RESUMO
OBJECTIVES: To describe clinical presentation and long-term outcomes in a large cohort of children diagnosed with thiamine-responsive megaloblastic anemia (TRMA)-related diabetes. METHODS: Data from the Diabetes Patienten Verlaufsdokumentation (DPV) and Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference (SWEET) registries were used to identify cases. Complementary information was collected through a chart review of each case. Descriptive analyses with medians and interquartile ranges and numbers (proportions) were tabulated. RESULTS: We identified 23 cases (52% male) in the 2 registries. Eighteen (78%) had genetic confirmation of TRMA. Median age at diabetes onset was 1.4 (quartiles 0.8 to 3.6) years and median age at initiation of thiamine treatment was 5.9 (2.4 to 12.4) years. At their most recent visit, patients' median age was 14.3 (8.1 to 17.5) years, glycated hemoglobin level was 6.9% (6.1% to 7.9%), insulin dose was 0.9 (0.4 to 1.2) units/kg per day and thiamine dose was 200 (100 to 300) mg/day. Three patients were not treated with insulin or antidiabetic drugs. There was no difference in diabetes outcomes in patients with initiation of thiamine ≤1 year after diabetes onset compared to patients with initiation of thiamine >1 year after diabetes onset. CONCLUSIONS: This is the longest case series of pediatric TRMA-related diabetes reported to date. Diabetes onset often occurs several years before initiation of thiamine supplementation. Early initiation of thiamine (within 1 year of diabetes onset) was not linked to improved diabetes outcome. However, the role of thiamine in pancreatic function needs further assessment. Patients with TRMA-related diabetes maintained good glycemic control even after 9 years (median) of follow up.
Assuntos
Anemia Megaloblástica/complicações , Diabetes Mellitus/tratamento farmacológico , Tiamina/uso terapêutico , Adolescente , Criança , Estudos de Coortes , Diabetes Mellitus/etiologia , Feminino , Humanos , Masculino , Sistema de Registros , Resultado do TratamentoRESUMO
AIM: To determine the prevalence of inflammatory bowel disease (IBD) in patients with type 1 diabetes (T1D) and to characterise patients with both diseases. METHODS: Data of 65.147 patients with T1D ≤18 years of 379 centres in Germany and Austria participating in the DPV initiative were analysed. A total of 63 children had comorbid IBD; IBD prevalence was 0.1%. Regression models were used to analyse differences in metabolic control, acute complications and steroid intake. RESULTS: Mean BMI-SDS in patients with T1D and IBD was lower (-0.15 ± 0.11) compared to patients with T1D only (0.27 ± 0.00, p < .001). Patients with T1D and IBD had a significantly higher use of steroids (22% ± 0.05% vs. 1% ± 0.00, p < .001) and a significantly higher rate of severe hypoglycaemic events per patient year (0.33 ± 0.07 vs. 0.16 ± 0.00, p = .001). No differences were found in HbA1c levels, insulin dose and occurrence of DKA. CONCLUSION: Although children and adolescents with T1D and IBD take steroids more often, they suffer from severe hypoglycaemia more frequently and have a lower BMI-SDS. These findings might be explained by chronic intestinal inflammation leading to malabsorption, malnutrition and increased severe hypoglycaemia.
Assuntos
Diabetes Mellitus Tipo 1 , Doenças Inflamatórias Intestinais , Adolescente , Áustria , Criança , Comorbidade , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Alemanha/epidemiologia , Hemoglobinas Glicadas , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologiaRESUMO
AIMS: We aimed to analyze the relationship between epilepsy and glutamic acid decarboxylase autoantibodies (GADA) in patients with type 1 diabetes mellitus (T1DM) and the impact of GADA on demographic, clinical, and metabolic data in T1DM patients with epilepsy. METHODS: We searched for patients with T1DM ≤20 years and GADA measurements, and within this group for patients with epilepsy. We formed groups: T1DM + Epilepsy + GADA positive; T1DM + Epilepsy + GADA negative; T1DM + GADA positive; T1DM + GADA negative. We used logistic regression to analyze the relationship between epilepsy and GADA with odds ratio adjusted for sex, duration of diabetes (DOD), and age at diabetes onset (ADO). We used logistic regression with odds ratio adjusted for DOD and ADO onset using epilepsy as a dependent variable and GADA, HbA1c, ketoacidosis, severe hypoglycemia (SH), sex, celiac disease, and autoimmune thyroiditis as independent variables. We conducted regression analyses adjusted for sex, DOD, and ADO to analyze differences in clinical/metabolic parameters between the groups. RESULTS: Epilepsy was not more frequent in GADA-positive patients (GPP). Logistic regression including all patients with GADA measurements showed that hypoglycemia with coma (HC) correlated with epilepsy when compared to no SH. We found no differences in clinical and metabolic data between GPP and GADA-negative patients (GNP) with epilepsy. SH occurred more often in GPP with epilepsy in comparison to GPP without epilepsy. GNP with epilepsy had a higher rate of HC than GPP without epilepsy. CONCLUSION: We found no relationship between epilepsy and GADA. A relationship between T1DM and epilepsy might be explainable by SH.
