Comprehensive Insights into Pediatric Craniopharyngioma: Endocrine and Metabolic Profiles, Treatment Challenges, and Long-term Outcomes with a Multicenter Approach.

Introduction: Craniopharyngiomas (CPG) have complex challenges in treatment due to their proximity to vital structures, surgical and radiotherapeutic complexities, and the tendency for recurrence. This study aims to identify the prevalence of endocrine and metabolic comorbidities observed during initial diagnosis and long-term follow-up in a nationwide cohort of pediatric CPG patients. The study also highlights the associated difficulties in their management. Methods: Sixteen centers entered 152 patients into the ÇEDD NET data system. We evaluated the clinical and laboratory characteristics at presentation, administered treatments, accompanying endocrine, metabolic, and other system involvements, and the patient's follow-up features. Results: Of the evaluated patients, 64 were female, and 88 were male. At presentation, the mean age was 9.1 ± 3.67 (min:1.46-max:16.92) years. The most common complaints at presentation were headache (68.4%), vision problems (42%), short stature (15%), nausea and vomiting (7%). The surgical procedure applied to the patients was gross total resection (GTR) in 97 cases (63.8%) and subtotal resection in 55 cases (36.2%). Radiotherapy was initiated in 11.8% of the patients. In the pathological examination, 92% of the cases were adamantinamatous type, 8% were papillary type. Postoperatively, hormone deficiencies consisted of thyroid-stimulating hormone (92.1%), adrenocorticotropic hormone (81%), antidiuretic hormone (79%), growth hormone (65.1%), and gonadotropin (43.4%) deficiencies. Recombinant growth hormone treatment (rhGH) was initiated on 27 patients. The study showed hesitancy among physicians regarding rhGH. The median survival without relapse was 2.2 years. Median time of relapse was 1.82 years (range: 0.13-10.35 years). Relapse was related to longer follow-ups and reduced GTR rates. The median follow-up time was 3.13 years. Among the last follow-up visits, the prevalence of obesity was 38%, but of these, 46.5% were already obese at diagnosis. However, 20% who were not obese at baseline became obese on follow-up. Permanent visual impairment was observed in 26 patients, neurological deficits in 13 patients, and diabetes mellitus in 5 patients. Conclusion: Recurrence was predominantly due to incomplete resection and the low rate of postoperative radiotherapy. It also emphasized challenges in multidisciplinary regular follow ups and suggested early interventions such as dietary restrictions and increased exercise to prevent obesity.

Evaluation of the relationship between pain inflammation due to dental caries and growth parameters in preschool children.

OBJECTIVES: To evaluate the relationship between pain inflammation due to dental caries and growth parameters, sleep disturbances, and oral health-related quality of life (OHRQoL) in preschool children before/after dental treatment and compare the results with the control group. MATERIALS AND METHODS: Study (pain inflammation due to caries) and control groups were included in this prospective clinical trial. The Child Sleep Habits Questionnaire (CSHQ) assessing sleep disturbances and the Early Childhood Oral Health Impact Scale (ECOHIS) assessing OHRQoL were applied in the corresponding time intervals to the study and control groups, respectively: baseline (T0study), 7 days after treatment (T1study), and following 6 months (T2study); baseline (T0control), and the following 6 months (T2control). Biochemical growth parameters (insulin-like growth factor-1 and insulin-like growth factor binding protein-3) and anthropometric measurements (standard deviation score of height, weight, and body mass index) were obtained at T0study, T2study, and T0control. Mann-Whitney U and the Student t-tests were used for statistical analyses. The significance level was set at p < 0.05. RESULTS: Data on 45 children (mean age: 55.6 ± 10.37 months) were analyzed. T2study was statistically higher than T0study for the anthropometric measurements and biochemical growth parameters (p < 0.05). T0study was statistically higher than T0control for biochemical growth parameters (p < 0.05). CSHQ and ECOHIS scores were found statistically significant at T0study than T0control (p < 0.05). Statistical scores of CSHQ and ECOHIS in T2study were significantly reduced compared to T0study (p < 0.05). CONCLUSION: Children's growth parameters, sleep disturbances, and OHRQoL improved after the elimination of pain and inflammation. CLINICAL RELEVANCE: This study's novelty is the observation of drastically increased growth parameters and reduced sleep disturbances following dental treatment.

Serum Irisin Levels in Central Precocious Puberty and Its Variants.

