Relación entre xerostomía y diabetes mellitus: una complicación poco conocida / Relationship between xerostomia and diabetes mellitus: A little known complication

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[Non-alcoholic fatty liver in children and adolescents with excess weight and obesity]. / Hígado graso no alcohólico en pacientes con sobrepeso y obesidad infantojuvenil.

BASIS AND OBJECTIVE: Hepatic steatosis, also known as non-alcoholic fatty liver (NAFL), is the most frequent liver disease in obese children. Due to an increase in infantile obesity, it is experiencing a significant increment in incidence. Our objetives are: Estimate the prevalence of NAFL in children with excess weight and obesity using the glutamate pyruvate transaminase (GPT) value as a biochemical test and an abdominal ultrasound, and correlate the presence of hepatic steatosis with various anthropometric and biochemical parameters. PATIENTS AND METHOD: Cross-sectional prevalence study which includes children with excess weight and obesity between the ages of 5 and 15 years, between the years 2004-2012. The independent variables included were: age, sex, weight, size, body mass index (BMI), waist circumference (WC), waist size index (WSI), insulinemia, Homeostasis model assessment-insulin resistance (HOMA-R), total cholesterol, triglycerides (TG), high density lipoproteins (HDL), low density lipoproteins (LDL), glutamic-oxaloacetic transaminase (GOT), GPT and gamma-glutamyl transpeptidase (GGT). RESULTS: One hundred and twenty-six patients, with an average age of 11.94 (3.12) years were recruited. A percentage of 19.66 of the patients presented elevated GPT pathology. Of the 126 abdominal ultrasounds performed, 38 patients presented hepatic steatosis (30.15%). The levels of insulinemia, HOMA-R and LDL were significantly higher in patients with altered GPT, compared to those with normal GPT values (P=.015, P=.008 and P=.002, respectively). The patients with an objective HGNA in ultrasound, also showed greater levels of insulinemia, WC, WSI, total cholesterol, TG, LDL, GLT, GPT and GGT than the patients with normal ultrasounds, thereby achieving statistical significance in insulinemia, HOMA-R, LDL and GPT values. CONCLUSIONS: NAFL is a relatively frequent disorder in obese children and adolescents. In our study, 2 of 10 children -using GPT- and 3 of every 10 -using abdominal ultrasound- present the same. The biochemical marker which best defines it is an elevation in GPT. A modification in lifestyle which includes weight loss as a principal means of avoiding complications in adult life, is essential and necessary.

[The X of dyslipemias]. / La X de las dislipemias.

Patients with cholestatic diseases can present secondary hypercholesterolemia, as a result of the accumulation of lipoprotein X (Lp-X); an abnormal LDL form, considered as the biochemical parameter more sensitive and specific for the diagnosis of cholestasis intra or extrahepatic cholestasis. The aim of this clinical communication is to illustrate this association. A 54-year-old male with severe cholestatic liver disease which in turn presents a progressive total cholesterol rise and LDL with presence of lipoprotein X. Total and LDL cholesterol were down to normal, also coinciding with the improvement of cholestatic liver disease conferring cardiovascular protection pattern.

Los pacientes con colestasis hepática pueden presentar hipercolesterolemia secundaria, como consecuencia de la acumulación de la lipoproteína X (Lp-X); una forma anómala de LDL, considerada como el parámetro bioquímico más sensible y específico para el diagnóstico de colestasis intra o extrahepática. El objetivo de esta comunicación clínica es ilustrar esta asociación. Se trata de un varón de 54 años con hepatopatía colestásica severa que a su vez presenta una elevación progresiva de colesterol total y LDL con presencia de lipoproteína X. El colesterol total y LDL, descendieron progresivamente hasta normalizarse, coincidiendo con la mejoría de la función hepática, confiriendo un patrón de protección cardiovascular.

La X de las dislipemias / The "x" of dyslipemias

Los pacientes con colestasis hepática pueden presentar hipercolesterolemia secundaria, como consecuencia de la acumulación de la lipoproteína X (Lp-X); una forma anómala de LDL, considerada como el parámetro bioquímico más sensible y específico para el diagnóstico de colestasis intra o extrahepática. El objetivo de esta comunicación clínica es ilustrar esta asociación. Se trata de un varón de 54 años con hepatopatía colestásica severa que a su vez presenta una elevación progresiva de colesterol total y LDL con presencia de lipoproteína X. El colesterol total y LDL, descendieron progresivamente hasta normalizarse, coincidiendo con la mejoría de la función hepática, confiriendo un patrón de protección cardiovascular (AU)

Patients with cholestatic diseases can present secondary hypercholesterolemia, as a result of the accumulation of lipoprotein X (Lp-X); an abnormal LDL form, considered as the biochemical parameter more sensitive and specific for the diagnosis of cholestasis intra or extrahepatic cholestasis. The aim of this clinical comunication is to illustrate this association. A 54-year-old male with severe cholestatic liver disease wich in turn presents a progressive total cholesterol rise and LDL with presence of lipoprotein X. Total and LDL cholesterol were down to normal, also coinciding with the improvement of cholestatic liver disease conferring cardiovascular protection pattern (AU)