Assuntos
Autoanticorpos/fisiologia , Diabetes Mellitus Tipo 1/epidemiologia , Epilepsia/epidemiologia , Adolescente , Idade de Início , Áustria/epidemiologia , Autoanticorpos/efeitos adversos , Autoanticorpos/sangue , Criança , Estudos de Coortes , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/imunologia , Epilepsia/sangue , Epilepsia/etiologia , Feminino , Alemanha/epidemiologia , Glutamato Descarboxilase/imunologia , Humanos , Hipoglicemia/sangue , Hipoglicemia/complicações , Hipoglicemia/epidemiologia , Luxemburgo/epidemiologia , Masculino , Fatores de Risco , Suíça/epidemiologiaRESUMO
We studied demographic, metabolic, and clinical characteristics of patients with diabetes and autoimmune hepatitis (AIH) from the German/Austrian DPV registry. A total of 139 patients with diabetes and AIH were analyzed and compared to 437 728 patients with diabetes without AIH. The prevalence of AIH in patients with T1DM (44.8/100 000) seems higher than in the general population, the prevalence of AIH in patients with T2DM (23.6/100 000) does not seem to be increased. Patients with T2DM and AIH had a shorter duration of diabetes (p=0.007) and a higher proportion of females (p<0.001) compared to T2DM without AIH. Patients with diabetes (T1DM or T2DM) and AIH required higher insulin doses (p<0.001 and p=0.03, respectively) and showed increased liver enzymes (aspartate transaminase, alanine transaminase, gamma-glutamyltransferase) compared to diabetes patients without (all p<0.001). We detected a lower percentage of patients treated with oral antidiabetic drugs (p=0.01) and a higher percentage of patients treated by insulin in patients with T2DM and AIH (p<0.001) compared to patients with T2DM alone. We observed a higher incidence of autoimmune thyroid disease (AIT) in patients with diabetes (T1DM or T2DM) and AIH (p<0.001) compared to diabetes patients without AIH. AIH seems more frequent in patients with T1DM. Patients with diabetes and AIH require intensification of antidiabetic therapy and seem to have a higher prevalence of AIT.
Assuntos
Diabetes Mellitus/fisiopatologia , Hepatite Autoimune/complicações , Hipoglicemiantes/uso terapêutico , Adolescente , Adulto , Idoso , Autoanticorpos/sangue , Demografia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Feminino , Alemanha/epidemiologia , Hepatite Autoimune/tratamento farmacológico , Hepatite Autoimune/epidemiologia , Humanos , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Fenótipo , Prevalência , Adulto JovemRESUMO
Friedreich ataxia (FRDA) is a multisystem autosomal recessive disease with progressive clinical course involving the neuromuscular and endocrine system. Diabetes mellitus (DM) is one typical non-neurological manifestation, caused by beta cell failure and insulin resistance. Because of its rarity, knowledge on DM in FRDA is limited. Based on data from 200,301 patients with DM of the German-Austrian diabetes registry (DPV) and two exemplary patient reports, characteristics of patients with DM and FRDA are compared with classical type 1 or type 2 diabetes. Diabetes phenotype in FRDA is intermediate between type 1 and type 2 diabetes with ketoacidosis being frequent at presentation and blood glucose levels similar to T1Dm but higher than in T2Dm (356⯱â¯165 and 384⯱â¯203â¯mg/dl). 63.2% of FRDA patients received insulin monotherapy, 21% insulin plus oral antidiabetics and 15.8% lifestyle change only, applying similar doses of insulin in all three groups. FRDA patients did not show overweight and HbA1c levels were even lower than in T1Dm or T2Dm patients, respectively, indicating good overall diabetes control. FRDADm can be controlled by individualized treatment regimen with insulin or oral antidiabetics. Patients with DM in FRDA may show a relevant risk to ketoacidotic complications, which should be avoided.
