The Hepcidin and 25-OH-Vitamin D Levels in Obese Children as a Potential Mediator of the Iron Status.

BACKGROUND: Obesity is associated with the risk factors such as iron and vitamin D deficiencies. Increased risk of iron deficiency generally correlates with the high levels of serum hepcidin in obese children. Vitamin D deficiency was also linked to an increase in serum hepcidin levels. We aimed to compare iron parameters and investigate the hepcidin levels in obese and non-obese children. METHODS: This study included 83 children and adolescents including obese (n = 35) and non-obese (n = 48). Laboratory values including serum iron levels, total iron-binding capacity, percentage of transferrin saturation, ferritin, reticulocyte parameters and high sensitivity C-reactive protein (hsCRP), hepcidin, 25-OH-Vitamin D were measured. RESULTS: Average levels of hepcidin, hsCRP, and ferritin were found to be similar in both study groups. Serum iron levels, total iron-binding capacity, percentage of transferrin saturation, and 25-OH-vitamin D levels were significantly lower in the obese group. There was no statistically significant difference between hepcidin and 25-OH-vi-tamin D levels. Average hepcidin levels were detected to be similar in both groups (p = 0.580) whereas, 25-OH-vi-tamin D levels were significantly lower in the obese group (p < 0.001). A statistically negative correlation was observed between average BMI (body mass index) and serum iron level (r = -0.476; p < 0.001), BMI and transferring saturation (r = -0.467; p < 0.001), and BMI and 25-OH-vitamin D levels (r = -0.474; p < 0.001). Hence, no statistically significant relation was detected between hepcidin and 25-OH-vitamin D levels (r = 0.233; p = 0.084). Being female, vitamin D deficiency, and IRF (%) (Immature Reticulocyte Fraction) were found as independent risk factors for BMI increase due to logistic regression analyses. CONCLUSIONS: In conclusion, observed statistical associations and correlations do not prove a causal relationship between the hepcidin levels and iron deficiency but vitamin D deficiency seems likely to cause high BMI levels or in contrast, obesity may cause vitamin D deficiency in the children. No association was found between hepcidin, ferritin, and hsCRP levels with obesity in children. However, vitamin D deficiency was detected to cause a 5.3-fold increase in BMI levels. We suggest that there may be different mechanisms in obesity-related metabolic and hematological events. One can also envision that there is not enough time for the chronic inflammation processes to develop during childhood as opposed to those frequently seen in adult obese individuals.

Attention-deficit Hyperactivity Disorder Symptoms and Conduct Problems in Children and Adolescents with Obesity.

OBJECTIVES: Recent studies focus on the potential factors that increase the potantial risks of obesity in children and adolescents. According to research for the past years, one of the factors that increases the risk of obesity may be attention- deficit hyperactivity disorder (ADHD). We hypothesized that overweight/obese children and adolescents that apply to pediatric endocrinology for treatment would be at higher risk for ADHD symptoms. METHODS: In this cross-sectional study, the sample consisted of 55 children and adolescents aged between 6-14 years with body mass index greater than 95th percentile and 37 nonobese control group. Sociodemographic form, Strengths and Difficulties Questionnaire and The Turgay Diagnostic and Statistical Manuel of Mental Disorders Based Child and Adolescent Behavior Disorders Screening and Rating Scale has been used. RESULTS: The rates of inattentive subtype, hyperactivity/impulsivity subtype, and the combined type in the subject group were 10.9%, 3.6% and 7.3%, respectively. The rates of inattentive subtype, hyperactivity/impulsivity subtype were 5.4%, 2.7%, respectively, in the nonobese group. In terms of SDQ scores, peer problems subscale scores were significantly higher in the subject group than the control group (5.13±1.24 vs 4.32±1.18, p=0.003). According to the binary regression analysis, having peer problems was found to be significantly related to being obese (Exp B (OR): 3.3, p=0.04). CONCLUSION: Our findings show that obese children and adolescents have higher rates of ADHD symptoms and problems in peer relations. Underestimation of ADHD might be a risk factor for treatment failure in obesity since ADHD symptoms cause a lack of motivation and compliance.

