Reproductive Health Literacy and Fertility Awareness Among Polish Female Students.

The falling fertility indicators and high prevalence of infertility in Poland make it important for people of reproductive age to have good knowledge of their own fertility in order to be able to take care of their reproductive health. This paper examines reproductive health literacy and fertility awareness among Polish female students. It can help identify gaps in reproductive health education in Poland. The study group included 456 women aged 18-29, who were students of 6 public universities located in Poznan, Poland. The method used was a survey using a self-developed questionnaire assessing the students' knowledge of female and male fertility-related physiology and fertility patterns. The respondents' knowledge was assessed on the basis of the percentage of correct answers. Regression analysis and univariate analysis of variance were used to explore relationships between the students' knowledge and their age, year of study, university and source(s) of information. The average score of correct answers was 55.8%. Older students and medical university students were the most knowledgeable. 93.4% of the respondents correctly identified the optimum age for a woman to have the first child from the point of view of achieving pregnancy fast. Over 90% of the respondents knew such fertility-compromising risks as smoking, diseases and psychological distress. There was much poorer awareness of the adverse effect of unbalanced diet, irregular sleep, and long-lasting physical effort. 47.1% of the students reported gaining information from a number of sources, but as many as 28.3% said their only source was primary or middle school classes. Reproductive health knowledge among the young female students is incomplete, especially as regards lifestyle-related risks. They should be encouraged to supplement it by consulting reliable sources such as health professionals. It is advisable to ensure that the curricula of medical university students provide thorough knowledge in this area, and to arrange suitable electives for students from other universities. As primary and secondary school classes remain an important source of information, quality teaching at these levels should be offered with a focus on making the knowledge as practical and operational as possible. Relevant graduate, postgraduate and in-service courses should be available to professionals responsible for spreading reproductive health knowledge.

Association between serum osteocalcin, adiposity and metabolic risk in obese children and adolescents.

INTRODUCTION: Childhood obesity has been associated with the development of insulin resistance, potentially leading to several metabolic disorders. Osteocalcin has been reported to contribute to the regulation of glucose tolerance and insulin sensitivity. The purpose of this study was to examine the relationship between serum osteocalcin and metabolic risk factors in obese children and adolescents. MATERIAL AND METHODS: Age, gender, pubertal stage, adiposity markers (standard deviation score of body mass index: BMI-SDS, percentage of body fat, waist circumference), blood pressure, serum osteocalcin (OC), fasting plasma glucose and insulin, glycated haemoglobin level (HbA1c), insulin resistance estimated by homeostasis model assessment (HOMA-IR), lipid profile, C-reactive protein (CRP), fibrinogen (FB), white blood cell count (WBC) and 25-hydroxyvitamin D (25-OH-D) were evaluated in 142 obese children and adolescents. Stepwise multiple regression analysis was used to determine the relationship between serum osteocalcin and metabolic risk parameters. RESULTS: Mean serum osteocalcin level was 72.0 ± 20.5 µg/L (range: 16.8-181.5 µg/L). After adjustment for multiple potential confounders, serum osteocalcin concentration was inversely associated with adiposity markers as well as HOMA-IR, HbA1c, triglycerides, CRP, FB and positively with 25-OH-D and HDL-cholesterol. In stepwise multiple linear regression analysis adjusted for age, gender and pubertal stage, osteocalcin was significantly negatively related to HOMA-IR, triglycerides and waist circumference. CONCLUSIONS: Serum osteocalcin concentration is associated with blood markers of dysmetabolic phenotype and measures of adiposity, suggesting that osteocalcin is important not only for bones but also for glucose and fat metabolism as early as during childhood.

Polymorphism of CD36 gene, carbohydrate metabolism and plasma CD36 concentration in obese children. A preliminary study.

