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1.
J Endocrinol Invest ; 46(12): 2555-2562, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37204691

RESUMO

PURPOSE: Testing 1-h glucose (1HG) concentration during oral glucose tolerance test is cost-effective to identify individuals at risk of incident type 2 diabetes. Aim of the study was to define 1HG cutoffs diagnostic of incident impaired glucose tolerance (IGT) in youths with obesity, and to evaluate prevalence and association of cutoffs identified in the cohort and from the literature (133 and 155 mg/dl) to cardiovascular disease (CVD) in a population of youths with obesity. METHODS: This is a longitudinal study of 154 youths to identify 1HG cutoffs, and cross-sectional study of 2295 youths to estimate prevalence of high 1HG and association to CVD. Receiver-operating characteristic curves (ROC) were used to establish 1HG cutoffs, and univariate regression analyses to test association of 1HG to blood pressure, lipids and aminotransferases. RESULTS: ROC analysis identified the 1HG cutoff of 159 mg/dl as having diagnostic accuracy of IGT with area under the ROC 0.82 (95% CI 0.66-0.98), sensitivity 0.86% and specificity 0.79%. In the cross-sectional population, prevalence of high 1HG was 36% and 15% for 133 and 155 mg/dl cutoffs, respectively, and 17% for the 159 mg/dl value. All the examined cutoffs were significantly associated with worse lipid profile, liver function test, reduced insulin sensitivity, secretion and disposition index. CONCLUSION: High 1HG is marker of persistent IGT and increased risk of metabolic abnormalities in youths. The 155 mg/dl cutoff is a convenient estimate in young people but longitudinal studies with retinopathy and overt diabetes as end points are advised to verify the 1HG cutoff with the best diagnostic accuracy.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Intolerância à Glucose , Estado Pré-Diabético , Humanos , Adolescente , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Estudos Transversais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Glicemia/metabolismo , Estudos Longitudinais , Fatores de Risco , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/epidemiologia , Glucose/metabolismo , Obesidade/complicações , Fatores de Risco de Doenças Cardíacas
2.
J Endocrinol Invest ; 45(11): 2165-2170, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35854182

RESUMO

CONTEXT: Hypogonadism in Prader-Willi syndrome (PWS) is generally attributed to hypothalamic dysfunction or to primary gonadal defect. MKRN3, a maternal imprinted gene located on 15q11.2-q13 region, encodes makorin ring finger protein 3, whose deficiency causes precocious puberty, an extremely rare symptom in PWS. OBJECTIVE: This study aimed to evaluate MKRN3 levels in patients with PWS and to analyze its correlation with sexual hormone levels, insulin resistance and Body Mass Index (BMI). METHODS: We performed an observational cross-sectional study and enrolled 80 patients with genetically confirmed diagnosis of PWS with median age of 9.6 years. RESULTS: MKRN3 levels were measurable in 49 PWS patients with a geometric mean of 34.9 ± 22 pg/ml (median: 28.4). Unmeasurable levels of MKRN3 were found in 31 patients. No statistically significant differences were found between patients with and without measurable MKRN3 levels for any clinical, biochemical, or genetic characteristics. However, MKRN3 levels were inversely correlated with HOMA-IR index (p: 0.005) and HbA1c (p: 0.046) values. No statistically significant correlations were found between MKRN3 and LH, estradiol and testosterone concentrations, pubertal development and genetic defect, whereas a direct correlation with FSH was found (p: 0.007). CONCLUSIONS: The typical genetic defect of PWS should lead to unmeasurable levels of the MKRN3 protein due to the inactivation of the paternal allele. Measurable circulating MKRN3 could suggest the possible involvement of tissue-specific imprinting mechanisms and other regulatory factors in gene expression. Correlations with HOMA-IR index, HbA1c, and FSH suggest peripheral actions of MKRN3, but future studies are warranted to investigate this topic.


