Subclass distribution of low-density lipoprotein triglyceride and the clustering of metabolic syndrome components in Japanese children.

BACKGROUND: Recent studies demonstrated that low-density lipoprotein-tryglyceride (LDL-TG) may represent another marker of cardiovascular risks. We therefore measured LDL-TG including the low-density lipoprotein (LDL) subclass distribution and investigated the association between LDL-TG subclass profile and the clustering of metabolic syndrome (MetS) components and insulin resistance in Japanese children. METHODS: The study included 237 schoolchildren (boys 115, girls 122). Four subclasses of low-density lipoprotein-tryglyceride (large, medium, small, and very small) was quantified using high-performance liquid chromatography. Total LDL-TG and TG levels in LDL subclasses were evaluated among four MetS component groups; non-abdominal obesity, abdominal obesity, pre-MetS, and MetS. RESULTS: Total LDL-TG (P = 0.0003, P = 0.0175) and triglyceride levels in LDL subclasses were significantly different among four MetS component groups (large: P = 0.0002, P = 0.0084; medium: P = 0.0009, P = 0.0491; small: P =0.0025, P = 0.0509; very small: P = 0.0808, P = 0.0228; boys and girls, respectively). Total LDL-TG (r = 0.411, P < 0.0001, r = 0.378. P < 0.0001) and triglyceride levels in LDL subclasses correlated positively with the homeostasis model of assessment ratio (large: r = 0.396, P < 0.0001, r = 0.346, P < 0.0001; medium: r = 0.274, P = 0.0030, r = 0.228, P = 0.0115; small: r = 0.342, P = 0.0002, r = 0.292, P = 0.0011; very small: r = 0.385, P < 0.0001, r = 0.426, P < 0.0001, boys and girls, respectively). CONCLUSIONS: Subclass distribution of LDL-TG was significantly associated with the clustering of MetS components in both sexes, and insulin resistance is a significant determinant of LDL-TG in all LDL subclasses. Lipoprotein-tryglyceride subclass analysis, rather than LDL-C, may provide a precise evaluation for cardiovascular disease risks in children with MetS.

The Characteristics Of Abdominal Fat Distribution In Japanese Adolescents With Type 2 Diabetes Mellitus.

PURPOSE: The aim was to investigate the characteristics of abdominal fat distribution in Japanese adolescents with type 2 diabetes mellitus. PATIENTS AND METHODS: Eighty-six Japanese adolescents with simple obesity or type 2 diabetes mellitus treated between 2002 and 2018 were included. The subjects were classified into the simple obesity group (SO group, n=38) and type 2 diabetes mellitus group (DM group, n=23) by matching average age and gender ratio. The metabolic parameters VFA, SFA, and V/S ratio were compared between the 2 groups. Multivariate logistic regression analysis was performed to identify clinical factors associated with type 2 diabetes mellitus. Linear regression analysis was performed between hemoglobin A1c (HbA1c) and visceral fat area (VFA), subcutaneous fat area (SFA), or VFA-to-SFA ratio (V/S ratio) among all enrolled subjects. Finally, correlation analyses were performed to determine the relationships between VFA, SFA, and V/S ratio and metabolic parameters of the DM group. For the metabolic parameters, serum lipids, alanine aminotransferase (ALT), and HbA1c were measured without fasting. The VFA and SFA at umbilical level were investigated using computed tomography. RESULTS: VFA and V/S ratio in DM group were higher than those in SO group (p=0.04 and p<0.01, respectively). SFA in DM group was lower than that in SO group (p<0.01). VFA and SFA, and non-high density lipoprotein (HDL) cholesterol were identified as being independently associated with type 2 diabetes mellitus (odds ratio, 1.05, 0.98, and 1.04, respectively, p<0.05). HbA1c was correlated with VFA and V/S ratio (p<0.01). In DM group, VFA and SFA were positively correlated with systolic blood pressure (p<0.01), ALT (p<0.05), total cholesterol (p<0.05), and non-HDL cholesterol (p<0.01); however, V/S ratio was not correlated. CONCLUSION: Abdominal fat distribution in Japanese adolescents with type 2 diabetes mellitus was different from those with simple obesity and might associate with glucose and lipid metabolism.

Effect of dalteparin, a low-molecular-weight heparin, as adjunctive therapy in patients with Kawasaki disease: a retrospective study.

