Biochemical markers of bone metabolism in children with cow's milk allergy.

INTRODUCTION: Patients with cow's milk allergy (CMA) and following a cow milk protein-free diet for a long time are potentially at risk of developing bone abnormalities. To assess the balance between bone formation and resorption processes, we determined serum concentrations of osteocalcin (OC), bone alkaline phosphatase (BALP), C-terminal telopeptide of type I collagen (CTX), fetuin-A, osteoprotegerin (OPG) and receptor activator of nuclear factor κB ligand (RANKL) in children with CMA. MATERIAL AND METHODS: The study included 50 prepubertal children with diagnosed cow's milk allergy, who were under systematic medical and nutritional care at the Institute of Mother and Child and 40 healthy counterparts as a control group. The concentrations of bone metabolism markers were determined by immunoenzymatic assays. RESULTS: The diets of all investigated children were correct in terms of phosphorus and magnesium contents but deficient in terms of calcium and vitamin D. Serum OC and CTX as well as fetuin-A concentrations were similar in both studied groups. The BALP activity was significantly (p < 0.05) higher in children with cow's milk allergy than in the controls. Serum OPG concentration was comparable in both groups, but the RANKL level was higher (p < 0.05) in CMA children than in healthy ones. Hence, the ratio of OPG/RANKL was lower in children with CMA. CONCLUSIONS: Our study demonstrates slight disturbances in the profile of bone metabolism markers in growing children with CMA. The increase in RANKL level and decrease in OPG/RANKL ratio may contribute to intensification of bone resorption in these patients.

Serum concentrations of sclerostin and bone turnover markers in children with cow's milk allergy.

THE AIM: of this study was to assess concentrations of sclerostin and biochemical markers of bone metabolism in children with cow's milk allergy. MATERIAL AND METHODS: The study included 45 children (age range 2-6 years) with diagnosed cow`s milk allergy, who were on a dairy-free diet and under systematic medical and dietary control at the Institute of Mother and Child in Warsaw. The control group consisted of 40 healthy children (2-6 years), who did not have any symptoms of cow`s milk allergy nor any diseases influencing bone metabolism. Their diets included milk and dairy products. Dietary intake of macro- and micronutrients was assessed based on 3-day records using the Dietetyk2® nutritional program. In the serum samples, we measured concentrations of calcium, phosphate and total alkaline phosphatase by standard methods, 25-hydroxyvitamin D3 by chemiluminescence method and bone metabolism markers by immunoenzymatic methods. The Statistica (version 10.0) computer software was used for statistical analysis. RESULTS: The nutritional status of studied children based on BMI value was normal. In all patients, the average daily value of dietary energy and percentage of energy from protein, fat and carbohydrates were consistent with the recommended values. The intake of calcium in the diets of all children was deficient, however, the intake of vitamin D was consistent with recommendations in the children with allergy, while in the healthy children it was below the recommended values. Mean serum concentrations of calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D3, osteocalcin and C-terminal telopeptide of type I collagen were similar in both studied groups. We observed significantly lower sclerostin levels in children with cow`s milk allergy (0.295±0.116 ng/ml) than in the healthy children (0.353±0.126 ng/ml) (p<0.05). The ratio of cytokines RANKL/OPG (receptor activator of nuclear factor κB ligand/osteoprotegerin) was significantly higher in children with allergy compared with their healthy counterparts (p<0.05). CONCLUSIONS: Basic laboratory parameters related to bone turnover in children with cow`s milk allergy, who were under medical and nutritional care, were normal. Reduced levels of sclerostin and increased ratio of cytokines RANKL/OPG may suggest disturbances in the balance between bone formation and bone resorption in these patients. Further research is needed on bone metabolism in children with food allergy, who due to the use an elimination diet may be at risk of developing abnormalities in the skeletal system.

Tobacco smoke exposure during pregnancy increases maternal blood lead levels affecting neonate birth weight.

To assess the effect of lead exposure from cigarette smoke on fetal growth, blood lead concentrations were measured using inductively coupled plasma mass spectrometry in 150 healthy pregnant women. Mean lead concentrations in plasma and whole blood were significantly higher in the smoking group compared with the nonsmoking group in each trimester of pregnancy (p < 0.001). Logistic regression analysis showed the highest impact of the number of cigarettes smoked per day for serum lead concentration (ß = 0.238; p < 0.05), while in whole blood, it was duration of smoking before conception (ß = 0.297; p < 0.001). Birth weight of the smoking mothers' infants was significantly lower (mean ± SEM, 3,192 ± 50.8 and 3,569 ± 49.6 g, respectively; p < 0.001) and negatively correlated with lead levels in plasma (r = -0.38; p < 0.001) and in whole blood (r = -0.27; p < 0.001). Therefore, it is suggested that smoking during pregnancy increases lead concentrations in maternal blood. Fetal exposure to low doses of lead in utero may be a serious risk factor causing lower birth weight.

[The effect of tobacco smoking on serum concentration of selected angiogenic factors and somatomedin C in pregnant women and umbilical cord blood]. / Wplyw palenia tytoniu na stezenia wybranych czynników angiogennych oraz somatomedyny C w surowicy krwi kobiet ciezarnych i krwi pepowinowej.