Assuntos
Síndrome de Prader-Willi , Criança , Estudos Transversais , Estradiol , Hormônio Foliculoestimulante , Hemoglobinas Glicadas , Humanos , Projetos Piloto , Síndrome de Prader-Willi/genética , Testosterona , Ubiquitina-Proteína Ligases/genética
3.
J Endocrinol Invest ; 45(9): 1741-1748, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35585295

RESUMO

PURPOSE: Impaired activity of the peptidylprolyl cis/trans isomerase NIMA-interacting 1 (PIN1) isomerase might contribute to link disturbed glucose metabolism and risk of glucose related neurotoxicity, neurodegeneration and cognitive decline. The isomerase modulates also pathways of peripheral insulin sensitivity and secretion. We aimed at investigating the levels of circulating PIN1 in adolescents with obesity and any association with their glucose metabolism. METHODS: We enrolled 145 adolescents (age 12-17.8 years); 67 lean controls (46.2%) and 78 (53.8%) with overweight or obesity (males n = 62, 46%). We estimated glucose and insulin in fasting condition and after a standard oral glucose tolerance test; fasting serum levels of PIN1, amyloid ß-protein 42 (Aß42), presenilin 1 (PSEN1), glucagon-like peptide 1 (GLP1) and Non Esterified Fatty Acids (NEFA). We calculated the homeostasis model assessment of insulin resistance (HOMA-IR), the ß cell function (HOMA-ß) and the Adipo-IR. RESULTS: There was no difference in PIN1 serum levels between normal weight individuals and patients with obesity. However, there was an inverse correlation between serum fasting PIN1 and glucose (r - 0.183 and p = 0.027). We confirmed levels of Aß42 and PSEN1 were higher in teens with obesity than in lean controls and their correlation with the body mass index (Aß42: r = 0.302, p = 0.0001, PSEN1 r = 0.231, p = 0.005) and the HOMA-IR (Aß42: r = 0.219, p = 0.009, r = 0.170, p < 0.042). CONCLUSIONS: There was no significant rise of circulating PIN1 levels in young individuals with obesity. Increased levels reported in the literature in adult patients are likely to occur late in the natural history of the disease with the onset of an overt impairment of glucose homeostasis.


Assuntos
Peptídeos beta-Amiloides , Resistência à Insulina , Peptidilprolil Isomerase de Interação com NIMA/sangue , Obesidade/sangue , Adolescente , Adulto , Glicemia , Criança , Feminino , Glucose , Teste de Tolerância a Glucose , Humanos , Insulina , Masculino , Peptidilprolil Isomerase de Interação com NIMA/metabolismo
4.
J Endocrinol Invest ; 43(4): 461-468, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31637675

RESUMO

OBJECTIVE: To evaluate the association between high uric acid (UA), reduced estimated glomerular filtration rate (eGFR), and non-alcoholic fatty liver disease (NAFLD) in outpatient children and adolescents with overweight (OW) or obesity (OB). METHODS: Anthropometric, biochemical, hepatic ultrasound and eGFR data were available from 2565 young people with OW/OB (age 5-18 years). eGFR was calculated using the Schwartz's bedside formula and reduced eGFR (ReGFR+) was defined by a value < 90 mL/min/1.73 m2. High UA was defined as ≥ 75th percentile by sex in children and adolescents. RESULTS: The population was stratified in four categories: (1) normal eGFR and absence of NAFLD (ReGFR-/NAFLD-) (n = 1,236); (2) ReGFR+ and absence of NAFLD (ReGFR+/NAFLD- (n = 155); (3) normal eGFR and presence of NAFLD (ReGFR-/NAFLD+) (n = 1019); (4) presence of both conditions (ReGFR+/NAFLD+) (n = 155). Proportions of youth with high UA across the four categories were 17%, 30%, 33% and 46%, respectively (P < 0.0001). Young people with high levels of UA had odds ratio (95% CI) of 2.11 (1.43-3.11) for ReGFR+; 2.82 (2.26-3.45) for NAFLD+; and 5.04 (3.45-7.39) for both conditions (P < 0.0001 for all), independently of major confounders. CONCLUSIONS: High levels of UA were independently associated with ReGFR, NAFLD and the combination of both conditions in young people with OW/OB. The strength of this association was the highest in cases presenting both reduced eGFR and NAFLD. UA may serve as marker to identify patients at risk for these conditions.


