Preschool children - obesity and risk behaviours. Trends from 2009 to 2013

In the beginning of 2011, according to WHO more than 40 million children under 5 years are overweight, and over 30 million of them live in developing countries. In Bulgaria Iotova et. al. (2009) reported an increased incidence of obesity in 9-year old girls from 4.3% to 10.4% over a period of 5 years (2002-2007).Aim: To determine the incidence of overweight and general and abdominal obesity in preschool children, and also some risk behaviors and their trend over 2009.Participants and methods: height, weight and WC were measured of a total of 117 children aged 4,53±0.29 years that were attending kindergartens in Varna. BMI (kg/m2) was calculated and compared with the IOTF references for the corresponding age and sex. The comparison was made with a group of 189 children from Varna, of the same age (mean age 4,58±0,31 years), measured by the same methods in 2009. Res ults : When comparing the two groups there was a significant reduction in WC (p=0.022). In 2009 OW/ obese were 12.7% of the children and significantly increased to 19.7% in 2013 (p=0.01). There is a decrease in the proportion of obese children (from 4.2% to 0.9%) and an increase in those who were overweight (from 8.5% to 18.8%).Conclusion: Reducing the percentage of obese children in this young age most likely reflects a positive trend in the attitude towards obesity. Increasing percentage of overweight children who are potential pool of increasing obesity with age, requires serious attention in the prevention of obesity

Clinical-laboratory characteristics, psychological assessment and quality of life in patients with non-classical congenital adrenal hyperplasia

Non-classical congenital adrenal hyperplasia (NCCAH) is a common autosomal recessive disease caused by partial or complete 21-hydroxylase deficiency, causing increased production of adrenal androgens and steroid precursors. As a hyperandrogenic condition, it negatively affects psychological health and quality of life.Aim: To evaluate the clinical-laboratory profile, psychological health, and quality of life in patients with NCCAH compared to healthy controls.Materials and methods: A cross-sectional study was conducted. It included 34 patients with NCCAH (mean age 16.2±3.4 years) and 34 healthy controls (mean age 15.0±3.1 years). Data on anthropometry, clinical and laboratory features of hyperandrogenism, and menstrual irregularities were collected. A validated World Health Organization (WHO) Quality of Life Questionnaire-26 was used to assess physical (D1) and psychological (D2) health, social relationships (D3), and environment (D4). Psychological assessment was evaluated using the EDI-3 standardized questionnaire.Results: Hirsutism and acne were more common in girls with NCCAH, also showing a higher Ferriman-Gallwey score (18.7±5.3 vs 7.7±8.3, p<0.001) correlating with Androstendione and 17OHProgesterone levels (r=0.519, p<0.001, r=0.424, p<0.001). The presence of overweight or obesity was found in 17.7% of all participants, with no significant difference between groups. Analyzing the WHOBrief QoL questionnaire, the NCCAH girls showed significantly lower physical and psychological health scores as well as worse EDI-3 scores on 8 of all the psychological scales used.Conclusion: Girls with NCCAH commonly demonstrate both clinical and biochemical hyperandrogenism, which is closely associated with impaired QoL and psychological health

Association between vitamin D status and obesity in Bulgarian pre-pubertal children: a pilot study

Background: It is considered that obesity and metabolic syndrome are accompanied with vitamin D deficiency. We aimed to examine the interrelations between vitamin D status and biomarkers for metabolic syndrome in Bulgarian pre-pubertal children.Methods: The study enrolled 51 pre-pubertal children (29 boys, 22 girls) examined for serum 25-xydroxyvitamin D, and routine parameters for metabolic syndrome. Obesity was evaluated by body mass index and waist circumference.Results: More than half (57.1%) of the studied children were vitamin D deficient, prevalent in girls than in boys (65.0% vs. 51.7% respectively). A tendency for worse metabolic status in the vitamin D-deficient group, expressed by higher fasting insulin, total cholesterol, total cholesterol/HDL-ratio and Homeostasis Model Assessment (HOMA)-index was observed. A trend for negative correlation was established between 25-xydroxyvitamin D and waist circumference, HOMA-index, and fasting insulin.Conclusions: Vitamin D deficiency and inverse relationships between 25-xydroxyvitamin D and waist circumference, HOMA-index, and insulin were found amongst studied children

Adiponectin, some markers of metabolic risk and abdominal obesity in preschool age