AIM: The exact mechanisms that trigger the onset of puberty are not well known. Adipomyokines are postulated to stimulate the central neural network. In the present study, we investigated irisin levels in girls with central precocious puberty (CPP), slowly progressing precocious puberty (SPPP), or premature thelarche (PT); we also studied prepubertal girls and to determine if this adipomyokine could be used as a marker in this context. METHODS: A total of 94 girls including 33 with CPP, 31 with precocious puberty (PP) variants (SPPP or PT), and 30 healthy controls were enrolled to the study. The mean irisin levels were compared between groups. The bivariate correlations of irisin levels with clinical and laboratory parameters were assessed. Multivariate linear regression analysis was performed to determine independent predictive factors of irisin levels. RESULTS: Irisin levels were higher in the CPP group compared with the other groups (CPP group: 723.25 ±â€…62.35 ng/mL; PP variants group: 529.60 ±â€…39.66 ng/mL; and control group: 325.03 ±â€…27.53 ng/mL) (P < 0.001). Irisin levels were positively correlated with body mass index standard deviation scores (BMI-SDS), height-SDS, weight-SDS, bone age, uterus long axis, ovary size, baseline FSH and LH, and peak LH levels. Multivariate linear regression analysis revealed that irisin levels had the strongest correlation with peak LH. The other independent predictive factor of irisin levels was BMI-SDS. CONCLUSIONS: The mean irisin levels were higher in patients with CPP compared with other groups. The results of this study imply that increased irisin levels may be used as a marker of CPP provided that these findings are confirmed in larger prospective studies.

Omentin-1 level in adolescents with polycystic ovarian syndrome.

BACKGROUND: Adipokines have been suggested to play an important role in the pathogenesis of polycystic ovarian syndrome (PCOS). Omentin is an adipokine secreted essentially by visceral adipose tissue with an insulin-sensitizing effect. Insulin resistance (IR) is a common feature of PCOS, therefore the aim of this study was to investigate omentin-1 level in adolescent girls with PCOS and its relationship with IR and androgens. METHOD: A total of 41 obese girls with PCOS, and 30 age- and body mass index (BMI)-matched obese girls without PCOS were enrolled in the study. The demographic, clinic and laboratory characteristics of the groups were compared. Additionally, bivariate correlation analysis of omentin-1 with BMI standard deviation score (BMI-SDS), insulin, glucose, homeostatic model assessment of IR (HOMA-IR), total and free testosterone was performed. RESULTS: In the PCOS group HOMA-IR, free and total testosterone were higher than in the control group. Omentin-1 was lower in the PCOS group compared with the controls (55.01 ± 7.99 ng/mL vs 59.10 ± 7.02 ng/mL, respectively; P = 0.027). Omentin-1 was inversely correlated with free testosterone (r = -0.527, P = 0.030) and BMI-SDS (r = -0.241, P = 0.046) but it was not correlated with total testosterone, HOMA-IR, glucose, insulin or serum lipids. CONCLUSION: Omentin-1 was lower in obese girls with PCOS and hyperandrogenism was associated with this condition.

Comparison of Hand Function Between Children With Type 1 Diabetes Mellitus and Children Without Type 1 Diabetes Mellitus.

PURPOSE: This study compared the hand function of children between the ages of 8 and 12 years with type 1 diabetes mellitus (T1DM) with that of children without diabetes. METHODS: The Modified Jebsen-Taylor Hand Function Test and the Purdue Pegboard Test were used to assess hand function. The Pediatric Quality of Life Inventory 4.0 was used for evaluating health-related quality of life. RESULTS: Duration of writing was found to be significantly longer on the dominant side of the T1DM group compared with the children without T1DM. The durations of card turning, moving large, light objects, and large, heavy objects on the nondominant side of the T1DM group were also found to be significantly longer than those in the children without T1DM. The total scale score of health-related quality of life was significantly lower in the T1DM group compared with the children without T1DM. CONCLUSIONS: T1DM affects hand function, particularly the dominant side for writing and nondominant side for card turning and moving large objects.

The relation of urinary bisphenol A with kisspeptin in girls diagnosed with central precocious puberty and premature thelarche.