Assuntos
Taxa de Filtração Glomerular/fisiologia , Hepatopatia Gordurosa não Alcoólica/etiologia , Obesidade/complicações , Insuficiência Renal Crônica/etiologia , Ácido Úrico/sangue , Criança , Feminino , Humanos , Fígado/diagnóstico por imagem , Fígado/metabolismo , Fígado/fisiopatologia , Masculino , Hepatopatia Gordurosa não Alcoólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Obesidade/metabolismo , Obesidade/fisiopatologia , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/fisiopatologia , Ultrassonografia
5.
Nutr Metab Cardiovasc Dis ; 28(12): 1230-1236, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30355472

RESUMO

BACKGROUND AND AIMS: We aimed to evaluate whether the metabolically healthy obese (MHO) phenotype was associated with hepatic steatosis (HS) or left ventricular hypertrophy (LVH) in young people with overweight (OW), obesity (OB) and morbid obesity (MOB) and whether the prevalence of these comorbidities was affected by OB severity. METHODS AND RESULTS: An abdominal ultrasound was performed in 1769 children and adolescents, mean age 10.6 years (range 5-18) with MHO phenotype, defined as the absence of traditional cardiometabolic risk factors, in order to identify HS. In a subsample of 177 youth the presence of LVH, defined by 95th percentile of LV mass/h2.7 for age and gender, was also analyzed. The prevalence of HS increased from 23.0% in OW to 27.8% in OB and 45.1% in MOB (P < 0.0001). The proportion of LVH increased from 36.8% in OW to 57.9% in OB and 54.5% in MOB (P < 0.05). As compared with OW, the odds ratio (95% CI) for HS was 2.18 (1.56-3.05), P < 0.0001) in OB and 6.20 (4.26-9.03), P < 0.0001) in MOB, independently of confounding factors. The odds ratio for LVH was 2.46 (1.20-5.06), P < 0.025) in OB and 2.79 (1.18-6.61), P < 0.025) in MOB, as compared with OW. CONCLUSION: In spite of the absence of traditional cardiometabolic risk factors, the prevalence of HS and LVH progressively increased across BMI categories. MHO phenotype does not represent a "benign" condition in youth.


Assuntos
Fígado Gorduroso/epidemiologia , Hipertrofia Ventricular Esquerda/epidemiologia , Obesidade Metabolicamente Benigna/epidemiologia , Obesidade Infantil/epidemiologia , Adolescente , Fatores Etários , Índice de Massa Corporal , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Fígado Gorduroso/diagnóstico por imagem , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Itália/epidemiologia , Masculino , Obesidade Metabolicamente Benigna/diagnóstico , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/epidemiologia , Obesidade Infantil/diagnóstico , Fenótipo , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
6.
Nutr Metab Cardiovasc Dis ; 27(9): 830-835, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28755804

RESUMO

BACKGROUND AND AIMS: Hypertension (HTH) is a frequent complication in pediatric obesity. To simplify the screening of HTH in overweight/obese (Ow/Ob) youth, we compared the performance of a new index (High Blood Pressure index, HBPi) with respect to the standard criteria of the IV Report [systolic BP (SBP) and/or diastolic BP (DBP) ≥95th percentile for age, gender and height]. We also compared the performance of HBPi with other simplified indices such as the BP/height ratio and the absolute height-specific BP thresholds. Ten pediatrics' outpatient centers participating in the "CARdiometabolic risk factors in ITALY study" provided medical records of 4225 Ow/Ob children and adolescents (age 6-16 years). METHODS AND RESULTS: Centers were divided into two groups: training set (TS) (n = 2204 participants) and validation set (VS) (n = 2021 participants). The simplified HBPi (mmHg) was: (SBP/2 + DBP/10) - age + (1 × female gender). In the TS, a HBPi value ≥57 mmHg in both children and adolescents had high sensitivity (0.89), specificity (0.97), positive (0.89) and negative (0.97) predictive values in classifying youth at high risk of HTN compared with the IV Report. In the VS, the HBPi showed a better performance than high levels of BP/height ratio and height-specific BP thresholds in classifying individuals at risk of HTN: area under curves 0.95 (0.93-0.96), 0.80 (0.78-0.82), 0.76 (0.74-0.79), respectively; specificities 0.95 (0.94-0.96), 0.69 (0.67-0.72), 0.60 (0.57-0.62), respectively. CONCLUSIONS: HBPi, combining SBP and DBP, gender and age, may help pediatricians to implement HTN screening in Ow/Ob youth.


