Alterations in markers of bone metabolism and adipokines following a 3-month lifestyle intervention induced weight loss in obese prepubertal children.

BACKGROUND: Adipokines may influence bone metabolism in children, but this phenomenon is not well understood. Therefore, we studied the relationships between bone markers and adipokines during weight loss in obese children. MATERIALS AND METHODS: We determined serum leptin, soluble leptin receptor (sOB-R), adiponectin, BALP (bone alkaline phosphatase), CTX-I (C-terminal telopeptide of type I collagen), body composition and bone mineral density (by dual-energy X-ray absorptiometry) in 100 obese prepubertal children before and after 3 months of lifestyle intervention (low-energy diet, physical activity). The control group consisted of 70 non-obese children. RESULTS: Obese children had higher BALP activity by about 20% (p<0.001) and similar value of CTX-I compared with non-obese children. After weight loss (-0.96 BMI-SDS mean change), the BALP value in obese patients decreased (p<0.001), whereas CTX-I concentration was unchanged. Changes in BALP were positively correlated with changes in BMI (Body Mass Index) (r=0.352, p<0.001), but not associated with adipokine levels. Trend analysis using SDS-BMI subgroups showed that greater reduction of body mass was associated with a greater decrease of BALP (p=0.035) and leptin values (p<0.001), as well as a greater increase of sOB-R (p<0.003). CONCLUSIONS: Obesity during the prepubertal period is associated with an alteration in the adipokines profile and greater whole-body bone mass as a result of increased bone formation rather than reduced bone resorption. Changes in bone metabolism during lifestyle intervention seem to be related to weight loss but not to changes in adipokines. Further studies should elucidate the influence of long-term therapy on bone mass in childhood.

[Serum leptin level in prepubertal children with simple obesity. Part one]. / Ocena poziomu leptyny u dzieci w wieku przedpokwitaniowym z otyloscia prosta. Czesc I.

The aim of the study was to determine the serum leptin level and anthropometric indices (body mass index - BMI) in a group of prepubertal children with simple obesity. These parameters were compared with the values characteristic for the group of slim children. The study showed that serum leptin levels were significantly higher in obese children compared with the group of slim children (p<0.0001). There was a positive correlation (r=0.48; p<0.05) between leptin levels and nutritional status indices expressed by BMI. Results of this study suggest that leptin level in the group of children with simple obesity does not have an effect on satiety, on reduction of appetite or on the increment of adipose tissue. The study showed also that hyperleptinemia might be an effect of leptin resistance.

[Nutrition of preschool age children. General considerations and assessment of child nutrition]. / Zywienie dzieci w wieku przedszkolnym. Ogólna charakterystyka sposobu zywienia.

Results of the study performed between June 1999 and January 2000 on dietary assessment of 822 pre-school children (age 3-7) showed that majority of children regularly consumed the main meals: breakfast, dinner and supper. The habit of snacks eating between the meals was observed in 91% of children. The presence and structure basic products in analysed children diets (milk, fermented milk products, fats, fish, whole grain bread, juices) was different. About 87% reported drinking of milk, 75%--yoghurt or other fermented milk products, 97%--fruit juices including nectar, water--42%. The main fat used to spreading on bread was butter. Fish products recommended as a source of n-3 polyunsaturated fatty acids were still not eaten by 23% of children. Whole grain bread was consumed daily only in 8% children. The study also showed that the diets included products being the source of unfavourable fatty acids (chips, sweet bars, cookies, hard margarine) and excess of saccharose (sweets, lollipops, chewing gum). The results of the study showed the permanent need of the dissemination of dietary recommendations for children at pre-school age.

[Models of feeding for healthy children]. / Modela zywienia zdrowego dziecka.

The subject of this study was to present dietary guidelines for healthy children recommended by the National Research Institute of Mother and Child. For infants breastfeeding is optimal. All infants should be exclusively breastfed until 6 months of age. Complementary food should be introduced in the 7th month of life according to infants' feeding schedule. Modified cow's milk formulas and complementary food are recommended in non-breastfed infants' nutrition. In all medical institutions infants' feeding should comply with these recommendations. The basis of rational nutrition of young children is high quality and safe food with reference to its nutritional value. Adequate choice of food products, variety of diet and meal frequency is the basis of proper nutrition and proper nutritional habits. Regular eating of 3-4 meals per day, avoiding products rich in fat, sugar, salt, cholesterol, as well as increasing physical activity, are recommended in dietary guidelines for school children. The recommended models should be much more effectively implemented in paediatricians' practice and should be the basis for postgraduate training for doctors, nurses and midwives as well.

[Evaluation of the nutritional status and feeding patterns of 3-7 year old children --results of a questionnaire]. / Ocena stanu odzywienia i sposobu zywienia dzieci w wieku 3-7 lat-wyniki badan ankietowych.

