The Effects of Growth Hormone Treatment Beyond Growth Promotion in Patients with Genetic Syndromes: A Systematic Review of the Literature.

Recombinant human growth hormone therapy (rhGH) has been widely accepted as the safe treatment for short stature in children with such genetic syndromes as Prader-Willi syndrome and Turner or Noonan syndrome. Some patients with short stature and rare genetic syndromes are treated with rhGH as growth hormone-deficient individuals or as children born small for their gestational age. After years of experience with this therapy in syndromic short stature, it has been proved that there are some aspects of long-term rhGH treatment beyond growth promotion, which can justify rhGH use in these individuals. This paper summarizes the data of a literature review of the effects of rhGH treatment beyond growth promotion in selected genetic syndromes. We chose three of the most common syndromes, Prader-Willi, Turner, and Noonan, in which rhGH treatment is indicated, and three rarer syndromes, Silver-Russel, Kabuki, and Duchenne muscular dystrophy, in which rhGH treatment is not widely indicated. Many studies have shown a significant impact of rhGH therapy on body composition, resting energy expenditure, insulin sensitivity, muscle tonus, motor function, and mental and behavioral development. Growth promotion is undoubtedly the primary benefit of rhGH therapy; nevertheless, especially with genetic syndromes, the additional effects should also be considered as important indications for this treatment.

Chronic inflammation and the growth hormone/insulin-like growth factor-1 axis.

Interactions between growth hormone (GH), insulin-like growth factor-1 (IGF-1), and the immune system are complex, bidirectional, but not fully explained. Current reviews based on numerous studies have indicated that chronic inflammation could suppress the GH/IGF-1 axis via several mechanisms such as relative GH and/or IGF-1 insufficiency, peripheral resistance to GH and/or IGF-1 resulting from down-regulation of GH and IGF-1 receptors, disruption in the GH/IGF-1 signalling pathways, dysregulation of IGF binding proteins (IGFBPs), reduced IGF bioavailability, and modified gene regulation due to changes in the microRNA system. It is well-known that relationships between the immune system and the GH/IGF-1 axis are mutual and GH as well as IGF-1 could modulate inflammatory response and the activity of systemic inflammation. Available data indicate that the GH/IGF-1 axis exerts both pro-inflammatory and anti-inflammatory effects. Pro-inflammatory cytokines such as interleukin-6 (IL-6), tumour necrosis factor-a (TNF-α), and interleukin-1b (IL-b) are some of the most significant factors, besides malnutrition, chronic stress, and prolonged use of glucocorticoids, which impair the activity of the GH/IGF-1 axis, and consequently lead to growth retardation in children suffering from childhood-onset chronic inflammatory diseases. In this review, we discuss the mechanisms underlying the impact of chronic inflammation on the GH/IGF-1 axis and growth processes during childhood and adolescence, based on a number of experimental and human studies.

Gender-Dependent Growth and Insulin-Like Growth Factor-1 Responses to Growth Hormone Therapy in Prepubertal Growth Hormone-Deficient Children.

Gender seems to be an important factor influencing the response to recombinant human growth hormone (rhGH) therapy in GH-deficient adolescents and adults. The results of studies evaluating gender-specific response to rhGH therapy in prepubertal GH-deficient children are divergent. The aim of this study was to determine the effect of gender on the growth and insulin-like growth factor-1 (IGF-1) responses in 75 prepubertal GH-deficient children during the first 2 years of rhGH therapy. There were no baseline gender differences in age, bone age, anthropometrical parameters, and IGF-1 SDS for bone age. After the initiation of rhGH therapy, there were no gender-specific differences concerning the reduction of height deficit. Serum IGF-1 levels were higher in the prepubertal GH-deficient girls than in the age-matched boys, but the difference was not significant when expressed as IGF-1 SDS for bone age. The increase in IGF-1 SDS for bone age was significantly greater in girls versus boys after the first 6 months of therapy, comparable between girls and boys after the first year of therapy, and tended to be higher in boys after the second year of therapy. In conclusion, prepubertal GH-deficient girls and boys do not differ significantly in growth response in the first 2 years of rhGH therapy.

