10.5%, P=0.002) and IMT was higher (0.50 vs 0.44 mm, P=0.0006) in diabetic children. We demonstrated a significant relationship between CD34+VEGFR-2+ cells and BMI (r=0.3, P=0.014), HDL (r=-0.27, P=0.04), sICAM-1 (r=0.47, P=0.023) and FMD (r=-0.45, P<0.001). Similarly, frequencies of CD34+VE-cadherin+ cells were significantly correlated with BMI (r=0.32, P=0.02) and FMD (r=-0.31, P=0.03). CONCLUSIONS: We demonstrated here that increased frequencies of EPCs observed in diabetic children are negatively correlated with endothelial function. Further studies are warranted to assess whether this phenomenon might result from effective mobilisation of EPCs in order to repair damaged endothelium in children at increased risk for atherosclerosis.

[Urolithiasis risk factors in obese and overweight children]. / Czynniki ryzyka tworzenia kamieni nerkowych u dzieci z otyloscia i nadwaga

INTRODUCTION: Childhood obesity is becoming a worldwide epidemic and its metabolic and cardiovascular complications may already be evident at a young age. Several epidemiologic studies in adults have clearly demonstrated that obesity and overweight increase the risk of kidney disease and urolithiasis. AIM OF THE STUDY: The purpose of this study was to evaluate the relationship between overweight and obesity and urolithiasis risk factors in children. MATERIALS AND METHODS: The main kidney stones risk factors in urine such as calcium concentration, oxalate concentration, citrate concentration, pH of urine as well as BRI (Bonn Risk Index) were analyzed in 249 overweight and obese children (study group) and in 281 children with normal weight (control) at the age of 3 to 18 years old. RESULTS: In the study group the mean oxalate concentration was significantly higher than in the control (0.52±0.48 vs. 0.26±0.12; p <0.05). The mean calcium concentration of overweight/obese patients was higher than that of normal body weight and the difference was close to statistically significant (3.23±2.55 vs 2.58±1.59; p=0.0537). The mean urine pH in the study group was 6.28±0.46 and was significantly lower (p <0.05) than the mean urine pH in the control, witch was 6.40±0.47. The mean citrate concentration among overweight/obese patients was significantly lower than in control (431,2±309,5 vs. 637,2±310,7; p <0.05). CONCLUSIONS: Our results suggest that obesity or overweight at a young age are associated with an increased risk of kidney stones. Weight loss might be explored as a potential treatment to prevent kidney stone formation.