Enhanced Myeloid Leukocytes in Obese Children and Adolescents at Risk for Metabolic Impairment.

Objective: We aimed to examine if myeloid leukocyte profiles are associated with metabolic impairment in children and adolescents with obesity, and if sex, age, or race influence this relationship. Methods: 282 children ages 8-17 were evaluated. Predictor measures were absolute neutrophil counts (ANC), absolute monocyte count, monocyte subtypes and C reactive protein (CRP). Outcome variables were waist circumference, fasting glucose and insulin, HOMA-IR, HbA1c (%) and lipid profiles. Pearson correlation coefficients were used to determine associations between predictor and outcome variables. Wilcoxon two-sample tests were used to evaluate differences by sex. Results: CRP (p < 0.0001), ANC (p < 0.0018), and classical monocytes (p = 0.05) were significantly higher in children with obesity. CRP, ANC and classical monocytes showed positive correlations with waist circumference, insulin, HOMA-IR and triglycerides. CRP was positively associated with ANC overall (p = 0.05). ANC demonstrated positive correlation with monocytes (p < 0.001). The associations between predictor and outcome variables were influenced by sex, race, and age. Conclusions: CRP and myeloid leukocyte populations, specifically classical monocytes and neutrophils associate with both body composition and metabolic parameters in children with obesity suggesting that these cells may play a critical role in metabolic impairment. Race, gender and age interactions between monocytes and metabolic parameters were significant.

Outcomes and Resource Use Among Overweight and Obese Children With Sepsis in the Pediatric Intensive Care Unit.

OBJECTIVE: To evaluate the effect of overweight and obesity on outcomes and resource use among patients with sepsis in the pediatric intensive care unit (PICU). DESIGN: Retrospective analysis of clinical characteristics, resource use, and mortality among children 0 to 20 years of age admitted to the C.S. MottChildren's Hospital PICU (University of Michigan) between January 2009 and December 2015, with a diagnostic code for sepsis at admission (based on International Classification of Diseases, Ninth Revision-Clinical Modification codes) and with weight and height measurements at PICU admission. MEASUREMENTS AND MAIN RESULTS: A total of 454 participants met the inclusion criteria. Seventy-six were categorized as underweight (body mass index [BMI] percentile <5th) and were excluded, which left a final sample size of 378 participants. Children with a BMI >5th and <85th percentiles for age were categorized as normal weight and those with a BMI >85th percentile as overweight/obese. After descriptive and bivariate analyses, multivariate regression methods were used to assess the independent effect of obesity status on mortality and the use of PICU technology after adjustment for patient age and illness severity at admission. Of the 378 patients studied, 41.3% were overweight/obese. There was no difference in microbiologic etiology of sepsis (P = .36), median PICU length of stay in days (5.4 vs 5.6; P = .61), or PICU mortality (6.4% vs 7.2%; P = .76) by weight status. The use of specialized PICU technology including extracorporeal membrane oxygenation (odds ratio [OR]: 2.77, 95% confidence interval [CI]:1.13-6.79) and continuous renal replacement therapy (OR: 4.58, 95% CI: 1.16-18.0) was higher among overweight/obese patients, compared with normal weight patients. CONCLUSIONS: Although PICU mortality and length of stay were similar for obese-overweight patients and normal weight critically ill children with sepsis, there was significantly higher use of specialized organ-supportive technology among obese patients, likely indicating higher occurrence of multiple organ dysfunction.

The relationship between adiposity and bone density in U.S. children and adolescents.

OBJECTIVE: In adults, obesity has been associated with several health outcomes including increased bone density. Our objective was to evaluate the association between percent body fat and fat mass with bone mineral density (BMD) in a nationally representative population of children and adolescents. STUDY DESIGN: A total of 8,348 participants 8-18 years of age from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 had whole body DXA scans performed. We conducted linear regressions to examine the relationship between percent body fat and fat mass with outcome variables of total body, pelvic and lumbar spine areal BMD (aBMD), controlling for lean body mass and assessing for gender and race/ethnicity interactions. RESULTS: We found evidence of gender and race/ethnicity interactions with percent body fat and total fat mass for the different BMD areas. Generally, there were decreases in total body aBMD (p<0.001) and lumbar spine aBMD (p<0.001) with increasing percent body fat and total fat mass, with less consistent patterns for pelvic aBMD. CONCLUSION: Our findings of regional differences in the relationship of adiposity to aBMD in children and adolescents with significant interactions by gender and race/ethnicity emphasizes the need for further investigations to understand the impact of adiposity on bone health outcomes.

[Resistance to thyroid hormone and Hashimoto's thyroiditis]. / Resistencia a hormonas tiroideas y tiroiditis de Hashimoto.

BACKGROUND: Resistance to thyroid hormone (RTH) is a rare condition characterized by elevation of thyroid stimulating hormone (TSH) and thyroid hormones (TH). Its association with Hashimoto's thyroiditis was described in 1993 and occurs in 1 of 1.3 million births. CLINICAL CASE: We present a female patient with a family history of hypothyroidism. The patient's condition began in 2008 with symptoms of hyperthyroidism, elevated triiodothyronine (T3), thyroxine (T4) and TSH levels. Thyroid scan showed hypermetabolic activity and she was positive for anti-peroxidase antibodies (anti-TPO). After administration of thiamazole, TSH increased. In 2009 she was diagnosed with clinical hypothyroidism, high levels of TSH, and normal T3 and T4 levels. Levothyroxine was prescribed but TSH increased and she presented clinical signs of hyperthyroidism. Patient abandoned treatment after 1 month. Her symptoms fluctuated among hyperthyroidism, euthyroidism and hypothyroidism. In 2010 she presented tachycardia, weight loss, and high T3, T4 and TSH levels. Thyrotropin-secreting adenoma (TSHoma) was suspected and ruled out by magnetic resonance imaging (MRI). Thyrotropin releasing hormone (TRH) test was performed. TSH increased and the α-subunit of pituitary hormones retained low levels. CONCLUSIONS: RTH diagnosis requires exclusion of a TSHoma because both present a similar pattern according to thyroid tests. The association between Hashimoto's thyroiditis and RTH is not well known. This pathological condition has a mutated TRß gene in 75% of the cases.