INTRODUCTION: CD36 may play an important role in removal of oxidized LDLs from plasma, protein glycation, the pathogenesis of insulin resistance, type 2 diabetes, and diabetic micro- and macroangiopathy. Some reports have pointed to decreased expression of macrophages in association with mutations of the CD36 gene in hyperglycemic and obese subjects. The aim of the study was to search for an association between CD36 gene polymorphism and carbohydrate metabolism disturbances or variability of plasma soluble CD36 concentrations in obese children. MATERIAL/METHODS: The study included 60 children aged 10 to 15 years: 30 with (study group) and 30 without (control group) obesity. Each patient's glycated hemoglobin, weight, height, waist and hip circumference, and systolic and diastolic blood pressure were measured, BMI, WHR and MAP were calculated, and oral glucose tolerance test was performed with glucose and insulin concentration measurements. Amplicons of exons 4-6 of CD36 were studied using DHPLC technique. The PCR products with alterations were bidirectionally sequenced. Plasma concentrations of human antigen CD36 was measured using a commercially available enzyme-linked immunosorbent assay (ELISA). RESULTS: We found two intronic alterations: IVS3-6 T/C (rs3173798) and IVS4-10 G/A (rs3211892), one nonsynonymous substitution: G367A (Glu123Lys, rs183461468) in exon 5 and two synonymous transitions in exon 6: G573A (Pro191Pro, rs5956) and A591T (Thr197Thr, rs141680676). There were no significant differences in any biochemical or morphometric parameters between genotype groups. DISCUSSION: The polymorphisms of the studied fragment of CD36 are not associated with carbohydrate metabolism disturbances or the variability of plasma soluble CD36 concentrations in obese children, but further research is necessary to assess their functional implications.

[Estimation of influence of congenital-adrenal hyperplasia treatment on bone mineralisation evaluated with densitometry]. / Ocena wplywu leczenia pacjentów z wrodzonym przerostem nadnerczy na mase kostna okreslona badaniem densytometrycznym

INTRODUCTION: Doses of glucocorticoids used when treating congenital adrenal hyperplasia (CAH) are larger than physiological secretion of hydrocortisone in healthy people. Optimal dosage should provide metabolic control and should not cause complications of steroid therapy. AIM OF THE STUDY: 1. Evaluation of the influence of CAH treatment on bone mineralisation established with densitometry. 2. Evaluation of steroid profiles usage, in estimation of bone mineralisation disorders risk in patients with CAH. MATERIAL AND METHODS: A total number of 28 patients with CAH, aged 2.7-27 years and receiving treatment with glucocorticoids was examined. Therapeutic coefficient and steroidal coefficient which relate to doses of hydrocortisone used were established using urine steroid profiling, which was effectuated by gas chromatography/mass spectrometry (GC/MS). Additionally dual energy x-ray absorptiometry (DXA) of the lumbar spine (L1-L4) was conducted, where bone mineral density (BMD) was established in g/cm(2), and interpreted as Z-score. RESULTS: BMD presented in Z-score, evaluated in correlation to bone age was significantly lower (p <0.01) than BMD presented in Z-score in correlation to chronological age. It was proved that greater hormonal treatment efficacy (lower steroidal coefficient or greater therapeutic coefficient) correlates with greater bone mineralisation deficits in relation to chronological age. CONCLUSIONS: 1. Greater efficiency of hormonal treatment links with larger bone mineralisation deficits in relation to CAH patients' chronological age. 2. Evaluation of steroid profiles, as one of the estimation methods for metabolic control of the disease, described by steroidal coefficient and therapeutic coefficient, allows for practical application of the above mentioned in prediction of bone mineralisation risk in patients with CAH.

Polymorphism of the CD36 Gene and Cardiovascular Risk Factors in Patients with Coronary Artery Disease Manifested at a Young Age.

This study investigates potential associations between CD36 gene variants and the presence of risk factors in Caucasians with coronary artery disease (CAD) manifested at a young age. The study group consisted of 90 patients; the men were ≤ 50 years old and the women were ≤ 55 years old. Amplicons of exons 4 and 5 including fragments of introns were analyzed by DHPLC. Two polymorphisms were found: IVS3-6 T/C (rs3173798) and IVS4-10 G/A (rs3211892). The C allele of the IVS3-6 T/C polymorphism was associated with higher prevalence of obesity and diabetes, higher hsCRP, lower Lp(a) serum concentrations, and younger age at myocardial infarction. The A allele of the IVS4-10 G/A polymorphism was associated with older age of myocardial infarction and higher white blood cell count. The functional role of CD36 polymorphisms in CAD development needs further research.