Assuntos
Diabetes Mellitus Tipo 2/etiologia , Ataxia de Friedreich/complicações , Adulto , Áustria , Diabetes Mellitus Tipo 2/patologia , Feminino , Ataxia de Friedreich/patologia , Alemanha , Humanos , Insulina/uso terapêutico , Masculino , Sistema de RegistrosRESUMO
PURPOSE: We aimed to determine the impact of insulin resistance and hyperandrogenemia on polysomnographic variables in obese adolescents with polycystic ovarian syndrome (PCOS), as studies in adults with PCOS suggest that parameters of glucose metabolism and serum androgens are related to respiratory polysomnographic variables (RPV), and the symptoms of PCOS usually begin around menarche. METHODS: We divided our study group of obese adolescents with PCOS according to HOMA-index and in a second analysis according to free androgen index (FAI). Study group A consisted of 14 girls with HOMA-index <4, study group B of 17 girls with HOMA-index >4. Study group C consisted of 19 girls with FAI <10, and study group D of 18 girls with FAI >10. The control group for both analyses consisted of 19 healthy obese adolescents without PCOS. All girls underwent overnight 12-channel polysomnography. RESULTS: In both analyses, we found no differences between the groups concerning the RPV. Study group B demonstrated a significantly lower percentage of REM-sleep than the control group (p = 0.02). Study group D demonstrated a significantly lower percentage sleep stages 3 and 4 of non-REM-sleep than study group C and the controls (p = 0.008). Study group D demonstrated significantly lower sleep efficiency than the controls (p = 0.03). CONCLUSIONS: Insulin resistance and hyperandrogenemia do not seem to have a significant impact on RPV in obese adolescents with PCOS. Differences in sleep architecture found between patients with PCOS and controls, however, are possibly influenced by insulin resistance and/or serum androgens.
Assuntos
Hiperandrogenismo/diagnóstico , Hiperandrogenismo/fisiopatologia , Resistência à Insulina/fisiologia , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/fisiopatologia , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/fisiopatologia , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Adolescente , Androgênios/sangue , Glicemia/metabolismo , Feminino , Alemanha , Humanos , Sono REM/fisiologia , Estatística como AssuntoRESUMO
PURPOSE: The prevalence of obstructive sleep apnea syndrome (OSAS) is clearly increased in adults with polycystic ovarian syndrome (PCOS), whereas OSAS does not seem to be frequent in adolescents with PCOS, pointing towards the fact that some patients with PCOS develop OSAS in the further course of the disease. We therefore aimed to analyze the changes of polysomnographic variables in obese adolescents with PCOS in a longitudinal analysis. METHODS: Fifteen adolescents with PCOS (age 15.3 years ± 1.2, BMI 32.9 kg/m(2) ± 6.4, SDS-BMI 2.5 ± 0.8) underwent overnight 12-channel polysomnography at baseline and after a mean duration of 28 ± 6 months (age 17.8 years ± 1.1, BMI 32.7 kg/m(2) ± 7.0, SDS-BMI 2.1 ± 0.9). After performing the initial polysomnography, we treated hyperandrogenemia and insulin resistance in the study group. We determined parameters of body weight/body composition, parameters of glucose metabolism, and serum androgens in all patients at baseline and follow-up. At follow-up, we compared the polysomnographic variables of the study group to those of healthy female adults. RESULTS: The polysomnographic variables, the parameters of body weight/body composition, and the parameters of glucose metabolism in the study group did not change significantly during the observation period. The serum levels of total testosterone and sex hormone binding globulin increased significantly, whereas free androgen index decreased significantly. At follow-up, the polysomnographic variables of the study group did not differ from those of healthy female adults. CONCLUSIONS: OSAS does not seem to develop in adolescents with PCOS being treated for hyperandrogenism and insulin resistance. The pathogenesis of OSAS in PCOS needs to be examined in larger controlled studies.
Assuntos
Androgênios/sangue , Glicemia/metabolismo , Obesidade/sangue , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/diagnóstico , Polissonografia , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/diagnóstico , Adolescente , Terapia Comportamental , Índice de Massa Corporal , Terapia Combinada , Comorbidade , Exercício Físico , Feminino , Humanos , Resistência à Insulina/fisiologia , Estilo de Vida , Estudos Longitudinais , Terapia Nutricional , Síndrome do Ovário Policístico/epidemiologia , Síndrome do Ovário Policístico/terapia , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapiaRESUMO
BACKGROUND: We aimed to determine the differences in polysomnographic variables between obese adolescents with polycystic ovarian syndrome (PCOS) with and without metabolic syndrome, as the prevalence of obstructive sleep apnea syndrome (OSAS) is increased in adults with PCOS, OSAS has been regarded as a manifestation of the metabolic syndrome, and the prevalence of metabolic syndrome is increased in patients with PCOS. METHODS: Fourteen obese adolescents with PCOS and metabolic syndrome [15.7 years ± 1.9, body mass index (BMI) 36.2 kg/m(2) ± 6.2], 14 obese adolescents with PCOS without metabolic syndrome (15.7 years ± 1.1, BMI 33.8 kg/m(2) ± 6.2), 19 healthy, obese adolescents without PCOS or metabolic syndrome (15.3 years ± 1.0, BMI 34.4 kg/m(2) ± 6.5), and 14 healthy, normal-weight adolescents (15.4 years ± 0.7, BMI 21.1 kg/m(2) ± 2.2) underwent polysomnography to compare transcutaneous arterial oxygen saturation (Sat O(2)), apnea index (AI), hypopnea index (HI), apnea-hypopnea index (AHI), the absolute number of obstructive apneas (NOA), percentage sleep stages 3 and 4 of non REM-sleep (stages 3 and 4), percentage of rapid eye movement (REM) sleep (%REM), sleep-onset latency, and sleep efficiency. RESULTS: We found no differences among the four groups concerning AI, HI, AHI, NOA, and stages 3 and 4. Significant differences among the groups were found regarding Sat O(2) (P = 0.04), %REM (P = 0.03), sleep-onset latency (P = 0.002), and sleep efficiency (P = 0.01). CONCLUSIONS: Weight status, PCOS, and metabolic syndrome do not seem to have significant effects on respiratory polysomnographic variables in adolescent girls with PCOS, suggesting that the pathomechanisms leading to OSAS in patients with PCOS develop in the later course of the disease.
