Breastmilk ghrelin, leptin, and fat levels changing foremilk to hindmilk: is that important for self-control of feeding?

The aim of this study was to evaluate the changes in the ghrelin, leptin, and fat levels in the foremilk and hindmilk and the possible relationship between these levels with the age and growth of term healthy infants. Sixty-two babies were subdivided (according to their nutrition) into breastfed (BF), formula-fed (FF), and BF plus FF (BF + FF) groups. The total and active ghrelin and tryglyceride levels and the total cholesterol levels in the foremilk and hindmilk were studied at the first and second visits (mean of the second and fifth months, respectively). At both visits, the total and active ghrelin and the total cholesterol levels were lower in the hindmilk than in the foremilk. However, the triglyceride levels were higher in the hindmilk than in the foremilk (p < 0.001). The leptin levels were also higher in the hindmilk, but this difference was not statistically significant. At the second visit, the mean total foremilk ghrelin (p < 0.01), leptin (p < 0.05), tryglyceride (p < 0.001), and cholesterol (p < 0.01) levels in the BF group were decreased compared with the levels at the first visit, whereas the active ghrelin levels increased (p < 0.001). At the second visit, we observed a 3.5% increase in the body mass index in BF infants, a 14.6% increase in FF infants, and an 11.8% increase in BF + FF infants (p < 0.01). The foremilk leptin levels were lower in the BF + FF group than in the BF group at both visits. In conclusion, at the first and second visits, the decreased ghrelin and increased tryglyceride and leptin levels in the hindmilk might be associated with the important role of self-control when feeding BF infants. The stable content of formulas might be associated with a lack of self-control during feeding and increased nutrition. Changing the breast milk ghrelin, leptin, and fat levels between the foremilk and hindmilk and between the first and second visits might explain the differences in the weight gain patterns of BF and FF infants.

Adrenal insufficiency associated with cytomegalovirus infection in two infants.

Adrenal insufficiency associated with cytomegalovirus (CMV) is a well-described condition in adults with AIDS, however there is little information about CMV-associated adrenal insufficiency in childhood. The cases of two infants with negative HIV serology, presenting with CMV-associated adrenal insufficiency, are described. Clinical findings and therapeutic interventions are discussed with reference to the affinity of CMV infection for the adrenal gland. The differential diagnosis of adrenal insufficiency in newborns and infants should include CMV infection, and clinical suspicion of CMV-associated adrenal insufficiency should lead to early initiation of appropriate adrenal substitution therapy and ganciclovir antiviral therapy. Timely therapy for CMV-associated adrenal insufficiency can be lifesaving.

Serum IGF-1, IGFBP-3 and growth hormone levels in children with congenital heart disease: relationship with nutritional status, cyanosis and left ventricular functions.

In this study we aimed to evaluate serum insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3) and growth hormone (GH) levels in children with congenital heart disease (CHD) and to determine if these parameters have any relationship to the cyanosis, nutritional status and the left ventricular systolic function. This study is prospective-randomized study which conducted in 94 CHD patients (36 girls and 58 boys, aged between one 1-192 months, 19 cyanotic CHD and 75 acyanotic CHD) and age-sex matched 54 children (26 girls and 28 boys) with no CHD. In the study group, 37 out of the 94 CHD patients (39.4%) and 16 out of the 54 controls (29.6%) had malnutrition. The difference between the cyanotic and acyanotic patients in respect to malnutrition was significant (57.9% and 34.6%, p<0.05). Serum IGF-1 levels were lower (41.8+/-3.9 microg/L, 106.9+/-17.9 microg/L respectively, p<0.001) and GH levels were higher (6.43+/-0.9 ng/ml, 3.87+/-0.5 respectively, p<0.05) in CHD patient group than the controls. Serum IGF-1 levels were significantly lower in cyanotic CHD patients than the acyanotic patients (17.2+/-3.2 microg/L, 48.7.0+/-4.6 microg/L respectively, p<0.001) and serum IGF-1 levels were both lower in acyanotic and cyanotic CHD patients than the controls (p<0.001 for both). Serum IGF-1 and GH levels were similar between the well-nourished CHD patients and CHD patients with malnutrition (p>0.05). In total study group, the most effective factors on serum IGF-1 levels was presence of CHD (p<0.001), in CHD patients, the presence of cyanosis is the most effective factor on serum IGF-1 level, the presence of malnutrition is the most effective factor on serum IGFBP-3 levels (p<0.01). In the acyanotic, cyanotic, and the entire CHD patient groups, we find no correlations between the serum IGF-1, IGFBP-3 levels and left ventricular systolic function measurements. But serum GH levels were negatively correlated with diastolic left ventricular interseptum diameter, diastolic left ventricular mass and left ventricular end-diastolic volume measurements in CHD patients. In conclusion, we determined that the most important factor on serum IGF-1 levels is cyanosis. Reduced IGF1 levels and decreased left ventricular mass with an elevated GH levels in CHD patients and these findings are prominent in the cases with cyanosis and malnutrition. For this reason we believe that chronic hypoxia plays a significant role in the pathogenesis of malnutrition and also we believe that IGF-1 deficiency seen in CHD patients may be responsible in the etiology of the decrease in left ventricular mass independently from GH.