Assuntos
Determinação da Pressão Arterial , Pressão Sanguínea , Hipertensão/diagnóstico , Programas de Rastreamento/métodos , Obesidade Infantil/diagnóstico , Adolescente , Fatores Etários , Área Sob a Curva , Estatura , Criança , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Itália , Masculino , Obesidade Infantil/epidemiologia , Obesidade Infantil/fisiopatologia , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco , Fatores Sexuais
7.
Pediatr Obes ; 12(3): 229-238, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27059430

RESUMO

BACKGROUND: Circulating microRNAs (miRNAs) may act as biomarkers of metabolic disturbances. OBJECTIVE: The aim of this study was to identify serum miRNAs signature of early insulin resistance in obese preschoolers. METHODS: Twelve obese children, aged 2-6 years, six insulin resistant (IR) and six controls were selected being age-matched, sex-matched and body mass index-matched. Profiling of 179 circulating miRNAs, known to be widely expressed in the bloodstream, was investigated by quantitative polymerase chain reaction at fasting and 120 min following a standard oral glucose tolerance test (OGTT). RESULTS: Twenty-one miRNAs were differentially regulated in IR obese preschoolers. miR-200c-3p, miR-190a and miR-95 were differently regulated both at fasting and 120 min after the OGTT. In controls, the fold changes of some miRNAs were correlated with Δglucose0-120 (miR-660, miR-26b-5p and miR-22-3p: p = 0.005 for all) and Δinsulin0-120 (miR-660 and miR-22-3p: p = 0.02 for both and miR-423-5p: p = 0.042). In IR patients, miR-1 fold changes were correlated with Δglucose0-120( r = -0.786; p = 0.036) and Δinsulin0-120( r = -0.821; p = 0.023). CONCLUSIONS: Our study identifies circulating miR-200c-3p, miR-190a and miR-95 as biomarkers of insulin resistance in obese preschoolers, being differentially regulated in IR patients both in fasting condition and after the OGTT. Expression of some circulating miRNAs seems reflecting glucose and insulin excursion following the OGTT differently in controls and IR obese preschoolers.


Assuntos
Biomarcadores/sangue , Teste de Tolerância a Glucose/métodos , Resistência à Insulina/genética , MicroRNAs/sangue , Obesidade Infantil/metabolismo , Criança , Pré-Escolar , Feminino , Humanos , Insulina , Masculino , Reação em Cadeia da Polimerase em Tempo Real
8.
J Endocrinol Invest ; 40(4): 409-416, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27854028

RESUMO

OBJECTIVE: To investigate in a large sample of overweight/obese (OW/OB) children and adolescents the prevalence of prediabetic phenotypes such as impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), and to assess their association with cardiometabolic risk (CMR) factors including hepatic steatosis (HS). METHODS: Population data were obtained from the CARdiometabolic risk factors in children and adolescents in ITALY study. Between 2003 and 2013, 3088 youths (972 children and 2116 adolescents) received oral glucose tolerance test (OGTT) and were included in the study. In 798 individuals, abdominal ultrasound for identification of HS was available. RESULTS: The prevalence of IFG (3.2 vs. 3.3%) and IGT (4.6 vs. 5.0%) was similar between children and adolescents. Children with isolated IGT had a 2-11 fold increased risk of high LDL-C, non-HDL-C, Tg/HDL-C ratio, and low insulin sensitivity, when compared to those with normal glucose tolerance (NGT). No significant association of IFG with any CMR factor was found in children. Among adolescents, IGT subjects, and to a lesser extent those with IFG, showed a worse CMR profile compared to NGT subgroup. In the overall sample, IGT phenotype showed a twofold increased risk of HS compared to NGT subgroup. CONCLUSIONS: Our study shows an unexpected similar prevalence of IFG and IGT between children and adolescents with overweight/obesity. The IGT phenotype was associated with a worse CMR profile in both children and adolescents. Phenotyping prediabetes conditions by OGTT should be done as part of prediction and prevention of cardiometabolic diseases in OW/OB youth since early childhood.