The objective of this study was to evaluate the effect of cigarette smoking on concentration of selected angiogenic factors (vascular endothelial growth factor VEGF, placenta growth factor PIGF) and somatomedin C (insulin-like growth factor-I) in blood of mothers and umbilical cord blood. The correlations between studied biochemical parameters and markers of estimated intensity of cigarette smoking as well as birth weight were also determined. Fifty healthy pregnant women were divided into two groups: smoking and tobacco abstinent group according to serum cotinine concentration. The current smokers were defined as those who had smoked 5 cigarettes per day for 2 years before conception and continued smoking during pregnancy. In the group of smoking mothers the mean serum concentration of cotinine was 91.6 microg/L and correlated positively with number of cigarettes daily consumed (r = 0.58, p < 0.01) as well as with time of smoking before conception (r = 0.40, p < 0.05). The mean serum concentration of PIGF in III trimester of pregnancy was significantly higher in the group of smokers than in non-smoking ones (p < 0.0001) and correlated with serum cotinine concentration (r = 0.41, p < 0.05) and number of cigarettes daily consumed (r = 0.58, p < 0.01). The concentration of serum VEGF was similar in both studied group. The mean serum level of IGF-I was significantly lower in group of smokers than in non-smokers in the I and III trimester of gestation (p < 0.01). Also in umbilical cord blood of smoking newborn the concentration of IGF-I was lower by 20% than in nonsmoking group (p < 0.05). We observed negative correlation between number of cigarettes daily consumed and serum level of IGF-I in blood of mothers as well as in blood of their children (I trimester: r = -0.43, p < 0.05; III trimester: r = -0.70, p < 0.001; umbilical cord blood: r = -0.45, p < 0.05). In both studied groups there were a positive correlation between birth weight and concentrations of IGF-I in blood of mothers and umbilical cord blood (group of smokers: mothers r = 0.43, p < 0.05, cord blood r = 0.50, p < 0.01; group of tobacco abstinent: mothers r = 0.51, p < 0.01, cord blood r = 0.41, p < 0.05). The birth weight of the smoking mothers' infants was lower by about 400 g (p < 0.01) and their birth body length by 1.5 cm (p < 0.05) and negatively correlated with number of cigarettes smoked per day (r = -0.55; p < 0.005). Our results indicate, that tobacco smoking during pregnancy increased serum PIGF levels in the final stages of gestation and has no effect on the concentration of VEGF, which may lead to an increase of trophoblast proliferation and uteroplacental dysfunction. Lower than in tobacco abstinent levels of IGF-I in serum of smoking mothers and in umbilical cord blood and their close relationship with birth weight, may suggests a direct effect of this factor on birth anthropometric parameters.

[Assessment of selected bone metabolism marker concentrations in children with cystic fibrosis]. / Analiza stezen wybranych parametrów metabolizmu kostnego u dxieci chorych na mukowiscydoze.

AIM: The aim of this study was to assess bone formation and resorption processes and bone metabolism regulators, such as osteoprotegerin and fetuin-A in children with cystic fibrosis. MATERIAL AND METHODS: We examined 45 children with cystic fibrosis aged 5-13 years treated at the Institute of Mother and Child in Warsaw. The control group consisted of 35 healthy children in the same synage range without any diseases which may influence bone metabolism. We determined serum calcium and phosphate levels by colorimetric methods, vitamin D3 by the chemiluminiscence method and bone metabolism markers (osteocalcin, 5b isoenzyme of tartrate-resistant acid phosphatase, osteoprotegerin, fetuin-A) by immunoenzymatic methods. RESULTS: Mean serum concentrations of calcium and phosphate in the studied children were within the reference ranges. However, the level of 25-hydroxyvitamin D3 was significantly lower in patients with cystic fibrosis compared to the controls (19.3±7.6 vs 25.2±8.9 ng/ml, p<0.01). In cystic fibrosis children we observed a statistically significant lower concentration of osteocalcin (81.9±28.9 vs 97.9±28.6 ng/ ml, p<0.01) and similar activity of 5b isoenzyme of tartrate-resistant acid phosphatase (12.5±2.9 vs 13.4±3.5 U/L) as compared to healthy peers. Mean serum concentration of osteoprotegerin in patients with CF was significantly lower than in the control children (4.1±0.98 vs 4.59±0.86 pmol/l, p<0.05). Serum concentration of fetuin-A was comparable in both groups of children. CONCLUSIONS: In children with cystic fibrosis changes in the profile of bone metabolism markers were observed. Even patients with CF who are clinically stable and supplemented with vitamins are at risk of osteopenia and osteoporosis in their later life. Therefore, they should be under a comprehensive medical and nutritional care in order to achieve their optimal peak bone mass.

The pregnancy-associated plasma protein A and insulin-like growth factor system in response to cigarette smoking.