Hyperuricemia and metabolic syndrome in children with overweight and obesity

Objetivo: Estudiar la prevalencia de hiperuricemia en niños con sobrepeso u obesidad y analizarla relación con el síndrome metabólico y las enfermedades que lo definen. Materiales y métodos: Se realizó un estudio de prevalencia transversal en 148 niños con sobrepeso u obesidad (12 ± 3 años, 48% chicos, IMC 31,8 ± 6,1) reclutados de una consulta de endocrinología pediátrica. Se determinaron el IMC, la cintura-talla, el perímetro de la cintura, la presión arterial con el equipo habitual y la glucosa (en ayunas y tras sobrecarga con 75 g), la resistencia a la insulina, el colesterol HDL, los triglicéridos y el ácido úrico. Resultados: La prevalencia de hiperuricemia era del 53%. Los pacientes con hiperuricemia tenían valores superiores de IMC (33,9 frente a 30,6; p = 0,003), perímetro de cintura (101,4frente a 91,1 cm; p < 0,001) y presión arterial sistólica (123,4 frente a 111,9 mmHg; p < 0,001)y diastólica (78,2 frente a 68,7 mmHg; p < 0,001). Mostraban además una glucemia más alta después de la sobrecarga oral de glucosa (107,5 frente a 100,7 mg/dl; p = 0,03), valores superiores de insulina (29,2 frente a 20,7 mg/dl; p = 0,001) y HOMA IR (6,5 frente a 4,4; p < 0,001) y concentraciones más bajas de HDL (49,5 frente a 54,4 mg/dl; p = 0,02).El valor de ácido úrico correspondiente con mayor probabilidad al diagnóstico de síndrome metabólico en nuestra muestra era de 5,4 mg/dl (sensibilidad del 64% y especificidad del 62%).Conclusión: La prevalencia de hiperuricemia en niños con sobrepeso y obesidad es alta. En el grupo de pacientes con obesidad e hiperuricemia hallamos que los parámetros determinados para diagnosticar el síndrome metabólico eran menos favorables. La concentración de ácido úrico a partir de la cual existe una mayor posibilidad de encontrar síndrome metabólico es de5,4 mg/dl (AU)

Objective: To study the prevalence of hyperuricemia in children with overweight or obesity and analyze the relation with metabolic syndrome and the diseases that define it. Materials and methods This is a cross-sectional prevalence study in 148 children recruited from pediatric endocrinology consultation, with overweight or obesity (12±3 years, 48% boys, BMI 31.8±6.1). We measured BMI, waist-height, waist circumference, blood pressure with standard instrumentation and glucose (fasting and after overload with 75g), insulin resistance, cholesterol HDL, triglycerides and uric acid. Results The prevalence of hyperuricemia was 53%. Patients with hyperuricemia had greater BMI (33.9 vs 30.6, p=0.003), plus waist circumference (101.4 vs 91.1cm, p<0.001), higher blood pressure: systolic (123.4 vs 111.9mm Hg, p<0.001), diastolic (78.2 vs 68.7mm Hg, p<0.001). They presented greater blood glucose after overload oral glucose (107.5 vs 100.7mg/dl, p=0.03), insulin was higher (29.2 vs 20.7mg/dl, p=0.001) as well as HOMA IR (6.5 vs 4.4, p<0.001) and HDL levels were lower (49.5 vs 54.4mg/dl, p=0.02).Uric acid's level which most is the likely diagnosis of metabolic syndrome corresponds to 5.4mg/dl in our sample (sensitivity: 64% and specificity 62%).Conclusion The prevalence of hyperuricemia in children with overweight and obesity is high. In the group of patients with obesity and hyperuricemia, we found out that the parameters measured to diagnose with metabolic syndrome were less favorable. Uric acid's level from where there is a higher possibility to see metabolic syndrome is 5.4mg/dl (AU)

Hyperuricemia and metabolic syndrome in children with overweight and obesity.