Всички проучвания на Балканския полуостров през последното десетилетие откриват нарастваща честота на затлъстяването. Абдоминалното затлъстяване се смята за по-морбидно поради по-високата метаболитна активност на абдоминалната мастна маса, характеризираща се с нискостепенно хронично възпаление.ЦЕЛ: Да се установи връзка между мастната маса (ММ) и някои метаболитни маркери в предучилищна възраст.УЧАСТНИЦИ И МЕТОДИ: Измерени са ръст, тегло и коремна обиколка (KO) на 40 здрави деца от област Варна на средна възраст 5,31 години (4-7 год.), разпределени като нормални, с наднормено тегло и със затлъстяване чрез ИТМ и CDC референтни стойности в зависимост от пола и възрастта. Биохимичните изследвания са взети след 12 ч. нощен глад. Поставени са педометри за определяне нивото на физическа активност (ФА). С цел валидизиране на абдоминалното затлъстяване се проведе DXA изследване заколичество MM.РЕЗУЛТАТИ: Със затлъстяване са 17,5% от участниците, като само 9,7% от всички покриват минималните препоръки за двигателна активност през седмицата и 16,1% през почивните дни. ММ (ср. кг) корелира сигнификантно с ИТМ и KO (р<0,001), a от метаболитните маркери корелира с hsCRP (r=0,533; p=0,04), както и с повишените нива на общ холестерол (r=0,458; р=0,016). Открива се значима връзка между серумния лептин и ИТМ, KO, ММ (р<0,001), както и с общия холестерол (r=0,482; р=0,008) и ниските нива на LDL-холестерол (r=0,434; р=0,019). Нивата на серумен адипонектин корелират обратнопропорционално с теглото (r=-0,415, p=0,025), при контролиране за ФА и с КО (r=-0,437; p=0,042).ЗАКЛЮЧЕНИЕ: Настоящото проучване открива значима връзка между коремната обиколка, мастната маса и утвърдени маркери за метаболитен риск при здрави деца дори в тази ранна възраст.All the studies in the Balkan countries, over the last decade, found an increasing incidence of obesity. Abdominal obesity is considered with higher morbidity,due to the higher metabolic activity of the abdominal fat mass, which is characterized by low-level chronic inflammation.OBJECTIVE: to establish a link between (abdominal) fat mass and some metabolic markers in preschool age.PARTICIPANTS AND METHODS: height, weight and waist circumference (WC) of 40 healthy children living in Varna district were measured, mean age 5.31 years (4-7 yr.). Normal weight, overweight and (abdominal) obesity was defined by BMI and CDC reference values according to sex and age. Biochemical tests were taken after 12 hours of overnight fasting. Children wore pedometers to measure physical activity. In order to determine and validate the abdominal obesity a DXA study was performed.RESULTS: With obesity were 17.5% of respondents, and only 9.7% of all meet the minimum recommendations for physical activity during the week and 16.1% at weekends. Fat mass correlated significantly with BMI and WC (p <0.001), and of metabolic markers it correlated with hsCRP (r=0,533, p=0,04), as well as with elevated cholesterol levels (r=0,458, р=0,016). A significant correlation between serum leptin and BMI, WC, fat mass (p<0.001), as well as total cholesterol (r=0,482, р=0,008) and lower levels of LDL-cholesterol (r=0,434, р=0,019) was found. Levels of serum adiponectin correlated inversely with weight (r=-0,415, p=0,025), when controlling for the level of physical activity with WC too (r=-0,437, p=0,042).CONCLUSION: This study found a significant association between waist circumference, fat mass and established metabolic risk markers in healthy children even at this early age

Advantages from “do-it-yourself” loops among children and adolescents in Varna’s Diabetes Center

Introduction: In the last 5 years, the use of automatic insulin delivery systems has been increasing among patients with type 1 diabetes mellitus (T1DM). It has been shown that they improve metabolic control, decrease the time spent in hypoglycemia and the number of episodes of nocturnal hypoglycemia; increase the time spent in target and are feasible and safe.Aim: Our aim is to evaluate the glycemic control in children/adolescents using do-it-yourself (DIY) regulatory unapproved insulin-delivery loops vs sensor-augmented pump therapy (SAP).Materials and Methods: A total of 43 families with child/children with T1DM on pump treatment and continuous use of continuous glucose monitoring (CGM) were invited to participate in the study; 31 (72.1%) of the families accepted. The children were followed for 6 months, a total of 196 patient months.Results: The study group consisted of 31 children with T1DM, 24 (77.4%) of them were on SAP, and 7 (22.6%) used DIY loops. No differences were observed in regard to age, duration of diabetes, and daily insulin dose between groups. Patients on DIY loops spent significantly more time in range (83.0 vs 68.8%, p=0.02), less time in hyperglycemia above 14 mmol/L (2.1 vs 8.6%, p=0.02). They had significantly better HbA1c at the 6th month (6.5 vs 7.2%, p=0.006) vs SAP patients for the follow-up period. No severe hypoglycemia and diabetic ketoacidosis (DKA) occurred. There were no gender differences between and within both groups.Conclusion: DIY unregistered loop systems showed promising results for better metabolic control at least in terms of mean blood glucose levels (BGLs) and without increasing the risk of severe hypoglycemia and DKA. Further impact e. g. mean insulin dose, long-term efficacy, consumed fat/protein in the daily diets, etc., remains to be studied in future larger and longer studies

