Growth and body composition of a cohort of children and adolescents with type 1 diabetes

Orientadores: André Moreno Morcillo, Sofia Helena Valente de Lemos MariniTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Objetivo: avaliar o crescimento e a composição corporal de crianças e adolescentes, com diabetes tipo 1 (DM1). Sujeitos e métodos: estudo de uma coorte de 44 pacientes com DM1 acompanhados em média por 4 anos, comparados a um grupo controle. Avaliou-se peso, estatura, índice de massa corporal (IMC), massa gorda (MG%), índice de massa gorda, cintura e razão cintura/altura. Resultados: no sexo feminino, na primeira avaliação a MG% das pacientes foi menor, enquanto na segunda, a média da cintura das pacientes foi maior que a dos controles. No sexo masculino, a altura dos pacientes foi menor na primeira avaliação, enquanto o IMC foi maior na segunda. Não foram observadas diferenças entre as variações dos escores z de altura, peso, IMC e da MG% ou na distribuição desses escores entre as duas avaliações em ambos os grupos. A análise multivariada mostrou diferença no IMC e na razão cintura/altura dos dois sexos e também na cintura das meninas. Conclusão: os pacientes apresentaram crescimento adequado, porém diferiram na composição corporal durante o período do estudoAbstract: Objective: the aim of this study was to evaluate the growth and body composition of children and adolescents with type 1 diabetes mellitus (T1DM). Subjects and methods: a cohort of 44 patients with T1DM were followed for approximately four years and compared with a control group. Weight, height, body mass index (BMI), body fat percentage (BF%), fat mass index, waist circumference (WC) and waist-height ratio were determined. Results: in females, in the first evaluation, BF% was lower in patients, while, in the second, mean WC was higher in patients than in controls. In males, height was lower in the first, while BMI was higher in the second. We did not find any differences among the changes in height, weight, BMI z-scores and BF% or in the distribution of those z-scores between the two evaluations, in both groups. Multiple regression analysis found differences in BMI and waist-height ratio in both sexes and also in WC in females. Conclusion: the patients had adequate growth but showed discrepancy in their body composition during the studyDoutoradoPediatriaDoutora em Saúde da Criança e do Adolescent

Growth and body composition in children with type 1 diabetes

Orientadores: Andre Moreno Morcillo, Sofia Helena Valente de Lemos MariniDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Objetivos: Avaliar o crescimento e a composição corporal de diabéticos tipo 1, pré-púberes, em relação à idade de início e tempo da doença, sexo, dose de insulina e hemoglobina glicada média. Pacientes e métodos: Foram incluídas no estudo 59 crianças diabéticas (30M; 29F), 1,2 - 11,5 anos, e 67 controles (36M; 31F), 1,2 - 11,7 anos. Peso, altura, IMC, áreas de massa gorda e muscular braquial foram determinados e transformados em escore z. Perímetro braquial e pregas cutâneas foram medidas e somatória de três e quatro dobras foram calculadas. Resultados: Verificou-se que entre os diabéticos a média de escore z de altura foi -0,13 (± 0,97) enquanto no grupo controle foi 0,28 (±0,86) (p=0,013). A diferença entre os escores de altura inicial e atual mostrou perda estatural (p<0,001) e a análise multivariada demonstrou associação com tempo de doença. Também observou-se diferença na prega cutânea tricipital, soma de 4 dobras e área de gordura braquial. As médias de escore z de peso, IMC, soma de 3 dobras e área muscular braquial não diferiram entre os grupos. Conclusões: as crianças diabéticas apresentaram perda de estatura durante o período de acompanhamento e eram significativamente mais baixas que os controles, embora suas alturas ainda estivessem dentro dos padrões de normalidade. Também mostraram área de gordura braquial aumentada em relação aos controles, e esta diferença parece ser devida à prega cutânea tricipital superestimada em razão da hipertrofia local induzida pela insulinaAbstract: Objective: to evaluate the growth and body composition of pre-pubertal diabetic children, and to check for influence of the age of diabetes onset and length, sex, insulin requirement and glycosylated hemoglobin. Patients and methods: 59 diabetic children (39M; 29F), age 1,2-11,5 years, and 67 controls (36M; 31F), age 1,2-11,7 years, were included. Weight, height, body mass index (BMI), fat mass and muscle areas were evaluated and transformed into standard deviation scores (SDS). Arm circumference and skinfolds thickness were measured and addition of 3 and 4 skinfolds were calculated. Results: among the diabetic children the mean height SDS was -0,13 (±0,97) while in the control group it was 0,28 (±0,86) (p=0,013). The difference between the first and the current height SDS showed that height SDS decreased significantly (p<0,001) and, multiple regression analysis indicated correlation with the duration of the disease. The triceps skinfold, the sum of 4 skinfolds measurements and the mean arm fat SDS also revealed differences. The means for weight, BMI, sum of 3 skinfolds measurements and muscle mass did not demonstrate difference between the groups. Conclusions: diabetic children showed reduction of height SDS during the period studied and they were significantly shorter than the controls, even though their statures were within the population standards. The arm fat area also showed to be increased when compared with controls, and this difference seems to be correlated to the overestimated triceps skinfold due the lipohypertrophy induced by insulinMestradoSaude da Criança e do AdolescenteMestre em Saude da Criança e do Adolescent

