Vitamin D3 supplementation in obese, African-American, vitamin D deficient adolescents

Objectives: Obese, African-American (AA) adolescents are at increased risk for vitamin D deficiency. The primary objective of this pilot study was to examine the effect of vitamin D supplementation upon 25-hydroxy vitamin D (25OHD) levels in obese, AA adolescents. Methods: A randomized, double-blinded, controlled pilot study included 26 obese (BMI ≥ 95%ile), vitamin D deficient (25OHD < 20 ng/mL), pubertal AA adolescents (ages 12–17). Subjects received cholecalciferol 1000 IU or 5000 IU daily for 3 months. Serum 25OHD, vitamin D binding protein, parathyroid hormone, and cardiometabolic risk markers were obtained at baseline and post-treatment. Results: Of 39 subjects enrolled, 26 (67%) were vitamin D deficient (mean 25OHD 12.0 ± 3.8 ng/mL) at baseline and were randomized, with 22 completing the study. Sex, age, season, pubertal stage, BMI, insulin resistance (HOMA-IR) and 25OHD were similar at baseline between the 1000 IU and 5000 IU groups. Post-treatment, 25OHD increased less in the 1000 IU group (5.6 ng/mL, p = 0.03) vs. the 5000 IU group (15.6 ng/mL, p = 0.002). 83% of the 5000 IU group and 30% of the 1000 IU group reached post-treatment 25OHD ≥ 20 ng/mL (p = 0.01); 50% of the 5000 IU group, but no subject from the 1000 IU group, achieved 25OHD ≥ 30 ng/mL (p = 0.009). We detected no group differences in mineral metabolites or cardiometabolic risk markers following supplementation. Conclusions: Cholecalciferol dosing in excess of the current Institute of Medicine dietary reference intakes was required to achieve 25OHD levels ≥20 ng/mL in obese, AA adolescents. Supplementation of 5000 IU may be required to achieve the desired goal

Sex differences in the associations of visceral adiposity, homeostatic model assessment of insulin resistance, and body mass index with lipoprotein subclass analysis in obese adolescents.

BACKGROUND: The relationship of lipoprotein particle subclasses to visceral adipose tissue area (VAT-area) in obese children has not been examined previously. OBJECTIVES: The study aims were to compare the relationships of VAT-area, homeostatic model assessment of insulin resistance (HOMA-IR), and body mass index (BMI) with lipids and lipoprotein subclasses in obese adolescents, and to determine if these relationships vary by sex. METHODS: This cross-sectional study of obese adolescents (BMI≥95(th) percentile), ages 12-18y, measured VAT-area by dual energy x-ray absorptiometry (DXA), BMI, fasting lipids, lipoprotein subclasses, and HOMA-IR. Linear regression models evaluated the associations of VAT-area, HOMA-IR, and BMI with lipid cardiometabolic risk factors. Sex-stratified analyses further explored these associations. RESULTS: Included were 127 adolescents (age=14.4±1.5 years; 53.5% female; 88.2% African-American), mean BMI=34.0±5.1 kg/m(2). VAT-area was negatively associated with LDL particle (−P) size (β=−0.28, p=0.0001), HDL-P size (β=−0.33, p<0.0001) and large HDL-P concentration (β=−0.29, p<0.0001), and positively associated with small LDL-P concentration (β=0.23, p=0.0005) and small HDL-P concentration (β=0.25, p=0.05). When VAT-area, HOMA-IR, and BMI associations were compared, VAT-area had the strongest associations with most of the lipoprotein subclasses. After sex-stratification, the associations of VAT-area with HDL cholesterol, LDL-P size, and large LDL-P concentration were significant only for females (all p<0.05). CONCLUSIONS: In a cohort of largely African-American obese adolescents, VAT-area was associated with a more atherogenic lipoprotein subclass profile. When compared to HOMA-IR and BMI, VAT-area had the strongest associations with most lipoprotein subclasses. The relationships between VAT-area and certain lipoprotein subclasses are significantly different in males versus females

A Comparison of Ventriculoperitoneal and Ventriculoatrial Shunts in a Population of 544 Consecutive Pediatric Patients

Copyright © 2019 by the Congress of Neurological Surgeons. BACKGROUND: Although ventriculoperitoneal shunts (VPS) remain the first-line option in most instances of pediatric hydrocephalus, the long-Term efficacy of ventriculoatrial shunts (VAS) remains unknown. OBJECTIVE: To characterize the long-Term outcomes and adverse occurrences associated with both VPS and VAS at our institution. METHODS: The authors retrospectively analyzed all cerebrospinal fluid (CSF) shunting procedures performed over a 13-yr period at a single institution. A total of 544 pediatric shunt patients were followed for at least 90 d (VPS: 5.9 yr; VAS: 5.3 yr). RESULTS: A total of 54% of VPS and 60% of VAS required at least 1 revision. VPS demonstrated superior survival overall; however, if electively scheduled VAS lengthening procedures are not considered true failures, no statistical difference is noted in overall survival (P =. 08). VPS demonstrated significantly greater survival in patients less than 7 yr of age (P =. 001), but showed no difference in older children (P =. 4). VAS had a significantly lower rate of infection (P \u3c. 05) and proximal failure (P \u3c. 001). CONCLUSION: VAS can be a useful alternative to VPS when the abdomen is unsuitable, particularly in older children. Although VPS demonstrates superior overall survival, it should be understood that elective VAS lengthening procedures are often necessary, especially in younger patients. If elective lengthening procedures are not considered true failures, then the devices show similar survival