Fructose Consumption and Lipid Metabolism in Obese Children and Adolescents.

Inappropriate dietary habits influence the development of excessive body weight. The role of added sugars, including fructose, notably is significant in this process. It is estimated that fructose intake has increased many times over the past two centuries. The aim of the study was to define the effect of fructose consumption on anthropometric indices and lipid metabolism in obese (body mass index (BMI) >30 kg/m2) children and adolescents. The study included 84 patients (47 girls and 37 boys) aged 7-18 years, divided into prepubertal, pubertal, and post-pubertal age groups. Aside from BMI, the assessment comprised waist circumference, body composition estimated with bioelectrical impedance (BIA), plasma lipid profile, fructose intake consumption based on a 3-day menu analysis, and a number of calculated atherogenic indices. The major findings were that total daily fructose intake was high, on average, ranging from 19 to 26 g, with no appreciable relation to age. A higher fructose intake from beverages is significantly associated with the percentage of body fat, waist circumference, waist-to-height ratio, and also with the content of total cholesterol, triglycerides, and the level of atherogenic indices. In conclusion, fructose appears a particularly unfavorable component in children's diet as it is conducive to visceral obesity and atherogenic lipid profile. However, inadequate proportions of other macronutrients may also be at play in the development of metabolic diet-related disorders.

Peripheral blood picture and aminotransferase activity in children with newly diagnosed Graves' disease at baseline and after the initiation of antithyroid drug therapy.

AIM OF THE STUDY: Assessment of the peripheral blood picture and aminotransferase activity in children with newly diagnosed Graves' disease (GD) at baseline and 4-6 weeks after the initiation of antithyroid drug (ATD) therapy. MATERIAL AND METHODS: Data of 59 children were assessed retrospectively. Baseline analysis included concentrations of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), TSH receptor antibodies (TSH-R Ab), complete blood cell count (CBC), aspartate (AST) and alanine aminotransferase (ALT) activity. Reassessment of CBC and aminotransferase activity was performed 4-6 weeks after the initiation of ATD therapy. RESULTS: Significant decreases in the neutrophil count, MCV, haemoglobin (Hgb), red blood cell (RBC) count, white blood cell (WBC) count and platelet (PLT) count were found in 37.3%, 32.2%, 22%, 13.6%, 8.5% and 5% of untreated patients, respectively. Increased baseline ALT and AST activity was observed in 44% and 32.2% of children, respectively. Initiation of ATD therapy led to significant changes in Hgb, RBC and PLT count, RDW and ALT activity. Negative associations between TSH-R Ab, TSH and MCV were found. ALT and AST activity were negatively related to baseline TSH levels. ALT activity was also associated with baseline fT4 and fT3. CONCLUSIONS: The incidence of haematopoiesis and liver abnormalities in GD children seems to be similar to that reported in adult patients. The most common alterations are changes in neutrophil count, RBC parameters and ALT activity. The initiation of ATD therapy usually leads to significant improvement in those parameters.

Changes in leukocyte profile and C-reactive protein concentration in overweight and obese adolescents after reduction of body weight.

AIM OF THE STUDY: To assess the changes in the leukocyte profile and C-reactive protein (CRP) concentration in adolescents with excess fat mass after 6-12 months of dietary intervention. MATERIAL AND METHODS: The retrospective study included 99 overweight and obese adolescents, aged from 10.0 to 17.5 years, 82 of whom were re-hospitalized 6 to 12 months after dietary counseling. The control group consisted of 42 normal weight peers. Anthropometric measurements and laboratory tests were performed, homeostasis model assessment - insulin resistance (HOMA-IR) and triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio were calculated. RESULTS: Obese and overweight adolescents had higher white blood cells (WBC), neutrophil, monocyte counts and CRP concentration. In the backward stepwise regression analysis, body mass index standard deviation score (BMI SDS) and fasting insulin concentration were independent predictors of WBC and neutrophil counts at the baseline. At the follow-up visit in 45 (54.8%) children, who had lost weight, decreases in WBC, neutrophil and monocyte counts and CRP, fasting insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) concentrations were observed. Changes in WBC and neutrophil counts were dependent on changes in HOMA-IR and TG/HDL ratio. Changes in HOMA-IR had a significant impact on changes in the monocyte count. CONCLUSIONS: Adipose tissue promotes systemic inflammation and its intensity depends on the degree of obesity and insulin resistance. This state is reversible. Changes in HOMA-IR were independent predictors of changes in WBC, neutrophil and monocyte counts after reduction of body weight.