BACKGROUND: Dalteparin, a low-molecular-weight heparin, has anticoagulant and anti-angiogenic activity. This study investigated whether dalteparin reduced coronary artery lesion (CAL) prevalence, and resistance to intravenous immunoglobulin (IVIG) therapy in Kawasaki disease (KD). METHODS: This retrospective study comprised two parts. In the first cohort, 126 patients with KD (68 male, 58 female; median age: 22 months, range: 1-67 months) admitted to Nihon University Nerima-Hikarigaoka Hospital from January 2004 to June 2008, received either dalteparin 75 IU/kg/day, IVIG 400 mg/kg/day for 5 consecutive days, and aspirin 30 mg/kg/day, or dalteparin 75 IU/kg/day and aspirin 30 mg/kg/day, until clinical improvement. Control data came from the 2005-6 Nationwide KD survey. In the second cohort, 112 patients with KD (59 male, 53 female; median age: 19 months, range: 1-66 months) admitted from June 2010 to February 2012, received either dalteparin 75 IU/kg/day, IVIG 2.0 g/kg over 12 h, and aspirin 30 mg/kg/day, or dalteparin 75 IU/kg/day and aspirin 30 mg/kg/day. Control data came from the 2009-10 Nationwide KD survey. No patients enrolled in the nationwide surveys received dalteparin. All patients at our institution were given dalteparin in their combination therapy. RESULTS: A comparison of the first cohort with controls in the nationwide survey showed that the prevalence of initial administration of IVIG was 80.2% versus 86.0%; the rate of additional IVIG administration was 7.1% versus 14.0% (p = 0.03); CAL prevalence in the acute period was 4.8% versus 11.9% (p < 0.01); and the prevalence of cardiovascular sequelae was 0% versus 3.8% (p < 0.05). A comparison of the second cohort with controls in the nationwide survey showed that the rate of initial administration of IVIG was 92.9% versus 89.5%; the rate of additional IVIG administration was 8.9% versus 17.1% (p = 0.02); the prevalence of resistance to IVIG was 3.6% versus 14.9% (p < 0.001); and CAL prevalence in the acute period was 2.7% versus 8.6% (p = 0.03). CONCLUSIONS: This study found that adjunctive dalteparin was associated with a lower prevalence of IVIG resistance and CAL in young children with KD. TRIAL REGISTRATION UMIN-CTR: UMIN000010349.

Apolipoprotein A-V level may contribute to the development of obesity-associated dyslipidemia.

AIM: In a mice study, insulin suppressed apolipoprotein A-V (apoA-V) gene expression in a dose dependent manner. Thus, we investigated the association between apoA-V levels and dyslipidemias in obese children with hyperinsulinemia. METHODS: The subjects were 17 obese children (15 male, 2 female) aged 11.8 ± 2.4 years. Total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), triglyceride (TG), apoA-V and insulin levels were determined. RESULTS: Obese children with hyperinsulinemia had greater percent overweight, higher TG level, lower HDLC level and lower apoA-V level than those without hyperinsulinemia. In simple regression analysis, apoA-V level correlated negatively with TG (r = -0.613, p = 0.0152) and insulin levels (r = -0.566, p = 0.0279), and positively correlated with HDLC (r = 0.811, p = 0.0002). In stepwise regression analysis, insulin level emerged as the independent determinant of TG level after apoA-V level was taken into account, whereas apoA-V emerged as the independent determinant of HDLC level after adjusting for insulin level. CONCLUSIONS: Insulin may be a potent regulator of serum apoA-V level in obesity, and apoA-V level may partly contribute to the development of obesity-associated dyslipidemia.

Serum vitamin D concentrations and associated severity of acute lower respiratory tract infections in Japanese hospitalized children.

BACKGROUND: Vitamin D is an immunomodulatory molecule related to innate immunity that may contribute to the increased occurrence of acute lower respiratory infection (ALRI) in children, one of the most common reasons for hospitalization and intensive care unit admission. In the present study, the association between vitamin D deficiency and the severity of respiratory infection was evaluated by determining serum concentrations of 25-hydroxyvitamin D (25(OH)D) in a group of hospitalized children with ALRI. METHODS: Of the 28 children admitted to Nihon University Nerima-Hikarigaoka Hospital with ALRI over the period November 2008­May 2009, 26 were diagnosed as having bronchiolitis and two were found to have pneumonia. A competitive protein binding radioimmunoassay was used to determine serum 25(OH)D concentrations. RESULTS: Mean 25(OH)D concentrations in breast-fed children with ALRI (n = 7) were significantly lower than those in children with ALRI who were bottle fed/weaned (n = 6) or on a regular diet (n = 15; 14.6 ± 9.7, 28.9 ± 6.9 and 24.6 ± 8.8 ng/mL, respectively). There was a significant correlation between vitamin D deficiency (<15 ng/mL) and the need for supplementary oxygen and ventilator management. CONCLUSION: Significantly more children with ALRI who needed supplementary oxygen and ventilator management were vitamin D deficient. These findings suggest that the immunomodulatory properties of vitamin D may influence the severity of ALRI.

Henoch-schönlein purpura complicated by reversible posterior leukoencephalopathy syndrome.

