Continuous monitoring of blood pressure in children and adolescents,a review of the literature.

Continuous or ambulatory blood pressure monitoring (CBPM or ABPM) is becoming a useful tool in the early detection of hypertension in children and adolescents. With increased obesity in pediatrics, chronic diseases such as hypertension, diabetes, dyslipidemia and metabolic syndrome which was more commonly seen in adults in the early years, can now be seen in this population. This review provides the clinical reports of the use of CBPM for diagnosis and management of hypertension in the pediatric population.

Estimates of body fat in children by Hologic QDR-2000 and QDR-4500A dual-energy X-ray absorptiometers compared with deuterium dilution.

We evaluated the accuracy with which the Hologic QDR-4500A and QDR-2000 densitometers measure fat mass (FM) in 95 children. FM was derived from total body water measured by deuterium dilution (DD) in all children, by QDR-4500A in 50, and by QDR-2000 in 45 children. Compared with DD, both instruments underestimated FM (QDR-4500A: 3.35 +/- 2.5 kg, P < 0.0001; QDR-2000: 1.05 +/- 1.5 kg, P < 0.0001). Both absorptiometers showed magnitude biases relative to DD (QDR-4500: r = +0.70, P < 0.001; QDR-2000: r = -0.51, P < 0.001). We conclude that neither densitometer is equivalent to DD for estimation of children's FM. The QDR-4500A's current calibration seems to provide an even greater underestimate of FM than the QDR-2000.

Pancreatic beta-cell hyperactivity in morbidly obese adolescents.

beta-cell hyperactivity, with increased beta-cell mass in the pancreas, contributes to insulin oversecretion in response to insulin resistance. beta-cell mass expansion, also known as "endocrine pancreas plasticity", is an adaptation to variations in insulin demand, is generally observed in obese persons and in women during late pregnancy. In obese persons, increased free fatty acids contribute to beta-cell growth. It is believed that type 2 diabetes develops in those persons unable to respond to an increased insulin demand with a high rate of beta-cell proliferation. Impairment of insulin secretion may originate from a genetic predisposition as well as aggravated by high lipid and glucose levels. Better understanding of endocrine pancreas plasticity and its regeneration mechanisms could lead to new treatment modalities for type 2 diabetes. Review of literature of pancreatic beta-cell hyperactivity in obesity and its existence in morbidly obese adolescents is hereby presented.

The prevalence of metabolic syndrome in inner city obese African-American youth.

BACKGROUND: In children and adolescents, obesity increases the risk of metabolic syndrome (MS). OBJECTIVE: We examined the prevalence of MS among obese and morbidly obese children and adolescents referred to an obesity clinic in a university-based hospital center. DESIGN/METHODS: A total of 194 obese (BMI > 95%) children and adolescents were evaluated. Fasting glucose, insulin, lipid panel, BMI, blood pressures were obtained. Main outcome measures were prevalence of components of MS by modified National Cholesterol Education Program (NCEP or Adult Treatment Panel 111 (ATP 111), with MS defined as > or = 3 components. RESULTS: There were 113 females (58%) and 81 males (42%); mean age of the cohort was 11.9 years (range: 3.4-18.8 years). One hundred seventy four (90%) of the cohort were African-American, 14 (7%) were Hispanic and 6 (3%) were others. Mean BMI z- score was 2.5 and ranged from 1.7 to 4.8. Thirty five percent of the total cohort had MS. Among the morbidly obese patients (BMI z-score > 2.5), the prevalence of the MS increased to 44%. Impaired fasting glucose (5.8 %), impaired glucose tolerance (6.5%) and silent diabetes mellitus (2.4%) were also identified. CONCLUSIONS: One third of obese patients referred to a hospital-based obesity center had the MS and nearly half of morbidly obese children and adolescents had MS.