Growth and body composition of a cohort of children and adolescents with type 1 diabetes

OBJECTIVE: To evaluate the growth and body composition of children and adolescents with type 1 diabetes mellitus (T1DM). SUBJECTS AND METHODS: A cohort of 44 patients with T1DM were followed up for approximately four years and compared with a control group. Weight, height, body mass index (BMI), body fat percentage (BF%), fat mass index, waist circumference (WC) and waist-height ratio were determined. RESULTS: In females, in the first evaluation, BF% was lower in patients than in controls, while in the second evaluation, mean WC was higher in patients than in controls. In males, height of the patients was lower in the first evaluation, while body mass index (BMI) was higher in the second one. We did not find any differences among the changes in height, weight and BMI z-scores and BF% or in the distribution of those z-scores between the two evaluations, in both groups. Multiple regression analysis found differences in BMI and waist-height ratio in both sexes and also in WC in females. CONCLUSION: The patients had adequate growth but showed discrepancy in their body composition during the study.OBJETIVO: Avaliar o crescimento e a composição corporal de crianças e adolescentes com diabetes tipo 1 (DM1). SUJEITOS E MÉTODOS: Estudo de uma coorte de 44 pacientes com DM1 acompanhados em média por quatro anos, comparados a um grupo controle. Avaliaram-se peso, estatura, índice de massa corporal (IMC), porcentagem de massa gorda (%MG), índice de massa gorda, cintura e razão cintura/estatura. RESULTADOS: No sexo feminino, na primeira avaliação a %MG das pacientes foi menor, enquanto na segunda avaliação a média da cintura das pacientes foi maior que a dos controles. No sexo masculino, a estatura dos pacientes foi menor na primeira avaliação, enquanto o IMC foi maior na segunda. Não foram observadas diferenças entre as variações dos escores z de estatura, peso e IMC e da %MG ou na distribuição desses escores entre as duas avaliações em ambos os grupos. A análise multivariada mostrou diferença no IMC e na razão cintura/estatura dos dois sexos e também na cintura das meninas. CONCLUSÃO: Os pacientes apresentaram crescimento adequado, porém diferiram na composição corporal durante o período do estudo.62363

A New Compound Heterozygosis For Inactivating Mutations In The Glucokinase Gene As Cause Of Permanent Neonatal Diabetes Mellitus (pndm) In Double-first Cousins.