Questionnaire studies on feeding patterns and nutritional status of 822 pre-school children (age 3-7) in different regions of Poland were performed between June 1999 and January 2000. Nutritional status was evaluated on the basis of anthropometric indices - height, body weight, body mass index (BMI) and BMI z-score. The mode of feeding was evaluated on the basis of recall of 24-hours menus. Average daily food rations and their nutritional value were calculated from the questionnaires data. Quantity and number of meals were also evaluated. In a group of 402 boys the average height was between 75-90 percentiles and body mass (50-75 percentiles). In 420 girls the average height was about the 90 percentile (age 3-4) and between 75-90 percentiles (age 5-7). The study showed that normal BMI z-score was found in 75% of children, underweight in 16.5% overweight and obesity in 8.5%. Feeding patterns showed great than differences. It was found that meat, fat, sweets and sugar content in daily food rations exceeded the recommended for pre-school children, but the vegetables intake was lower than recommended. Vitamins A and C deficiency in average daily rations didn't occur. The fat intake provided 36% of total energy, whereas carbohydrates (without lactose and starch) - about 20%. This can have inhibitory effect on microelements (Fe, Zn) absorption. Attention must be paid to the choice of products and the wrong distribution of total energy intake in daily rations. The habits of snack eating between the meals were reported in 91% of children. These snacks consisted of fruits, chips, french fries, sweets and sandwiches. These products provides 232 kcal +/- 171 kcal/day.

[Water in children's diet]. / Woda w zywieniu dzieci.

Water is one of the main dietary components. Its quality plays an important role for the safety of food particularly for infants. For the youngest children the groundwater free of chemical and microbiological pollution and with the proper chemical composition can be used. For infants is recommended natural spring water and natural mineral water of low sodium concentration

[The evaluation of organizational structure and work hygiene in milk kitchen centers in Poland on the basis of questionnaire]. / Ocena organizacji i higieny pracy w kuchniach mlecznych w Polsce na podstawie badania ankietowego.

On the basis of available publications and obligatory legal regulations regarding the organisation of collective feeding patterns in Social Service Health Centres a questionnaire study was established to examine the way milk kitchen function in Poland. The study covered 533 milk kitchen centres (in hospitals, orphanages and crèches) from February to December 1997. The afore-mentioned study analysed the general characteristics of the milk kitchen centre, its type of work, supervisory methods and the personnel's hygiene. From the results of this research it can be concluded that the organisational structure of the milk centres was appropriate, appliances and equipment in the majority centres were adequate but basis utensils were insufficient. It is obvious that dietetic feeding methods for this particular group of children are insufficiently applied. Only 22.2% of the centres apply the recommended proposals i.e. without boiling, without pasteurisation, ready for consumption when preparing, infant formulae, follow-up formulae and other mixed products. Work hygiene and health quality of production in the milk kitchen centres is subject to systematic controls by competent individuals from the State Sanitary Inspection services. In the years 1995-96, 72 samples of infant food that mainly came from hospital milk kitchen centres were taken due to the poor microbiological quality of the food. The considerable changes that have taken place over the last few years as far as infant feeding is concerned, for example, the promotion of breast-feeding, taking advantage of prepared dietetic products for infants (infant formulae, follow-up formulae, vegetable products, fruits, vegetable-meat products, cereal products) require changes at the organisational level of infant collective feeding which was confirmed by the afore-mentioned study.

[Evaluation of a diet and nutritional status of breast feeding women on the basis of a questionnaire study]. / Ocena sposobu zywienia i stanu odzywienia kobiet karmiacych piersia na podstawie badania ankietowego.

The subjects were 120 breast-feeding mothers whose children were admitted for outpatient or inpatient treatment at the Institute of Mother and Child in Warsaw, between March, 1998 and July, 1999. A special nutritional questionnaire was elaborated with the aim to evaluate subjects' nutritional status as well as their diet. All subjects completed the questionnaire and then selected parameters of their nutritional status and diet were evaluated. For 43 of the women under study it was the first month of lactation, for 33--the fourth month, for 23--the sixth and 21 women had been breast-feeding for more then six months. The subjects were of different age, coming from both urban and rural areas. In the studied group the nutritional status, i.e. body mass indices (BMI) before pregnancy, at the end of pregnancy and during lactation were within the normal range. 65 of the subjects had changed their diet due to pregnancy and 52 due to lactation. Women declared to be used to eating 3-4 meals per day. Having additional snacks was declared by 62.5%. Liquids' intake was on average about 2.5 l/24 hr, range 2-31. Average daily energy intake--2938 kcal/12,980 kJ, the lowest--in a diet of a mother with diabetes, the highest--in a diet of a vegetarian mother. The proportion of protein in energy intake was 15.1%, whereas fat--36.3%. Dietary practices of women under study in the period of lactation were well adjusted to nutritional recommendations for this group, as evidenced by indices of nutritional status (i.e. BMI). Among 120 women, 71 were taking supplementary preparations of vitamins and minerals. It turned out that a level of some vitamins in a daily food intake together with supplementation was definitely too high.