Epidemiology of type 1 diabetes in Polish children: A multicentre cohort study.

BACKGROUND: The incidence of childhood type 1 diabetes (T1D) varies greatly between populations, and the estimates and/or predictions of the rates would aid in adequate planning of health care resources. The study's aim was to assess the incidence of T1D in the paediatric population of eastern and central Poland. METHODS: In this cohort study covering the period from January 2010 to December 2014, data were collected for children and adolescents below 18 years of age with newly diagnosed T1D living in eastern and central Poland. A total of 2174 children were included in the analysis. The population estimates were from the Central Statistical Office of Poland. RESULTS: Overall, the annual incidence of T1D increased from 12.84/100,000 in 2010 to 18.46/100,000 in 2014 with the incidence rate (IR) ratio of 1.5 (an increase in the IR by 12.7% per year over 5 years). The lowest increase in the IR by 7.1% per year was seen in 15 to 17-year-olds. In the urban population (age 0-17 years), the overall incidence rate was significantly higher than in subjects from rural communities (P < .02). The incidence of T1D in rural areas was significantly higher (p = .004) in voivodeships of higher population density. Such dependence was not observed in urban areas. CONCLUSIONS: The incidence of T1D in children living in eastern and central Poland increased 1.5-fold over the 5-year observation period with the highest rise in 10 to 14-year-olds and significantly higher rates in urban children compared with their peers living in rural areas.

The Diagnostics of Human Steroid Hormone Disorders.

Disturbances of the steroidogenesis or altered peripheral metabolism of steroids may result in severe clinical manifestations. Therefore, prompt diagnosis and initiation of medical treatment are desirable. The diagnostics of disorders of steroid hormone production, metabolism, and action have been previously based on immunoassay tests. However, in a modern medical laboratory, due to low accuracy of immunoassays, this technique is continuously replaced by chromatographic separation methods coupled to mass spectrometric detection systems. In this review we present current advances in the diagnostics of adrenal gland disorders, focusing on the role of mass spectrometry in prenatal and newborn screening, and in the diagnostics of sexual maturation disorders.

Body Mass Disorders in Healthy Short Children and in Children with Growth Hormone Deficiency.

The aim of the study was to determine the degree of adiposity and the incidence of body mass disorders, including abdominal obesity, in healthy short children and children with growth hormone deficiency. The study included 134 short children (height < 10th percentile) aged 7-15. In this cohort there were 63 (31 boys and 32 girls) children without diagnosed hormonal disorders and 71 patients (35 boys and 36 girls) with growth hormone deficiency. Basic somatic features were assessed and the study participants were categorized according to the percentage of body fat (%FAT), body mass index (BMI), and waist-to-height ratio (WHtR). We found that there were no significant differences in %FAT and the incidence of body weight disorders depending on gender or diagnosis. %FAT deficit was observed in 12-21% of the participants and underweight in almost every fourth child. Overweight involved 3-14% of the participants and obesity was diagnosed in isolated cases (0-3%); both were considerably lower compared to the estimates based on %FAT. Using the cut-off points of WHtR, abdominal adiposity was observed in 3-15% of the participants. In conclusion, quite a large number of short children (between 25 and 50%) are characterized by abnormal body fat or body mass index values. The results indicate a limited usefulness of BMI in evaluating the incidence of overweight and obesity in children characterized by a height deficit.

