Disfunción diastólica subclínica del ventrículo izquierdo en adolescentes con diabetes tipo 1 / Subclinical left ventricular diastolic dysfunction in adolescents with type 1 diabetes

Introducción: El objetivo de este trabajo fue determinar la prevalencia de disfunción diastólica subclínica del ventrículo izquierdo (DDVI) y su asociación con el descontrol metabólico en adolescentes con diabetes tipo 1. Métodos: Se trató de un estudio en 53 adolescentes con diabetes tipo 1 en dos fases: primero, un estudio transversal descriptivo y, después de realizar un ecocardiograma, un transversal comparativo. Se consideró DDVI cuando tuvieron tres o más datos ecocardiográficos alterados: velocidad de contracción auricular (relación E/A), tiempo de desaceleración (TD), tiempo de relajación volumétrico (TRIVI) y función sistólica mayor de 50%. Además, se les determinaron los niveles de glucosa, de hemoglobina glucosilada y microalbuminuria. Resultados: El 16.98% de los adolescentes diabéticos mostraron datos ecocardiográficos de DDVI, y el 15.10% correspondió al sexo masculino. El patrón pseudonormalizado se observó en 7.54%, en relación con el 5.66% del patrón de alteración de la relajación y del 3.77% del restrictivo. Estos pacientes, además, mostraron mayor tiempo de la enfermedad, obesidad y un aumento en la glucemia, en la hemoglobina glucosilada y de la microalbuminuria. Conclusiones: La DDVI es una complicación frecuente en los adolescentes con diabetes tipo 1. Aquellos con DDVI presentaron con mayor frecuencia obesidad, mayor tiempo de evolución de la enfermedad y un peor control metabólico. Se propone que en estos pacientes se realice un diagnóstico oportuno y sistemático a través de un ecocardiograma.

Background: To determine the prevalence of subclinical left ventricular diastolic dysfunction (LVDD) and its association with metabolic control in adolescents with type 1diabetes. Methods: We carried out a study in 53 adolescents with type 1 diabetes in two phases: cross-sectional and after performing two-dimensional M-mode echocardiogram and color Doppler, a cross-sectional comparison. Subjects were divided into two groups: the first without LVDD and the second with LVDD. LVDD was considered when there were three or more alterations according to echocardiographic data (rate of atrial contraction, time of deceleration, time of volumetric relaxation) accompanied by systolic function >50%. We also determined glucose, hemoglobin, glycosylate, and microalbuminuria. Results: Of the adolescents with diabetes, 16.98% showed echocardiographic data of LVDD; 15.10% were male. Pseudonormalized pattern was observed in 7.54% compared to 5.66% with impaired relaxation pattern and 3.77% with restrictive pattern. Furthermore, there was a longer time of disease evolution, obesity and a significant increase of glycemia, glycosylated hemoglobin and microalbuminuria. Conclusions: LVDD is a frequent complication in adolescents with type 1 diabetes. Those with LVDD had a higher prevalence of obesity, longer time of disease, and poorer metabolic control. Therefore, we propose that a timely and systematic search with echocardiogram is important in patients with type 1 diabetes.

Serotonin and dopamine in the hypothalamus of control and malnourished mother rats during pregnancy and lactation and body composition of their offspring.

OBJECTIVE: To determine concentrations of serotonin and dopamine in the hypothalamus of undernourished rats and controls during pregnancy and lactation and body composition of their offspring. METHODS: Malnourished rats along with control rats were used during pregnancy and lactation. At birth of their offspring, control mothers nursed their young and malnourished rats and the undernourished mothers nursed their offspring and control pups. On days 5, 10, 15, and 21 of lactation (at the beginning and end of a feeding), L-tryptophan (L-Trp)-free, bound and total, plasma prolactin (PRL) and milk composition were determined. Serotonin and dopamine were measured in the hypothalamus. Body composition of offspring was determined. RESULTS: Increase of free L-Trp was confirmed in undernourished mothers. Furthermore, hypothalamic serotonin was elevated at the start of suckling and decreased at termination. There was also a decrease in dopamine in the hypothalamus at the beginning and end of suckling followed by an increase of plasma PRL that was greater in control mothers who breastfed malnourished offspring. Interestingly, undernourished offspring consumed more milk and showed a clear recovery of body composition with accumulation of body fat. DISCUSSION: Changes observed in hypothalamic neurotransmitters appear to be closely related to nutritional status and to the response and control of PRL production, possibly to adapt the offspring to the metabolic changes. It was also confirmed that on-demand feeding of undernourished offspring is the main factor involved in nutritional recovery and a predisposition to overweight in the recovered undernourished animals.

Association of metabolic syndrome with reduced central serotonergic activity.

