Insulin sensitivity indices: Fasting versus glucose-stimulated ýndices in pediatric non-alcoholic fatty liver disease

OBJECTIVE: We aimed to compare insulin sensitivity indices, fasting vs glucose stimulated, in children and adolescents with non-alcoholic fatty liver disease. PATIENTS AND METHODS: Two hundredeleven obese children with median age of 11.24 ± 2.65 years were evaluated. After initial clinical and anthropometric examination, B-mode ultrasonography (USG) was performed and all subjects underwent Oral Glucose Tolerance Test (OGTT). Quantitative insulin sensitivity check index (QUICKI), homeostatic model assessment for insulin resistance (Homa-IR), the insulinogenic index (IGI), the Matsuda index, and the oral glucose insulin sensitivity (OGIS) model were used to determine peripheral insulin sensitivity. RESULTS: 59.24% (68 boys, 57 girls) of obese children had NALFD. The prevalence of FLD in obese adolescents was significantly higher than in prepubertal children (65.8% vs. 51.5%). Fasting glucose, insulin, Homa-IR, QUICKI, and OGIS and Matsuda were significantly different between subjects with and without NALFD. Insulin and glucose indices were not found to be significantly different in the prepubertal group, whereas Homa-IR, QUICKI, Matsuda, and OGIS were significantly different in the pubertal group. Age, waist circumference, and OUICKI were found to be risk factors associated with the presence of NALFD in the logistic-regression analysis. CONCLUSIONS: Age, waist circumference, and OUICKI were found to be risk factors associated with NALFD. As the value of QUICKI decreases, the probability of having steatosis increases. Although OGTT results gave the information about the glucose tolerance of a subject, indices derived from OGTT were not found to be superior to the traditional surrogates such as Homa-IR or QUICKI

Effects of Vitamin D levels on asthma control and severity in pre-school children

OBJECTIVE: Prevalence of asthma and Vitamin D deficiency has been increasing and leading to significant morbidities. This study aimed to compare the Vitamin D levels in the pre-school children with asthma and in healthy controls and to assess the relationship between Vitamin D levels and asthma clinical parameters and control. PATIENTS AND METHODS: Vi tamin D [25(OH)D3] levels were measured in 102 preschool children, aged 1-4 years with asthma and 102 healthy controls in winter. The patients with asthma were grouped according to serum Vitamin D levels as sufficient, insufficient and deficient. Asthma control was classified according to the Global Initiative for Asthma (GINA) guidelines and the Test for Respiratory and Asthma Control in Kids (TRACK) in 1-4 years-old children. RESULTS: Serum Vitamin D levels were 22.64 (9.96) ng/ml in the asthma group and 32.11 (14.74) ng/ml in the control group (p = 0.001). Total number of exacerbations during the previous year were significantly lower in the Vitamin D sufficient group, compared to the deficient and insufficient groups (p = 0.03). Frequency of patients with controlled asthma was higher in the sufficient group compared to the deficient and insufficient groups (p = 0.001 and p = 0.001, respectively). There was a positive correlation between serum Vitamin D levels and asthma control. CONCLUSIONS: The frequency of Vitamin D deficiency and insufficiency was higher in children with asthma, compared to the controls. Therefore, we suggest that lower levels of Vitamin D are associated with poor asthma control and increased asthma severity

Turner syndrome and associated problems in turkish children: A multicenter study

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population. Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014. Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosi) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto’s thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%. Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespan. © Journal of Clinical Research in Pediatric Endocrinology

Obez çocuk ve adolesanlarda metabolik sendrom öngörüsünde boya uyan ağırlığın önemi; cinsiyet ve pubertenin etkisi

Purpose:To determine the role of anthropometric indices such as waist circumference, waist-to-hip ratio, waist– height ratio, and weight for height in predicting metabolic syndrome in obese children and adolescents. Materials and methods: A total of 291 obese children and adolescents aged 6–16 years were included in this study. Anthropometric and biochemical parameters were evaluated. Metabolic syndrome was defined according to the International Diabetes Federation criteria. Results:The prevalence of metabolic syndrome was 22.3% and significantly higher in pubertal obese group than in pre-pubertal ones (p=0.004). Higher waist circumference and weight for height were found in obese children and adolescents with metabolic syndrome (p<0.05). Significantly higher weight for height was found in obese girls with metabolic syndrome but the difference was not significant for obese boys. Multi-variable logistic regression analysis revealed that weight for height was the most important predictor of metabolic syndrome in obese children and adolescents except obese boys (p<0.05). Conclusion: Weight for height may be a better marker predictor of metabolic syndrome in obese children and adolescents. The cut-off point of weight for height of 136.5% for all obese children, pubertal obese children, and obese girls, 139.5% for pre-pubertal obese children was proposed to predict for metabolic syndrome. Anthropometric parameters, particularly weight for height, must be evaluated in all obese children.Amaç:Obez çocuklar ve ergenlerde, metabolik sendrom tanısının öngörülmesinde bel çevresi, bel-kalça oranı, bel-boy oranı, ve boya uyan ağırlık gibi antropometrik endekslerin rolünü belirlemek. Gereç ve yöntem: Bu çalışmaya 6-16 yaş arasındaki toplam 291 obez çocuk ve ergen dahil edildi. Antropometrik ve biyokimyasal parametreler değerlendirildi. Metabolik sendrom tanısı, Uluslararası Diyabet Federasyonu kriterlerine göre tanımlandı. Bulgular: Metabolik sendrom prevalansı % 22,3 (65) idi ve pubertal obez grupta prebupertal gruba göre anlamlı derecede yüksekti (p = 0.004). Obez çocuklarda ve metabolik sendromlu ergenlerde yüksek bel çevresi ve bel-boy oranı saptandı (p <0.05). Metabolik sendrom olan obez kızlarda anlamlı olarak yüksek bel-boy oranı bulundu, ancak obez erkeklerdeki fark anlamlı değildi. Çok değişkenli lojistik regresyon analizinde, obez çocuk ve ergenlerde boya uyan ağırlık metabolik sendromun belirteci olarak kabul edilebilir saptandı (p <0.05). Sonuç: Obez çocuklar ve ergenlerde, boya uyan ağırlık metabolik sendrom öngörüsünde iyi bir belirteç olabilir. Tüm obez çocuklar, ergenlik çağındaki obez çocuklar ve obez kızlar için boya uyan ağırlık için kesme noktası % 136.5, pre-pubertal obez çocuklar için % 139.5, metabolik sendromu öngörmek için kullanılabilir. Antropometrik parametreler, özellikle boya uyan ağırlık, tüm obez çocuklarda değerlendirilmelidir