Permanent neonatal diabetes mellitus (PNDM) is a rare disorder, characterized by uncontrolled hyperglycemia diagnosed during the first 6 months of life. In general, PNDM has a genetic origin and most frequently it results from heterozygous mutations in KCNJ11, INS and ABCC8 genes. Homozygous or compound heterozygous inactivating mutations in GCK gene as cause of PNDM are rare. In contrast, heterozygosis for GCK inactivating mutations is frequent and results in the maturity-onset diabetes of young (MODY), manifested by a mild fasting hyperglycemia usually detected later in life. Therefore, as an autosomal recessive disorder, GCK-PNDM should be considered in families with history of glucose intolerance or MODY in first relatives, especially when consanguinity is suspected. Here we describe two patients born from non-consanguineous parents within a family. They presented low birth weight with persistent hyperglycemia during the first month of life. Molecular analyses for KCNJ11, INS, ABCC8 did not show any mutation. GCK gene sequencing, however, revealed that both patients were compound heterozygous for two missense combined in a novel GCK-PNDM genotype. The p.Asn254His and p.Arg447Gly mutations had been inherited from their mothers and fathers, respectively, as their mothers are sisters and their fathers are brothers. Parents had been later diagnosed as having GCK-MODY. Mutations' in silico analysis was carried out to elucidate the role of the amino acid changes on the enzyme structure. Both p.Asn254His and p.Arg447Gly mutations appeared to be quite damaging. This is the first report of GCK-PNDM in a Brazilian family.710

Clinical and laboratory profile of pediatric and adolescent patients with type 1 diabetes

OBJECTIVE: To evaluate clinical and laboratory profiles of patients with type 1 diabetes mellitus in three public hospitals in São Paulo, Brazil, since type 1 diabetes mellitus is a chronic illness that occurs mainly in the pediatric age group in the Brazilian population. METHODS: Cross-sectional study with patients followed up in reference centers in São José do Rio Preto (FAMERP), Campinas (UNICAMP) and São Paulo (Conjunto Hospitalar do Mandaqui). Data about gender, age, diabetes duration, daily insulin dose, number of daily insulin injections, and glycosylated hemoglobin (HbA1c) were analyzed. RESULTS: Two hundred and thirty-nine patients (131 females) were evaluated; mean age was 13.1±4.7 years and mean diabetes duration was 6.6±4.2 years. Daily insulin doses ranged from 0.1 to 1.78 units/kg/day (0.88±0.28), and 180 (74.7%) patients had two daily injections. HbA1c ranged from 4.6 to 17.9% (10.0±2.3%). CONCLUSIONS: Although the hospitals included in this study are excellence centers for the follow-up of patients with diabetes in three municipalities in the state of São Paulo, one of the most developed states in Brazil, blood glucose control evaluated according to HbA1c was not adequate. Findings confirm that, despite the efforts of all the professionals involved, great challenges still lie ahead.OBJETIVO: Realizar a avaliação clínica e laboratorial dos pacientes com diabetes melito tipo 1 em três hospitais públicos em São Paulo (SP), uma vez que o diabetes melito tipo 1 é uma doença crônica que ocorre principalmente em crianças e adolescentes. MÉTODOS: Estudo transversal com pacientes em acompanhamento em centros de referência em São José do Rio Preto (FAMERP), Campinas (UNICAMP) e São Paulo (Conjunto Hospitalar do Mandaqui). Dados como gênero, idade, duração do diabetes, dose diária de insulina, número de aplicações diárias de insulina e hemoglobina glicosilada (HbA1c) foram analisados. RESULTADOS: Foram avaliados 239 pacientes (131 do sexo feminino); a idade média foi de 13,1±4,7 anos e o tempo médio de duração do diabetes foi de 6,6±4,2 anos. As doses diárias de insulina variaram de 0,1 a 1,78 unidades/kg/dia (0,88±0,28), e 180 (74,7%) pacientes faziam somente duas aplicações por dia. A HbA1c variou de 4,6 a 17,9% (10,0±2,3%). CONCLUSÕES: Embora os hospitais incluídos neste estudo sejam centros de referência para o seguimento de pacientes com diabetes melito em três cidades do estado de São Paulo, um dos estados mais desenvolvidos do Brasil, o controle da glicemia avaliado através da HbA1c não foi adequado. Isso confirma o fato de que, embora haja esforço de todos os profissionais envolvidos, grandes desafios ainda deverão ser vencidos.49049