OBJECTIVE: Maternal smoking during pregnancy is associated with a reduction in birth size but the mechanism by which this occurs still remains unclear. The purpose of this study was to evaluate the effect of tobacco smoking on concentrations of pregnancy-associated plasma protein A (PAPP-A), insulin-like growth factor I (IGF-I), II (IGF-II) and binding proteins BP-3 and BP-4 in pregnant women and correlations between these parameters. METHODS: Sixty healthy pregnant women were divided into smoking and tobacco-abstinent group according to results of serum cotinine concentration. The current smokers were defined as those who had smoked five or more cigarettes per day during pregnancy. RESULTS: The mean serum concentrations of PAPP-A, IGF-I and IGF-II were significantly lower in smoking than in non-smoking pregnant women (p < 0.01). The level of PAPP-A correlated positively with the IGF-II concentration in both studied group (non-smoking: r = 0.54; p < 0.001; smoking: r = 0.40; p < 0.05). In tobacco-abstinent group negative correlation between IGF-II and IGFBP-4 concentrations was found (r = -0.35; p < 0.05). CONCLUSION: Tobacco smoking during pregnancy decreases the pregnancy-associated plasma protein A and insulin growth factors I and II levels. The correlation between PAPP-A and IGF-II may suggest function of this protein as a protease and regulator in the IGF system.

[Effects of elimination diets on bone metabolism in children and adolescents with phenylketonuria, galactosemia and celiac disease]. / Wplyw stosowania diet eliminacyjnych na metabolizm kostny u dzieci i mlodziezy z fenyloketonuria, galaktozemia, celiakia.

Phenylketonuria, galactosemia and celiac disease are disorders in which elimination diets are the only known therapy, which reverses many clinical manifestations of acute phase in the patients. Unfortunately, most of them develop long-term complications, including bone turnover impairment and low bone mineral density. These disturbances are not only observed in adulthood but also in childhood and adolescence. Insufficient accumulation of peak bone mass in these periods is a risk factor for osteoporosis and fractures in later life. The pathological mechanisms leading to a diminished bone mineral content in these disorders are not well known. The patients might be at risk for a decreased bone mineral content because of either dietary deficiencies secondary to the elimination diets and/or unknown intrinsic factors. This article overviews bone metabolism disturbances in phenylketonuria, galactosemia and celiac disease during childhood and adolescence, when growth and bone turnover are most intensive. The available data and own results concerning bone markers in children with these disorders and proposal for the prevention of osteoporosis in pediatric patients treated with elimination diets are discussed.

[Effect of cigarette smoking on blood lead levels in pregnant women]. / Wplyw palenia tytoniu na poziom olowiu we KRWI kobiet ciezarnych.

UNLABELLED: Tobacco smoking creates health problems which apply not only to individuals and the family but also to different ages and social groups, as well as the national economy. Epidemiologic studies conducted at the Institute of Mother and Child indicated that in Poland 25-30% women smoke during pregnancy. Lead exposure from cigarette smoke may have a negative effect on the transplacental flow of micronutrients and have an adverse influence on the growth and development of the fetus, and then on children. The aim of this study was to estimate the effect of smoking cigarettes on plasma and whole blood lead levels in pregnant women. MATERIAL AND METHODS: Eighty healthy pregnant women, patients of the Clinical Department of the Obstetrics and Gynecology Institute of Mother and Child and Warsaw Medical University, were divided into two groups: group I - tobacco smokers and group II- tobacco abstainers according to questionnaire declaration and serum cotinine concentration. Current smokers were defined as those who had smoked 5 cigarettes per day for 2 years before conception and continued smoking during pregnancy. The women exposed to environmental tobacco smoke (smoking spouse or other family members, co-workers) were excluded from the non-smoking group. All pregnant volunteers signed a written, informed consent form, approved by the Institute's Ethical Committee. The concentrations of lead in plasma and whole blood were analyzed using inductively coupled plasma mass spectrometry on spectrometer analyzer ICP MS Elan 6100 (Perking Elmer, Germany). Levels of cotinine in serum were determined by Cotinine Direct ELISA test (Calbiotech Inc. Canada). RESULTS: In the group of smoking mothers the mean serum cotinine concentration was 69.1 µg/L, whereas in the group of tobacco abstainers it was present only in trace amount. In group I we observed a significant positive correlation between serum cotinine and the number of cigarettes smoked daily (r=0.74; p<0.001), as well as the period of smoking before conception (r=0.60; p<0.001). The concentrations of lead in the plasma of smoking women were significantly higher than in the group of tobacco abstainers in each trimester of pregnancy (I trimester: 0.22 µg/dL vs 0.12 µg/dL p<0.01; II trimester: 0.19 µg/L vs 0.10 µg/L p<0.001; III trimester 0.28 µg/ dL vs 0.13 µg/dL p<0.0001). Tobacco smoking mothers also had a higher concentration of lead in whole blood as compared to pregnant non-smoking women. These differences were statistically significant and amounted to 2.15 µg/dL vs 1.28 µg/L in the first, 1.99 µg/dL vs 1.19 µg/dL in the second and 2.11 µg/dL vs 1.58 µg/dL in the third trimester of pregnancy. We observed that the level of lead was correlated with cotinine in blood, as well as with the number of cigarettes and the length of time women smoked before conception. Such an effect was observed in every trimester of gestation. A strong correlation between the number of cigarettes/day and lead concentration in plasma (r=0.57; p<0.001) and whole blood (r=0.54; p<0.001) was found in the third trimester of pregnancy. CONCLUSIONS: Tobacco smoking during pregnancy increased the concentrations in maternal blood lead. The level of lead in plasma and whole blood correlated with the degree of intensity of cigarette smoking in the pregnant women studied. It may be a result of influencing the mobilization of calcium from the bone with simultaneous release of lead deposited in the bone. Further studies are required to characterize the effect of higher lead level in the blood of mothers on the risk of premature labor, low birth weight of newborns and their inferior development.