Seizures and diagnostic difficulties in hyperinsulinism-hyperammonemia syndrome.

Hyperinsulinism/hyperammonemia (HI/HA) syndrome is a rare disorder presented with recurrent hypoglycemia and elevated serum ammonia, which may lead to development delays, permanent neurologic damages, if it remains underdiagnosed. It is caused by activating mutations in the GLUD1 gene which encodes the intra-mitochondrial enzyme glutamate dehydrogenase (GDH). HI/HA syndrome is considered the second most common form of hyperinsulinism (HI), and usually associated with epileptic seizures, mental retardation and generalized dystonia. We reported a patient who was diagnosed as HI/HA with multiple episodes of seizures; and previously had been diagnosed and treated for epilepsy. She has heterozygous mutation in GLUD1 gene. Treatment with diazoxide enabled complete resolution of the seizures. One year later, when her brother was six months old, he was also diagnosed with HI/HA. Later, the same mutation of GLUD1 was detected in both her father and brother too.

The relationship between bifidobacteria and allergic asthma and/or allergic dermatitis: a prospective study of 0-3 years-old children in Turkey.

Bifidobacteria are beneficial bacteria for humans. These bacteria are particularly effective at protecting against infectious diseases and modulating the immune response. It was shown that in newborns, the fecal distribution of the colonizing Bifidobacterium species influences the prevalence of allergic diseases. This study aimed to compare the faecal Bifidobacterium species of allergic children to those of healthy children to detect species level differences in faecal distribution. Stool samples were obtained from 99 children between 0 and 3 years of age whose clinical symptoms and laboratory reports were compatible with atopic dermatitis and allergic asthma. Samples were also obtained from 102 healthy children who were similar to the case group with respect to age and sex. Bifidobacteria were isolated by culture and identified at the genus level by API 20 A. In addition, 7 unique species-specific primers were used for the molecular characterization of bifidobacteria. The McNemar test was used for statistical analyses, and p < 0.05 was accepted as significant. Bifidobacterium longum was detected in 11 (11.1%) of the allergic children and in 31 (30.3%) of the healthy children. Statistical analysis revealed a significant difference in the prevalence of B. longum between these two groups (X(2): 11.2, p < 0.001). However, no significant differences in the prevalence of other Bifidobacterium species were found between faecal samples from healthy and allergic children. (p > 0.05). The significant difference in the isolation of B. longum from our study groups suggests that this species favors the host by preventing the development of asthma and allergic dermatitis. Based on these results, we propose that the production of probiotics in accordance with country-specific Bifidobacterium species densities would improve public health. Thus, country-specific prospective case-control studies that collect broad data sets are needed.

Abdominal aorta intima media thickness in obese children.

The aim of this study is to investigate whether abdominal aorta intima media thickness (aIMT), increases in obese children and to determine risk factors. Ninety-six children aged 5-16 (51 obese and 45 non-obese) were enrolled in this prospective and cross-sectional study. Age, gender, and relative body mass index (BMI) were recorded. Their serum lipids, thyrotropin, fasting glucose and insulin levels were analyzed. The homeostasis model assessment (HOMA-IR) score was calculated for insulin resistance. Anthropometric and biochemical data were assessed along with aIMT. Findings in obese children were compared with those of non-obese control subjects. The aIMT was significantly greater in obese children. Similar trends were observed in both prepubertal children and adolescents. In obese children, the mean aIMT (mm) was 0.021 (years of age) +0.519. In non-obese children, the mean aIMT (mm) was 0.017 (years of age) +0.381. Our data suggests a relationship between glucose metabolism and aIMT in obese children. BMI was an independent risk factor for increasing aIMT. In conclusion, when compared with non-obese controls, obese children demonstrated significantly increased aIMT. Higher BMI, insulin, HOMA-IR and increased systolic blood pressure seem to be the main factors contributing to increased aIMT and risk for developing vascular disease. Childhood obesity contributes to the development of an increased aIMT.

