Insulin resistance surrogates and left ventricular hypertrophy in normotensive obese children.

BACKGROUND: The relationship between different surrogates of insulin resistance and left ventricular geometry in obese children is still unclear. OBJECTIVE: We sought to explore the relationship between commonly used measures of insulin sensitivity/resistance (homeostatic model assessment index, serum uric acid, and triglycerides to high-density lipoprotein cholesterol ratio) and left ventricular geometry in normotensive obese children. METHODS: In this cross-sectional study, 32 normotensive obese children were examined. Transthoracic echocardiography was used to measure left ventricular mass index and relative wall thickness. Homeostasis model assessment index, serum uric acid level, and a ratio of triglycerides to high-density lipoprotein cholesterol were used as markers of the insulin resistance. Simple and partial correlation analyses (to control for the effects of body mass index) were conducted to explore relationship between studied variables and left ventricular mass index or relative wall thickness as outcome variables. RESULTS: We found positive correlations between homeostasis model assessment index and relative wall thickness (r = 0.47, p = 0.03) which remained significant after controlling for the effect of body mass index, z-score (r = 0.48, p = 0.03). The cutoff level of homeostasis model assessment index with the optimum sensitivity (Sn) and specificity (Sp) derived from the receiver operating characteristic (ROC) curves for predicting concentric remodelling was ≥5.51 with Sn = 83.33 and Sp = 68.75. CONCLUSION: There is a positive relationship between homeostasis model assessment index and relative wall thickness of obese normotensive children which may help to distinguish at risk obese normotensive children for the development of concentric left ventricular remodelling.

The relationship between currently recommended ambulatory systolic blood pressure measures and left ventricular mass index in pediatric hypertension.

This study aims to explore the relationship between currently recommended ambulatory blood pressure (ABP) measures used to classify pediatric hypertension and left ventricular mass index (LVMI) in children with true ambulatory hypertension. We performed a cross-sectional survey among 94 children who were consecutively referred for suspected hypertension. The calculated ABP measures were average 24-h systolic blood pressure (24-h aSBP) and 24-h SBP load. The LVMI was estimated by M-mode echocardiography using Devereux's formula and indexed by height(2,7). A total of 35 children fulfilled the criteria for true ambulatory hypertension (elevated office blood pressure, 24-h SBP load >25 %, and 24-h aSBP >95th percentile). Compared with children not fulfilling these criteria, those with true ambulatory hypertension had significantly higher values of 24-h aSBP, 24-h SBP load, and LVMI, as well as body mass index (BMI; P < 0.0001). In a separate analysis of both groups, none of the examined ABP measures adjusted for age, sex, and BMI correlated with LVMI. In those with true hypertension, only BMI was significantly associated with increased LVMI (F = 9.651; P = 0.004; adjusted R (2) = 0.203). The results of our study suggest that pediatric hypertension, as determined by currently recommended ABP (SBP) measures, is not associated with subclinical end-organ damage as defined by the increased left ventricular mass. Therefore, additional factors associated with BMI increase must be considered as risk factors for the development of end-organ damage in hypertensive children.

Awareness and knowledge of heterozygous familial hypercholesterolemia among Serbian pediatricians.

Objective: Published reports describing awareness and knowledge of familial hypercholesterolemia (FH) among pediatricians are few and differ considerably across countries. We aimed to assess awareness and knowledge of the FH among pediatricians in Serbia. Methods: A web-based cross-sectional study using a self-designed questionnaire was conducted during the annual congress of the Serbian Association of Preventive Pediatrics in 2020. Results: A total of 141 pediatricians completed the questionnaire (response rate 16.1%). Overall, 91% of participants have knowledge about genetic inheritance of FH, 84.3% were aware of long-term health risks of FH, 77% were familiar with normal cholesterol values in children and 71% knew the FH prevalence in the general population. On the other hand, only 36.8% declared that they were familiar with international guidelines for FH drug treatment and only 26.2% declared to have patients with FH. Conclusion: There is a substantial lack of practical clinical knowledge among Serbian pediatricians on managing children with FH. In addition, an extremely low questionnaire response rate (16.1%) suggests that most pediatricians are not aware of the clinical importance of FH in childhood.