Changes in inflammatory biomarkers after successful lifestyle intervention in obese children.

BACKGROUND: Obesity has been associated with low-grade systemic inflammation, potentially leading to insulin resistance, type 2 diabetes, dyslipidemia, and cardiovascular diseases. Even moderate weight loss through dietary changes and physical exercise is effective in preventing and managing obesity-associated disorders. The aim of this study was to determine the effect of weight loss in response to a lifestyle modification on the serum levels of inflammatory markers in obese children and adolescents. MATERIAL AND METHODS: Fifty obese subjects completed a six-month programme consisting of combined hypocaloric diet and moderate physical activity. High-sensitive C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen (FB), white blood count (WBC), glucose, insulin, insulin resistance index (HOMA IR), glycosylated haemoglobin (HbA(1c)), lipids as well as systolic (SBP) and diastolic blood pressure (DBP) were measured before and after intervention. RESULTS: Patients had a 5.3 ± 3.4 kg average weight loss, with significant decreases of SDS-BMI, percentage of body fat, SDS-waist, SBP and DBP, HOMA-IR, HbA(1c) and reductions in serum IL-6, CRP, WBC, FB. In the multivariable linear models, changes in percentage of body fat and HOMA-IR were positively associated with favourable changes in inflammatory parameters. CONCLUSION: This study demonstrates that weight reduction after successful lifestyle intervention results in improvements of blood inflammatory markers in obese children and adolescents.

Serum 25-hydroxyvitamin D (25-OH-D) in obese adolescents.

BACKGROUND: There is increasing evidence that vitamin D deficiency is common and has been associated with several non-bone related outcomes, including insulin resistance, type 2 diabetes and cardiovascular disease. The influences of gender, puberty, and adiposity on serum hydroxyvitamin D (25-OH-D) levels and the relationship between 25-OH-D and insulin resistance in obese children were studied. MATERIAL AND METHODS: Age, gender, pubertal stage, weight status (standard deviation score of body mass index: BMI-SDS, percentage body fat, waist circumference), 25-OH-D levels, and insulin resistance index calculated by homeostasis model assessment (HOMA-IR) were evaluated in 64 obese adolescents. Multivariable linear regression was used to determine factors associated with decreased serum 25-OH-D levels and to study the relationship between 25-OH-D and HOMA-IR. RESULTS: Median serum 25-OH-D level was 10.1 ng/mL (25.2 nmol/L). 14% of patients were vitamin D-sufficient (25-OH-D ≥ 20 ng/mL), 36% had intermediate values (11-19 ng/mL), and 50% were deficient (25-OH-D ≤ 10 ng/mL). In the multivariable model, older age, puberty, higher value of percentage of body fat, and the presence of acanthosis nigricans (AN) were all negatively associated with 25-OH-D. Lower 25-OH-D levels were also associated with higher blood glucose, insulin and HOMA-IR after adjustment for puberty and SDS-BMI. Summer positively correlated with 25-OH-D level. CONCLUSION: Our study confirms that obesity is a risk factor for vitamin D deficiency. Hypovitaminosis D, common in obese adolescents at risk for type 2 diabetes (older age, puberty, acanthosis nigricans) is associated with worse insulin resistance.

Serum leptin concentrations in children with mild and moderate malnutrition.