BACKGROUND: Bisphenol A (BPA) is known as an endocrine disruptor and it is supposed to have a role on the development of central precocious puberty (CPP). Kisspeptin, a hypothalamic peptide, is a neuromodulator of gonadotropin releasing hormone and it has an important role on regulation of the onset of puberty. The BPA levels in girls with CPP and premature thelarche (PT) and its relation with kisspeptin levels were investigated. METHODS: Twenty-eight girls with CPP, 28 girls with PT and 22 prepubertal girls as a control group were enrolled to the study. Urinary BPA and serum kisspeptin levels were compared in the groups. Bivariate correlations were performed to evaluate the relations of BPA with kisspeptin and estradiol. RESULTS: There was no statistical difference between groups regarding BPA levels. Serum kisspeptin levels were higher in CPP group than controls [306.56 (interquartile range (IQR), 175.63-504.66) vs. 157.62 (IQR, 55.61-285.00) p: 0.008]. There were no correlations between BPA and kisspeptin levels (r: 0.088, p: 0.391) and between BPA and estradiol (r: -0.171, p: 0.144). CONCLUSIONS: The BPA levels did not differentiate between groups and it seems that the exposed amount of BPA in daily life did not affect kisspeptin levels in girls with CPP and PT.

Rare Causes of Primary Adrenal Insufficiency: Genetic and Clinical Characterization of a Large Nationwide Cohort.

CONTEXT: Primary adrenal insufficiency (PAI) is a life-threatening condition that is often due to monogenic causes in children. Although congenital adrenal hyperplasia occurs commonly, several other important molecular causes have been reported, often with overlapping clinical and biochemical features. The relative prevalence of these conditions is not known, but making a specific diagnosis can have important implications for management. OBJECTIVE: The objective of the study was to investigate the clinical and molecular genetic characteristics of a nationwide cohort of children with PAI of unknown etiology. DESIGN: A structured questionnaire was used to evaluate clinical, biochemical, and imaging data. Genetic analysis was performed using Haloplex capture and next-generation sequencing. Patients with congenital adrenal hyperplasia, adrenoleukodystrophy, autoimmune adrenal insufficiency, or obvious syndromic PAI were excluded. SETTING: The study was conducted in 19 tertiary pediatric endocrinology clinics. PATIENTS: Ninety-five children (48 females, aged 0-18 y, eight familial) with PAI of unknown etiology participated in the study. RESULTS: A genetic diagnosis was obtained in 77 patients (81%). The range of etiologies was as follows: MC2R (n = 25), NR0B1 (n = 12), STAR (n = 11), CYP11A1 (n = 9), MRAP (n = 9), NNT (n = 7), ABCD1 (n = 2), NR5A1 (n = 1), and AAAS (n = 1). Recurrent mutations occurred in several genes, such as c.560delT in MC2R, p.R451W in CYP11A1, and c.IVS3ds+1delG in MRAP. Several important clinical and molecular insights emerged. CONCLUSION: This is the largest nationwide study of the molecular genetics of childhood PAI undertaken. Achieving a molecular diagnosis in more than 80% of children has important translational impact for counseling families, presymptomatic diagnosis, personalized treatment (eg, mineralocorticoid replacement), predicting comorbidities (eg, neurological, puberty/fertility), and targeting clinical genetic testing in the future.

Association of physical activity level with depression, anxiety, and quality of life in children with type 1 diabetes mellitus.

BACKGROUND: Children with type 1 diabetes mellitus (T1DM) have low physical activity levels and are at high risk for psychosocial morbidities, including depression, heightened anxiety and low health-related quality of life (HRQoL). OBJECTIVE: The aim of this study was to assess the associations of physical activity level with depression, anxiety, and HRQoL in children with T1DM. SUBJECTS AND METHODS: A cross-sectional study design, including children with T1DM aged between 8 and 12 years and healthy controls, was used. Physical activity (PA) level was assessed with the Physical Activity Questionnaire for Older Children (PAQ-C). Anxiety was screened by The Screen for Anxiety Related Emotional Disorders (SCARED) questionnaire. Depressive symptoms were evaluated using the Children's Depression Inventory (CDI). Quality of life was assessed with the The Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0). RESULTS: Forty-seven T1DM and 55 healthy children were included with mean ages of 9.87±1.63 and 9.56±1.60 years, respectively. The T1DM group had significantly higher depression and anxiety score (p<0.05) and lower HRQoL-child self-report score (p<0.05, for all) compared with the control group. Significant associations were found between PAQ-C and PedsQL 4.0 (p<0.05), between SCARED and PedsQL 4.0 (p<0.05), and between HbA1c and PedsQL 4.0 (p<0.05) in children with T1DM. CONCLUSIONS: The result of our study suggested that only HRQoL was related to physical activity, anxiety and HbA1c in children with T1DM.