The Association Between Level of Physical Activity and Body Mass Index, and Quality of Life Among Elderly Women.

The process of aging leads to changes in functional abilities, fitness levels, level of physical activity, and body mass index (BMI), all of which causes changes in the quality of life. The current study aims to determine the association between the level of physical activity (PA) and BMI, and quality of life (QoL) among elderly women. The total sample numbered 156 women, with an average age of 67.7 ± 5.6 years. To determine the level of physical activity, the self-reported International Physical Activity Questionnaire Long Form (IPAQ-LF), was used. To calculate the values of the BMI, the standard procedure recommended by the World Health Organization was used. Quality of life was evaluated using the short form of the WHOQOL-BREF questionnaire designed by the World Health Organization. All the data were processed using the statistical package for data analysis SPSS 20.0. Pearson's correlation analysis shows statistically significant relations at the level of p < 0.01 between PA and Physical health in Housework = 0.36, Leisure time PA = 0.27, Walking = 0.24, Moderate PA 0.43, Total PA = 0.43, while the correlations between the variables at the significance level of p < 0.05 were determined in PA in transportation = 0.19 and High-intensity PA = 0.16. Multiple linear regression analysis of different levels of PA as independent variables on individual domains of QoL shows that there is an association of PA and Physical health (Sig = 0.000), more precisely, Total PA is statistically the most closely related to Physical health (Sig = 0.000), and then follows PA at work and Social relations (Sig = 0.036). Similar results were obtained when BMI is added to model A. In contrast to model A, model B shows a statistically significant association between PA and BMI with the environmental domain of QoL (Sig = 0.001). The results of the current study indicate that high- and moderate-intensity physical activity both have benefits for physical health, whereas moderate PA showed higher significance levels. Results also show that elderly women with higher BMI values achieve better results in the environmental domain of QoL.

Heart rate variability in children with exercise-induced idiopathic ventricular arrhythmias.

Ventricular arrhythmias (VAs) are common pediatric rhythm disorders requiring comprehensive laboratory evaluation. Although usually idiopathic, implying a benign character and favorable prognosis, the initial clinical approach is still not established in all cases. Considering their prognostic significance, exercise-induced (precipitated or aggravated) VAs usually require additional diagnostics, treatment, and follow-up. A number of reports have presented experimental and clinical evidence that increased sympathetic activity can initiate, or at least facilitate, VAs. Recent data highlight the relationship between exercise-induced idiopathic VAs (IVAs) and the long-term risk of cardiovascular death. The aim of this study was to assess the utility of heart rate variability (HRV) analysis as a noninvasive method for estimating autonomic nervous activity in children with exercise induced IVAs. The study included 42 children with IVAs, who were divided into two groups: children with exercise induced (precipitated or aggravated) IVAs and children with exercised-suppressed IVAs. Time-domain HRV parameters were analyzed from 24-h ambulatory electrocardiography recordings, and the majority of children underwent an exercise stress test using the McMaster protocol. The results of this study showed no significant changes in parasympathetic index, i.e., the square root of the mean of the sum of the squares of the differences between adjacent NN intervals (the length between two successive heartbeats) between the groups examined. On the other hand, we observed diminished time-domain values for the standard deviation of all adjacent NN intervals, as well as diminished time-domain values for standard deviation of the averages of NN intervals in all 5-min segments in the group of children with exercise-induced IVAs, implicating increased sympathetic activity in such individuals. HRV analysis could be a helpful diagnostic method, giving useful information regarding cardiac autonomic control in some children with exercise-induced IVAs.

Arginase activity in human milk during the first month of lactation.