Adiponectin, some markers of metabolic risk and abdominal obesity in preschool age

Всички проучвания на Балканския полуостров през последното десетилетие откриват нарастваща честота на затлъстяването. Абдоминалното затлъстяване се смята за по-морбидно поради по-високата метаболитна активност на абдоминалната мастна маса, характеризираща се с нискостепенно хронично възпаление. Цел: Да се установи връзка между мастната маса (ММ) и някои метаболитни маркери в предучилищна възраст.Участници и методи: Измерени са ръст, тегло и коремна обиколка (KO) на 40 здрави деца от област Варна на средна възраст 5,31 години (4-7 год.), разпределени като нормални, с наднормено тегло и със затлъстяване чрез ИТМ и CDC референтни стойности в зависимост от пола и възрастта. Биохимичните изследвания са взети след 12 ч. нощен глад. Поставени са педометри за определяне нивото на физическа активност (ФА). С цел валидизиране на абдоминалното затлъстяване се проведе DXA изследване за количество MM.Резултати: Със затлъстяване са 17,5% от участниците, като само 9,7% от всички покриват минималните препоръки за двигателна активност през седмицата и 16,1% през почивните дни. ММ (ср. кг) корелира сигнификантно с ИТМ и KO (р<0,001), a от метаболитните маркери корелира с hsCRP (r=0,533; p=0,04), както и с повишените нива на общ холестерол (r=0,458; p=0,016). Открива се значима връзка между серумния лептин и ИТМ, KO, ММ (р<0,001), както и с общия холестерол (r=0,482; p=0,008) и ниските нива на LDL-холестерол (r=0,434; p=0,019). Нивата на серумен адипонектин корелират обратнопропорционално с теглото (r=-0,415, p=0,025), при контролиране за ФА и с КО (r=0,437; p=0,042).Заключение: Настоящото проучване открива значима връзка между коремната обиколка, мастната маса и утвърдени маркери за метаболитен риск при здрави деца дори в тази ранна възраст.All the studies in the Balkan countries, over the last decade, found an increasing incidence of obesity. Abdominal obesity is considered with higher morbidity, due to the higher metabolic activity of the abdominal fat mass, which is characterized by low-level chronic inflammation.Objective: to establish a link between (abdominal) fat mass and some metabolic markers in preschool age. Participants and methods: height, weight and waist circumference (WC) of 40 healthy children living in Varna district were measured, mean age 5.31 years (4-7 yr.). Normal weight, overweight and (abdominal) obesity was defined by BMI and CDC reference values according to sex and age. Biochemical tests were taken after 12 hours of overnight fasting. Children wore pedometers to measure physical activity. In order to determine and validate the abdominal obesity a DXA study was performed. Results: With obesity were 17.5% of respondents, and only 9.7% of all meet the minimum recommendations for physical activity during the week and 16.1% at weekends. Fat mass correlated significantly with BMI and WC (p <0.001), and of metabolic markers it correlated with hsCRP (r=0,533, p=0,04), as well as with elevated cholesterol levels (r=0,458, p=0,016). A significant correlation between serum leptin and BMI, WC, fat mass (p<0.001), as well as total cholesterol (r=0,482, p=0,008) and lower levels of LDL-cholester ol (r=0,434, p=0,019) was found. Levels of serum adiponectin correlated inversely with weight (r=-0,415, p=0,025), when controlling for the level of physical activity with WC too (r=-0,437, p=0,042).Conclusion: This study found a significant association between waist circumference, fat mass and established metabolic risk markers in healthy children even at this early age. Keywords: metabolic risk, adiponectin, abdominal obesity, preschoolers

Comparative analysis of the practices of diagnostics and treatment of short stature, established in the outpatient clinics of general practitioners from Pleven and Varna