Assuntos
Glicemia/metabolismo , Jejum/metabolismo , Intolerância à Glucose/fisiopatologia , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Estado Pré-Diabético/fisiopatologia , Adolescente , Estudos de Casos e Controles , Criança , Feminino , Intolerância à Glucose/epidemiologia , Teste de Tolerância a Glucose , Humanos , Insulina , Resistência à Insulina , Itália/epidemiologia , Masculino , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Estado Pré-Diabético/epidemiologia , Prevalência
10.
Nutr Metab Cardiovasc Dis ; 26(6): 502-9, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27048715

RESUMO

BACKGROUND AND AIMS: Subclinical inflammation is a central component of cardiometabolic disease risk in obese subjects. The aim of the study was to evaluate whether the white blood cell count (WBCc) may help to identify an abnormal cardiometabolic phenotype in overweight (Ow) or obese (Ob) children. METHODS AND RESULTS: A cross-sectional sample of 2835 Ow/Ob children and adolescents (age 6-18 years) was recruited from 10 Italian centers for the care of obesity. Anthropometric and biochemical variables were assessed in the overall sample. Waist to height ratio (WhtR), alanine aminotransferase (ALT), lipids, 2 h post-load plasma glucose (2hPG), left ventricular (LV) geometry and carotid intima-media thickness (cIMT) were assessed in 2128, 2300, 1834, 535 and 315 children, respectively. Insulin resistance and whole body insulin sensitivity index (WBISI) were analyzed using homeostatic model assessment (HOMA-IR) and Matsuda's test. Groups divided in quartiles of WBCc significantly differed for body mass index, WhtR, 2hPG, HOMA-IR, WBISI, lipids, ALT, cIMT, LV mass and relative wall thickness. Children with high WBCc (≥8700 cell/mm(3)) showed a 1.3-2.5 fold increased probability of having high normal 2hPG, high ALT, high cIMT, or LV remodeling/concentric LV hypertrophy, after adjustment for age, gender, pubertal status, BMI and centers. CONCLUSIONS: This study shows that WBCc is associated with early derangements of glucose metabolism and preclinical signs of liver, vascular and cardiac damage. The WBCc may be an effective and low-cost tool for identifying Ow and Ob children at the greatest risk of potential complications.


Assuntos
Doenças Cardiovasculares/sangue , Hepatopatias/sangue , Síndrome Metabólica/sangue , Obesidade Infantil/sangue , Adolescente , Fatores Etários , Alanina Transaminase/sangue , Biomarcadores/sangue , Glicemia/metabolismo , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Espessura Intima-Media Carotídea , Criança , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Contagem de Leucócitos , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Hepatopatias/fisiopatologia , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Obesidade Infantil/diagnóstico , Obesidade Infantil/epidemiologia , Obesidade Infantil/fisiopatologia , Fenótipo , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Fatores de Risco , Função Ventricular Esquerda , Remodelação Ventricular
12.
Nutr Metab Cardiovasc Dis ; 25(5): 489-94, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25813687

RESUMO

BACKGROUND AND AIMS: Lipid ratios to estimate atherosclerotic disease risk in overweight/obese children are receiving great attention. We aimed to compare the performance of non-high-density lipoprotein-cholesterol (HDL-C) versus triglycerides-to-HDL-C ratio (Tg/HDL-C) in identifying cardiometabolic risk factors (CMRFs) or preclinical signs of organ damage in outpatient Italian overweight/obese children. METHODS AND RESULTS: In this retrospective, cross-sectional study, 5505 children (age 5-18 years) were recruited from 10 Italian centers for the care of obesity, of which 4417 (78%) showed obesity or morbid obesity. Anthropometric, biochemical, and blood pressure variables were analyzed in all children. Liver ultrasound scan, carotid artery ultrasound, and echocardiography were performed in 1257, 601, and 252 children, respectively. The entire cohort was divided based on the 75th percentile of non-HDL-C (≥130 mg/dl) or Tg/HDL-C ratio (≥2.2). The odds ratio for insulin resistance, high blood pressure, metabolic syndrome, presence of liver steatosis, increased levels of carotid intima-media thickness (cIMT) and concentric left ventricular hypertrophy (cLVH) was higher in children with high levels of Tg/HDL-C with respect to children with high levels of non-HDL-C. CONCLUSIONS: In an outpatient setting of overweight/obese children, Tg/HDL-C ratio discriminated better than non-HDL-C children with CMRFs or preclinical signs of liver steatosis, and increased cIMT and cLVH.