Response to Disodium Etidronate Treatment in Three Siblings with Pulmonary Alveolar Microlithiasis.

Pulmonary alveolar microlithiasis (PAM) is a rare chronic genetic lung disease in childhood with no proven therapy. It is characterized by the deposition of calcium phosphate microliths within the alveolar air spaces. The effect of disodium etidronate (DE) treatment on PAM is controversial. We report 3 siblings (an 11-year-old boy and 4-year-old twin girls) with PAM diagnosed by chest X-ray, thoracic high-resolution computed tomography, technetium-99m bone scan and bronchoalveolar lavage fluid findings. After the administration of DE (200 mg/day) for a 1-year period, 2 siblings showed radiological improvement, while 1 sibling did not. No drug side effects were observed within the treatment period.

SIRT1 gene variants are related to risk of childhood obesity.

UNLABELLED: Obesity is a multifactorial disorder resulting from the interaction between genetic, psychological, physical, environmental, and socioeconomic factors. SIRT1 gene has important effects on the regulation of adiponectin, caloric restriction, insulin sensitivity, coronary atherosclerosis, and cardiovascular diseases. The aim of this study was to investigate the association between childhood obesity and SIRT1 gene polymorphisms regarding rs7895833 A > G in the promoter region, rs7069102 C > G in intron 4, and rs2273773 C > T in exon 5 using PCR-CTPP method in 120 obese and 120 normal weight children. In this study, BMI, systolic and diastolic blood pressure, LDL cholesterol, triglyceride, and insulin levels were significantly higher and HDL-cholesterol levels were significantly lower in obese children compared to normal weight children. For rs7895833 A > G, the rate of having AG genotype and G allele was significantly higher in obese children compared to non-obese group (p < 0.001). The risk for obesity was increased by 1.9 times in G allele carriers; therefore, A allele may be protective against obesity. Both study groups had CT heterozygote genotype for rs2273773 C > T. There was no significant difference for rs7069102 C > G gene polymorphism between groups. CONCLUSION: This is the first study reporting an association between SIRT1 gene polymorphisms and obesity in children.

Vitamin D-containing supplements for children between 1-3 years of age: are they essential for bone health?

OBJECTIVE: We aim to evaluate how vitamin D-containing supplements affect the vitamin D status of children 1-3 years old and to assess the variation of the vitamin D concentrations across different seasons. METHODS-MATERIAL: This retrospective study included a review of medical reports of 1035 patients (aged 1-3 years) who presented to our hospital between October 2011 and October 2013. The children were divided into 3 groups: Group 1: those supplemented with vitamin D3 (400 IU/day), Group 2: those supplemented with multivitamins, which included 200-400 IU/day of vitamin D2 or D3, and Group 3, the controls: those not supplemented with vitamin D. The groups were compared as to their biochemical findings and variation of vitamin D status with over four seasons. RESULTS: Gender distribution was not statistically different between the three groups (p=0.38). The children who had taken vitamin D-containing supplements had significantly higher vitamin D levels compared with the children who were given no vitamin D supplementation (p<0.001). Children with no vitamin D supplementation had significantly lower calcium and phosphorus levels compared with Groups 1 and 2. Vitamin D levels were affected by vitamin D supplementation (f=16.125, p<0.001) but not by season (f=0.699, p=0.650). CONCLUSION: The children aged 1-3 years who did not receive vitamin D-containing supplements had insufficient vitamin D and low levels of calcium and phosphorus. Vitamin D levels were affected by vitamin D supplementation but not by season.

Correlation of Brain Neuropeptide (Nesfatin-1 and Orexin-A) Concentrations with Anthropometric and Biochemical Parameters in Malnourished Children.

