THE IMPACT OF THE DEGREE OF OBESITY ON METABOLIC PARAMETERS IN CHILDREN AND ADOLESCENTS.

The aim of our investigation was to determine the impact of the degree of obesity on metabolic characteristics in children and adolescents with metabolic syndrome. We studied 117 children and adolescents 8-15 years of age with BMI exceeded the 85th percentile for their age and sex and the complaints associated with obesity. Investigated patients were divided according BMI percentiles for age and sex established by the U.S. Centers for Disease Control and Prevention (CDC) as follows: Group 1. Overweight (OW; 85-94.99th percentiles, n=10); Group 2. Obesity of I degree (Ob1; 95-96.99th percentile, n=12); Group 3. Obesity of II degree (Ob2; 97-98.99th percentile, n=51); Group 4. Obesity of III degree (Ob3; >98.99th percentile, n=39). Plasma glucose levels (fasting plasma glucose - FPG, postprandial plasma glucose - PPG) were determined by glucose oxidase method and Serum lipid (total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol, Triglycerides) levels have been measured. Plasma C-peptide, fasting plasma insulin (FPI), postprandial plasma insulin (PPI) and Leptin levels were determined by Enzyme-linked Immuno-Sorbent Assay kits. Like adults, the children and adolescents in our study were classified as having the MS if they met three or more of the following criteria for age and sex: 1) a WC≥90th percentile or 1a) WC/Height≥0.05, 2) a triglyceride level above the 95th percentile, an HDL cholesterol level below the 5th percentile,3) systolic or diastolic blood pressure above the 95th percentile, and 4) impaired glucose tolerance or insulin resistance. Metabolic syndrome was diagnosed in 68 cases (out of 117; 58.12%). The results of FPG, PPG, FPI, PPI, serum C-peptide and HOMA-IR in groups shows that FPG and PPG have not significant difference in between groups (p=NS). FPI, PPI, C-peptide and HOMA-IR-were significantly increased by the increase of degree of obesity. The values of systolic BP are significantly higher in Ob2 and Ob3 rather that OV and Ob1 groups. It has not been detected significant difference between diastolic BP values. The levels of total cholesterol, VLDL-cholesterol, and Triglycerides are significantly lower in group 1 (OV) than analogous values of other obese groups. HDL-cholesterol was significantly sharply lower only in group 4. Triglyceride and leptin levels are sharply significantly higher in Ob3 group in comparison to others. The degree of obesity in children and adolescents has important clinical implications. Data on the prevalence of severe obesity in children and adolescents do not exist, to our knowledge. Our results show a significant adverse effect of worsening obesity on insulin resistance, glycemia, lipids and blood pressure, underscoring the deleterious effect of increasing BMI percentile.

THE IMPACT OF 12-MONTH GROWTH HORMONE REPLACEMENT THERAPY ON LIPID METABOLISM AND ADIPOSE TISSUE DISTRIBUTION IN GEORGIAN PATIENTS WITH ADULT GROWTH HORMONE DEFICIENCY.

Growth hormone deficiency (GHD) is one of the reasons of significant metabolic morbidities inchildren and adults. The aim of our study was to evaluate the impact of growth hormone (GH) replacement therapy on lipid profile and adipose tissue distribution in adults with GHD. Twenty hypopituitary adults, aged 40.75±2.2 years (mean ± SE, range 20.5-60), with adult onset GHD (aGHD) were enrolled in a randomized, double blind, placebo-controlled study. 10 patients received recombinant growth hormone injection once weekly for 12 months, and the rest 10 patients (as control group) received placebo. The patients were selected from the basis of National Institute of Endocrinology. After 12 months of treatment mean values of low density lipoprotein cholesterol (LDL-CH), total cholesterol (CH) and triglycerides (TG) were increased in GH treated patients, compared to the control group (median increase in LDL-CH, CH and TG were 0.1 mmol/l, 0.1 mmol/l and 0.3mmol/l, respectively). In contrast, the favorable effect was seen in high density lipoprotein cholesterol (HDL-CH) levels with the median increase of 0.2 mmol/l). Furthermore, there was an increase in adipose tissue distribution percentages, in GH treated patients (DXA: Legs +10.22%, Trunk: +7.43%, Android: +5.59%, Gynoid: +10.59%, Total body: +7.6%), compared to the control group, in which adipose tissue distribution was slightly improved or remained unchanged. Since the results of 12-month growth hormone treatment therapy did not show any improvements in lipid profile and adipose tissue distribution, the decision was made to prolong the study for the next 12 months.

ERECTILE DYSFUNCTION AS A PREDICTOR OF CARDIOVASCULAR DISEASE.

Endothelial dysfunction precedes the clinical stage of atherosclerotic disease and is recognized as an additional risk factor when detecting symptomatic patients. Endothelial function is largely mediated by nitric oxide, and this vasodilatory mechanism is also responsible for the venous and arterial dilatation required to obtain and maintain an erection. The physiological effects and clinical aspects of sexual function have been extensively studied and reported in patients who have angina or who have experienced a myocardial infarction and in those who have undergone coronary artery bypass graft surgery or heart transplant. The relationship between erectile dysfunction (ED) and the risk factors for coronary heart disease was noted in the Massachusetts Male Aging Study (MMAS). MMAS included 1290 men (aged 40-70 years) and reported a 52% incidence of some degree of ED. Sildenafil and other PDE-5(Phosphodiesterase type-5) inhibitors will eventually be developed for a number of cardiovascular indications including essential hypertension, endothelial dysfunction, ischemia/reperfusion injury, myocardial infarction, ventricular remodelling and heart failure. A recent clinical study suggested that PDE-5 inhibitors might be a new class of drug that can potentially be used for the treatment of essential hypertension. The unique mechanism of action and high efficacy of PDE5 inhibitors has generated immense interest among researchers dealing with sexual dysfunction. The recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise.