[Five-year follow up of lipid profile in children in the Rivas-Vaciamadrid study]. / Seguimiento de 5 años del perfil lipídico en los niños. Estudio Rivas-Vaciamadrid.

OBJECTIVE: To evaluate lipid balance in children after a 5-year follow-up and tracking between initial and final levels. METHODS: Two hundred eighty-one children included in the Rivas-Vaciamadrid study were evaluated at the ages of 6 and 11 years. In all children, total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and apoproteins A1 (Apo A) and B100 (Apo B) were measured. Low-density lipoprotein-cholesterol (LDL-C) was determined and the Apo B/Apo A, TC/HDL-C, and LDL-C/HDL-C ratios and the atherogenic index were calculated. RESULTS: At 11 years of age, lipid balance was worse in girls than in boys. Levels of TG and HDL-C were significantly higher at the age of 11 years than those at the age of 6 years, but levels of the remaining variables analyzed were lower, except for Apo A and TC, which showed a non-significant increase. The correlation coefficients between values at the ages of 6 and 11 years were significant for all variables and the highest was LDL-C in girls (0.711). Kappa and Nishio tracking indexes were significant for all variables and were highest for the atherogenic index (0.431 and 6.71 respectively) and lowest for TG (0.129 and 2.85 respectively). Subjects in the highest quartile at 6 years old had a relative risk of 8.04 (CI 4.34-14.88) for having the same atherogenic index at the age of 11 years and a relative risk of 1.91 (CI 1.05-3.46) for having the same TG value. CONCLUSION: There is a significant correlation between lipid profile values in children at the ages of 6 and 11 years. The best tracking was found in the atherogenic index.

Seguimiento de 5 años del perfil lipídico en los niños. Estudio Rivas-Vaciamadrid / Five-year follow up of lipid profile in children in the Rivas-Vaciamadrid study

Objetivo. Evaluar el perfil lipídico en niños tras 5 años de seguimiento, y el tracking entre los valores iniciales y los finales. Métodos. Se estudiaron 281 niños a los 6 y 11 años incluidos en el estudio Rivas-Vaciamadrid. Todos eran prepúberes. A todos se les midió el colesterol total (CT), triglicéridos (TG), colesterol unido a las lipoproteínas de alta densidad (C-HDL), apoproteína A1 (apo-A), y B100 (apo-B100), y se calculó el colesterol unido a las lipoproteínas de baja densidad (C-LDL) y los índices apo-B/apo-A, CT/C-HDL, C-LDL/C-HDL e índice aterogénico. Resultados. A los 11 años el perfil lipídico de las niñas es peor que el de los niños. Se encontraron unos valores a los 11, respecto a los 6 años, significativamente mayores de TG y C-HDL, y menores de los demás parámetros estudiados, excepto de apo-A y el CT que no presentaron significación estadística. Los coeficientes de correlación entre los valores a los 6 y 11 años fueron significativos para todos ellos, encontrándose el más elevado en las niñas para el C-LDL (0,711). Los índices de tracking de k y Nishio fueron significativos para todos los parámetros, oscilando entre los mayores valores obtenidos para el índice aterogénico (0,431 y 6,71, respectivamente) y para los triglicéridos (0,129 y 2,85, respectivamente). El riesgo relativo de un sujeto que estaba en el cuartil superior a los 6 años de estar en el misma situación a los 11 estuvo entre 8,04 (intervalo de confianza [IC]: 4,34-14,88) para el índice aterogénico y 1,91 (IC: 1,05-3,46) para los triglicéridos. Conclusión. Existe una correlación significativa entre los valores del perfil lipídico a los 6 y 11 años, siendo el índice aterogénico el que presenta un mejor tracking

