Obesity-Related Metabolic Risk in Sedentary Hispanic Adolescent Girls with Normal BMI

Hispanic adolescent girls with normal BMI frequently have high body fat %. Without knowledge of body fat content and distribution, their risk for metabolic complications is unknown. We measured metabolic risk indicators and abdominal fat distribution in post-pubertal Hispanic adolescent girls with Normal BMI (N-BMI: BMI < 85th percentile) and compared these indicators between girls with Normal BMI and High Fat content (N-BMI-HF: body fat ≥ 27%; n = 15) and Normal BMI and Normal Fat content (N-BMI-NF: body fat < 27%; n = 8). Plasma concentrations of glucose, insulin, adiponectin, leptin and Hs-CRP were determined. Insulin resistance was calculated using an oral glucose tolerance test. Body fat % was measured by DXA and subcutaneous, visceral and hepatic fat by MRI/MRS. The N-BMI-HF girls had increased abdominal and hepatic fat content and increased insulin resistance, plasma leptin and Hs-CRP concentrations (p < 0.05) as compared to their N-BMI-NF counterparts. In N-BMI girls, insulin resistance, plasma insulin and leptin correlated with BMI and body fat % (p < 0.05). This research confirms the necessity of the development of BMI and body fat % cut-off criteria per sex, age and racial/ethnic group based on metabolic risk factors to optimize the effectiveness of metabolic risk screening procedures

Self-Reported Dietary Intake of Youth with Recent Onset of Type 2 Diabetes: Results from the TODAY Study

Despite the widely recognized importance of diet in managing diabetes, few studies have documented usual dietary intake in youth with type 2 diabetes (T2D). The objectives of this study were to assess dietary intake among a large, ethnically diverse cohort of youth with T2D and compare intake to current recommendations. Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) is a multi-center randomized clinical trial of 699 youth aged 10-17. At baseline, following a run-in period that included standard diabetes education, diet was assessed using a food frequency questionnaire between 2004 and 2009. Analysis of variance and non-parametric tests were used to compare mean and median nutrient intakes; logistic regression was used to compare the odds of meeting pre-defined dietary intake recommendation cut points between subgroups of age, sex and race-ethnicity. Percent of energy from saturated fat was consistently 13-14% across all subgroups – substantially exceeding national recommendations. Overall, only 12% of youth met Healthy People (HP) 2010 guidelines of < 10% saturated fat and only 1% of youth met American Diabetes Association recommendations of <7% saturated fat. Dietary intake fell substantially below other HP 2010 targets; only 3% met calcium intake goals, 11% met fruit consumption goals, 5% met vegetable consumption goals, and 67% met grain intake goals. Overall, dietary intake in this large cohort of youth with T2D fell substantially short of recommendations, in ways that were consistent by sex, age, and race-ethnicity. The data suggest a critical need for better approaches to improve dietary intake of these youth

Growth Hormone Research Society perspective on the development of long-acting growth hormone preparations

Objective The Growth Hormone (GH) Research Society (GRS) convened a workshop to address important issues regarding trial design, efficacy, and safety of long-acting growth hormone preparations (LAGH). Participants A closed meeting of 55 international scientists with expertise in GH, including pediatric and adult endocrinologists, basic scientists, regulatory scientists, and participants from the pharmaceutical industry. Evidence Current literature was reviewed for gaps in knowledge. Expert opinion was used to suggest studies required to address potential safety and efficacy issues. Consensus process Following plenary presentations summarizing the literature, breakout groups discussed questions framed by the planning committee. Attendees reconvened after each breakout session to share group reports. A writing team compiled the breakout session reports into a draft document that was discussed and revised in an open forum on the concluding day. This was edited further and then circulated to attendees from academic institutions for review after the meeting. Participants from pharmaceutical companies did not participate in the planning, writing, or in the discussions and text revision on the final day of the workshop. Scientists from industry and regulatory agencies reviewed the manuscript to identify any factual errors. Conclusions LAGH compounds may represent an advance over daily GH injections because of increased convenience and differing phamacodynamic properties, providing the potential for improved adherence and outcomes. Better methods to assess adherence must be developed and validated. Long-term surveillance registries that include assessment of efficacy, cost-benefit, disease burden, quality of life, and safety are essential for understanding the impact of sustained exposure to LAGH preparations

Growth Hormone Research Society perspective on the development of long-acting growth hormone preparations: Table 1

The Growth Hormone (GH) Research Society (GRS) convened a workshop to address important issues regarding trial design, efficacy, and safety of long-acting growth hormone preparations (LAGH)

Glucose and Alanine Metabolism in Children with Maple Syrup Urine Disease

In vitro studies have suggested that catabolism of branched chain amino acids is linked with alanine and glutamine formed in, and released from, muscle. To explore this possibility in vivo, static and kinetic studies were performed in three patients with classical, and one patient with partial, branched chain α-ketoacid decarboxylase deficiency (maple syrup urine disease, MSUD) and compared to similar studies in eight age-matched controls. The subjects underwent a 24-30-h fast, and a glucose-alanine flux study using stable isotopes. Basal plasma leucine concentrations were elevated (P <0.001) in patients with MSUD (1,140±125 μM vs. 155±18 μM in controls); and in contrast to the controls, branched chain amino acid concentrations in plasma increased during the fast in the MSUD patients. Basal plasma alanine concentrations were lower (P <0.01) in patients with classical MSUD (153±8 μM vs. 495±27 μM in controls). This discrepancy was maintained throughout the fast despite a decrease in alanine concentrations in both groups. Plasma alanine and leucine concentrations in the patient with partial MSUD were intermediate between those of the controls and the subjects with the classical form of the disease. Circulating ketone bodies and glucoregulatory hormones concentrations were similar in the MSUD and normal subjects during the fast. Alanine flux rates in two patients with classical MSUD (3.76 and 4.00 μmol/Kg per min) and the patient with partial MSUD (5.76 μmol/Kg per min) were clearly lower than those of the controls (11.72±2.53 [SD] μmol/Kg per min). After short-term starvation, glucose flux and fasting concentrations were similar in the MSUD patients and normal subjects. These data indicate that branched chain amino acid catabolism is an important rate limiting event for alanine production in vivo

Hexoneogenesis in the human breast during lactation

Lactose is the major osmotic agent in milk. Therefore, lactose synthesis indirectly regulates milk volume. The aim of this study was to determine the source of glucose and galactose in lactose. Six healthy lactating women were studied twice, during a 24-h fast and during ingestion of a mixed macronutrient drink (Sustacal) using [U-13C]glucose and [2-13C]glycerol. Six additional lactating women were studied on one single occasion during ingestion of glucose labeled with [1-13C]glucose. Using the ratios of [13C6] enrichments of glucose in lactose and plasma glucose and that of galactose in lactose and plasma glucose, we determined that 98 ± 3% of glucose and 68 ± 7% of galactose in lactose were derived from plasma glucose in the fed state, and 72 ± 4 and 51 ± 3%, respectively, after a 24-h fast. Virtually identical results (97 ± 6 and 64 ± 4%, respectively) were obtained during the glucose feeding study. On the basis of the [13C1] enrichment of glucose and galactose in lactose (derived from [2-13C]glycerol), glycerol contributes to the production of galactose but not glucose within the breast. Thus, plasma glucose is an important source of lactose, but significant amounts of glucose and galactose in lactose are generated within the breast, a process denoted hexoneogenesis. In this process, glycerol is a precursor for milk galactose but not glucose