OBJECTIVE: To study the prevalence of hyperuricemia in children with overweight or obesity and analyze the relation with metabolic syndrome and the diseases that define it. MATERIALS AND METHODS: This is a cross-sectional prevalence study in 148 children recruited from pediatric endocrinology consultation, with overweight or obesity (12±3 years, 48% boys, BMI 31.8±6.1). We measured BMI, waist-height, waist circumference, blood pressure with standard instrumentation and glucose (fasting and after overload with 75 g), insulin resistance, cholesterol HDL, triglycerides and uric acid. RESULTS: The prevalence of hyperuricemia was 53%. Patients with hyperuricemia had greater BMI (33.9 vs 30.6, p=0.003), plus waist circumference (101.4 vs 91.1cm, p<0.001), higher blood pressure: systolic (123.4 vs 111.9 mm Hg, p<0.001), diastolic (78.2 vs 68.7 mm Hg, p<0.001). They presented greater blood glucose after overload oral glucose (107.5 vs 100.7 mg/dl, p=0.03), insulin was higher (29.2 vs 20.7 mg/dl, p=0.001) as well as HOMA IR (6.5 vs 4.4, p<0.001) and HDL levels were lower (49.5 vs 54.4 mg/dl, p=0.02). Uric acid's level which most is the likely diagnosis of metabolic syndrome corresponds to 5.4 mg/dl in our sample (sensitivity: 64% and specificity 62%). CONCLUSION: The prevalence of hyperuricemia in children with overweight and obesity is high. In the group of patients with obesity and hyperuricemia, we found out that the parameters measured to diagnose with metabolic syndrome were less favorable. Uric acid's level from where there is a higher possibility to see metabolic syndrome is 5.4 mg/dl.

Importancia de la lactancia materna en la prevalencia de síndrome metabólico y en el grado de obesidad infantil / Importance of breastfeeding in the prevalence of metabolic syndrome and degree of childhood obesity

Objetivos: El objetivo de nuestro estudio es evaluar la relación entre lactancia materna (LM) y prevalencia de obesidad y síndrome metabólico, en un grupo de niños y adolescentes obesos. Material y métodos: Se realizó un estudio retrospectivo en niños y adolescentes con obesidad tratados en el Servicio de Endocrinología y Nutrición del Hospital de Getafe (Madrid). Las variables estudiadas fueron edad, sexo, talla, peso, índice de masa corporal (IMC), circunferencia de cintura (CC), índice cintura-talla (ICT), presión arterial (PA), triglicéridos, lipoproteínas de alta densidad y glucemia basal. Asimismo, se recogió información sobre la alimentación recibida en los primeros meses de vida, considerando LM positiva la recibida durante al menos 3 meses. El programa estadístico utilizado fue SPSS v.15. Resultados: Se reclutó a 126 pacientes obesos (71 niños y 55 niñas), con una media de edad de 11,94 ± 3,12 años; 117 (92,86%) de ellos presentaron obesidad mórbida (IMC > P97 para edad y sexo). Todos los pacientes presentaban CC > P90 para edad y sexo. De los 126 pacientes evaluados, el 36,8% recibió LM durante más de 3 meses, y el 63,2%, sólo lactancia artificial (LA). Frente a los pacientes alimentados con LA, aquellos que recibieron LM presentaban menor IMC (31,53 ± 5,77 frente a 32,08 ± 6,78) y menor CC (95,02 ± 3,4 frente a 95,69 ± 3,2 cm), aunque no se alcanzó la significación estadística. La prevalencia de síndrome metabólico en la población estudiada fue del 19,8%. Dentro de este grupo, el 64% no había recibido LM frente a un 36% alimentado con LA. Conclusiones: Haber recibido LM durante al menos 3 meses conllevó un menor grado de obesidad, menor CC y menos complicaciones relacionadas con el síndrome metabólico durante la infancia y la adolescencia. El 64% de los niños con síndrome metabólico completo habían sido alimentados con LA. Son necesarios más estudios para conocer el impacto de la LM en el desarrollo de obesidad y riesgo cardiometabólico (AU)

Objectives: To evaluate the relationship between breastfeeding and the prevalence of obesity and metabolic syndrome in a group of obese children and adolescents. Material and methods: We performed a retrospective study in obese children and adolescents treated at the Endocrinology and Nutrition Service of the Hospital de Getafe (Madrid). The variables studied were age, sex, height, weight, body mass index (BMI), waist circumference, waist-height ratio, blood pressure, triglycerides, high-density lipoprotein and fasting glucose. Information was also collected on food received in the first months of life. Breastfeeding was defined as feeding with maternal milk for at least 3 months. The SPSS v.15 statistical package was used. Results: A total of 126 patients with obesity were recruited (71 boys and 55 girls) with a mean age of 11.94 ± 3.12 years. Of these, 117 (92.86%) were morbidly obese (BMI > 97th percentile for age and sex). All patients had a waist circumference > 90th percentile for age and sex. Of the 126 patients evaluated, 36.8% were breastfed for more than 3 months and 63.2% were fed with artificial milk only. Compared with patients fed with artificial milk, those who were breast fed had a lower BMI (31.53 ± 5.77 vs 32.08 ± 6.78) and lower waist circumference (95.02 ± 3.4 vs. 95.69 ± 3.2 cm), although this difference was not statistically significant. The prevalence of metabolic syndrome in the study population was 19.8%. Within this group, 64% had not been breast fed compared with 36% who had been fed with artificial milk. (..) (AU)