Objective. To evaluate lipid balance in children after a 5-year follow-up and tracking between initial and final levels. Methods. Two hundred eighty-one children included in the Rivas ­ Vaciamadrid study were evaluated at the ages of 6 and 11 years. In all children, total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and apoproteins A1 (Apo A) and B100 (Apo B) were measured. Low-density lipoprotein-cholesterol (LDL-C) was determined and the Apo B/Apo A, TC/HDL-C, and LDL-C/HDL-C ratios and the atherogenic index were calculated. Results. At 11 years of age, lipid balance was worse in girls than in boys. Levels of TG and HDL-C were significantly higher at the age of 11 years than those at the age of 6 years, but levels of the remaining variables analyzed were lower, except for Apo A and TC, which showed a non-significant increase. The correlation coefficients between values at the ages of 6 and 11 years were significant for all variables and the highest was LDL-C in girls (0.711). Kappa and Nishio tracking indexes were significant for all variables and were highest for the atherogenic index (0.431 and 6.71 respectively) and lowest for TG (0.129 and 2.85 respectively). Subjects in the highest quartile at 6 years old had a relative risk of 8.04 (CI 4.34-14.88) for having the same atherogenic index at the age of 11 years and a relative risk of 1.91 (CI 1.05-3.46) for having the same TG value. Conclusion. There is a significant correlation between lipid profile values in children at the ages of 6 and 11 years. The best tracking was found in the atherogenic index

[Meningococcal sepsis in pediatrics. Parameters associated with poor outcome]. / Sepsis meningocócica en pediatría. Parámetros asociados a mala evolución.

BACKGROUND: Mortality due to meningococcal sepsis continues to be extremely high. Patients with a poor prognosis require aggressive therapy and should be identified early. OBJECTIVE: To investigate the clinical and biological factors associated with poor outcome. PATIENTS AND METHOD: Seventy-one children aged 2 months to 13 years with meningococcal sepsis were studied. Inclusion criteria were meningococcus isolation in cultures or characteristic clinical features with purpuric exanthema. METHODS: A correlational descriptive study was performed. In all patients we evaluated the Pediatric Risk of Mortality (PRISM), the Glasgow Scale for Meningococcal Sepsis (GSMS), polymorphonuclear (PMN) count and prolactin (PRL), leptin (LPT) and C-reactive protein (CRP) levels. RESULTS: Fourteen children (19.7 %) died. Death was associated with multiple organ dysfunction syndrome (MODS) (p = 0.0001), high GSMS and PRISM scores (p = 0.0001) and to a lesser extent with shock (p = 0.01). In patients who died, the determinations showing greatest alteration at admission were PRL levels (p = 0.0009) and PMN count (p = 0.0005). CRP levels were not associated with differences in mortality but were high in patients with shock (p = 0.008). Children with high body weight percentiles were at greater risk of death and showed higher levels of PRL, PCT (p = 0.006) and LPT (p = 0.006), without differences in GSMS or PRISM scores. Age did not influence mortality or PRL levels but did influence GMSM and PRISM scores and PMN and CRP levels. These differences disappeared after the age of 2-3 years. In patients with MODS or shock, the only differences found were reduced PMN count (p = 0.0001) and elevated PRL levels (p = 0.0001). CONCLUSIONS: In meningococcal sepsis, death is more frequent in children with high body weight percentiles. Moreover, these children present elevated PRL and LPT levels, although whether these variables act independently remains to be elucidated.

Sepsis meningocócica en pediatría. Parámetros asociados a mala evolución / Meningococcal sepsis in pediatrics. PArameters associated with poor outcome

