Continuous glucose monitoring in the treatment of obesity in patients with glycogen storage disease type Ia.

UNLABELLED: Glycogen storage disease (GSD) type I is characterized by impaired production of glucose from glycogenolysis and gluconeogenesis resulting in severe hypoglycaemia and increased production of lactic acid, triglyceride and uric acid. The most common type, glycogenosis type Ia, demands a balanced, sufficient carbohydrate intake to preserve normal 24-h glycaemia. Insufficient intake of carbohydrates can cause hypoglycaemia, as the missing glucose-6-phosphatase enzyme cannot free the glucose stored as liver glycogen and nor is gluconeogenesis possible. The principle means of handling this disorder is to avoid starving by taking regular meals during the day and night. Such a dietary regimen could lead to obesity. Herein, we present the case of an adult patient with glycogenosis type Ia suffering from hyperuricaemia, dyslipidaemia and arterial hypertension. The accumulation of these cardiovascular risk factors could lead to the early onset of atherosclerosis, which should be postponed by contemporary methods of surveillance and treatment. LEARNING POINTS: Continuous subcutaneous glucose monitoring may be of value in every adult patient with GSD type I to evaluate the actual prevalence of eventual hypoglycaemic and hyperglycaemic episodes.Good dietary management minimizes the metabolic abnormalities of the disease and decreases the risk of long-term complications.Treatment of obesity in patients with GSD reduces the risk of earlier atherosclerosis and cardiovascular disease.

Comparison between continuous ambulatory arterial blood pressure monitoring and standard blood pressure measurements among patients of younger and older age group.

The purpose of the study was to evaluate whether there is a difference between blood pressure measured in a physician's office and the average 24 hr continuous blood pressure monitored by hypertensive patients at home. If there is a difference between these two situations then is it possibly the result of a blood pressure response by the patient to the physician which is known as "white coat effect" or "white coat hypertension". We studied 80 hypertensive outpatients which were divided into two groups of 40 patients each--a younger patient group, with a mean age of 22.8 +/- 1.8 years, and an older patient group with a mean age of 50.3 +/- 5.7 years. They were selected because they had been diagnosed as essentially hypertension grade 1, according to 2007 ESH/ESC Guidelines, or the USA Joint National Committee Guidelines (JNC 7) (i.e., arterial blood pressure > 140/90 mm Hg and < 160/100 mmHg) and 35 were not having any antihypertensive treatment. All participants in the study went through a two-week "wash-out" period without medication. At the beginning of the study blood pressure was measured using the Riva-Rocci-Korotkoff method (mercury sphygmomanometer) after 5 minutes of rest and with the patient in the sitting position. The average of the two last measurements by sphygmomanometer was used in the analysis. The subsequent measurement was made by continuous ambulatory blood pressure monitoring (SpaceLabs 90207 device). Continuous ambulatory blood pressure monitoring revealed that 17 patients of the younger age group (42.5%) who were diagnosed hypertonic, according to mercury sphygmomanometeric measurement, were in fact normotonic. In the older age group only 7 (17.5%) of participants were normotonic during 24 hr blood pressure monitoring. The proportion of miss-diagnosed normotonic younger patients was directly related to elevated clinic blood pressure, which could be referred to as office hypertension or isolated clinic hypertension (white coat hypertension). This was statistically significant (chi2 = 5.95; p = 0.015). Hypertension diagnosed in younger patients based only on occasional doctor's office mesurements, using a mercury sphygmomanometer, could be miss-interpreted and treated as the start of arterial hypertension. This could sometimes have unwanted results due to the side effects of precipitate antihypertensive medication as well as the unnecessary cost of testing, cost of treatment, prevalence of white-coat hypertension at baseline, and the varying incidence of new hypertension after the initial screening. The results indicate a potential savings of 3-14% in the cost of care for hypertension, and a 10-23% reduction in treatment days when ambulatory blood pressure monitoring is incorporated into the diagnostic process. Therefore CABPM should be used as a legitimate method in the diagnosing of "white coat hypertension", particularly in young patients. The identification of white coat hypertensive"' patients should be followed by a search for metabolic risk or organ damage using the latest guidelines, and medication should start after an organ damage or cardiovascular risk assesement.

Impact of sociodemographic features of mothers on breastfeeding in Croatia: questionnaire study.

AIM: To determine sociodemographic features that describe mothers who are likely to wean their babies earlier then is recommended and whether the rates of breast-fed children in Croatia had improved since 1996. METHODS: A sample of 500 mothers was selected from the population of women who had delivered 2 to 12 months before the interview. The sample was stratified according to the region, urbanization, and child's age. The questionnaire was designed to give a sociodemographic profile of the mother and to describe child's present nutritional habits, duration and reasons for breast-feeding, and reasons for weaning. Chi-square test was used to estimate statistical differences of two qualitative variables. ANOVA test was used for multiple group comparisons. RESULTS: There were significantly more breast-feeding mothers among older than among younger women (46.3% vs 31.7%; p=0.041). Significantly greater proportion of women with higher educational level breast-fed, as compared with less educated women (53.8% vs 31.3%, p=0.002). Percentage of non-smokers among breast-feeding mothers was significantly higher than that of smokers (45.0% vs 25.7%, p=0.001). After the age of 3 months, 30.7% of children were still breast-fed, and only 11.0% after 6 months of age. With regard to the nutritional habits in the first year of life, 40.0% of all children were fed with cow's milk. Supplementary feeding was started by 29.2% of respondents before the end of the third month. CONCLUSION: Older, better educated, and non-smoking mothers in Croatia breast-fed at a higher rate then young, less educated, and smoking mothers. Older mothers also weaned their children significantly later than the young ones. Percentage of children fed with cow's milk during the first year of life is disturbingly high and introduction of solids into child's nutrition is earlier than recommended.