Arginase (L-arginine amidinohydrolase, EC 3.5.3.1) is the key enzyme in urea synthesis, hydrolyzing L-arginine into L-ornithine and urea. Arginase modulates levels of nitric oxide, creatine, and creatinine, likely by regulating intracellular L-arginine availability. The objective of the present study was to determine the arginase activity and concentration of urea and creatinine in colostrum and mature human milk obtained from nursing mothers. Our longitudinal biochemical analyses show that arginase activities and urea concentrations were the highest at the first day of lactation (colostrum). The decreasing enzyme activity and urea start at the second day, remaining at this level until the end of the first month of lactation (30th day). The concentration of creatinine in human colostrum and mature milk did not significantly change. The alteration of arginase activity between colostrum and mature milk may be a consequence of the transfer of arginase from the blood of the breast mother mammary glands into the colostrum and mature milk. The concentration of nutrients in colostrum and mature milk undergo alterations, probably to satisfy the requirements of the nursing infant for arginine, essential amino acids for human body growth, and normal physiology.

Polyamine oxidase activity in peripheral blood of newborn infants with neonatal hyperbilirubinemia: is bilirubin an antioxidant?

BACKGROUND: Neonatal hyperbilirubinemia can be physiological and pathological and most frequently is a consequence of faster erythrocytes (RBC) hemolysis. Free unconjugated bilirubin is a highly toxic compound, especially for the central nervous system. The most abundant polyamines circulating in blood are spermidine (Spd) and spermine (Sp), which are mainly localized in RBC, where they control membrane permeability. Polyamine oxidase (PAO) exerts an important activity in the plasma and erythrocytes of newborn infants with hyperbilirubinemia, catalyzing the oxidative deamination of Sp and Spd, producing potentially toxic agents that induce apoptosis of mammalian cells. The present study investigated polyamine metabolism by measuring PAO activity in the blood of newborn infants with hyperbilirubinemia and explored the possible antioxidant function of bilirubin through monitoring malondialdehyde (MDA) levels. METHODS: The study included 43 newborns, 10 in the control and 33 in the diseased group. Blood PAO activity and bilirubin and MDA levels were measured using spectrophotometric methods. RESULTS/DISCUSSION: Our results indicate that bilirubin, at physiologic concentrations, protects neonatal erythrocytes against oxidative stress. The positive correlation between PAO activity and MDA levels with high bilirubin concentrations (> 200 micromol/L) in newborn infants indicates that in pathological conditions, bilirubin cannot exert its antioxidant function. CONCLUSION: Investigating the function of polyamines in erythrocytes and the importance of PAO related to hemolysis and bilirubin synthesis is necessary to shed light on the functions of PAO and its metabolites on the permeability of the erythrocyte membrane.

The effects of the aerobic endurance running program on the morphological characteristics of adolescent girls with different nutritional status / Efectos del programa de carrera de resistencia aeróbica en las características morfológicas de las adolescentes con diferentes estados nutricionales

SUMMARY: This study aimed to explore the effects of a single moderate-intensity aerobic endurance running program on the morphological characteristics of normal-weighted and overweighted female adolescents and whether effects differ between individuals of different nutritional statuses. A total of 47 adolescent girls participated in this randomized controlled trial. Before and after 12 weeks of intervention, measurements were obtained for body height, body mass, BMI, triceps, subscapular, abdominal, thigh, and calf skinfolds, and chest, abdominal, thigh, and calf circumference. The total duration of the program was 12 weeks, with a frequency of 2 hours/week (24 sessions). The individual session lasted 60 minutes, and the intensity ranged from 60 % HRmax to 80 %. The findings from the present study suggest that the 12-week aerobic endurance running program induced changes in morphological characteristics of female adolescents. The significant reductions in body mass and BMI were small for normal-weight adolescents (-2,64 % and -3,48 %) and moderate for overweight adolescents (-4,14 % and -4,36 %) following the experimental program. The magnitude of reductions in the skinfold thickness was small for both groups (triceps, subscapular, abdominal, and calf) and moderate for thigh skinfold and a sum of skinfolds in the overweight group. The reductions in the magnitude of all circular measures were small for both groups. It ranged from - 1.59 % to -2.59 % for normal-weight and from -2.54 % to -3.92 % for overweight adolescents, respectively. Additionally, the effects of the applied program seem more favorable to overweight than normal-weight adolescents. This study's current findings indicate that the 12-week aerobic endurance running program is effective due to improvements in morphological characteristics, body mass, and BMI of female adolescents. Additionally, this study's findings show that applied aerobic endurance running program proved more effective for overweight adolescents.