Changes in concentration of serum adiponectin multimeric forms following weight reduction programme in prepubertal obese children.

INTRODUCTION: It is widely recognized that lifestyle intervention with modification of dietary habits and physical activity is effective in weight reduction and may improve the biochemical parameters in obese children and adolescents. However, the levels of adiponectin multimeric complexes during lifestyle intervention have not been extensively studied in obese children. AIM: The aim of this study was to investigate the effect of the 3-months weight-reduction programme on serum adiponectin multimeric complexes in obese prepubertal children. MATERIAL AND METHODS: Changes in clinical, anthropometric and metabolic parameters including total adiponectin and its multimeric forms were assessed in 30 obese children aged 4-10 years, after a 3-months lifestyle intervention programme. This programme consisted of dietary and physical activity modifications and behaviour therapy including individual psychological care for the child and its family. The recommended daily intake from low-energy diet was 1200-1400 kcal/day. The reference group consisted of 35 healthy normal-weight children. Concentration of serum total adiponectin (Total-A) and its multimeric complexes: low molecular weight (LMW) adiponectin, medium molecular weight (MMW) adiponectin and high molecular weight (HMW) adiponectin were measured by ELISA kit. RESULTS: We observed that the concentrations of total adiponectin and HMW adiponectin were 25% (p<0.01) and 45% (p<0.0001) lower respectively, in obese children compared to controls. HMW/ Total-A ratio was lower in the obese children than in the controls (p<0.001), whereas LMW/Total-A ratio was higher in the obese as compared to the normal-weight children (p<0.001). After 3-months therapy the increases of total adiponectin concentration (by 20%, p<0.001), HMW (by 25%, p<0.001) and MMW adiponectin (by 30%, p<0.05) were recorded in these patients in comparison to baseline values. The increase of HMW/Total-A ratio (p<0.05) and the decrease of LMW/Total-A ratio (p<0.05) were also found in obese patients after weight-reduction programme as compared to the level before therapy. After modification of the diet and physical activity, the BMI of the obese children declined by 10% (p<0.01). CONCLUSIONS: Our results indicate that the weight loss in children after 3-months therapy is associated with the increase of total and HMW, MMW adiponectin concentration. This suggests that the intervention programme is sufficient to detect significant changes in adiponectin multimeric profile, which confirms the efficacy of this therapy in prepubertal obese children.

The effect of vegetarian diet on selected essential nutrients in children.

INTRODUCTION: Vegetarian diets are considered to promote health and reduce the risk of some chronic diseases. It is also known that restriction or exclusion of animal foods may result in low intake of essential nutrients. The aim of the presented study was to assess the intake and serum status of vitamin B12, folate, vitamins A, E and D, as well as concentrations of homocysteine, total antioxidant status and iron balance in Polish vegetarian children. MATERIAL AND METHODS: The study included 50 children, aged 5-11 who had been referred to the Institute of Mother and Child for dietary consultation. From those, 32 were vegetarians (aged 6.5±4.2 years) and 18 omnivores (aged 7.9±2.7 years). Dietary constituents were analyzed using the nutritional programme Dietetyk2®. Folate and vitamin B12 were determined with a chemiluminescence immunoassay, total homocysteine with a fluorescence polarization immunoassay and TAS (total antioxidant status) by colorimetric method. Vitamin A and E in serum were determined by the high-pressure liquid chromatography method (HPLC) and vitamin D by immunoenzymatic assay (ELISA). Concentrations of iron, ferritin, transferrin and total iron-binding capacity (TIBC) in serum were determined by commercially available kits. RESULTS: In vegetarian children daily intake of vitamin B12 (1.6 eg) was in the recommended range, that of folate (195 eg) and vitamin A (1245 eg) higher, but vitamin E slightly lower (6.6 eg) and three-fold lower vitamin D (1.1 eg) than references allowance. Serum concentrations of vitamin B12 (548 pg/ml), folate (12.8 ng/ml), vitamin A (1.2 emol/L), vitamin E (15.6 emol/l) were within physiological range, but that of vitamin D (13.7 eg/L) was only half of the lowest limit of the reference value. In vegetarian children in comparison to omnivorous similar levels of homocysteine (6.13 emol/L vs 5.45 emol/L) and vitamin A (1,17 emol/L vs 1.32 emol/L) were observed. Lower (p<0.05) values of vitamin E (15.6 emol/L vs 18.4 emol/L) and TAS (1.21 mmol/L vs 1.30 mmol/L; p<0.0001) were found. Concentrations of iron markers were in physiological range. CONCLUSION: Obtained results indicated that intakes of vitamin B12 and folic acid from vegetarian diets are sufficient to maintain serum concentrations of both homocysteine and iron in the range observed in omnivorous children. High consumption of vitamin A and low vitamin E only slightly affected their serum values. Significantly lower concentration of serum vitamin E in vegetarian children in comparison to nonvegetarians may be reflected with statistically significant lowering of total antioxidant status. Insufficient intake of vitamin D and its low serum concentration should be under close monitoring in vegetarian children. In order to prevent vitamin D deficiency appropriate age-dependent supplementation should be considered.