Waist to height ratio: a simple screening tool for nonalcoholic fatty liver disease in obese children

&Ouml;zhan B, Ersoy B, &Ouml;zkol M, Kiremitci S, Ergin A. Waist to height ratio: a simple screening tool for nonalcoholic fatty liver disease in obese children. Turk J Pediatr 2016; 58: 518-523. Simple predictors are needed for the screening of nonalcoholic fatty liver disease (NAFLD) in obese children. We aimed to assess the role of anthropometric parameters in the prediction of NAFLD. Three hundred and thirty two obese children (152 male, 180 female) aged 4.6-17.0 years were included in this study. Weight, height, waist (WC), and hip circumference were measured. Body mass index (BMI), waist-hip-ratio (WHR), and waist-height-ratio (WHtR) were calculated. Obesity was defined as BMI for age and sex &gt;= 95th percentile. NAFLD was diagnosed using ultrasonography (US). NAFLD was present in 60.8% of obese children. Fatty liver prevalence differed significantly by gender and puberty (55.0% of girls vs 67.7% of boys, and 28.7% in prepubertal vs 71.3% in pubertal children; p&lt;0.05). Significantly higher BMI, BMI standard deviation score (SDS), WC, and WHtR were found in obese children with NAFLD compared to obese children without NAFLD (p&lt;0.05). Only WHtR was found to be an independent predictor for NAFLD in a logistic regression analysis (p&lt;0.001, B:1.096, 95% CI 1.047-1.148). Fatty liver is common among obese children, particularly in obese boys. WHtR is a simple and easy index for predicting of NAFLD in obese children and can be used for mass screening in public health

Acanthosis nigricans: A warning sign of lower urinary tract dysfunction in obese children?

OBJECTIVE: There have been very few studies on the relationship between lower urinary tract dysfunction (LUTD) and obesity-related metabolic disorders in the pediatric age group. This study investigated the relationship between LUTD and metabolic disturbances in obese children. PATIENTS AND METHODS: Four-hundred obese children (body mass index ≥ 95th percentile) were included in the present study. Anthropometric, clinical, and biochemical parameters were evaluated. The Dysfunctional Voiding and Incontinence Scoring System (DVISS) questionnaire was administered and scores over 8.5 were considered to be reflective of LUTD. Subjects were stratified into two groups based on DVISS symptom scores - obese children with and without LUTD. The homeostasis assessment model was used to evaluate insulin resistance and the International Diabetes Federation criteria to identify metabolic syndrome. RESULTS: Lower urinary tract dysfunction was detected in 19% of the study population. There were no significant differences between the two groups in terms of laboratory results. No statistically significant relationship was found between LUTD and the presence of metabolic syndrome or insulin resistance; however, a significant association was observed between LUTD and acanthosis nigricans. Regression analysis revealed that only the presence of acanthosis nigricans significantly increased the risk of lower urinary tract dysfunction by 1.75-fold (p < 0.05). CONCLUSIONS: The presence of acanthosis nigricans in obese children may suggest the concurrent occurrence of lower urinary tract dysfunction and should be investigated accordingly. © 2020 Verduci Editore s.r.l. All rights reserved

Perceptions of second year medical school students regarding ageing and geriatric education: A qualitative study

Introduction: Existing literature on the geriatric-related attitudes of medical students reveals inconsistent results in terms of feelings for the elderly. This study aims to determine the perceptions of medical students regarding ageing and geriatric education. Materials and Method: A qualitative study was conducted with 160 second-year medical students who visited a nursing home and responded to three open-ended questions about this experience. The responses were qualitatively analysed using the constant comparative method for themes. Results: Second year medical students indicated both positive and negative impressions of ageing. Although they generally believed that ageing brings experience and maturity, happy ageing was seen as being dependent on individual characteristics and personality factors that affect the emotional aspects of ageing and, therefore, quality of life. The students indicated recognition that ageing is related to inevitable physiological changes and a belief that most illnesses in the elderly are untreatable because of the natural decline in health related to ageing. Students indicated a sense of inadequacy in communicating with the elderly and emphasised the importance of introducing geriatric psychiatry lessons into the curriculum to improve their understanding of the elderly. Conclusion: This study provides a better understanding of the opinions of future doctors about ageing and of beliefs that should be addressed to help in the making of doctors with more positive attitudes toward older people. © 2016, Geriatrics Society. All rights reserved