Diagnosis of a trend towards obesity in preschool children: a longitudinal study.

The study was planned to determine identifiable starting points of a trend towards obesity and the influence of variables in preschool children aged 0 to 6 years. In this longitudinal follow-up study, 102 children were enrolled. Anthropometric measurements such as weight-height centiles (specific for gender and age group), weight-height growth velocities, and body mass indices were taken annually and compared within each group from birth to 6 years. Family history and lifestyle variables were also recorded and compared. Our study has shown that gender does not affect the trend towards obesity. In obese children, the earliest sign of a trend was the rapid increase of weight and weight gain velocity after 6 months. There were upward trends in the BMI values indicating obesity at 1 year of age in boys and at 6 months of age in girls. The height was higher in obese children than in non-obese ones after 4 years of age. Paternal obesity and having an obese sibling were significant risk factors for obesity. In conclusion, 6 months are considered to be the most critical periods for evaluating the development of obesity in childhood. The efforts for preventing obesity should be initiated at 6 months of age.

Role of early EEG and neuroimaging in determination of prognosis in children with complex febrile seizure.

BACKGROUND: The present study investigates the role of early use of EEG in children with no known neuropathology prior to the first CFS, and the contribution made by computed tomography (CT) and magnetic resonance imaging (MRI) to treatment and prognosis. METHODS: Over a period of 7 years, the authors evaluated 159 children (age range: 2 months-5 years) who were being treated for CFS at Haydarpasa Numune Training and Research Hospital, Pediatrics Clinic, Istanbul, Turkey, and who had no previously known neurological disorder. Patients who presented with febrile seizure were determined to have CFS if they fulfilled the following criteria: <3 months of age when seizure occurred, duration of seizure >/=15 min, more than one seizure occurred during a single episode of illness, or focal seizures and postictal neurological deficit was found. EEG was performed on all patients. CT was performed on the patients who had postictal neurologic deficit or focal seizures. Cranial MRI was performed on patients who had focal findings in their EEGs. RESULTS: Electroencephalogram abnormality was found in 71 cases; 51 of these were diagnosed with epilepsy during follow up. Six of the 16 cases whose EEGs were abnormal between days 2 and 6 were diagnosed with epilepsy. Twenty of the 30 cases whose EEGs were abnormal between days 7 and 10 were diagnosed with epilepsy. All 25 cases who had abnormal EEGs after day 11 were diagnosed with epilepsy. CT was performed for 36 patients, of which five were found to have pathological changes. Pathological changes were detected in two of the nine patients who had cranial MRI. Patients who received CT or MRI were all diagnosed with epilepsy during follow up. CONCLUSION: The results suggest that if neurological examination of CFS patients are normal after their clinical status has stabilised, EEG should be performed after 7 days at the earliest, however for the most accurate diagnosis EEG should be performed 10 days after CFS. The most important predictor for neuroimaging was found to be detection of postictal neurologic deficit. MRI had no advantages over CT in first treating CFS in the emergency unit.

The relationship of tonsillar hyperplasia and asthma in a group of asthmatic children.

BACKGROUND: The decline of infections in childhood may contribute to the rising severity and prevalence of atopic disorders in developed countries. With this regard, we examined the relationship of frequent tonsillitis and consequent tonsillar hyperplasia with the development of asthma. METHODS: Sixty-seven asthmatic children (ages 3-14) who had no signs or symptoms of acute tonsillitis were included. The control group consisted of 92 randomly selected children who had no signs or symptoms of asthma or acute tonsillitis. Parents were interviewed about the incidence of tonsillitis diagnosed by physicians and history of tonsillectomy; tonsil sizes were evaluated by oropharyngeal inspection by the same observer using the Brodsky L. Scala. RESULTS: A statistically significant association is found between frequent tonsillitis and consequent tonsillar hyperplasia with the development of asthma. CONCLUSIONS: Our data suggests that recurrent tonsillitis is associated with a decline in the prevalence of asthma by inducing a Th 1 predominant immune response. Our findings are compatible with the hygiene hypothesis.