The aim of this study was to determine the differences between two groups of adolescents with metabolic syndrome (MetS) and normal controls in relation to brain serotonergic activity through intensity-dependent auditory-evoked potentials (IDAEPs) and plasma free fraction of L-tryptophan. Eighteen adolescents with MetS and thirteen controls were studied. Free fraction, bound and total plasma L-tryptophan, glucose, cholesterol, triglycerides, HDL-cholesterol, albumin and IDAEPs were determined. Glycemia, triglycerides were significantly elevated, and HDL-cholesterol in plasma was significantly reduced. Free fraction and free fraction/total L-tryptophan ratio were decreased. The slope of the amplitude/stimulus intensity function of the N1/P2 component significantly increased in adolescents with MetS. Decrease of free fraction of L-tryptophan in plasma and increase of the slope of the N1/P2 component suggest a low brain serotonin tone. Cortex responses are regulated by serotonergic innervations and may show a different behavior in young patients with MetS. Therefore, the slope of the N1/P2 component along with the free fraction of L-tryptophan in plasma, indicate that in adolescents with MetS the state of serotonergic brain activity is depressed and possibly related to psychiatric disorders.

Lack of agreement between the revised criteria of impaired fasting glucose and impaired glucose tolerance in children with excess body weight.

OBJECTIVE: The aim of this study was to describe the agreement between impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) in children with excess body weight using the original and the revised definitions of IFG. RESEARCH DESIGN AND METHODS: Obese and overweight children aged 4-17 years were included (n = 533). Anthropometric parameters and biochemical tests (fasting and 2-h glucose tests after an oral glucose load [1.75 g/kg]) were performed. Case subjects with a fasting plasma glucose >/=126 mg/dl were excluded. The diagnostic parameters of the original and the revised definitions of IFG for detecting IGT were estimated. The analysis of agreement between these categories was made using the kappa test. RESULTS: The prevalence of IFG increased from 6.2 to 13.3% using the new criteria. The prevalence of IFG became closer to the prevalence of IGT (14.8%). The revised criteria increased the sensitivity from 26.6 to 36.7%. However, the new IFG definition was not useful for identifying IGT cases. Of the 71 case subjects with IFG, only 29 (40.8%) had IGT. In addition, 50 case subjects with IGT (9.4%) and 13 with diabetes (2.4%) had a fasting glycemia <100 mg/dl. A poor agreement was found between the 2003 IFG definition and abnormal 2-h postchallenge plasma glucose (kappa = 0.359). The proportion of false-positive cases increased (36.3-59.1%) under the new definition. CONCLUSIONS: The new definition modestly increases the sensitivity of IFG for detecting IGT in children with excess body weight. Despite this, more than one-half of these cases are not detected. In addition, the false-positive rate was increased by 61%.

Elevación crónica de la síntesis de serotonina cerebral en rata adulta desnutrida in utero y resuperada nutricionalmente durante el amamantamiento / Chronic elevated brain serotonin synthesis in adult rats undernourished in utero and nutritionally recovered with breast-feeding

Introducción. Las ratas desnutridas in utero tienen la síntesis de 5-hidroxitriptamina (5-HT) cerebral acelerada y su concentración elevada, secundaria a un aumento del L-triptófano (L-Trp) y de la actividad de la triptófano-5-hidroxilasa (TrpOH). Además de un cambio cinético de la TrpOH, que consiste en un aumento de la afinidad por el L-Trp y mayor actividad por mecanismos de fosforilación. Por otra parte, cuando estos desnutridos fueron sometidos a un esquema de recuperación nutricia neonatal, mostraron completa recuperación física y retorno a lo normal del L-Trp durante el amamantamiento; pero a pesar de este hecho, la actividad de la TrpOH permaneció elevada y persistió un aumento de la 5-HT cerebral. El objetivo del presente estudio fue investigar si los cambios en la actividad de la TrpOH y en la síntesis de 5-HT cerebral, persisten o regresan a lo normal en el animal adulto nutricionalmente recuperado. Material y métodos. Se utilizaron ratas Wistar; adaptadas durante 2 semanas a condiciones ambientales estándar. Al término del período se formaron 2 grupos: uno con desnutrición (D) y el otro control (C). Después de 2 semanas, las hembras fueron pareadas con machos normales. Al nacimiento las crías fueron redistribuidas a madres del mismo grupo D y C. Además, se realizó un cruzamiento de las crías desnutridas a madres controles, lo que formó el grupo desnutrido recuperado (DR). Al día 21 de edad todas las crías fueron destetadas y se les continuó con el mismo esquema de alimentación. En los días 21, 60, 90 y 120, se obtuvo el tallo y la corteza cerebral en donde se determinó la TrpOH y las concentraciones de L-Trp y 5-HT. Además se les tomó sangre en donde se cuantificó el L-Trp y albúmina. También se les midió la ingesta de comida cada 24 horas y se les determinó el peso corpora, cerebral y de la longitud céfalo-sacra. Resultados...