Assuntos
Síndrome Metabólica/fisiopatologia , Síndrome do Ovário Policístico/fisiopatologia , Polissonografia , Sono/fisiologia , Adolescente , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Feminino , Teste de Tolerância a Glucose , Humanos , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/fisiopatologia , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/epidemiologia , Prevalência , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologiaRESUMO
The aim of this study was to compare polysomnographic variables of obese adolescents with polycystic ovarian syndrome (PCOS) to those of healthy controls and to analyse whether polysomnographic variables correlate to parameters of body weight/body composition, to serum androgens and to parameters of glucose metabolism. Thirty-one obese adolescents with PCOS (15.0 years ± 1.0, body mass index 32.7 kg per m(2) ± 6.2) and 19 healthy obese adolescents without PCOS (15.2 years ± 1.1, body mass index 32.4 kg per m(2) ± 4.0) underwent polysomnography to compare apnoea index, hypopnoea index, apnoea-hypopnoea index, the absolute number of obstructive apnoeas, percentage sleep Stages 1, 2, 3 and 4 of non-rapid eye movement (NREM) sleep, percentage of REM sleep, TIB, total sleep time (TST), sleep-onset latency, total wake time (TWT), wakefulness after sleep onset (WASO) and sleep efficiency. Furthermore, we correlated polysomnographic variables to parameters of body weight/body composition, to serum androgens and to parameters of glucose metabolism. We found no differences between the two groups concerning the respiratory indices, percentage sleep Stages 2, 3 and 4 of NREM sleep, TIB and sleep-onset latency. The girls with PCOS differed significantly from the controls regarding TST, WASO, TWT, sleep efficiency, percentage Stage 1 of NREM sleep and percentage of REM sleep. We found a weak significant correlation between insulin resistance and apnoea index and between insulin resistance and apnoea-hypopnoea index. Concerning the respiratory variables, adolescents with PCOS do not seem to differ from healthy controls; however, there seem to be differences concerning sleep architecture.
Assuntos
Androgênios/sangue , Glucose/metabolismo , Obesidade/fisiopatologia , Síndrome do Ovário Policístico/fisiopatologia , Polissonografia , Sono/fisiologia , Adolescente , Androstenodiona/sangue , Glicemia/análise , Índice de Massa Corporal , Estudos de Casos e Controles , Sulfato de Desidroepiandrosterona/sangue , Feminino , Humanos , Obesidade/sangue , Obesidade/complicações , Obesidade/metabolismo , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/metabolismo , Sono REM/fisiologia , Testosterona/sangue , Vigília/fisiologiaRESUMO
PURPOSE: The purpose of this study was to determine the differences in polysomnographic variables between obese adolescents with polycystic ovarian syndrome (PCOS) and healthy, normal-weight and obese controls, as the prevalence of obstructive sleep apnea syndrome (OSAS) is increased in adults with PCOS. METHODS: Twenty-two obese adolescents with PCOS (mean age 15.2 +/- 1.3 years, mean BMI 31.7 +/- 6.2 kg/m(2)), 18 healthy, normal-weight adolescents (mean age 15.0 +/- 0.9 years, mean BMI 20.6 +/- 2.3 kg/m(2)), and 11 healthy, obese adolescents (mean age 15.0 +/- 1.0 years, mean BMI 34.8 +/- 8.7 kg/m(2)) underwent polysomnography to compare mean transcutaneous arterial oxygen saturation (Sat O(2)), apnea index (AI), hypopnea index (HI), apnea-hypopnea index (AHI), the absolute number of obstructive apneas (NOA), percentage sleep stages 3 and 4 of non-REM sleep (stages 3 and 4), percentage of REM sleep (%REM), sleep-onset latency, and sleep efficiency. RESULTS: We found no differences between the three groups concerning Sat O(2), AI, HI, AHI, NOA, and stages 3 and 4. The girls with PCOS differed from normal-weight and obese controls regarding sleep-onset latency and sleep efficiency and from the normal-weight controls regarding %REM. CONCLUSIONS: OSAS does not seem to be more prevalent in adolescents with PCOS. Concerning the respiratory variables, adolescents with PCOS do not seem to differ from healthy controls; however, there seem to be differences concerning sleep architecture.
