Vitamin D, Insulin Resistance and Cytokine Levels in Obese Pubertal Children

Insulin resistance (IR) develops in obese children because of low vitamin levels and increased pro-inflammatory cytokine levels. This study aimed to analyze the relation between vitamin D, insulin resistance, tumor necrosis factor-alpha and interleukin 6 (IL-6) levels at admission and after weight loss. This study included 84 obese and 28 healthy pubertal children. Patient group was divided into four: IR positive and negative; weight loss (WL) positive and negative. Baseline and follow-up (6th month) values of serum 25-hydroxyvitamin D and other parameters were evaluated. The prevalence of serum vitamin D deficiency and insufficiency were 3.6% and 21.4% in the control group, 15.2% and 10.9% and 7.9% and 15.8% in the obese insulin positive and negative group; respectively. There was no relationship between vitamin D and IRand IL-6 levels, whereas cytokine levels were lower in obese children. As WL increased, vitamin D level and IR improved. No significant difference was found between vitamin D levels of obese and control subjects. In obese children with weight loss, an insignificant increase was observed in vitamin D, cytokines, quantitative insulin sensitivity check index values and an insignificant decrease was noted in homeostatic model assessment for IR value. Further longitudinal studies with larger patient series with greater WL are warranted

PUBERTAL OBEZ ÇOCUKLARDA VİTAMİN D METABOLİZMASI, İNSÜLİN DİRENCİ, TNF-α VE IL-6 DÜZEYLERİ

Çocukların sağlıklı beslenmesi fiziksel, kognitif ve psikolojik gelişimleri açısından önem taşımaktadır. Günümüz çocuklarında beslenme bozuklukları nedeniyle birçok sağlık problemi görülmektedir. Bu sorunlardan birisi olan obezitenin sıklığı giderek artmakta ve beraberinde başka sağlık sorunlarını da getirmektedir. Yapılan çalışmalarda obezlerde insülin direnci ve vitamin D eksikliği sık görülmektedir. Vitamin D’nin sadece kalsiyum ve kemik metabolizmasında değil immün sistem ve insülin sekresyonu üzerinde de etkileri gösterilmiştir. Çalışmamız pubertal obez çocuklarda vitamin D’nin insülin direnci, TNF-α, IL-6 düzeyleri ile ilişkisini ve kilo kaybı sonucu bu parametrelerdeki değişiklikleri araştırmak için yapılmıştır. Çalışma Ocak-Haziran 2009 tarihleri arasında yapılmıştır. 84 obez, 28 sağlıklı çocuk çalışmaya alınmıştır. Olguların serum AKŞ, insülin, Ca, P, ALP, 25-OH vitamin D, 1,25(OH)2 vitamin D, PTH, TNF-α, IL-6 seviyeleri çalışılmıştır. Kontrol grubunda 25-OH vitamin D eksikliği % 3,6, yetersizliği % 21,4 bulunmuş iken, insülin direnci (-) grupta 25-OH vitamin D eksikliği % 15,2, yetersizliği % 10,9, insülin direnci (+) grupta ise 25-OH vitamin D eksikliği % 7,9 iken yetersizliği %15,8 olarak saptanmıştır. Sadece obez olgularda saptanan insülin direnci ve vitamin D arasında ilişki bulunmamıştır. Vitamin D eksikliği ile IL-6 düzeyleri arasında ilişki saptanmazken, TNF-α düzeyleri obez grupta daha düşük bulunmuştur. Kilo kaybı ile, vitamin D seviyelerinde yükselme ve insülin direncini gösteren HOMA-IR değerinde düşme, QICKI değerinde ise yükselme saptanmıştır. Ancak vitamin D, insülin direnci ve sitokin seviyeleri arasındaki ilişkiyi araştırmak için daha uzun süreli çalışmalara ihtiyaç vardır.Children must have a healthy nutrition in order to achieve a good physical, cognitive and psychological development. Nowadays, several health issues due to nutrition disorders are seen in children. Obesity, one of these nutrition problems, is increasing in frequency each day and it brings along many other health problems. Studies show insulin resistance and vitamin D deficiency are common in the obese children. Vitamin D does not only act on calcium and bone metabolism but also has effects on insulin secretion. Our study was done in order to investigate the relationship between vitamin D and other parameters such as, insulin resistance, TNF-α and IL-6 levels in pubertal obese children and the effects of weight loss on these parameters. Study was performed between January-June 2009. 84 obese and 28 healthy children were included in this study. The serum levels of fasting blood sugar, insulin, calcium, phosphorous, alkaline phosphatase, 25-OH vitamin D, 1.25(OH)2 vitamin D, PTH, TNF- α, IL-6 were analyzed. In the insulin resistant group 25-OH vitamin D deficiency was seen in 7.9% of the cases, 25-OH vitamin D insufficiency was seen in 15.8% of the cases where as in the insulin non-resistant group 25-OH vitamin D deficiency was found to be 15.2% and insufficiency was found to be 10.9%. In the control group 25-OH vitamin D deficiency was seen in 3.6% of the cases and insuficiency was seen in 21.4% of the cases. No relationship between insulin resistance and vitamin D was observed in obese cases. TNF- α levels found to be lower in the obese group while no relationship was detected between vitamin D deficiency and IL-6 levels. Weight loss caused an increase in vitamin D levels, decrease in HOMA-IR levels, a parameter showing insulin resistance and increase in QICKI levels were found. However long term studies are necessary in order to investigate the relationship between vitamin D levels, insulin resistance and cytokine levels

Refugee children with beta-thalassemia in Turkey: Overview of demographic, socioeconomic, and medical characteristics

Aim Since the beginning of the Syrian civil war, more than 3.5 million Syrians have been under temporary protection status in Turkey. Because beta-thalassemia (BT) is a prevalent disorder in the Mediterranean countries, we decided to estimate the prevalence of and make an overview of the demographic, socioeconomic, medical characteristics, and healthcare problems of refugee children with BT. Patients Eighteen Turkish Pediatric Hematology Oncology Centers (PHOC) with 318 refugee children from 235 families participated in the study. The mean age of the patients was 8.1 +/- 4.8 years (0.5-21 years). The mean time after immigration to Turkey was 2.5 +/- 1.5 years (range, 0.1-7 years). Seventy-two (22.6%) of them were born and diagnosed with BT in Turkey. On physical examination, 82 patients (26%) were underweight and 121 patients (38%) were stunted. The appearance of a thalassemic face was reported for 207 patients (65.1%). Hepatomegaly and splenomegaly were reported in 217 (68.2%) and 168 (52.8%) patients, respectively. The median ferritin level was 2508 ng/mL (range, 17-21 000 ng/mL) at the first admission, and 2841 ng/mL (range, 26-12 981 ng/mL) at the last visit after two years of follow-up in a PHOC (P > 0.05). The most frequently encountered mutation was IVSI-110 (G>A) (31%). Before immigration, only 177 patients (55.6%) reported the use of chelators; after immigration it increased to 268 (84.3%). Conclusion Difficulties in communication, finding a competent translator capable in medical terminology, nonregular use of medications, and insensitivity to prenatal diagnosis were preliminary problems. The current extent of migration poses emerging socioeconomic and humanitarian challenges for refugee patients with BT