RESUMEN: Este estudio tuvo como objetivo explorar los efectos de un programa único de carrera de resistencia aeróbica de intensidad moderada sobre las características morfológicas de mujeres adolescentes con peso normal y con sobrepeso y si los efectos difieren entre individuos con diferentes estados nutricionales. Un total de 47 niñas adolescentes participaron en este ensayo controlado aleatorio. Antes y después de 12 semanas de intervención, se obtuvieron mediciones de altura corporal, masa corporal, IMC, tríceps, pliegues cutáneos subescapular, abdominal, muslo y pantorrilla, y circunferencia torácica, abdominal, muslo y pantorrilla. La duración total del programa fue de12 semanas, con una frecuencia de 2 horas/semana (24 sesiones). La sesión individual tuvo una duración de 60 minutos y la intensidad osciló entre el 60 % y el 80 % de la FCmáx. Los hallazgos del presente estudio sugieren que el programa de carrera de resistencia aeróbica de 12 semanas indujo cambios en las características morfológicas de las adolescentes. Las reducciones significativas en la masa corporal y el IMC fueron menores para los adolescentes con peso normal (-2,64 % y -3,48 %) y moderadas para los adolescentes con sobrepeso (-4,14 % y -4,36 %) después del programa experimental. La magnitud de las reducciones en el grosor del pliegue cutáneo fue pequeña para ambos grupos (tríceps, subescapular, abdominal y pantorrilla) y moderada para el pliegue cutáneo del muslo y la suma de los pliegues cutáneos en el grupo con sobrepeso. Las reducciones en la magnitud de todas las medidas circulares fueron pequeñas para ambos grupos. Osciló entre -1,59 % y -2,59 % para normopeso y entre -2,54 % y -3,92 % para adolescentes con sobrepeso, respectivamente. Además, los efectos del programa aplicado parecen más favorables para los adolescentes con sobrepeso que para aquellos de peso normal. Los hallazgos actuales de este estudio indican que el programa de carreras de resistencia aeróbica de 12 semanas es eficaz, debido a las mejoras en las características morfológicas, la masa corporal y el IMC de las adolescentes. Además, los hallazgos de este estudio muestran que el programa de carrera de resistencia aeróbica aplicada demostró ser más efectivo para los adolescentes con sobrepeso.

Heart rate recovery time in metabolically healthy and metabolically unhealthy obese children.

BACKGROUND: Autonomic dysfunction is an emerging non-traditional cardiovascular risk factor that correlates with obesity, components of metabolic syndrome, as well as cardiorespiratory fitness. As a simple and validated index of autonomic balance, heart rate recovery (HRR) has been reported as a useful biomarker for predicting cardiovascular morbidity and mortality. OBJECTIVES: The aim of this study was to compare HRR in metabolically healthy vs. metabolically unhealthy obese children. METHODS: A total of 56 obese children of whom 31 had metabolic syndrome were examined. All the participants underwent the multistage submaximal cycle ergometer test and HRR was determined one minute after the test. RESULTS: The HRR was significantly lower (18.9 ± 3.7) in a group of metabolically unhealthy obese children compared to metabolically healthy obese children (24 ± 4.1) p < 0.001. Logistic regression analysis showed that reduction in HRR was also influenced by higher BMI. CONCLUSION: Our findings implicate the presence of the autonomic dysfunction as reflected by impaired heart rate recovery (HRR) in obese children with metabolic syndrome.

The Association of Prenatal Tocolysis and Breastfeeding Duration.

BACKGROUND: To date there are no clinical studies analyzing potential effects of tocolytics on breastfeeding duration in humans. OBJECTIVES: The purpose of this study was to evaluate the association between beta 2 agonists prescribed for tocolysis during pregnancy and breastfeeding duration. METHODS: We conducted a cross-sectional questionnaire study of 114 mothers and filled in the questionnaire developed to directly address the goals of the study. RESULTS: There was a statistically significant difference between breastfeeding duration of mothers who were on tocolytics during pregnancy versus those who were not prescribed tocolytics (9.5 ± 5.7 months versus 4.5 ± 2.1 months) p < 0.001. In addition, hypogalactia was statistically significantly more prevalent in mothers with positive history versus mothers with negative history of tocolytic usage p < 0.001. CONCLUSION: The results of our study indicate that tocolytic treatment in pregnancy is associated with shorter breastfeeding duration and hypogalactia.