Assuntos
Peso Corporal , Obesidade/epidemiologia , Síndrome do Ovário Policístico/epidemiologia , Polissonografia/instrumentação , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Adolescente , Índice de Massa Corporal , Comorbidade , Feminino , Humanos , Prevalência , Índice de Gravidade de DoençaRESUMO
AIM: To investigate which obese children have an increased risk for impaired glucose tolerance (IGT), a risk factor for later diabetes. METHODS: We studied 169 European untreated obese children and adolescents with normal glucose tolerance at baseline. Waist circumference, fasting glucose, lipids, blood pressure, pubertal stage, 2 h glucose in oral glucose tolerance test (oGTT), and HbA1c were determined at baseline and 1 year later. RESULTS: One year after baseline, 19 (11.2%) children demonstrated IGT, 4 (2.4%) children had impaired fasting glucose, no (0%) child suffered from diabetes, and 146 (86%) children still showed normal glucose tolerance. At baseline, the children with IGT and with normal glucose tolerance in a one-year follow-up did not differ significantly in respect of any analyzed parameter, apart from pubertal stage. The children developing IGT entered puberty significantly more frequently (37% vs 3%, P < 0.001). One year after baseline, the children with IGT demonstrated significantly increased waist circumference, blood pressure values, insulin and triglyceride concentrations, and insulin resistance index HOMA. The children remaining in the normal glucose tolerance status 1 year after baseline did not demonstrate any significant changes. CONCLUSION: During the study period of 1 year, more than 10% of the obese children with normal glucose tolerance converted to IGT. Repeated screening with oGTT seems meaningful in obese children entering puberty or demonstrating increased insulin resistance, waist circumference, blood pressure, or triglyceride concentrations.
RESUMO
BACKGROUND: While an association between androgens and the metabolic syndrome (MS) is well established in obese women, studies concerning this relationship are scarce in obese adolescent girls. Therefore, we analysed the relationships between androgens, MS and intima-media thickness (IMT) in this age-group. METHODS: In 160 obese girls (aged 12-18 years, mean BMI: 32.6 +/- 5.0 kg/m((2))), androgens [testosterone, dehydroepiandrosterone sulphate (DHEA-S), androstenedione], SHBG and the components of MS (waist circumference, blood pressure (BP), lipids, uric acid, insulin, glucose, 2 h glucose in oral glucose tolerance test (oGTT)) were studied. Furthermore, IMT was determined in a subgroup of 71 randomly chosen girls. RESULTS: Testosterone correlated significantly to systolic BP (r = 0.20), diastolic BP (r = 0.24), 2 h glucose in oGTT (r = 0.30), triglycerides (r = 0.19), uric acid (r = 0.17), waist circumference (r = 0.25) and IMT (r = 0.54). These relationships (except for waist circumference and uric acid) were independent of BMI and insulin resistance index homeostasis model assessment. In contrast to testosterone, DHEA-S, androstenedione and SHBG showed no or weaker correlations to any parameter of MS. The 48 girls with MS demonstrated significantly higher testosterone (1.8 +/- 0.7 nmol/l; P = 0.025) and DHEA-S (4.7 +/- 2.3 micromol/l; P = 0.008) concentrations as compared with the 112 girls without MS (mean testosterone 1.5 +/- 0.7 nmol/l, mean DHEA-S 3.6 +/- 2.3 micromol/l). CONCLUSIONS: Testosterone was significantly related to MS and its components in obese adolescent girls independently of BMI and insulin resistance. As IMT was significantly associated with testosterone, this supports the clinical relevance of this finding.