Osteoprotegerin, Receptor Activator of Nuclear Factor Kappa B Ligand, and Growth Hormone/Insulin-Like Growth Factor-1 Axis in Children with Growth Hormone Deficiency.

The growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis is involved in the regulation of the receptor activator of nuclear factor kappa B ligand (RANKL)/RANK/osteoprotegerin (OPG) system, but the exact mechanism of the associations is not fully explained. In this study we investigated the serum OPG and total sRANKL concentrations in short children who had differences in GH secretory status. We also investigated the associations between the GH/IGF-1 and OPG/RANKL systems in GH-deficient children during GH treatment. There were no significant differences in any anthropometric or biochemical parameters evaluated between the GH-deficient and GH-sufficient children. The OPG content and total alkaline phosphatase (ALP) activity increased significantly after the initiation of GH treatment, while total sRANKL remained unchanged. The variables baseline BMI SDS for height-age (ß = 0.42; p < 0.05), baseline ALP activity (ß = 0.36; p < 0.05), weight SDS for height-age at 6 months of GH treatment (ß = 1.86; p < 0.01), and total ALP activity at 6 months of GH treatment (ß = 0.48, p < 0.01) were identified as independent predictors of ΔOPG6-month-baseline. We conclude that OPG and total sRANKL concentrations are independent from GH secretory status in short children. OPG elevation during GH treatment is independently associated with total ALP activity and nutritional status in GH-deficient children.

Association Between Vitamin D and Carboxy-Terminal Cross-Linked Telopeptide of Type I Collagen in Children During Growth Hormone Replacement Therapy.

Growth hormone and insulin-like growth factor-1 (IGF-1) play a crucial role in the regulation of bone turnover. Adequate vitamin D status supports proper bone remodeling, leading to normal longitudinal bone growth and normal peak bone mass. The aim of this study was to evaluate the association between serum 25-hydroxyvitamin D [25(OH)D] and carboxy-terminal cross-linked telopeptide of type I collagen (ICTP) in children and adolescents with growth hormone deficiency at baseline and during recombinant human growth hormone (rhGH) replacement therapy. The study was prospective and included 30 children and adolescents aged 5 to 17 years. Concentrations of 25(OH)D, ICTP, and IGF-1 were measured at baseline and during the first year of rhGH therapy. Baseline serum 25(OH)D concentration correlated with ICTP concentrations during the first trimester of rhGH therapy (r = 0.38, p < 0.050); the correlation was stronger in the second trimester of therapy (r = 0.6, p = 0.002). We conclude that proper vitamin D status is important in reaching the adequate dynamics of bone remodeling during growth, which is essential to achieve a catch-up growth during rhGH therapy.

The pre-treatment characteristics and evaluation of the effects of recombinant human growth hormone therapy in children with growth hormone deficiency and celiac disease or inflammatory bowel disease.

THE AIM OF THE STUDY: was to investigate the coincidence of growth hormone deficiency (GHD) and celiac disease (CD) or inflammatory bowel disease (IBD) in patients referred for short stature, and to evaluate the baseline anthropometric parameters and the effectiveness of recombinant human growth hormone (rhGH) therapy in the first year in those patients (GHD+CD/IBD subgroup) in comparison to patients with GHD without CD or IBD (GHD-CD/IBD subgroup). MATERIAL AND METHODS: The study was retrospective and included 2196 short patients (height SDS [Standard Deviation Score] ≤ -1.2). 1454 patients had height SDS ≤ -2. Twenty-nine patients suffered from CD or IBD. GHD was confirmed in 419 patients with height SDS ≤ -2. The coexistence of GHD and CD or IBD was found in seven patients (GHD+CD/IBD subgroup). RESULTS: At baseline the GHD-CD/IBD subgroup did not differ significantly in chronological age, height SDS, height velocity (HV) before rhGH therapy, body weight SDS, and body mass index SDS from the GHD+CD/IBD subgroup. The improvement in height SDS within the first year of rhGH therapy was higher in the GHD+CD/IBD subgroup than in the GHD-CD/IBD subgroup and the difference was statistically significant (p<0.05). HV in the first year of rhGH therapy was also significantly higher in the GHD+CD/IBD subgroup than in the GHD-CD/IBD subgroup (p < 0.05). CONCLUSIONS: In patients with chronic inflammatory disorders of the gastrointestinal tract, especially celiac disease, coexisting with GHD, rhGH therapy could be effective and should be administered together with therapy of primary gastrointestinal disease.