OBJECTIVE: Malnutrition continues to be a leading cause of stunted growth in many countries. This study aimed to investigate serum nesfatin-1 and orexin-A levels in underweight children and the potential correlations of these levels with anthropometric and nutritional parameters. METHODS: The study enrolled 44 prepubertal children (between 2 and 12 years of age) with thinness grades of 1-3 and 41 healthy age- and gender-matched children. The demographic, clinical and laboratory parameters including nesfatin-1 and orexin-A concentrations were compared between the two groups. The correlations of nesfatin-1 and orexin-A with biochemical and anthropometric parameters were investigated. The receiver operating characteristic (ROC) analysis were also performed for evaluating nesfatin-1 and orexin-A in distinguishing children with malnutrition from healthy controls. RESULTS: Thyroid-stimulating hormone, vitamin B12 and insulin levels were significantly lower in the study group than controls (p=0.001, p=0.049 and p=0.033, respectively). Mean nesfatin-1 levels in the malnourished group was also significantly lower compared to the healthy controls (3871.2 ± 1608.8 vs. 5515.0 ± 3816.4 pg/mL, p=0.012). No significant difference was observed in the orexin-A levels between the two groups (malnourished vs. control groups: 1135.7 ± 306.0 vs. 1025.7 ± 361.6 pg/mL, p=0.141). Correlation analyses revealed a positive correlation of nesfatin-1 and a negative correlation of orexin-A with body mass index (BMI) z-score. ROC analysis demonstrated that nesfatin-1 and orexin-A cannot be used to distinguish children with malnutrition from healthy controls (AUC: 0.620, p=0.061 for nesfatin-1 and AUC: 0.584, p=0.190 for orexin-A). CONCLUSION: The positive correlation of nesfatin-1 and the negative correlation of orexin-A with BMI suggest that these neuropeptides may be a part of a protective mechanism in the maintenance of nutritional status and that they may have a role in regulating food intake in undernourished children.

Relationship Between Functional Exercise Capacity and Lung Functions in Obese Chidren.

OBJECTIVE: Cardiovascular, respiratory and musculoskeletal system disorders which may affect the functional exercise capacity are common in obese patients. We aimed to investigate the functional exercise capacity and its relationship with functional pulmonary capacity in obese children. METHODS: A total of 74 obese and 36 healthy children as a control group were enrolled in the study. Pulmonary functions and functional exercise capacity were measured by spirometry and six-minute walk test (6 MWT), respectively. RESULTS: The distances covered during the 6 MWT in obese and control groups were 570.9 ± 67.5 and 607.8 ± 72.5 meters, respectively (p=0.010). In spirometric pulmonary function tests (PFTs), forced expiratory volume in 1 sec (FEV1) and forced mid-expiratory flows (25-75) were lower in the obese group (p=0.048 and p=0.047, respectively), whereas forced vital capacity (FVC), the FEV1/FVC ratio and peak expiratory flow were not statistically different between the obese and control groups. Multiple regression analysis revealed that among all parameters of anthropometric measures and PFTs, only body mass index standard deviation score (BMI-SDS) was the independent factor influencing 6 MWT. CONCLUSION: Functional exercise and lung capacities of obese children were diminished as compared to those of non-obese children. The most important factor influencing functional exercise capacity was BMI-SDS.

Determination of early urinary renal injury markers in obese children.

BACKGROUND: Obesity is an important health issue, the prevalence of which is increasing in childhood. The aim of this study was to examine urinary renal injury markers in order to determine the renal effect of obesity and its comorbidities in a pediatric population. METHODS: Eighty-four obese children and 64 healthy control subjects were enrolled in the study. We checked their urine using N-acetyl-beta-D-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and microalbumin as renal injury markers. Associations of renal damage markers with hypertension, an impaired glucose tolerance test, and insulin resistance were assessed. RESULTS: Obese individuals had higher urinary NAG and KIM-1 values compared to those of healthy controls (p = 0.027, p = 0.026). There was no difference in urinary NGAL between obese and lean subjects (p = 0.885). Urinary renal injury markers were not statistically different in the obese group when checked for impaired glucose tolerance, insulin resistance, and hypertension (p > 0.05). CONCLUSIONS: This study shows that urinary NAG and KIM-1 could be used as a screening method for detection of early renal damage in obese children.

The effect of obesity degree on childhood pulmonary function tests.