Assuntos
Androgênios/sangue , Síndrome Metabólica/sangue , Síndrome Metabólica/patologia , Obesidade/sangue , Obesidade/patologia , Túnica Íntima/patologia , Adolescente , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Criança , Feminino , Teste de Tolerância a Glucose , Humanos , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Obesidade/epidemiologia , Obesidade/fisiopatologia , Tamanho do Órgão , Estatística como Assunto , Testosterona/sangue , Túnica Média/patologiaRESUMO
OBJECTIVE: Leptin resistance is discussed to be involved in the genesis of obesity. Therefore, we hypothesized that leptin levels were negatively associated with degree of weight loss in obese children participating in a lifestyle intervention. METHODS: We studied 248 obese children aged 8-14 years attending the "Obeldicks" lifestyle intervention (mean age 10.6+/-0.2 years, 53% female, 48% pubertal, mean body mass index (BMI) 27.8+/-0.3 kg/m2, and mean standard deviation score [SDS]-BMI 2.43+/-0.03). Baseline leptin concentrations were correlated with change of weight status, waist circumference, and percentage body fat, as calculated from skinfold measurements in the one-year intervention by Pearson correlation and multiple linear regression analyses. Furthermore, the relationship between leptin and cardiovascular risk factors (insulin, insulin resistance index HOMA, blood pressure, lipids, and glucose) were analyzed. RESULTS: A total of 212 children (85%) reduced their overweight, 9 children (4%) dropped out, and 27 children (11%) did not reduce their overweight in the lifestyle intervention "Obeldicks". The mean reduction of SDS-BMI was 0.34+/-0.02. The reduction of SDS-BMI (r=- 0.27), waist circumference (r=- 0.64), and percentage body fat (r=- 0.26) were significantly negatively associated with baseline leptin levels both in univariate analyses and in multiple regression analyses, adjusted to baseline age, BMI, gender and pubertal stage. Baseline leptin concentrations were significantly associated with BMI, pubertal stage, gender, waist circumference, and insulin, but not to any other cardiovascular risk factors in multiple regression analyses. CONCLUSIONS: The finding that baseline leptin concentrations were significantly negatively correlated with the degree of weight loss in a lifestyle intervention supports the hypothesis of leptin resistance in obesity. This study is registered at clinicaltrials.gov (NCT00435734).
Assuntos
Leptina/sangue , Obesidade/terapia , Sobrepeso/terapia , Comportamento de Redução do Risco , Redução de Peso , Adiposidade , Adolescente , Terapia Comportamental , Biomarcadores/sangue , Índice de Massa Corporal , Criança , Terapia Combinada , Terapia por Exercício , Feminino , Humanos , Modelos Lineares , Masculino , Terapia Nutricional , Obesidade/sangue , Obesidade/dietoterapia , Obesidade/fisiopatologia , Sobrepeso/sangue , Sobrepeso/dietoterapia , Sobrepeso/fisiopatologia , Medição de Risco , Fatores de Risco , Dobras Cutâneas , Fatores de Tempo , Resultado do Tratamento , Circunferência da CinturaRESUMO
UNLABELLED: Little longitudinal information is available on changes of growth, insulin-like growth factor-I (IGF-I), its main binding protein (IGFBP-3) and their relationships to leptin and insulin in obese children reducing their overweight. We compared these parameters between baseline and after participating in a one-year lifestyle intervention in 319 obese children. The control group comprised 52 lean children. Obese children demonstrated significantly increased IGFBP-3, leptin, and insulin concentrations and were taller compared to the lean children, while they did not differ in respect to their IGF-I concentrations. Reduction of overweight was associated with a significant decrease of IGFBP-3 SDS, leptin, and insulin concentrations. IGF-I SDS and height SDS did not change after weight loss. CONCLUSIONS: IGFBP-3, leptin and insulin concentrations are increased in obese children and normalized in weight loss demonstrating the reversibility of these alterations. Weight loss due to lifestyle intervention was not associated with growth disturbances.
