First body fat percentiles for 607 children from Thessaloniki-Northern Greece.

BACKGROUND AND AIM: The purpose of this study was to establish for the first time reference curves for body fat levels in a Greek pediatric population aged 7-15y. METHODS: Six hundred and seven (607) children randomly selected from 8 primary and secondary schools from Northern Greece. Percentage body fat was measured by bioelectrical impedance analysis and percentile curves were constructed using the LMS method. All children were measured twice in the morning and the mean number of the two measurements was considered as the percentage of body fat. RESULTS: The mean number of the percentage body fat for the age group (7-9) was 18.2 ± 5.1 and 18.4 ± 6.1 for boys and girls, respectively. In the second age group (10-12) the girls had higher mean fat levels than boys (22.6 ± 5.8 vs. 20.4 ± 6.2). This increase was continued also in the third age group (13-15) with the girls having higher mean body fat levels (24.2 ± 5.5 vs. 17 ± 5.9). The 85th and 95th percentiles represented the cut-off point for overweight and obesity and it was (26.3, 33.0 and 28.9%) and (34.0, 38.2 and 38.1) for boys for the three age groups (7-9, 10-12 and 13-15), respectively. On the other hand, the girls had higher 85th and 95th percentiles for the same age group (7-9, 10-12, 13-15y) and it was (34.5, 32.9 and 33.6%) and (39.0, 370 and 38.3%), respectively. CONCLUSION: Body fat level, which is the component of overweight that leads to pathology, is a better representative over body mass index. These first percentile curves will be at great assistance helping the medical community to identify obesity in these children at early stages and to prevent development at pathological diseases early in their lives.

Effects of oral folate supplementation on serum total homocysteine and cholesterol levels in hyperhomocysteinemic children.

BACKGROUND: Hyperhomocysteinemia may be a risk factor for cardiovascular disease even among children. Increased levels of total serum homocysteine (tHcy) may initiate atherosclerosis by modulating increased cholesterol synthesis in the liver. Folate supplementation has been found to reduce homocysteine levels. However, no data have been reported about the relationship between folate supplementation and cholesterol levels in children. METHODS: Twenty of 26 hyperhomocysteinemic (>95th percentile for age) children underwent a therapeutic intervention of 5 mg of oral folate supplementation twice per week for 2 months. RESULTS: After the 2-month intervention with folate supplement, tHcy levels were statistically significantly decreased (P < .001), folate levels were significantly increased (P < .001), while total cholesterol levels were significantly improved from 183.8 (115-296 mg/dL) to 160.8 (109-265 mg/dL) (P < .05). CONCLUSIONS: Folate supplementation may reduce tHcy, serum folate, and total serum cholesterol levels in hyperhomocysteinemic children.

Oral supplementation of folic acid for two months reduces total serum homocysteine levels in hyperhomocysteinemic Greek children.

BACKGROUND & AIM: Hyperhomocysteimemia is a cardiovascular risk factor even among children. Supplementation of oral folic acid may reduce homocysteine levels to normal. However, data is limited at this point for healthy children and adolescents. METHODS: Five hundre and twenty four children participated in the study; Twenty six of them were found to be hyperho mocysteinemic(>95(th) percentile for age). Twenty of them received 5 mg of folic acid twice per week for two consecutive months while the other six received a diet rich in dietary folate. RESULTS: Serum homocysteine levels were statistically significantly decreased from 13.1 (10-24.2 micromol/L ) to 7.7 (4.9- 15.2 micromol/L), p<0.001. Serum folate levels were significantly rose from 4.3 (3-20 ng/mL) to 16.8 (7-20 ng/mL), p<0.001. On the contrary, no important changes were observed in the above parameters in children to whom a diet rich in folic acid was recommended. Homocysteine levels were found to be positively associated with age (r=0.314, p<0.001), BMI (r=0.192, p<0.001), WC (r = 0.215, p<0.001), simple sugars (r= 0.182, p<0.001 ) and negatively associated with folic acid (r = -0.331, p<0.001), vitamin B12 (r = -0.214, p<0.001) and dietary folic acid (r= -0.228, p=0.003). CONCLUSIONS: Oral folic acid 5 mg twice per week may efficiently reduce serum homocysteine levels and increase serum folic acid levels in healthy children with increased homocysteine levels (>95(th) percentile for age). Hyperhomocysteinemia in childhood may be a predictive factor of cardiovascular disease. In addition, these results may offer more help to health practioners in order to establish more prospective studies to elucidate the relationship between homocysteine, folic acid and heart disease in children.

The role of vitamin D receptor activation in chronic kidney disease.