Thyroid function in children with growth hormone deficiency during long-term growth hormone replacement therapy.

AIM OF THE STUDY: The aim of this study was to investigate the effects of growth hormone (GH) therapy on thyroid function in a group of euthyroid children with isolated idiopathic growth hormone deficiency (GHD). MATERIAL AND METHODS: The study was retrospective and included 117 children treated with GH for 1-4 years. Anthropometric measurements and serum concentrations of insulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), and free thyroxine (fT4) were analysed at baseline and during GH therapy. RESULTS: TSH levels did not change significantly after the initiation of GH treatment, while fT4 levels decreased after the second year of GH treatment (p < 0.01) and remained lower than baseline until the end of observation (p < 0.01, after both the third and fourth year of therapy) in the whole group. Analysis according to baseline pubertal status revealed significant changes in TSH and fT4 levels during GH treatment, but only in the prepubertal children. Multiple regression analysis confirmed that mean GH doses administered in the first two years of GH therapy were independently (R = 0.218, p < 0.05) associated with changes in fT4 levels in this period (∆fT42 years - baseline), even when taking into account changes in height SDS and bone age. CONCLUSIONS: FT4 levels decreased during GH replacement therapy, while TSH levels appeared to be unaffected by GH therapy. Prepubertal children seem to be more predisposed to thyroid function alterations during such therapy in comparison to pubertal children. Changes in fT4 levels during GH replacement therapy are related to GH doses.

Graves' disease in children in the two decades following implementation of an iodine prophylaxis programme.

Grave's disease (GD) is a form of thyroid autoimmune disease characterised by hyperthyroidism. It is a rare clinical problem in paediatrics. Development of disease is the result of genetic susceptibility and some environmental factors. One of the best-documented environmental factors involved in thyroid autoimmunity is iodine excess. The aim of our study was to analyse the clinical course and response to pharmacological treatment in children diagnosed with Graves' disease in first two decades after mandatory salt iodination. Records of 94 children diagnosed with GD in the years 1998-2017 were analysed. Medical data of patients was compared between two decades following implementation of iodine prophylaxis: 1998-2007 (first-decade group - FDG) and 2008-2017 (second-decade group - SDG); 34 and 60 patients, respectively. Medical data of FDG was obtained from archival records and previous analysis performed in 2006. Data of 60 patients from SDG were obtained from currently available medical records. Results were statistically analysed using Microsoft Excel and Statistica 11 software. Results: In our study, after mandatory salt iodination, the tendency of an increase in newly diagnosed GD in children without family susceptibility was observed. The antibody profile indicates the significant contribution of the autoimmune process involving all thyroid antigens; therefore, the term "autoimmune hyperthyroidism" seems to be more appropriate than classical GD in this group of patients. The first-choice treatment with methimazole rarely causes adverse events during the therapy, and they have benign character.

Utility of leucocyte antigens in distinguishing between bacterial and viral infection in children.