Pericardial effusion due to hypothyroidism in Down syndrome: report of four cases.

Pericardial effusion may be the first sign of congenital or acquired hypothyroidism and will completely resolve after thyroxin therapy. Hypothyroidism is more common in Down syndrome population than normal population. In this report we present four infants with Down syndrome who have pericardial effusion due to congenital hypothyroidism. All of these children with Down syndrome were admitted to our clinic with pericardial effusion. Pericardial effusion was completely resolved with thyroxin therapy without pericardiosentesis. Any child with Down syndrome who present with dyspnea and cardiomegaly should be suspected of having pericardial effusion due to hypothyroidism and echocardiography examination should be performed immediately. Pericardial effusion due to hypothyroidism will completely resolve with L-thyroxin therapy without pericardiosentesis. In conclusion, since a delayed diagnosis of hypothyroidism is likely and may favor the development of massive pericardial effusion and because of the difficult diagnosis of the hypothyroidism in Down syndrome, periodic follow-up of thyroid function tests are important.

Serum leptin levels in children with cerebral palsy: relationship with growth and nutritional status.

AIM: Children with Cerebral Palsy (CP) are generally undernourished and growth retarded than normal children. The reasons of malnutrition are not only due to poor nutritional status but also nonnutritional factors including negative neurotrophic effects and indirect factor such as immobility, endocrinological abnormalities or spasticity that energy requirements might be contributing factors. Several studies indicated that leptin which is produced by adipocytes, might regulate energy intake and expenditure. The aim of this study is to determine serum leptin levels in children with CP and to investigate the relationship between nutritional status and anthropometric measurements. METHODS: Forty children with CP and 18 healthy controls were included in this study. The weight, height, body mass index (BMI), upper arm length (UAL) and triceps skinfold thickness (TST) was measured in all children. Serum leptin, growth hormone, C-peptide and cortisol levels were studied. Based on TST measurement CP patients were divided as DSF group (decreased subcutaneous fat) and non-DSF group (nondecreased subcutaneous fat). RESULTS: UAL were shorter and TST measurements were thinner than control group (p<0.05, p<0.01). Group DSF had lower leptin concentrations compared to Group non-DSF and controls (p<0.001, p<0.001). On the other hand non DSF group had higher leptin levels than controls (p<0.05). There was a positive and significant correlation between leptin and anthropometric measurements, especially TST in children with CP. Serum leptin levels were also lower in non-ambulatory children than ambulatory children with CP (p<0.05). CONCLUSION: This study has shown that triceps skinfold thickness is better index for the evaluation of nutritional status in children with CP. Serum leptin levels were lower in CP, especially in DSF group. The possible explanation of this finding may not only related with malnutrition, but also immobility related other factors such as bone metabolism and spasticity. We concluded that leptin which regulates energy intake might have a role of nutritional disorders in cerebral palsy. To better understand this relationship further studies are needed.

Plasma total homocysteine levels in children with type 1 diabetes: relationship with vitamin status, methylene tetrahydrofolate reductase genotype, disease parameters and coronary risk factors.

The objectives of this study were: to determine plasma total homocysteine tHcy levels and the prevalence of hyperhomocysteinemia in children with type 1 diabetes, to determine correlates of plasma tHcy levels with nutritional factor such as serum folic acid and vitamin B12 levels, genetic factors as methylenetetrahydrofolate reductase MTHFR gene polymorphism (C677T and A1298C), to attempt to identify possible dependencies between tHcy and the degree of metabolic control, the duration of the disease and presence of complications, and also to determine the relationship between other coronary risk factors. Plasma tHcy levels and other related parameters performed in 32 children with type 1 diabetes and 23 age-sex matched healthy children. Median tHcy level was higher in the patient group (11.38, 3.28 to 66.01 micromol/l) than the control group (8.78, 1.06 to 13.66 mol/l) (p < 0.05). A 28.1 per cent (n = 9) of the diabetic patients had hyperhomocysteinemia, four case with mild and five case with moderate. Plasma tHcy levels were positively correlated with disease duration and C-reactive protein CRP levels and negatively correlated with disease onset age. The hyperhomocysteinemic group had higher CRP levels, longer disease duration and early onset of disease than non-hyperhomocysteinemic group (p < 0.05 in both), respectively. The hyperhomocysteinemic group had significantly higher CRP, total cholesterol, triglyceride, apolipoprotein B, systolic blood pressure, blood urea nitrogen and creatinine levels and lower folate, apolipoprotein A1 levels and glomerular filtration rate values than the control group. Plasma tHcy levels were higher in diabetic children with poor metabolic control. Because of hyperhomocysteinemia is common in diabetic children and plasma tHcy levels correlated with early onset of the disease and disease duration, we recommend the usage of plasma tHcy levels as a risk indicator parameter with other coronary risk factor for detecting and preventing cardiovascular disease in diabetic children.

Seckel syndrome associated with atrioventricular canal defect: a case report.

Seckel syndrome is a rare autosomal recessive disorder and its characteristic features are marked growth and mental retardation, significant microcephaly and a convex nose. We report a boy with this syndrome who also had severe cardiac anomalies. Although his parents were non-consanguineous, it is suggested that he had autosomal recessive inheritance.