We report a 7-year-old girl with Henoch-Schönlein purpura who developed hypertensive encephalopathy. She showed a sudden onset of neurological symptoms, including hypertension, convulsions, disturbance of consciousness, and cortical blindness. Reversible posterior leukoencephalopathy syndrome was diagnosed from the findings on magnetic resonance imaging. Reports of this syndrome in patients with Henoch-Schönlein purpura are very rare. However, if symptoms suggest central nervous system involvement, neuroimaging should be done for rapid diagnosis, and immediate treatment should be provided to avoid sequelae.

A pediatric patient with acute suppurative thyroiditis caused by Eikenella corrodens.

A previously healthy 6-year-old boy had continuous fever for 6 days before admission to our hospital. His general condition was good except for pyrexia. The left lobe of the thyroid gland was swollen, red, hot, and tender, and neck movement was limited. The provisional diagnosis was upper respiratory tract infection. We demonstrated the existence of an orifice of the left piriform sinus by esophagography in this case, and made a diagnosis of acute suppurative thyroiditis caused by a piriform sinus fistula in the hypopharynx. The causative organisms of acute suppurative thyroiditis include Peptostreptococcus, Staphylococcus haemolyticus, and α-streptococcus, but the organisms responsible are commonly undetectable in clinical cases. We detected Eikenella corrodens in the present patient. Although Eikenella species occasionally causes acute suppurative thyroiditis in adults, it is rare for this to happen in pediatric patients. Antibiotics were administered for 7 days. We also performed aspiration of the abscess on the 8th day of the illness. The abscess was reduced in size and tenderness was relieved after aspiration. In conclusion, if a pediatric patient has swelling, heat, tenderness, and redness of the anterior neck, we should keep in mind acute suppurative thyroiditis and the possibility of a fistula. If there is an abscess, we should immediately perform aspiration, culture, and isolation, and choose the appropriate antibiotics for the causative bacteria.

B-flow sonographic demonstration for assessing carotid atherosclerosis in young patients with heterozygous familial hypercholesterolemia.

PURPOSE: To determine whether bloodstream swirls detected with B-mode flow (B-flow) sonography at the region of the carotid bifurcation can predict the early progression of atherosclerosis, we prospectively examined the relationships between the size of bloodstream swirls as identified with B-flow sonography, the local mechanical behavior of the common carotid artery (CCA), and some cardiovascular risk factors in young patients with heterozygous familial hypercholesterolemia (FH). METHODS: Thirty-eight young patients (mean age 25.8 +/- 14.1 years) with FH were evaluated for the following parameters: age, sex, body mass index, degree of dyslipidemia, presence of a plaque, intima-media thickness (IMT), elastic modulus (Ep) and internal diameter of the CCA via duplex scan, wall shear stress, maximal diameter of the bloodstream swirl (Sm) at bifurcation, maximal diameter of the CCA (Cm) at the level of the swirl's center, and diameter ratio (Sm/Cm) via B-flow sonography. RESULTS: Bloodstream swirls of varying size at the site of bifurcation were observed in all patients. Six (15.7%) out of 38 patients exhibited plaques at bifurcation. All plaques were located at the far wall and were in contact with the distal portion of the bloodstream swirl as observed with B-flow sonography. Univariate analysis revealed that Sm/Cm and Sm were positively correlated with age, presence of a plaque, IMT, and Ep and were negatively correlated with shear stress. Multivariate analysis revealed that Sm was significantly correlated with age (P < 0.01) and Ep (P < 0.05). CONCLUSIONS: Our results suggest that a bloodstream swirl visualized at the carotid bifurcation with B-flow sonography may be an indicator of a local mechanism for the age-related progression of atherosclerosis in young patients with FH.

Assessment of individual changes in body fatness in boys during early pubertal period.

BACKGROUND: In order to know whether the changes in indexes of overweight, body mass index (BMI; kg/m2) and percentage of overweight (POW) (%), really represent the tendency toward obesity, we examined longitudinal individual changes in these indexes, and the change in body composition in boys during early pubertal period. METHODS: The subjects were 50 school boys who lived in Shizuoka, Japan. Standing height and weight were measured, and BMI and POW were obtained. Body fat percentage (BF%), fat mass (FM) and lean body mass (LBM) were estimated by bioelectrical impedance method. The influence of predictive variables (LBM, FM) on the changes in BMI and POW was investigated by multiple regression analysis. We examined the 3-year changes in BMI, POW and predictive variables in each individual, from 9 to 12 years of age. RESULTS: The mean change of BMI was 1.7 +/- 0.3 (mean +/- SEM) kg/m2 and that of POW was 2.2 +/- 1.9%. The influence of predictive variables on the changes in BMI and POW was determined. The variance of the change in POW could be explained by that in FM (r(2) = 0.737, P < 0.0001), while the change in BMI was influenced by both LBM and FM (r2 = 0.891, P < 0.0001). CONCLUSIONS: Based on the definition of obesity, POW is the better index of body fatness to assess its individual change for boys during early pubertal period, because the index independent from the change in LBM is supposed to be the appropriate index for obesity in practical use.