Serum concentration of adipocytokines in prepubertal vegetarian and omnivorous children.

UNLABELLED: THE AIM of our study was to investigate associations between serum adipocytokines status and anthropometric parameters as well as total energy and macronutrient intake in vegetarian, normal-weight omnivorous and obese omnivorous children. MATERIAL AND METHODS: We examined 90 healthy prepubertal children aged 4-10 years who had been referred to the Department of Nutrition at the Institute of Mother and Child in Warsaw for dietary consultation. Patients with endocrine disorders or genetic syndromes, as well as those who were taking medications that could affect growth, pubertal development or nutritional status were excluded. Children were divided into groups: vegetarians (n=30), normal-weight omnivores (n=30) and obese omnivores (n=30). Anthropometric measurement (weight, height) was performed in all children and body mass index (BMI) was calculated. A whole body dual-energy X-ray absorptiometry (DXA) scan was performed to determine fat mass, the percentage of body fat and lean body mass using a Lunar Prodigy (GE, USA). Dietary constituents were assessed by questionnaire (nutrient intake from a 3-day period: 2 weekdays and 1 weekend day) and calculated using the nutritional computer program Dietetyk2®. Serum total cholesterol, high-density and low-density lipoproteins, and triglycerides concentrations were assessed by standard enzymatic methods. Serum levels of leptin, soluble leptin receptor and adiponectin were determined by immunoenzymatic assays. RESULTS: There were no significant differences in body weight, height, BMI and lean mass values between vegetarians and normal-weight children on traditional mixed diet. Children on vegetarian diet had lower fat mass (p<0.05) and fat mass/lean mass ratio (p<0.05) than normal-weight omnivores. However, omnivorous children with simple obesity had significantly higher body weight, height, BMI, fat and lean mass in comparison to vegetarian as well to normal-weight omnivorous children. The fat mass/lean mass ratio in obese children was about 2.5-fold higher than in normal-weight subjects on traditional diet. Total energy and percentage of energy from macronutrients in diets of all children were within the recommended daily intake. Children on vegetarian diet was related with lower fat and higher carbohydrates intake in comparison to their omnivorous peers. Vegetarian children had significantly lower mean total cholesterol (151.5±18.0 mg/dL), low-density lipoprotein (81.0±13.6 mg/dL) and triglycerides (61.6±20.5 mg/dL) than omnivores, especially the obese ones (165.0±22.3 mg/dL, 94.7±19.2 mg/dL, 82.4±32.3 mg/dL, respectively). These differences were statistically significant (p<0.05). Serum concentration of leptin was significantly lower in vegetarian children (3.0±2.1 ng/ml) compared with omnivores (6.8±3.4 ng/ml in normal weight versus 37.8±12.7 ng/ml in obese) (p<0.0001). However, serum soluble leptin receptor as well as adiponectin were at higher levels in vegetarians than in omnivores (p<0.001 and p<0.05, respectively). We observed that serum leptin levels positively and soluble leptin receptor negatively correlated with body mass index and fat mass in prepubertal children. Moreover, leptin levels negatively correlated with its soluble receptor and with adiponectin. CONCLUSIONS: In children different kinds of diet might modify not only body mass and lipid profile but also serum concentration of adipocytokines. Determination of leptin and its soluble receptor, as well as adiponectin levels may be clinically useful in the medical and nutritional care of obese as well as vegetarian prepubertal children.

The effect of tobacco smoking during pregnancy on plasma oxidant and antioxidant status in mother and newborn.

OBJECTIVE: The aim of the study was to estimate the effect of tobacco smoking during pregnancy on oxidative damage and antioxidant defence in matched samples of maternal blood and cord blood. STUDY DESIGN: Healthy, pregnant women (n=140) were divided into non-smoking and smoking groups according to the concentration of cotinine in serum and urine. Oxidative damage was measured through levels of malondialdehyde (MDA) and plasma antioxidant status was evaluated by measuring concentrations of total radical trapping parameters (TRAP) and selected antioxidants (ß-carotene, vitamin A, vitamin E, uric acid). Statistical analysis was done using the SAS System for Windows (SAS Institute, Cary, NC). RESULTS: In the course of pregnancy the concentration of MDA increased, but to higher values in smoking women than in non-smoking ones. It was accompanied by significantly lower TRAP in the smoking group than in the controls (p<0.05). Plasma concentration of uric acid (p<0.05) and antioxidant vitamins E (p<0.01), A and ß-carotene (p<0.0001) were all reduced in smokers as compared with non-smoking pregnant women especially in the third trimester. Concentration of MDA in plasma of cord blood of newborns of smoking mothers was significantly higher (p<0.01) but the antioxidant defence was lower (p<0.0001) than in non-smoking ones. It was particularly pronounced for ß-carotene (32%; p<0.0001) and vitamin A (28%; p<0.001). A significant negative correlation was found between MDA and TRAP levels of maternal plasma (non-smoking and smoking: r=-0.50, p<0.0001) and cord plasma (non-smoking: r=-0.54, p=0.0057; smoking: r=-0.71, p=0.0004) in all the study subjects. Total antioxidant status positively correlated with concentrations of uric acid and vitamin E in non-smoking and smoking mothers as well as their newborns. CONCLUSION: Tobacco smoke enhances lipid peroxidation and depletes antioxidant potential in the plasma of pregnant women and umbilical cord blood. Therefore smoking during pregnancy may stimulate free radical damage in the mother and the growing fetus.