BACKGROUND: Childhood obesity has become a global epidemic. It is related to several chronic diseases such as essential hypertension, type 2 diabetes mellitus, and renal disease. The relationship between the degree of obesity and lung functions is well defined in adults, but limited information is available about the childhood period. AIMS: This study aims to determine the impact of the degree of obesity on the pulmonary functions of school children and adolescents. STUDY DESIGN: Cross sectional study. METHODS: Included in the study were a total of 170 school children and adolescents (9-17 years old) referred to our paediatric outpatient clinic. Of these subjects, 42 were lean and non-obese (BMI % <85), 30 subjects were overweight (BMI % >85, <95), 34 subjects were obese (BMI % >95, <97), and 64 subjects were morbidly obese (BMI % >97). Anthropometric measurements were taken and spirometry was performed on all subjects. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced vital capacity 25-75 (FEV25-75) and peak expiratory flow (PEF) were used to measure the ventilatory functions for all the subjects. RESULTS: The groups showed no significant differences in age or gender. Despite no statistically significant differences in FEV1, FVC, or FEV1/FVC, there were significant reductions in PEF (p<0.001) and FEV25-75 (p<0.001) in the overweight, obese and morbidly obese subjects, when compared with those who were non-obese. CONCLUSION: Overweight, obese and morbidly obese children have no obstructive abnormalities compared with healthy lean subjects.

Serum paraoxonase activity and oxidative stress and their relationship with obesity-related metabolic syndrome and non-alcoholic fatty liver disease in obese children and adolescents.

OBJECTIVE: Oxidative stress has been reported to be involved in the pathogenesis of metabolic disorders related with obesity. The aim of the study was to investigate the association of oxidative stress and paraoxonase activities with non-alcoholic fatty liver disease (NAFLD) as well as metabolic syndrome. MATERIALS AND METHODS: A total of 109 obese children and adolescents and 44 healthy and lean control subjects were enrolled in the study. According to their ultrasonographic steatosis scores, they were classified into four groups as follows: healthy children; obese, non-NAFLD; obese, grade I-NAFLD; and obese, grade II-III NAFLD. The biochemical parameters and insulin resistance (HOMA-IR) were evaluated from fasting samples. The plasma total antioxidant status (TAS), total oxidant status (TOS), and serum paraoxonase activities were measured and then oxidative stress index (OSI) was calculated as the indicator of degree of oxidative stress. RESULTS: As the steatosis increased, the alanine aminotransferase, C-reactive protein, HOMA-IR, total cholesterol, and LDL cholesterol increased, whereas HDL cholesterol decreased. The TAS measurements were higher in the obese NAFLD group compared with that of the healthy control group. The TOS and OSI measurements did not differ between the groups. Paraoxonase activities increased significantly as steatosis increased. CONCLUSIONS: Among the children in this study, no relationship could be demonstrated between obesity with/without steatosis and oxidant/antioxidant status.

Thyroid hormone levels in obese children and adolescents with non-alcoholic fatty liver disease.

OBJECTIVE: We aimed to determine the association of thyroid functions with the components of metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) in pediatric obese patients. METHODS: The study included 109 obese children (aged 9-15 years) and a control group of 44 healthy age and gender-matched children of normal weight. NAFLD was diagnosed by conventional ultrasound examination. We assessed the anthropometric data and serum biochemical parameters including lipid profile, alanine aminotransferase (ALT), fasting glucose and insulin levels and thyroid stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) levels. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated as a measure of IR. RESULTS: The mean age and gender distributions in the groups were similar (p=0.23). The mean body mass index (BMI) z-scores of obese children with grade 2-3 NAFLD were significantly higher than those of the obese children without hepatic steatosis (p<0.001). Mean ALT, triglyceride (TG) and LDL cholesterol increased and HDL-cholesterol significantly decreased as the hepatic steatosis increased (p<0.05). HOMA-IR levels in obese subjects with grade 2-3 NAFLD were significantly higher than those in both obese children without NAFLD and grade 1 NADFL (p=0.05 and 0.001, respectively). In the obese subjects, TSH levels were increased significantly as the degree of steatosis increased (p=0.04) but fT3 and fT4 levels were not different. In correlation analysis, TSH was significantly correlated with ALT, BMI SDS and the degree of steatosis. CONCLUSIONS: Obese children demonstrate an increase in TSH levels as the degree of steatosis increased.

Myeloperoxidase 463 G>A and superoxide dismutase Ala16Val gene polymorphisms in obese children.