Assuntos
Constituição Corporal/fisiologia , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Estilo de Vida , Obesidade/sangue , Redução de Peso/fisiologia , Adolescente , Estatura/fisiologia , Peso Corporal/fisiologia , Criança , Feminino , Humanos , Insulina/sangue , Leptina/sangue , Masculino , Obesidade/diagnóstico , Obesidade/terapiaRESUMO
Leptin and insulin resistance are being discussed to be involved in the pathogenesis of nonalcoholic fatty liver disease, which is frequently characterized by moderately elevated transaminases. However, longitudinal studies proving an association between leptin, insulin resistance, and transaminases are scarce. We examined weight status, aspartate aminotransferase (AST), alanine aminotransferase (ALT), leptin, glucose, and insulin in 180 overweight children at baseline and 1 year later. Relationships between these parameters at baseline and their changes in the course of 1 year were determined by multiple regression analysis adjusted for age, sex, pubertal stage, and body mass index (BMI). Leptin but not homeostasis model assessment of insulin resistance index correlated significantly to transaminases in both cross-sectional and longitudinal analyses. The same findings were observed in 30 children with suspected nonalcoholic fatty liver disease by ultrasound. The 130 children who participated in a 1-year lifestyle intervention reduced their overweight (standard deviation score [SDS]-BMI, -0.37 +/- 0.11). In the course of 1 year, their changes of transaminases depended on change of weight status (SDS-BMI decrease >0.5: ALT 12 [10-15] --> 9 [8-13] U/L, AST 11 [9-12] --> 9 [8-12] U/L; SDS-BMI decrease >0 but
Assuntos
Alanina Transaminase/metabolismo , Aspartato Aminotransferases/metabolismo , Leptina/fisiologia , Sobrepeso/metabolismo , Criança , Estudos Transversais , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Sobrepeso/enzimologiaRESUMO
OBJECTIVES: The current worldwide increase of prediabetes defined as impaired fasting glucose or impaired glucose tolerance and type 2 diabetes mellitus (T2DM) coincides the increase of obesity. However, it is unclear that which children have an increased risk and should be screened for prediabetes. METHODS: We studied 437 overweight children and adolescents to identify risk factors for prediabetes. A risk score for prediabetes was calculated using logistic regression. This score was examined in a second, independent cohort of 567 overweight children and adolescents. History of T2DM in parents and grandparents, degree of overweight, age, pubertal stage, birth weight, hypertension, dyslipidemia, acanthosis nigricans, and abdominal obesity were considered as potential risk factors. RESULTS: The frequency of prediabetes was 6% in sample 1 and 17% in sample 2. The strongest association was observed for history of parental diabetes with an adjusted odds ratio (aOR) of 9.5 [95% confidence interval (CI) 2.5-36.4] in sample 1 and 6.3 (95% CI 3.7-10.7) in sample 2, followed by pubertal stage with an aOR of 5.5 (95% CI 0.7-45.4) in sample 1 and 6.2 (95% CI 2.4-15.6) in sample 2, and by extreme obesity with an aOR of 5.0 (95% CI 1.7-15.3) in sample 1 and 3.3 (95% CI 2.0-5.4) in sample 2. CONCLUSIONS: The main risk factors for prediabetes were parental diabetes, pubertal stage, and extreme obesity. Screening for prediabetes seems meaningful in subjects with either a parental history of diabetes or a combination of extreme obesity and pubertal stage and detected nearly 90% of the overweight children and adolescents with prediabetes.
Assuntos
Diabetes Mellitus/epidemiologia , Obesidade/genética , Estado Pré-Diabético/epidemiologia , Adolescente , Peso ao Nascer , Criança , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Diabetes Mellitus/genética , Feminino , Intolerância à Glucose/epidemiologia , Intolerância à Glucose/genética , Humanos , Hipertensão/epidemiologia , Masculino , Anamnese , Obesidade/epidemiologia , Sobrepeso , Pais , Estado Pré-Diabético/genética , Valor Preditivo dos Testes , Puberdade/fisiologia , Análise de Regressão , Medição de Risco , Fatores de Risco , Circunferência da CinturaRESUMO
BACKGROUND/AIMS: The aim of this study was to analyze thyroid hormones in female adolescents with obesity and anorexia nervosa (AN) before and after normalization of weight. METHODS: Thyroid-stimulating hormone (TSH), fT3, and fT4 were determined in 100 obese girls, 32 normal-weight girls and 20 girls with AN aged 14-18 years at baseline and 1 year later. Additionally, leptin, insulin, and the insulin resistance index HOMA were analyzed in the obese and normal-weight girls. RESULTS: TSH and fT3 levels of girls with AN were significantly lower compared to TSH concentrations of normal-weight girls, while TSH and fT3 levels of the obese girls were significantly higher. The 21 obese females with weight loss >5% demonstrated a significant decrease in fT3 and TSH, while the 9 adolescents with AN and weight gain >5% showed a significant increase in fT3 and TSH. Insulin and HOMA were not significantly correlated to TSH, fT3 and fT4, while leptin was correlated to TSH and fT3 in both cross-sectional and longitudinal analysis. CONCLUSIONS: Thyroid function seems to be reversibly related to weight status with increased TSH and fT3 concentrations in obesity and decreased TSH and fT3 levels in AN. We hypothesize that leptin may be the link between weight status and TSH.