The influence of vegan diet on bone mineral density and biochemical bone turnover markers.

INTRODUCTION: Vegetarian diets can be healthy when they are well balanced and if a variety of foods is consumed. However, elimination of animal products from the diet (vegan diets) decreases the intake of some essential nutrients and may influence the bone metabolism. This is especially important in childhood and adolescence, when growth and bone turnover are most intensive. The aim of the study was to assess the effect of vegan diet on bone density (BMD) density and serum concentrations of bone metabolism markers. MATERIAL AND METHODS: We examined a family on vegan diet which consisted of parents and two children. Dietary constituents were analysed using a nutritional program. Total and regional BMD were measured by dual-energy X-ray absorptiometry. Concentrations of calcium and phosphate in serum obtained from fasting patients were determined by colorimetric methods, 25-hydroxyvitamin D by the chemiluminescence method and bone turnover markers by specific enzyme immunoassays. RESULTS: In studied vegans, the dietary intake of phosphate was adequate while calcium and vitamin D were below the recommended range. Concentrations of calcium, phosphate and bone turnover markers in the serum of all subjects were within the physiological range, but 25-hydroxyvitamin D level was low. Age-matched Z-score total BMD was between -0.6 and 0.3 in adults, however in children it was lower (-0.9 and -1.0). Z-score BMD lumbar spine (L2-L4) was between -0.9 to -1.9 in parents and -1.5 to -1.7 in children. CONCLUSIONS: Our results suggest that an inadequate dietary intake of calcium and vitamin D may impair the bone turnover rate and cause a decrease in bone mineral density in vegans. The parameters of bone density and bone metabolism should be monitored in vegans, especially children, in order to prevent bone abnormalities.

[Influence of vegetarian diet on serum values of homocysteine and total antioxidant status in children]. / Wplyw stosowania diety wegetarianskiej na stezenie homocysteiny oraz calkowita aktywnosc przeciwutleniajaca w surowicy u dzieci.

UNLABELLED: The vegetarian diet may play a preventive role in the development of chronic diseases such as coronary heart and cardiovascular disease. However increase of homocysteine (Hcy) concentration in peoples avoiding animal products may contribute to an increased atherosclerotic risk in these subjects. Recent evidence has suggested that role of hyperhomocysteinemia in atherogenesis is associated with process of autooxidation, which can promote the production of hydroxyl radicals, resulting in oxidative modification of low density lipoprotein and endothelium injury. The oxidant-antioxidant imbalance depends not only on the amount of enhanced free oxygen species but also insufficiency of antioxidant defence system. Total antioxidant status (TAS) expresses capacity for scavenging of free radicals minimizes oxidative damage. The aim of this study was to asses concentrations of homocysteine and total antioxidant status in serum of children on vegetarian and omnivorous diet. We also studied levels of vitamin A (retinol) and vitamin E (alpha-tocopherol) particular components of TAS. MATERIAL AND METHODS: The study included 35 children, aged 5-16 who had been referred to Institute of Mother and Child for dietary consultation. From those, 17 were lacto-ovo-vegetarians and 18 omnivores. Dietary constituents were analyzed using the nutritional programme Dietetyk2 and completed with supplementation data. Concentration of homocysteine was estimated in serum with fluorescence polarization immunoassay and TAS by colorimetric method. Levels of vitamin A and E were determined using high-pressure liquid chromatography (HPLC). RESULTS: The mean concentration of homocysteine was similar in both studied groups (vegetarians: 6.13 +/- 1.01 micromol/l vs. omnivores: 5.45 +/- 0.98 micromol/l). In vegetarian children serum level of TAS was significantly lower (1.21 +/- 0.06 mmol/I) as compared to those in non-vegetarian ones (1.30 +/- 0.05 mmol/l, p < 0.0001), but remained within the physiological range (1.16-1.40 mmol/l). The mean concentrations of vitamins A and E in serum of vegetarians were lower than observed in omnivores group, but only in case of alpha-tocopherol the difference was statistically significant (vegetarians: 15.58 +/- 4.12 vs. omnivores: 18.41 +/- 3.10; p < 0.05). CONCLUSION: In studied group of children on lacto-ovo-vegetarian diet, serum concentrations of homocysteine are normal and daily food intake of antioxidants and their level in blood are sufficient for preserving adequate total antioxidant status.

[A comparison of serum concentrations of biochemical bone turnover markers in patients with osteosarcoma with good and poor prognosis]. / Analiza stezenia biochemicznych markerów obrotu kostnego u chorych na miesaka kosciopochodnego z korzystnym i niekorzystnym rokowaniem.