INTRODUCTION: Accurate diagnosis of bacterial and viral infection is very difficult. Unfortunately, there is still no quick and discriminative diagnostic test that would help clinicians in establishing the diagnosis and taking a decision on treatment. The aim of the study was to compare the expression of antigens on phagocytes, which are involved in the first defence line during bacterial and viral infections in children, as a potential tool to distinguish the etiology of the infection. MATERIAL AND METHODS: The expression of CD35, CD32, CD88, and MHC class I on phagocytes in 49 blood samples from children with high fever and suspected infection as well as 19 healthy children (control group) was assessed by flow cytometry. Thirty-three children were diagnosed with bacterial and 16 with viral infection. Expression of antigens was analysed on a FACSCanto II flow cytometer according to mean fluorescence intensity (MFI) and antibody binding cites (ABC). RESULTS: Significant differences were observed for the following: CD32, CD35, CD88, and MHCI on granulocytes; CD32, CD35, CD88 on monocytes; and MHC-I ratio between groups were observed. The obtained results did not allow us to establish valuable score points for distinguishing between bacterial and viral infections. Classification and a regression tree using CD88 expression on granulocytes and CRP was developed. It enabled us to differentiate between the origin of infection with sensitivity and specificity of more than 90%. CONCLUSIONS: Utility of use of wide range antigens' expression on phagocytes for distinguishing between bacterial and viral infection in children has limited value. More adequate seems to be use of CD88 expression on granulocytes linked with CRP value.

High incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes among Polish children aged 10-12 and under 5 years of age: A multicenter study.

AIM: Despite its characteristic symptoms, type 1 diabetes (T1D) is still diagnosed late causing the development of diabetic ketoacidosis (DKA). The aim of this study was to estimate the incidence of DKA and factors associated with the development of acidosis at T1D recognition in Polish children aged 0-17. METHODS: The study population consisted of 2100 children with newly diagnosed T1D in the years 2010-2014 in 7 hospitals in eastern and central Poland. The population living in these areas accounts for 35% of the Polish population. DKA was defined as a capillary pH < 7.3, blood glucose > 11 mmol/L. The analyzed data included age, sex, diabetes recognition, pH, glycated hemoglobin (HbA1c), fasting C-peptide, and body mass index standard deviation score (BMI-SDS). RESULTS: We observed DKA in 28.6% of children. There were 2 peaks in DKA occurrence: in children <5 years of age (33.9%) and aged 10-12 (34%). The highest incidence of DKA was noted in children aged 0-2 (48.4%). In the group with DKA, moderate and severe DKA occurred in 46.7% of children. Girls and children <2 years of age were more prone to severe DKA. The multiple logistic regression analysis showed the following factors associated with DKA: age (P = .002), fasting C-peptide (P = .0001), HbA1c (P = .0001), no family history of T1D (P = .0001), and BMI-SDS (P = .0001). CONCLUSIONS: The incidence of DKA is high and remained unchanged over the last 5 years. Increasing the awareness of symptoms of DKA is recommended among children <5 years of age (especially <2 years of age) and aged 10-12. Children <2 years of age and girls were at the highest risk of severe DKA.

Thyroid Autoimmunity in Girls with Turner Syndrome.

Turner syndrome is associated with increased incidence of autoimmune diseases, especially those of the thyroid gland. The aim of this study was to assess the prevalence of thyroid autoimmunity among pediatric patients with Turner syndrome. The study was retrospective and included 41 girls with Turner syndrome aged 6-18 years. Free thyroxine (FT4), thyroid stimulating hormone (TSH), anti-thyroid peroxidase (TPO-Ab) antibodies, anti-thyroglobulin (TG-Ab) antibodies, and karyotype were investigated. The correlation between karyotype and incidence of thyroid autoimmunity was also examined. Eleven patients (26.8%) were positive for TPO-Ab and/or TG-Ab. Three girls from that subgroup were euthyroid, 5 had subclinical hypothyroidism, and 3 were diagnosed with overt hypothyroidism. Out of these 11 patients affected by thyroid autoimmunity, 6 girls had mosaic karyotype with X-isochromosome (n = 4) or with deletions (n = 2), and 5 had the 45,X karyotype. The study findings confirmed a high incidence of thyroid autoimmunity in girls with Turner syndrome, but we failed to observe an association between the incidence of thyroid autoimmunity and karyotype. We conclude that it is important to monitor thyroid function in patients with Turner syndrome because they are prone to develop hypothyroidism.