The aim of the study was to determine the role of MnSOD Ala16Val and MPO G-463A gene polymorphisms in the pathogenesis of metabolic syndrome in obese children. A total of 97 obese children with insulin resistance and, as a control group, 96 healthy children were enrolled in the study. In the obese group, AA, AV and VV genotype frequencies of the MnSOD gene and GG, GA and AA genotype frequencies of the MPO gene were not significantly different from the frequencies found in the control group (p=0.555 and 0.530, respectively). In the obese group, children who carry both VV (for MnSOD) and GG (for MPO) alleles (n= 26) had higher HOMA-IR levels (6.51 ± 3.91 vs 5.03 ± 2.12) than those of all other genotype combinations (n=71) (p=0.013). Children who have the maximum risk of developing oxidative stress with the combination of the VV (for MnSOD) and GG (for MPO) genotypes had higher HOMA-IR levels, suggesting these polymorphisms may lead to insulin resistance.

Carotid intima-media thickness and flow-mediated dilation in obese children with non-alcoholic fatty liver disease.

BACKGROUND/AIMS: This study aimed to understand the role of non-alcoholic fatty liver disease (NAFLD) in increasing the risk of atherosclerosis in obese pediatric patients. MATERIALS AND METHODS: The study included 109 obese children (age, 9-15 years) and a control group comprising 44 healthy age- and gender-matched children with normal weight. NAFLD was diagnosed using conventional ultrasound (US) examination. Both right carotid intima-media thickness (CIMT) and flow-mediated dilation (FMD) were assessed in addition to anthropometric measures and serum biochemical parameters, including lipid profile and fasting glucose and insulin levels. Homeostatic model assessment of insulin resistance (HOMA-IR) was calculated as a measure of insulin resistance. RESULTS: Mean age and gender distributions were similar in the obese children and control group (p=0.168 and p=0.705, respectively). Median body mass index standard deviation scores of obese children with grade II-III NAFLD were significantly higher than those of obese children without hepatosteatosis (p<0.001). Median total cholesterol levels were similar in all the groups (p=0.263). Low-density lipoprotein cholesterol and triglyceride levels increased and high-density lipoprotein cholesterol levels decreased significantly as the grade of steatosis increased (p<0.001, p<0.05, and p=0.05, respectively). Median alanine aminotransaminase (ALT) and HOMA-IR levels of obese children with grade II-III NAFLD were significantly higher than those of obese children without NAFLD (p=0.01) and obese children with grade I NAFLD (p=0.001). CIMT was significantly correlated with the grade of steatosis (p<0.001) and level of ALT (p=0.005). Linear regression analysis showed that the grade of hepatosteatosis had a significant effect on CIMT. FMD decreased as the grade of hepatosteatosis increased, but it did not reach a significant level. CONCLUSION: The obese children with hepatosteatosis showed increased CIMT, as indicated by the grade of steatosis, compared with healthy controls and obese children without hepatosteatosis. FMD was not superior to CIMT in predicting the risk of early atherosclerosis.

Vitamin d deficiency and insufficiency in obese children and adolescents and its relationship with insulin resistance.

Objectives. We aimed to determine the relationship between insulin resistance and serum 25-hydroxyvitamin D (25-OHD) levels in obese children and their nonobese peers. Materials and Methods. Included in the study group were 188 obese children (aged 9-15 years), and 68 age- and gender-matched healthy children of normal weight as control group. Anthropomorphic data were collected on patients and fasting serum glucose, insulin, serum lipids, alanine aminotransaminase (ALT) and 25-OHD were measured. The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated in both groups. Results. The levels of 25-OHD in the obese group were significantly lower than those of the nonobese (P = 0.002). HOMA-IR, triglycerides, low-density lipoprotein, and ALT levels in the obese group were significantly higher than values of control group (P < 0.001 and P = 0.002, resp.). In the obese group, vitamin D deficiency, insufficiency, and sufficiency (25-OHD < 10 ng/dl, < 20, >10 ng/dl; > 20 ng/dl, resp.) were not correlated with HOMA-IR (r : -0.008, P = 0.935). HOMA-IR was negatively correlated with BMI, BMI SDS, and BMI%, and triglycerides, low-density lipoprotein, and ALT levels (P < 0.001). Conclusion. The insulin resistance of the obese subjects who were vitamin D deficient and insufficient did not statistically differ from those with vitamin D sufficiency. Low 25-hydroxyvitamin D levels were not related with higher insulin resistance in obese children and adolescents. In obese subjects, insulin resistance was affected more from BMI, BMI SDS, and BMI% than from 25-hydroxyvitamin D levels.