The death rate from cardiovascular disease for dialysis patients is much higher than the general population, regardless of age. Observational data indicate that there is a close inter-relationship between progressive renal dysfunction in patients with chronic kidney disease cardiovascular disease and mortality. Continuously evidence indicates that deficiencies in vitamin D receptor activation represents one of key players in adversely affecting cardiovascular health, as well as inducing to secondary hyperparathyroidism in chromic kidney disease patients. Vitamin D receptors are widely expressed throughout the body and modulations of vitamin D levels results in correlative regulatory effects on mineral metabolism homeostasis, cardiovascular disease, and vascular calcification. The management of SHPT has developed enormously in recent years and different drug classes are available to treat this disease. Potentially, selective VDR activators not only reduce serum parathyroid hormone levels minimizing the risk of hypercalcemia and hyperphosphatemia, but also may improve patient health, reducing the risk of cardiovascular disease.

Homocysteine lowering with folic acid supplements in children: effects on blood pressure.

Hyperhomocysteinemia is emerging as an independent predictor of cardiovascular disease and hypertension among children. The aim of the study was to examine the effects of oral folic acid on homocysteine and blood pressure. Folic acid supplementation has been found to reduce homocysteine levels and in some cases blood pressure. Five hundred and twenty children participated in the study, and 26 of them were found to be hyperhomocysteinemic; 20 of these children randomly received 5 mg oral folic acid supplement while the other six children were the controls. Serum homocysteine (P < 0.001) levels as well as systolic (P < 0.001) and diastolic (P = 0.045) blood pressure were statistically significantly decreased in the intervention group compared with the controls, while folic acid levels were statistically significantly increased (P < 0.001). Total serum homocysteine levels were correlated with age, serum folate, body mass index, and blood pressure. It appears that folic acid may be a safe and effective supplement to reduce homocysteine and possibly blood pressure, which consequently may prevent cardiovascular disease in children in early life.

Adaptation and validation of the Kidney Disease Quality of Life-Short Form questionnaire in the Greek language.

AIM: The aim of this study was to examine the validity, reproducibility and internal consistency of a Greek translation of the Kidney Disease Quality of Life-Short Form (KDQOL-SF) questionnaire. METHODS: The KDQOL-SF questionnaire was translated from English to Greek and was administered in 240 randomly selected patients undergoing hemodialysis in six Renal Units in Greece. The instrument's validity was tested by examining the association between patient's KDQOL-SF scores and comorbidity assessed with the Index of Coexistent Disease. Reproducibility was examined by readministering the questionnaire in 50 randomly selected patients within 1 month. Internal consistency was assessed by estimating Cronbach's alpha coefficient. RESULTS: Patients were divided into two groups according to the severity of comorbidity assessed with the Index of Coexistent Disease. Those with less comorbid conditions had significantly higher scores in most components of the KDQOL-SF questionnaire, confirming its validity. The correlation coefficients between the two administrations of the instrument ranged from 0.88 to 0.98 for each of the main components, which was above the desired level of 0.85. Cronbach's alpha coefficient ranged from 0.91 to 0.92 for the various components, values well above the minimum desired 0.70 level. CONCLUSIONS: The present study shows that the Greek version of the KDQOL-SF questionnaire has high validity, reproducibility and internal consistency. Production of validated translations of the KDQOL-SF questionnaire in various languages will help promote health-related quality of life of end-stage renal disease patients all over the world.

Coagulation factors as biological risk markers of endothelial dysfunction. Association with the thrombotic episodes of chronic hemodialysis patients.

BACKGROUND AND AIM: The aim of our study was to assess the coagulation factors as endothelial dysfunction markers and prospectively their association with thrombotic episodes in chronic hemodialysis patients. PATIENTS AND METHODS: Fifty-four randomly selected patients on chronic hemodialysis (HD), 34 men and 20 women were included in this study. Their mean age was 56 years and the mean hemodialysis duration was 53.0861.92 months. The variations of tissue factor pathway inhibitor (TFPI), thrombomodulin (TM) and von Willebrand factor (vWF) were studied. The above-mentioned parameters were measured before and after HD session. Low molecular weight heparin (tinzaparin) was administered to all patients during hemodialysis. The results were compared with those obtained from 20 healthy volunteer-controls, age and sex matched. After the initial assessment, all patients were followed for a period of 15 months. RESULTS: Two patients experienced one hemorrhagic event each, regarding the upper and/or the lower gastrointestinal tract. Twenty patients showed at least one thrombotic episode. Eleven patients presented fistula thrombosis, four angina pectoris incidents and five thrombosis of the lower limbs. The rest of the patients did not experience any clinical symptomatology that could be attributed to coagulation disorders. Parameter differences between patients and controls were statistically significant (p<0.005 for TFPI and p<0.001 for TM and vWF) and were improved after hemodialysis session. The age and the elevated levels of the vWF were found to be significantly different (p<0.03 and p<0.02 respectively) between the groups of patients who experienced or not thrombotic episodes. CONCLUSIONS: Coagulation factors TFPI, TM, and vWF are increased in hemodialysis patients and the clinical disorders are mainly thrombotic episodes. The age of patients and the elevated levels of vWF are associated with the thrombotic incidents. Hemodialysis contributes in the improvement of these coagulation factors, which could be considered as biological risk markers of endothelial dysfunction in chronic HD patients.