Antecedentes: La mortalidad por sepsis meningocócica continúa siendo muy elevada. Los enfermos con mal pronóstico precisan terapias agresivas y deben ser identificados precozmente. Objetivo: Investigar los factores clínicos y biológicos asociados a una mala evolución. Pacientes y método: Se estudiaron 71 niños de 2 meses a 13 años de edad con sepsis meningocócica. Los criterios de inclusión fueron aislamiento de meningococo en cultivos o sintomatología característica con exantema purpúrico. Se realizó un estudio descriptivo correlacional. En todos los enfermos se valoró el PRISM (Pediatric Risk of Mortality), la Escala de Glasgow para Sepsis Meningocócicas (EGSM), el recuento de polimorfonucleares y los niveles de procalcitonina, leptina y proteína C reactiva (PCR). Resultados: Fallecieron 14 enfermos (19,7 por ciento). La muerte se asoció a síndrome de disfunción multiorgánica (SDMO) (p=0,0001), alta puntuación en la EGSM y el PRISM (p=0,0001) y con menor significación a shock (p=0,01). En el grupo de fallecidos, las determinaciones más alteradas al ingreso fueron la procalcitonina (p=0,0009) y los polimorfonucleares (p=0,0005). Los valores de PCR no se asociaron a diferencia de mortalidad pero estaban altos en los casos con shock (p=0,008). Los niños con percentiles elevados de peso fallecieron con mayor frecuencia y mostraron niveles más altos de procalcitonina (p=0,006) y leptina (p=0,006), pero sin diferencias de valores de EGSM y PRISM. La edad no influyó ni en la mortalidad ni en la procalcitonina, pero sí en el EGSM y PRISM y en los niveles de polimorfonucleares y PCR, desapareciendo estas diferencias antes de los 2-3 años. En los casos con SDMO o shock sólo presentaron diferencias el recuento disminuido de polimorfonucleares (p=0,0001) y la procalcitonina elevada (p=0,0001). Conclusiones: En la sepsis meningocócica el fallecimiento es más frecuente en niños con altos percentiles de peso. Además presentan elevaciones de procalcitonina y leptina, quedando sin aclarar si actúan de forma independiente (AU)

[Lipid profile in children from Rivas-Vaciamadrid. Two-year follow-up]. / Perfil lipídico en niños de Rivas-Vaciamadrid. Seguimiento de 2 años.

AIM: Evaluate the lipid profiles in children after two years of follow-up. METHODS: Longitudinal cohort study. A two years follow-up of a group of children since they were 6 years old. Blood analysis were carried in every children measuring total cholesterol, triglycerides, cLDL, cHDL, apoproteins A and B. It also included TD/cHDL, cLDL/cHDL, Apo B/A ratios and atherogenic index. RESULTS: 200 mg/dl, cLDL > 135 mg/dl and Apo B > 100 mg/dl in the follow-up was of 9.51, 5.18 and 8 for those children who had in the initial study these same values. The values of lipid profile and of the index studied improved in the two years of follow-up. This improvement has an statistical signification only in men. CONCLUSIONS: There is a significant correlation between the values of the lipid profile and the index measured in those children who were six years old in the beginning of the two years follow-up.

Perfil lipídico en niños de Rivas-Vaciamadrid. Seguimiento de 2 años / Lipid profile in Rivas-Vaciamadrid children. Two years follow-up

OBJETIVO: Evaluar el perfil lipídico en niños después de 2 años de seguimiento. MÉTODOS: Se trata de un estudio de cohorte longitudinal. Seguimiento a los 2 años de un grupo de niños estudiados inicialmente a los 6 años de edad. A todos se les determinó en analítica sanguínea el colesterol total, triglicéridos, cLDL, cHDL, apoproteínas A y B, y los índices CT/cHDL, cLDL/cHDL, Apo B/A e índice aterogénico. RESULTADOS: 200 mg/dl, cLDL > 135 mg/dl y Apo B > 100 mg/dl en el seguimiento fue de 9,51, 5,18 y 8 para quienes tenían en el estudio inicial estos mismos valores. Los valores del perfil lipídico y de los índices estudiados fueron mejores en el control a los 2 años, pero sólo tuvieron significación estadística en los varones. CONCLUSIÓN: En los niños que tenían en el estudio inicial 6 años de edad, a los 2 años de seguimiento existe una buena relación entre los valores del perfil lipídico y los índices evaluados (AU)

[The value of lipid profile and of CT/C-HDL, C-LDL/C-HDl, Apo B/A indexes and atherogenic index in 6-year-old children from Rivas- Vaciamadrid]. / Valores del perfil lipídico y de los índices CT/C-HDL, C-LDL/C-HDL, Apo B/A e índice aterogénico, en niños de 6 años de Rivas-Vaciamadrid.