Carotid Intima-Media Thickness and Metabolic Syndrome Components in Obese Children and Adolescents.

Obesity in children and adolescents contributes to increased prevalence of metabolic and hemodynamic complications, which may impair endothelial function and structure. A high resolution B-mode ultrasound measurement of intima-media thickness (IMT) is a useful tool to assess early, preclinical stage of atherosclerosis. The objective of this study was to evaluate the carotid artery IMT in obese children and its association with insulin resistance and other traditional metabolic syndrome components. The study entailed 80 obese children, aged 5.3-17.9 year and a control group of 31 children. Obesity was defined using the International Obesity Task Force (IOTF) criteria. Metabolic syndrome was defined using the International Diabetes Federation (IDF) criteria of 2007. Each patient's anthropometric measurements, blood parameters, and the carotid IMT were evaluated. Insulin resistance indices were calculated. We found that children with metabolic syndrome had a significantly increased IMT compared to children who did not meet the syndrome criteria (0.62 ± 0.09 mm vs. 0.55 ± 0.18 mm, p = 0.03) and compared to control group (0.62 ± 0.09 vs. 0.52 ± 0.14, p = 0.02). In a multivariable linear regression analysis, IMT correlated with systolic blood pressure (p = 0.005). The results did not show an association between IMT and insulin resistance. We conclude that abdominal obesity and the accompanying components of metabolic syndrome lead to increased carotid IMT. The enhanced systolic blood pressure plays a major role in changing the carotid IMT.

Thyroid Function in Obese Children and Adolescents and Its Association with Anthropometric and Metabolic Parameters.

Fat accumulation leads to dysfunction of hypothalamic-pituitary-thyroid axis and to changes in thyroid function. A higher serum level of thyroid stimulating hormone (TSH), with normal levels of thyroid hormones, suggesting subclinical hypothyroidism, is often found in obese individuals. The influence on lipid and glucose metabolism of thyroid dysfunction in obese patients remains unclear. This retrospective study encompassed 110 obese children and 38 healthy non-obese children aged 5-18. Anthropometric measurements, including bioelectrical impedance, were taken in all children. Fasting TSH, fT4, glucose, lipid profile, and a glucose tolerance test in case of the obese individuals, were evaluated. The obese children demonstrated a significantly higher mean concentration of TSH compared with their peers with proper body weight: 2.1 ± 1.0 µIU/ml vs. 1.5 ± 0.6 µIU/ml, p = 0.001. The fT4 was not different between the two groups. In the obese children, TSH correlated with body mass index (BMI) and waist circumference after controlling for age and gender. A multivariate regression analysis showed a relationship of TSH with total cholesterol, LDL cholesterol, triglycerides, and non-HDL after adjusting for BMI. None of these relationships were revealed for fT4. The level of TSH correlated with the degree of abdominal obesity. We conclude that the serum TSH concentration, even remaining within the norm, could adversely affect the lipid profile, irrespective of obesity.

Nutrition and Immune System in Children with Simple Obesity.

The purpose of this study was to evaluate dietary factors in nutrition influencing the immune system of children and teenagers suffering from simple obesity. The study involved 100 children and teenagers aged 7-18 with simple obesity. Nutritional data were obtained from 3-day food records. The consumed nutrients, including immunomodulators and immunostimulants, were estimated based on the nutrition interview. The results were compared with the nutritional norms. On average, the proportion of n-6:n-3 fatty acids equalled 10:1. Among the amino acids, the highest intake values in the diet were observed for glutamine (13,694.6 mg/day). The study demonstrates inadequate intake levels of iron (73% of recommended dietary allowance, RDA), vitamin C (65% of RDA), and vitamin D (11% of RDA) taking into account the median values for the entire study group. The median daily intake of other nutrients exceeded the RDA values. The diets of the participants in this study were not properly balanced with respect to immunomodulators, which may contribute to the occurrence of immunological disorders and immunodeficiency in this group of patients.