Assuntos
Anorexia Nervosa/sangue , Peso Corporal , Obesidade/sangue , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue , Adolescente , Anorexia Nervosa/terapia , Feminino , Seguimentos , Humanos , Insulina/sangue , Resistência à Insulina , Leptina/sangue , Obesidade/terapiaRESUMO
We report the findings and clinical course of ten girls aged 0.2 to 6.3 years with precocious pseudopuberty due to autonomous ovarian cysts. We found elevated oestrogen levels in five patients and failure of gonadotropin response to GnRH stimulation in four patients during the first episode, of the disease. In one patient, a GnRH stimulation test was not performed. Pelvic ultrasound examination showed large ovarian cysts in all ten patients. Following the initial episode the secondary sexual characteristics of nine patients regressed completely without treatment. The cyst of one girl was removed surgically on demand of her parents. Three girls presented recurrent autonomous ovarian cysts. Two of these girls developed central precocious puberty requiring treatment with a GnRH-agonist after repeated episodes of precocious pseudopuberty. We started treating the third girl with a GnRH agonist after the second relapse of the autonomous ovarian cyst because of rapidly advancing bone age. We conclude that in the majority of cases autonomous ovarian cysts regress spontaneously and that surgery is in general not indicated. Furthermore, autonomous ovarian cysts can relapse before the onset of physiological puberty and accelerate biological maturation leading to central precocious puberty and consequent decrease of height potential.
Assuntos
Cistos Ovarianos/complicações , Puberdade Precoce/etiologia , Estatura , Criança , Pré-Escolar , Estrogênios/sangue , Feminino , Seguimentos , Hormônio Liberador de Gonadotropina/agonistas , Humanos , Lactente , Cistos Ovarianos/diagnóstico por imagem , Cistos Ovarianos/tratamento farmacológico , Recidiva , Remissão Espontânea , UltrassonografiaRESUMO
OBJECTIVE: Several definitions of the metabolic syndrome (MS) have been proposed for children and adolescents. The aim of this study was to analyse whether these definitions are linked to intima-media thickness (IMT), which is predictive for atherosclerosis and later cardiovascular disease. METHODS: The prevalence of the MS according to the different published definitions was studied in 264 Caucasian overweight children and adolescents aged 7-16 years (mean BMI 27.3 kg/m(2)). IMT was related to the occurrence of the MS and its components. RESULTS: IMT was influenced by weight status, waist circumference, fasting glucose levels, glucose levels at 2h in the glucose tolerance test, and blood pressure, but not by lipids, fasting insulin, and insulin resistance index. A significant association between IMT and the definitions of MS by Viner (p=0.019) and Weiss (p<0.001) could be observed in a linear regression analysis, but not between the IMT and other proposed definitions. Impaired glucose tolerance had a positive predictive value of 96% (95% confidence interval: 93-98%) for IMT equal or above the top quartile (>or=0.7 mm), while the positive predictive values for IMT>or=0.7 mm were <50% in the different proposed definition of MS. CONCLUSIONS: Children with impaired glucose tolerance seem to be at increased risk for later cardiovascular diseases. Impaired glucose tolerance demonstrated the strongest association to high IMT far superior to any proposed definition of MS. Furthermore, since the proposed definitions of the MS were not or only weakly related to IMT, outcome driven studies are necessary to prove the concept of the MS in childhood.
Assuntos
Aterosclerose/epidemiologia , Aterosclerose/patologia , Síndrome Metabólica/epidemiologia , Adolescente , Pressão Sanguínea , Criança , Feminino , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/epidemiologia , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Sobrepeso/epidemiologia , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Túnica Íntima/patologia , Túnica Média/patologiaRESUMO
OBJECTIVES: Obestatin and ghrelin, which are derived from the same gene, are observed to have opposite effects on weight status. The aims of this study were to compare obestatin concentrations in obese and normal-weight children and to analyse the effect of weight loss on obestatin and ghrelin levels. METHODS: We examined anthropometrical markers and fasting serum obestatin, ghrelin, leptin, glucose and insulin concentrations in 44 obese children (mean age 11.2 years) before and after participating in a 1-year outpatient obesity intervention programme based on a high-carbohydrate, fat-reduced diet and increased physical activity. Additionally, total ghrelin, obestatin and leptin levels were determined in 22 normal-weight healthy children of similar age, gender and pubertal stage. RESULTS: Obestatin and leptin concentrations were significantly (P < 0.001) higher and ghrelin concentrations were significantly (P < 0.001) lower in obese children compared to nonobese children. In contrast to the 13 children without weight loss, substantial weight loss in 31 children led to a significant (P = 0.007) increase in obestatin and to a significant (P < 0.05) decrease in leptin and insulin concentrations, while ghrelin concentrations did not change significantly. Children with substantial weight loss demonstrated significantly (P = 0.009) lower obestatin and a tendency (P = 0.064) to higher ghrelin concentrations at baseline. Changes in insulin were not related to changes in ghrelin or obestatin. CONCLUSION: The increase in obestatin and the decrease in ghrelin in obese children point towards an adaptation process of weight status. Weight reduction due to a long-term lifestyle intervention resulted in an increase in obestatin levels.