OBJECTIVE: The purpose of this study was to analyze the lipid profiles in children six years of age according to sex and to compare this with other Spanish studies. PATIENTS AND METHODS: A transverse epidemiological study was performed. All six year old children in our area were studied. The following tests were performed in all children: total cholesterol (TC), triglycerides, LDL-C, HDL-C, apoproteins A and B after fasting for ten hours. In addition, TC/HDL-C, LDL-C/HDL-C, and Apo B/A ratios and atherogenic index (ATI) were calculated. RESULTS: A population of 673 subjects (352 males and 321 females) were studied. The value of TC, triglycerides, LDL-C, Apo B, LDL-C/HDL-C and TC/HDL-C were significantly greater in females compared to males. Males had higher levels of HDL-C and ApoA. The values were similar to those obtain in Madrid in 1992, except that the values of HL-C were significantly higher in both sexes. CONCLUSIONS: In six year old children, the lipid profile in girls is worse than in boys. The data from our study do not show that the lipidic risk is getting worse during the past years in Spanish children.

[Lipoprotein(a) in children with hypercholesterolemia as a marker of the familial history of cardiovascular risk. The Working Group on Cardiovascular Risk Factors in Childhood and Adolescence]. / Lipoproteína (a) en niños con hipercolesterolemia, como marcador de antecedentes familiares de riesgo cardiovascular. Grupo de Trabajo sobre Factores de Riesgo Cardiovascular en la Infancia y Adolescencia.

OBJECTIVE: To evaluate the levels of lipoprotein (a) (Lp(a)) as a marker of familiar history of cardiovascular risk. MATERIAL AND METHODS: We have studied 176 children and adolescents between the ages of 3 and 18 years with hypercholesterolemia. In these children we determined Lp(a) levels and collected the family history concerning cardiovascular risk factors (hypercholesterolemia and cardiovascular disease under 55 years of age). RESULTS: Of the cases studied, 67.04% had a family history of cardiovascular risk. In this group, levels of Lp(a) were significantly higher than in the group without a family history of cardiovascular risk. Lp(a) levels higher than 30 mg/dl were found in 3.44% of the patients without a family history of cardiovascular risk in contrast to 28,43% and 37.5% of the cases with familiar history of hypercholesterolemia and cardiovascular disease, respectively. CONCLUSIONS: The levels of lipoprotein (a) in children and adolescents with hypercholesterolemia are a marker of family history of cardiovascular disease and hypercholesterolemia.

[The effect of the socioeconomic level on the lipid pattern in children and adolescents]. / Influencia del nivel socioeconómico en el patrón lipídico de niños y adolescentes.

BACKGROUND: The aim of this study was to evaluate the association between socioeconomic status and the presence of cardiovascular risk factors in children from Madrid. METHODS: We studied 2224 boys and girls, ages 2-18 years, attending five different school centers. They were divided into three socioeconomic groups: low class, middle-low class and middle high class, in regard to their parent's occupation and educational attainment. The evaluation included a blood analysis of serum triglycerides (TG), total cholesterol (CT), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), apolipoprotein A1 (ApoA), apolipoprotein B100 (Apo B), and the Apo A/Apo B and LDL/HDL ratios. RESULTS: There was a positive correlation between socioeconomic status and total cholesterol, Apo A, Apo B and Apo A/Apo B, whereas socioeconomic status and triglycerides were inversely related. The LDL/HDL ratio varied according to age. CONCLUSIONS: Unlike some previously published studies, we found that children belonging to high socioeconomic status have a more atherogenic lipid profile than those of middle low or low socioeconomic levels.

[Variations in the excretion of N-acetyl-glucosaminidase in the first year of life]. / Variación de la excrección de N-acetil-glucosaminidasa en el primer año de vida.

We have studied 122 patients, all younger than 12 months of age, to whom we check the N-acetylglucosaminidase/creatinine (NAG/creatinine) ratio in the first morning urine. The NAG/creatinine values were decreasing with age increase of the patients, being significantly different (p less than 0.001) in the younger 3 months of age comparative with the older than six months of age. The NAG/creatinine values were inversely correlated with age, height and weight. We have made normal values percentils of the NAG/creatinine ratio for each age group.