Childhood and parental obesity in the poorest district of Greece.

BACKGROUND AND AIM: Childhood obesity represents a rising threat in southern Europe. It is widely accepted that childhood obesity is an important risk factor for the appearance of obesity in adulthood. Our aim was to estimate the prevalence of obesity in school aged children living in one of the poorest districts of Europe, as well as to estimate the association between the frequency of obesity observed in these children and their parents. MATERIAL AND METHODS: We examined and calculated the body mass index (BMI) in 107 children aged 12.2+/-0.78 years. BMI was adjusted for age and sex and it was correlated with children parents' weight status. RESULTS: Obesity was diagnosed in 16% of the children. The relationship between children's and their parents weight status was very strong. In 40% of the obese parents, their children were found to be obese also (p<0.001). CONCLUSION: In the present study a strong relationship between children weight status and their parents' weight status was confirmed. Additionally, this correlation was proven at a district with very low house income. Knowing that it is easier to prevent obesity, rather than to cure it, our aim should be, when a child is brought to the doctor, independently of the cause, to assess both the child as well as its parents' weight status.

Prevalence of hypertension and association of dietary mineral intake with blood pressure in healthy schoolchildren from northern Greece aged 7-15 years.

BACKGROUND AND AIMS: Pediatric hypertension is urgently increasing in Greece. The purpose of this study is to record the prevalence of hypertension in schoolchildren and to relate dietary minerals to blood pressure (BP). METHODS AND RESULTS: 308 males and 298 females, aged 7-15 years, from 10 schools in Northern Greece participated in the study. BP and dietary minerals were measured in all children. Twenty-seven and 12.3% of boys and 21.2 and 15.1% of girls were diagnosed with prehypertension systolic BP and systolic hypertension, respectively. For diastolic BP, 19 and 13.3% of boys and 21.5 and 15.1% of girls were diagnosed with prehypertension diastolic BP and diastolic hypertension, respectively. Systolic BP was significantly positively associated with age (beta: 0.283, 95% CI: 1.440-2.484, p < 0.001), BMI (beta: 0.267, 95% CI: 0.830-1.489, p < 0.001) and potassium (beta: 0.139, 95% CI: 0.001-0.005, p < 0.001) and negatively related to Ca (beta: -0.160, 95% CI: -0.012 to 0.002, p = 0.007). Diastolic BP was positively related only to BMI (beta: 0.194, 95% CI: 0.380-0.968, p < 0.001). CONCLUSION: The current study tried to estimate the prevalence of hypertension among children in Northern Greece. Early prevention through nutrition education programs on BP that include diet and exercise modifications is urgently needed in order to avoid certain chronic risk factors in early life.

Angina pectoris and intensive intravenous iron treatment in hemodialysis patients.

BACKGROUND: Intravenous iron and erythropoietin are commonly used for the treatment of anemia in end stage renal disease (ESRD) patients. Even though i.v. iron is proven to be very effective, there is great concern regarding its possible toxic effects. The aim of our study was to evaluate the possible correlation between iron administration and the incidence of angina pectoris in hemodialysis patients. METHODS: The study sample consisted of 10 stable coronary heart disease patients, receiving chronic hemodialysis treatment. The patients followed consecutively three different i.v. iron dose regimens according to their needs. Their standard monthly laboratory measurements were correlated with the incidence of angina pectoris and i.v. iron treatment. RESULTS: Hematocrit, ferritin, serum iron and mean rhEPO dose were related to the total amount of administered iron. Angina pectoris was related to intensive iron treatment, age and platelet count. Total white blood cell count were related to hemodialysis duration, platelet count and serum triglycerides. CONCLUSION: It is suggested that the intensive intravenous iron treatment (300 mg/week) is associated with the increased incidence of angina pectoris in stable coronary heart disease patients receiving hemodialysis.

[Posttraumatic duodenal lesions in children. The therapeutic considerations]. / Leziunile posttraumatice ale duodenului la copil. Consideratii terapeutice.

The posttraumatic lesions of the duodenum in children represent rare cases in the surgical field. 4 cases of duodenal lesions were registered and operated upon in the Pediatric Surgery and Orthopedic Clinic, in cooperation with the ICU Clinic, 2 of them having postoperative complications (duodenal fistulae), these cases being initially situated in a retroperitoneal position (lateral and posterior). The ICU therapy was directed in the first step towards the traumatic and septic shock, in the second one to the immediate postoperative care and in the third step towards late complications. For the 2 cases having postoperative complications, the care was directed towards the elements of local complications (retroperitoneal abscess, fistulae), MSOF, sustaining the immune system correcting the nutritional deficiencies. Surgical methods used for sustaining the ICU therapy were: endovenous catheterisation, gastro-duodenal aspiration, solving the fistulae through catheters and suture. The results, using the methods described above, were good.