Introduction: Normal growth of the child is an index of good health, but it is a limited in time process, and for this reason, timely diagnosis and start of treatment of children with short stature (SS) are crucial for achieving adequate adult height and good quality of life.Aim: The aim of the present interview is to study the knowledge of general practitioners (GPs) about growth disorders and to increase the informational level in the process of creating national referral criteria and algorithms for the management of children with SS.Materials and Methods: GPs from Pleven and Varna (n=40, mean age 54.5 ± 8.85 yrs, work experience 25.9 ± 8.8 yrs, working in urban settings – 75%, children in their practices 0-18 - 23 079) have completed a questionnaire with 20 questions. All interviewed GPs defined SS as a problem for children. Almost all of them (80%) indicated use of standards for growth evaluation. They claimed that they provided screening for early detection of SS and they knew where to send a child with growth deviation. The main cause of SS, according to GPs, is genetic predisposition (35%), and that both - GPs and parents, are active in diagnosis of SS (82.5%). However, GPs shared that they were faced with some difficulties in the diagnosis of SS because of the “unclear” path of the patient after directing him to a specialist and that was the reason some of the children with SS to remain undiagnosed.Conclusion: SS is a problem that GPs are conscious of, but there is a strong need of measurements for building the “route” of the patient with SS, starting from the first step – the general practitioner

Design and specific features of a study of the long term cardiovascular and metabolic risk in type 1 diabetes mellitus

Among the traditional risk factors for cardiovascular diseases (CVD) in individuals with type 1 diabetes mellitus (T1DM), new ones are constantly being sought for timely prophylaxis and treatment. The increasing knowledge of the role of inflammation and visceral adipose tissue in the pathogenesis of T1DM complications is an integral part of the work of leading European centers. Obesity is a progressing risk factor and its role in the cardiovascular pathology of patients with T1DM is unclear. Lack of established practices and algorithms for management in these individuals has been poorly studied and presented to date. With prevalence of intensified insulin therapy in T1DM, leading sometimes to relatively high doses, and with the contemporary habits of eating, the patients’ risk of morbidity and mortality increases. Prioritization of cost-effective projects and specific timely commitment to protect disability in these patients is of utmost importance in scientific and healthcare aspects. The aim of this article is to present the design of the study of the cardiovascular and metabolic risk in patients with long-term T1DM

Mortality in childhood-onset type 1 diabetes

It is well-recognized that diabetes-related complications are the leading cause of the still increased morbidity and mortality from diabetes and exert a heavy economic burden on society. The discovery of insulin led to a dramatic change in life expectancy of patients with type 1 diabetes (T1D). Furthermore, it caused a major shift in the distribution of causes of death - from diabetic coma in the pre-insulin era, to long-term complications being the predominant causes of death nowadays. The aim of the present review is to assess the trends in the absolute and the relative mortality rates as well as the leading causes of death among patients with childhood-onset (< 18 years) T1D in populations from different latitudes. It is also observed how disease duration, age at diagnosis, and year of diagnosis affect these mortality trends. Eight population-based studies published in English in the last 14 years, as well as another one, published in 2001, with different duration of follow-up, are included in the review. However, it is hard to compare different populations due to the dissimilarities in the study methods and the characteristics of the examined cohorts

Childhood obesity, renal injury and future disease risk

INTRODUCTION: Evidence associates obesity with glomerular hyperfiltration. Concurrent inflammation, hypertension, dyslipidemia, and insulin resistance represent further established risks to renal health in both children and adults. Our aim was to investigate the relationship between childhood obesity and the risk of renal impairment.MATERIALS AND METHODS: A total of 114 obese but otherwise healthy children, who were investigated in 2013, were included in the study (mean age 11.5±3.6). Auxology was measured using standard procedures. The pubertal status was defined applying the Tanner scale. Blood and urine tests were performed after overnight fast. Kidney size was measured by standard abdominal ultrasound; kidney volume and estimated glomerular filtration rate were calculated.RESULTS: Microalbuminuria was detected in 8.5% of the children, and 40.2% of all patients were with high systolic blood pressure (BP). Close to half of the children (43.4%) showed insulin resistance (assessed by HOMA-IR) and 95.4% displayed hyperinsulinism. Kidney volume correlated with waist circumference (WC) (left r=0.636, p<0.001; right r=0.532, p<0.001), as well as with weight and elevated systolic BP. Children with hyperfiltration (9.6% of all) at this stage all had elevated total cholesterol and triglycerides. In further 14.3% of the children (all pubertal) the glomerular filtration rate was low, and they had significantly larger kidney volume (left p<0.001; right p=0.004), HOMA-IR (p=0.001), WC and BMI (p<0.001) compared to those with normal and hyperfiltration rate.CONCLUSION: To summarize, childhood obesity showed an association with established risk factors for renal toxicity. Whether kidney volume in obese children has an independent predictive value of future chronic kidney disease remains to be investigated