INTRODUCTION: Numerous studies have reported a strong relationship between plasma leptin concentration and percentage of body fat, fat mass, and body mass index (BMI) in obese and non-obese children. The objective of the present study was to assess the usefulness of serum leptin concentration in disclosing prepubertal malnutrition. MATERIAL AND METHOD: Leptin concentrations in serum were determined and anthropometric parameters were measured in 149 children (3-6 and 7-10 years old). The Cole index of nutritional status was calculated. 44 children (I) presented with long-standing malnutrition due to celiac disease or food allergy and 105 children (II) were healthy. RESULTS: Leptin concentrations in both age groups of undernourished boys (median 2.7 and 2.7 microg/L) and in younger undernourished girls (median 4.2 microg/L) did not differ from concentrations in healthy children (median 2.9, 2.9, and 3.4 microg/L, respectively). Leptin concentrations in older undernourished girls were significantly lower than in healthy girls (median 4.2 vs. 8.8 microg/L, respectively; p < 0.05) of comparable age. In healthy children, leptin levels correlated with gender, body mass, BMI, Cole ratio (r = 0.39-0.41, r = 0.33, r = 0.28, r = 0.22, respectively; p < 0.005), and height (r = 0.19; p < 0.05). Serum leptin concentrations in undernourished children correlated with gender, arm circumference, and BMI (r = 0.27-0.35, r = 0.27, r = 0.25, respectively; p < 0.05). CONCLUSIONS: Our results show that serum leptin concentration is not a useful indicator of mild and moderate malnutrition in prepubertal children.

[Correlation between serum homocysteine levels and selected atherosclerosis risk factors in children and adolescents with simple obesity]. / Zaleznosc pomiedzy stezeniem homocysteiny a wybranymi czynnikami ryzyka miazdzycy u dzieci i mlodziezy z otyloscia prosta.

Homocysteine is known as an independent risk factor of atherosclerosis. The aim of this study was assessment of serum homocysteine concentrations in obese children and evaluation of possible relationship between homocysteine and risk factors of atherosclerosis. 498 children with simple obesity were included into our study. There was a significant correlation between serum homocysteine levels and both traditional and new risk factors of atherosclerosis. The issues confirm a necessity of evaluation serum homocysteine levels of obese children in estimation of cardiovascular disease risk.

Bone mineral density and markers of bone turnover in boys with constitutional delay of growth and puberty.

It has been suggested that poor growth in childhood or puberty might be a correctable determinant of osteoporosis. To assess the effect of the growth and puberty delay on bone metabolism, we measured bone mineral density (BMD) and markers of bone turnover in 41 boys with constitutional delay of growth and puberty. Total body (TB) and lumbar spine (LS) BMD were measured by dual-energy x-ray absorptiometry. Serum osteocalcin, total alkaline phosphatase, and urinary deoxypyridinoline cross-links as markers of bone turnover were evaluated. BMD was decreased by at least 1 sd in TB in 23 boys (56%) and in LS in 27 boys (66%). After adjustment of BMD for bone age, TB was decreased in 11 boys (27%) and LS in 13 boys (32%). Bone age and chronological age significantly correlated with areal and volumetric BMD. The significant increments of height, weight, TB, and LS BMD between the consecutive pubertal stages were reported. Mean alkaline phosphatase, osteocalcin, and deoxypyridinoline were within reference ranges and showed no differences between pubertal stages. In conclusion, in boys with constitutional delay of growth and puberty, bone turnover is normal, and BMD increases in a manner similar to healthy children.

[Immaturity or hypotrophy? The cord blood leptin levels in preterm and small-for-gestational age neonates]. / Niedojrzalosc czy niedozywienie? Poziom leptyny we krwi pepowinowej noworodków urodzonych przedwczesnie i z hipotrofia wewnatrzmaciczna.

OBJECTIVES: To assess cord blood leptin levels in preterm and small-for-gestational age neonates and determine whether fetal leptin levels correlate with selected clinical parameters associated with prematurity and undernutrition at birth. DESIGN: Study of preterm newborns (p-AGA; n = 31) and small-for-gestational age (t-SGA; n = 23) cases in a population of neonates born in Szczecin between September 2001 and June 2002. METHODS: Fetal cord blood was sampled after delivery. Leptin levels were measured by RIA. Anthropometric data (birth weight, birth length, head and chest circumferences, body mass index, Ponderal index) were also recorded. RESULTS: Cord blood leptin levels did not differ significantly between p-AGA and t-SGA neonates with similar birthweight. Among the two groups of newborns the correlations between fetal leptin and anthropometric data were only observed in p-AGAs, but not in t-SGA group. CONCLUSIONS: We suggest that cord blood leptin level depends on body mass rather than maturity of newborn. It is also hypothesized that leptin level in SGA neonates is determined by other than anthropometric parameters used in this study.