UNLABELLED: Osteosarcoma is a primary malignant bone tumor, whose peak incidence occurs in the second decade of life during the adolescent growth spurt. Complex oncological treatment consisted of chemotherapy combined with surgery which substantially increased the cure rate of patients with osteosarcoma, but it is very important to identify patients with poor prognosis and to treat them with more aggressive therapy. THE AIM OF THIS STUDY: To assess serum biochemical bone turnover markers as prognostic indicators in patients with osteosarcoma. MATERIAL AND METHODS: We studied 55 patients from age 5 to 20 years with diagnosed osteosarcoma treated at the Institute of Mother and Child in Warsaw. The studied group was divided into 2 subgroups consisted of 27 patients with favorable (disease remission) and 28 patients with unfavorable (disease progression) prognosis. Venous blood was collected from patients in the morning hours at time of diagnosis, during anticancer treatment and after completion of treatment. Serum osteocalcin (OC), bone alkaline phosphatase (BALP) and C-terminal cross-linking telopeptide of type I collagen (CTX) were analyzed by immunoenzymatic methods. RESULTS: At time of diagnosis, in patients with unfavorable prognosis concentration of bone formation markers were higher (OC by 30% and BALP by 60%) than in those with good prognosis, however, CTX level was similar in both groups of patients. During chemotherapy in patients with poor prognosis we observed higher levels of bone turnover markers in comparison to subjects with favorable prognosis. After the completion of therapy, in patients with progression median values of bone formation markers were over twofold and bone resorption marker about 50% higher as compared to patients with remission of disease. These differences were statistically significant at p < 0.05 for OC, p < 0.001 for BALP and p < 0.01 for CTX. CONCLUSIONS: Our results suggest that bone turnover markers, especially bone alkaline phosphatise may be useful in the monitoring and in the assessment of the efficacy of therapy in children with osteosarcoma. Higher rates of bone formation and resorption during treatment and after its completion are associated with unfavorable prognosis and may indicate progression of disease.

[Evaluation of iron balance in healthy pregnant women and their newborns]. / Badanie gospodarki zelazem u kobiet w przebiegu ciazy niepowiklanej oraz we krwi pepowinowej ich dzieci.

AIM OF THE STUDY: The aim of this study was to evaluate the iron status markers in normal healthy pregnancy as well as the influence of maternal diet on iron concentration in their newborns. MATERIAL AND METHODS: A longitudinal prospective study was conducted in a sample of 69 healthy non-smoking pregnant women under prenatal care of The Institute of Mother and Child. Blood samples were collected in the first, second and third trimesters and from the umbilical vein. Concentrations of ferritin and transferrin were assessed using turbidimetric technique, the concentration of iron--with ferrozine colorimetric method. Pentra 120 analyzer was used to define hematological parameters. Maternal diet was assessed by means of a weekly questionnaire, processed with computer software Dietetyk 2. RESULTS: Hematological parameters in the analyzed blood were normal. The average hematocrit values in the first trimester of pregnancy was 36.7%, in the second--34.92%, in the third--35.95%. The concentration of hemoglobin was 27.82 g/dl, 28.55 g/dl, 27.27 g/dl in the respective trimesters of pregnancy. In the umbilical blood it was 25.84 g/dl (5.2% less than in the maternal blood). The number of erythrocytes was the highest in the first (4.16 mln/mm3), and the lowest in the second trimester (3.92 mln/mm3). The average concentration of iron was the highest in the first trimester--99.61 microg/dl. In the second and third trimester it decreased by 25% and 2% respectively. The concentration was 76.34% higher in the umbilical blood than in maternal blood at the time of labor. The concentration of ferritin in the first trimester was 43.96 microg/l, in the second and the third trimester it was lower by 46% and 29% respectively. It was 126.4 microg/l in the umbilical blood (fourfold higher than in maternal blood). The concentration of transferrin was 321.01 mg/dl in the first trimester and it increased in consecutive trimesters by 36.14% and 5.12%; it was 219.92 mg/dl in the umbilical blood--48% of the concentration of transferrin in the maternal blood at the time of labor. The analysis of an average daily food ration revealed that the supply of iron was 80% of the recommended dose in the first half and only 41% of the recommended dose in the second half of the pregnancy. Fat consumption was 99% and 95% of the recommended dose, respectively. There was a 30%-decrease in the protein and carbohydrates consumption in comparison with the recommended dose in the second half of the pregnancy. CONCLUSIONS: In spite of normal hematological parameters, we observed insufficient supply of iron in the diet of pregnant women, which was demonstrated by a decreased level of ferritin. It should be reason enough to issue dietary recommendations and guidelines for pregnant women in each stage of pregnancy.

[The effect of tobacco smoking during pregnancy on birth mass on the basis of population studies--preliminary results]. / Wplyw palenia tytoniu przez kobiety ciezarne na mase urodzeniowa dzieci w oparciu o badania populacyjne--doniesienie wstepne.

It is commonly known, that tobacco smoking during pregnancy has negative influence on child birth mass. Also in polish population neonates of smoking mothers are frequently born with lower body mass and are smaller. Purpose of this study was to estimate the percentage of women smoking during pregnancy and its relation to body mass of newborns. Research was made on the basis of standardized survey questionnaire done in the group of 20320 mothers. Women were divided into non-smoking and smoking before conception and during pregnancy. Questions concerned also intensity of smoking and body mass of a child. Among of participants 41.5% were in smokers group with tendency to decrease in the course of pregnancy. However even in 3-rd trimester percentage of smoking mothers was high. Body mass of newborns of smokers was lower than in group of abstinent and was related to intensity of smoking. In the light of these results some more intensive prophylactic and education actions are needed.