Impact of folic acid supplementation on single- and double-stranded RNA degradation in human colostrum and mature milk.

Sufficient intake of folic acid is necessary for normal embryogenesis, fetal, and neonatal development. Folic acid facilitates nucleic acid internalization, and protects cellular DNA from nuclease degradation. Human milk contains enzymes, antimicrobial proteins, and antibodies, along with macrophages, that protect against infections and allergies. However, little to no information is available on the effects of folic acid supplementation on degradation of nucleic acids in human milk. In the present study, we aimed to determine the RNase activity (free and inhibitor-bound) in colostrum and mature milk, following folic acid supplementation. The study design included a total of 59 women, 27 of whom received 400 µg of folic acid daily periconceptionally and after. Folic acid supplementation increased the free RNase and polyadenylase activity following lactation. However, the increased RNase activity was not due to de novo enzyme synthesis, as the inhibitor-bound (latent) RNase activity was significantly lower and disappeared after one month. Folic acid reduced RNase activity by using double-stranded RNA as substrate. Data suggests that folic acid supplementation may improve viral RNAs degradation and mRNA degradation, but not dsRNA degradation, preserving in this way the antiviral defense.

Artificial neural networks based prediction of cerebral palsy in infants with central coordination disturbance.

BACKGROUND: In a previous study we demonstrated that heart variability parameters (HRV) could be helpful clinically as well as a prognostic tool in infants with central coordination disturbance (CCD). In recent years, outcome predictions using artificial neural networks (ANN) have been developed in many areas of health care research, but there are no published studies considered ANN models for prediction of cerebral palsy (CP) development. OBJECTIVE: To compare the results of an ANN analysis with results of regression analysis, using the same data set and the same clinical and HRV parameters. METHODS: The study included 35 infants with CCD and 37 healthy age and sex-matched controls. Time-domain HRV indices were analyzed from 24h electrocardiography recordings. Clinical parameters and selected time domain HRV parameters are used to predict CP by logistic regression, and then an ANN analysis was applied to the same data set. Input variables were age, gender, postural responses, heart rate parameters (minimum, maximum and average), and time domain parameters of HRV (SDNN, SDANN and RMSSD). For each of one the pairs of ANN and clinical predictors, the area under the receiver operating characteristic (ROC) curves with test accuracy parameters were calculated and compared. RESULTS: In the observed dataset, ANN model overall correctly classified all infants, compared with 86.11% correct classification for the logistic regression model, and compared with 67.65% and 77.14% for SDANN and SDNN respectively. CONCLUSIONS: ANN model, based on clinical and HRV data can predict development of CP in patients with CCD with accuracy greater than 90%. Our results strongly indicate that a well-validated ANN may have a role in the clinical prediction of CP in infants with CCD.

Polyamine Oxidase and Diamine Oxidase Activities in Human Milk during the First Month of Lactation.

OBJECTIVE: Human milk (HM) is the ideal food for all newborns and infants. Apart from various bioactive compounds, including cytokines, antibodies, hormones, vitamines, it also contains polyamines, such as spermine (Sp), spermidine (Spd) and putrescine (Put). AIM: The present study investigated polyamine metabolism in colostrum and mature human milk by measuring the polyamine oxidase (PAO) and diamine oxidase (DAO) enzyme activities, which are necessary for polyamine catabolism, as well as by determining the malondialdehyde (MDA) levels, the final product of polyamine biodegradation. METHODS: The PAO, DAO activity and MDA levels were quantified in colostrum (1st and 2nd day) as well as in mature human milk, 30th day of lactation. FINDINGS: We found the steady increase of PAO activity and steady decrease of DAO activity and MDA levels during first month of lactation. CONCLUSION: Since the products of PAO activity such as, amino aldehydes and hydrogen peroxide (H(2)O(2)) might have potential antimicrobial effects, promoting the oxidative stress, it is likely that human milk PAO throughout the lactation period, contributes to the protective effects of human milk.

