Prevalence of Metabolic Syndrome and its Associated Risk Factors in Pediatric Obesity.

Objective: We aimed to study the prevalence of metabolic syndrome (MetS) and the factors associated with metabolic syndrome among obese children. Methodology: We recruited 175 subjects, aged 7 to 18 years old, referred for obesity. We studied their demography (age, gender, ethnicity, family background), performed clinical/auxological examinations [weight, height, body mass index (BMI), waist circumference (WC), blood pressure (BP)], and analyzed their biochemical risks associated with metabolic syndrome [fasting plasma glucose (FPG), fasting lipid profile (FLP), fasting insulin, liver function tests (LFT)]. MetS was identified according to the criteria proposed by the International Diabetes Federation (IDF) for pediatric obesity. Multiple logistic regression models were used to examine the associations between risk variables and MetS. Results: The prevalence of metabolic syndrome among children with obesity was 56% (95% CI: 48.6 to 63.4%), with a mean age of 11.3 ± 2.73 years. Multiple logistic regression analysis showed age [adjusted odds ratio (OR) 1.27, 95% CI: 1.15 to 1.45] and sedentary lifestyle (adjusted OR 3.57, 95% CI: 1.48 to 8.59) were the significant factors associated with metabolic syndrome among obese children. Conclusion: The prevalence of metabolic syndrome among obese children referred to our centers was 56%. Older age group, male gender, birth weight, sedentary lifestyle, puberty and maternal history of gestational diabetes mellitus (GDM) were found to be associated with MetS. However, older age group and sedentary lifestyle were the only significant predictors for metabolic syndrome.

Reference intervals for thyroid-stimulating hormone (TSH) and free thyroxine (FT4) in infants' day 14-30 of life and a comparison with other studies.

Objectives Established reference intervals of thyroid function in neonates are important; however, studies often consist of a small sample size or lack of clinical information. We aim to define reference intervals for thyroid-stimulating hormone (TSH) and free thyroxine (FT4) for infants aged 14-30 days. We also reviewed follow-up TSH for infants with initial values 10-20 mIU/L. Methods Venous TSH and FT4 of term babies aged 14-30 days with breast milk jaundice that had thyroid function test performed as part of a prolonged jaundice workout from September 2016 to March 2017 were analyzed. Electronic medical records were reviewed to ensure only well babies with no pathological causes of jaundice or conditions that may affect thyroid function were included. TSH and FT4 were analyzed using immunoassay analyzer Dxl 800, Beckman Coulter. Results There were no correlations between FT4 and TSH with gender, birth weight and ethnicity. Correlation coefficient between FT4 and total bilirubin was weak at 0.138 (p=0.001). No association was found between TSH and bilirubin levels. Mean FT4 was higher in the younger age group day 14-21 (p<0.01). There was no significant difference in TSH values between the age groups. Infants with mildly elevated TSH 10-20 mIU/L had normalized values on follow-up (mean, 11.41 vs. 4.42 mIU/L; p<0.01; 95%CI, 5.88-8.09). The following reference intervals (2.5-97.5th percentile) were derived: FT4 day 14-21 (n=513): 11.59-21.00 pmoL/L; FT4 day 22-30 (n=66): 10.14-19.60 pmoL/L; TSH day 14-30 (n=579): 1.90-10.34 mIU/L. Comparison between studies showed variations of reference intervals with different manufacturer assays, age and methodology. Conclusions Our reference intervals would be useful in the clinical setting. Infants with mildly elevated TSH could be monitored first instead of immediate treatment.

Predictors of non-alcoholic fatty liver disease (NAFLD) among children with obesity.

Background The prevalence of childhood obesity and its related comorbidities in Malaysia are alarming. Malaysia ranked second in childhood obesity among South-east Asian countries with a prevalence of 12.7%. This study was conducted to investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) among obese children and to ascertain the predictors associated with NAFLD. Methods NAFLD was diagnosed via ultrasonographic evidence of fatty liver in obese and overweight children who presented to the Paediatric Obesity Clinic of University Malaya Medical Centre (UMMC), Malaysia. Demographic, anthropometric, clinical and biochemical parameters were analysed and compared between the NAFLD and non-NAFLD groups. Statistical analyses were carried out. Results Twenty-one out of 33 obese and overweight children (63.6%) were found to have NAFLD. We found that 62% of our study population in the NAFLD group had metabolic syndrome based on the definition by the International Diabetes Federation (IDF). Mean body mass index (BMI), waist circumference (WC), triglyceride (TG) and alanine aminotransferase (ALT) were found to be significantly greater in the NAFLD group compared to the non-NAFLD group (35.2 [6.1] vs. 29.3 [4.7] kg/m2 [p-value 0.007]; 104.1 [11.4] vs. 94.1 [12] cm [p-value 0.034]; 1.5 [0.9] vs. 0.9 [0.3] mmol/L [p-value 0.002]; 60.7 [53.8] vs. 27.3 [13] U/L [p-value 0.007]). Multivariate regression analysis revealed TG as the independent predictor for NAFLD, with an odds ratio of 41.7 (95% confidence interval [CI] 0.001, 0.819) (p-value 0.04). Conclusions Prevalence of NAFLD among children who are obese and overweight is alarming with 62% having metabolic syndrome. TG was found to be a strong predictor for NAFLD.