[The effect of tobacco smoking on serum concentration of IGF-I and its binding proteins IGFBP-3 and IGFBP-4 in pregnant women]. / Wplyw palenia tytoniu na stezenia IGF-I oraz jego bialek wiazacych IGFBP-3 i GFBP-4 w surowicy krwi kobiet ciezarnych.

However smoking during pregnancy has been show to result in growth restriction of the fetus but the mechanism by which this occurs has not been adequately clarified. Insulinlike growth factor (IGF) and its insulin-like growth factor binding protein (IGFBP) are the main mediators of intrauterine fetal growth. The aim of the study was to estimate the effect of tobacco smoking on serum concentrations of IGF-I, IGFBP-3 and IGFBP-4 in pregnant women. Forty five healthy pregnant women patients of Clinical Department of Obstetrics and Gynecology, Institute of Mother and Child, were divided into two groups: smoking and tobacco abstinent according to questionnaire declaration and serum cotinine concentration. The current smokers were defined as those who had smoked 5 cigarettes per day for 2 years before conception and continued smoking during pregnancy. Serum concentrations of cotinine, IGF-I, IGFBP-3 and IGFBP-4 were determined by immunoenzymatic method. We observed, that in group of smoking mothers the mean serum concentration of cotinine was 82.9 microg/l and correlated positively with number of cigarettes daily consumed (r = 0.47; p < 0.05). In group of tobacco abstinent cotinine in serum was present only in trace amount (range: 0-3.5 microg/l). The mean serum concentration of IGF-I was significantly lower in group of smokers than in non-smoking ones (222,4 microg/L vs 282,1 microg/L; p < 0.05). In tobacco abstinent group we observed positive correlation between gestational age and serum level of IGF-I (r = 0.40; p < 0.05). There was no association among this parameters in smoking pregnant women. In serum of cigarette users the mean concentration of IGFBP-3 was slightly higher as compared to those of tobacco abstinent (6798 microg/L vs 6427 microg/L). In this group level of IGFBP-4 was lower by 20% than in non-smoking ones, but the difference was not statistically significant. Our results indicate that tobacco smoking during pregnancy affect in maternal IGF-I and its binding proteins, which may correlate with smaller birth weight. Further studies will be continued in larger group of women in all trimesters of pregnancy and their children to confirm of this association.

[The influence of tobacco smoking on concentration of the pregnancy-associated plasma protein A (PAPP-A) in pregnant women]. / Wplyw palenia tytoniu na stezenie osoczowego bialka ciazowego A (PAPP-A) u kobiet ciezarnych.

This article presents a review of scientific literature concerning adverse effect of tobacco smoking on concentration of the pregnancy-associated plasma protein A (PAPP-A) in pregnant women. PAPP-A is produced in great amounts during pregnancy by the syncytiotrofoblast, but can be also detected in a variety of cell types such as fibroblasts, osteoblasts and vascular smooth muscle cells (VSMC). We describe the structure of PAPP-A and its function as an insulin-like growth factor binding proteins (IGFBPs) protease with a focus on data obtained in tobacco smoking pregnant women. We also discuss the results of studies indicating a correlation between smoking and deficit of PAPP-A in the first trimester of pregnancy. The review summarizes possible mechanisms relating tobacco smoking to the changes of PAPP-A concentration during pregnancy.

Pro-hepcidin concentration in serum of women in uncomplicated pregnancy, pregnancy complicated by premature rupture of membranes and in pregnancy induced hypertension.

UNLABELLED: Pro-hepcidin, mainly synthesized in hepatocytes is the pro-hormone of hepcidin which demonstrates antimicrobial activity and is the body's main regulator of iron homeostasis. THE AIM: The estimation of serum pro-hepcidin concentrations in uncomplicated pregnancy and complicated by premature rupture of membranes (PROM) and in pregnancy induced hypertension (PIH). MATERIAL AND METHODS: The studies were performed in 24 women in pregnancy complicated by premature rupture of membranes, 31 women in pregnancy with induced hypertension and 35 healthy women in corresponding weeks of gestation (third trimester). Concentration of pro-hepcidin, C-reactive protein, white blood cell count, haemoglobin and haematocrit were studied using commercially available kits. RESULTS: Levels of serum pro-hepcidin in studied pregnant women were similar and amounted respectively to 99.6 microg/L, 93.7 microg/L and 98.2 microg/L in PIH, PROM and in the uncomplicated pregnancy group. In the group of patients with PROM and PIH, concentration of haemoglobin was significantly lower than in healthy pregnant women, but remains in the physiological range. In the studied groups values of C-reactive protein and leucocytes count were normal. We did not observe any correlation between the concentration of serum pro-hepcidin and iron status measurements. CONCLUSION: In pregnancies complicated by premature rupture of membranes and pregnancy induced hypertension with normal values of haemoglobin and haematocrit serum pro-hepcidin concentrations are similar to those observed in healthy pregnant women with normal course of pregnancy.