Alkaline phosphatase activity in human colostrum as a valuable predictive biomarker for lactational mastitis in nursing mothers.

AIMS: Biochemical investigations have shown that an indigenous milk enzyme - alkaline phosphatase (ALP) - which is detectable in the lactocytes, plays a very important diagnostic role in clinical medicine, since its activity varies in different tissues and serves as a specific indicator of disease states. The purpose of this study was to evaluate ALP activity in human colostrum as a possible early predictive biomarker for lactational mastitis in nursing mothers. PATIENTS & METHODS: During a period from May to July 2010, a total of 60 healthy nursing mothers were recruited for this study. RESULTS: The mean level of colostrum ALP activity from the affected breasts was significantly higher when compared with ALP activity from the contralateral asymptomatic as well as 'healthy' breasts (p < 0.01). CONCLUSION: Determining ALP activity in colostrum could be a valuable biochemical marker for an early prediction of mastitis in nursing mothers.

Heart rate variability in infants with central coordination disturbance.

Despite a remarkable medical progress in the field of Developmental Medicine and Child Neurology, early identification of infants at risk for permanent motor disabilities still presents challenge for both clinicians and researchers. As an indicator of cardiac autonomic control, it was shown that heart rate variability (HRV) might reflect not only sympathetic or parasympathetic activity but also functional integrity of the central nervous system (CNS). Furthermore a pattern of HRV was demonstrated to correlate with motor developmental outcome in high risk infants. The purpose of this study was to analyze the clinical usefulness as well as predictive value of time-domain HRV parameters in infants with central coordination disturbance. The study included 35 infants with central coordination disturbance and 37 healthy age and sex-matched controls. Time-domain HRV indices were analyzed from 24-h electrocardiography recordings. We found significantly lower values of SDNN, SDANN and RMSSD parameters in infants with central coordination disturbance compared to controls. Additionally, logistic regression analyses demonstrated independent predictive value of parameters SDNN and SDANN in infants who subsequently developed cerebral palsy (CP). By performing receiver operating characteristic (ROC) analyses, the optimal cut-off value of SDNN<=48ms predicted CP with a sensitivity of 68.7% (95% CI 41.4-88.9) and specificity of 84.2% (95 CI 60.4-96.4) while the optimal cut-off value of SDANN<=41ms predicted CP with a sensitivity of 87.5% (95% CI 61.6-98.1) and specificity of 57.9% (95 CI 33.5-79.7). We are in opinion that time domain HRV analysis could be helpful clinically as well as a prognostic tool in infants with central coordination disturbance.

Heart rate variability in children with idiopathic ventricular tachycardia.

Idiopathic ventricular tachycardia (IVT) is a rare arrhythmia in children. A great deal of uncertainty and numerous questions still remain regarding the extent of investigation, therapy, and long-term prognosis for children with IVT. The existence of subclinical cardiac disease, as well as of autonomic dysfunction in patients with ventricular arrhythmias, has been well documented. A number of experimental and clinical studies have suggested that imbalances within the cardiac autonomic system's activity may be crucial in the generation of ventricular tachycardia, irrespective of the presence of cardiovascular pathological substrate. Heart rate variability (HRV) analysis provides a useful method for measuring the autonomic activity. This study evaluates HRV in children with IVT. The study included 31 children with ventricular arrhythmia who were divided into two groups: (1) patients with frequent ventricular extrasystoles (VES) and (2) patients with IVT. The control group comprised 23 healthy children without pathological findings on 24-h ECG Holter. Twenty-four-hour ambulatory electrocardiography recordings were obtained, and the time-domain variables were calculated. HRV was compared to age-related normal values. It was observed that the overall heart rate variability is diminished in children with IVT. We recommend HRV analysis of any child with IVT. Quantification of the autonomic nervous system activity using time domain analyses may be a helpful diagnostic tool in the clinical assessment and initial evaluation of these children.