Assuntos
Doenças Cardiovasculares/etiologia , HDL-Colesterol/sangue , Colesterol/sangue , Síndrome Metabólica/etiologia , Sobrepeso/fisiopatologia , Obesidade Infantil/fisiopatologia , Triglicerídeos/sangue , Adolescente , Algoritmos , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Itália/epidemiologia , Fígado/diagnóstico por imagem , Fígado/fisiopatologia , Masculino , Síndrome Metabólica/epidemiologia , Sobrepeso/sangue , Obesidade Infantil/sangue , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia
13.
Minerva Pediatr ; 66(5): 381-414, 2014 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-25253187

RESUMO

Obesity in childhood is associated with the presence of complications that can undermine health immediately or in the long term. Several conditions, such as pulmonary or orthopedic complications are strictly associated with the severity of overweight, since they are directly associated to the mechanic stress of fat tissue on the airways or on the bones. Other conditions, such as metabolic or liver complications, although increasing with the extent of overweight, are associated with insulin resistance, which can be modulated by different other factors (ethnicity, genetics, fat distribution) and can occur in overweight children as well. No less important are psychological correlates, such as depression and stigma, which can seriously affect the health related quality of life. Pediatric services for the care of childhood obesity need to be able to screen overweight and obese children for the presence of physical and psychological complications, which can be still reversed by weight loss. This article provides pediatricians a comprehensive update on the main complications in obese children and adolescents and their treatment.


Assuntos
Doenças Cardiovasculares/etiologia , Depressão/etiologia , Nível de Saúde , Resistência à Insulina , Doenças Musculoesqueléticas/etiologia , Obesidade/complicações , Doenças Respiratórias/etiologia , Adolescente , Terapia Comportamental , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Criança , Aconselhamento , Depressão/epidemiologia , Complicações do Diabetes/epidemiologia , Humanos , Itália/epidemiologia , Estilo de Vida , Doenças Musculoesqueléticas/epidemiologia , Obesidade/epidemiologia , Obesidade/terapia , Sobrepeso/complicações , Prevalência , Doenças Respiratórias/epidemiologia , Fatores de Risco , Redução de Peso
14.
Radiol Med ; 117(8): 1408-18, 2012 Dec.
Artigo em Inglês, Italiano | MEDLINE | ID: mdl-22986694

RESUMO

PURPOSE: Cystic-fibrosis-associated liver disease (CFLD) may lead to portal hypertension (PHT) and cirrhosis. Clinical signs and biochemistry of liver involvement are not discriminating. The aim of the study was to evaluate the performance of acoustic radiation force impulse (ARFI) with virtual tissue quantification in comparison with clinical signs, biochemistry and standard hepatic ultrasound (US) patterns. MATERIALS AND METHODS: Virtual Touch Tissue Quantification, an implementation of US ARFI with shear-wave velocity (SWV) measurements was used in 75 children with cystic fibrosis (CF) and suspected CFLD to quantify hepatic stiffness. In each patient, ten measurements of SWV were performed on the right hepatic lobe. Patients were also evaluated by standard diagnostic tools (standard US, liver- and lung function tests, oesophagogastroscopy). RESULTS: Among CF patients, median SWV was significantly higher in patients with clinical, biochemical and US signs of hepatic involvement than in patients without US evidence of liver disease 1.08 m/s [(95% confidence interval (CI), 1.02-1.14]. Median SWV values in patients with portal hypertension, splenomegaly and oesophageal varices were 1.30 (95% CI, 1.17-1.43), 1.54 (95% CI, 1.32-1.75) and 1.63 (95% CI, 1.26-1.99), respectively. Differences were significant (p<0.001). CONCLUSIONS: ARFI is an innovative screening technique able to help identify CFLD in children.


Assuntos
Fibrose Cística/complicações , Técnicas de Imagem por Elasticidade , Hepatopatias/diagnóstico por imagem , Adolescente , Varizes Esofágicas e Gástricas/complicações , Feminino , Humanos , Hipertensão Portal/complicações , Fígado/diagnóstico por imagem , Hepatopatias/complicações , Masculino , Esplenomegalia/complicações , Esplenomegalia/diagnóstico por imagem
15.
Minerva Pediatr ; 64(4): 413-31, 2012 Aug.
Artigo em Italiano | MEDLINE | ID: mdl-22728613

RESUMO

Obesity is a complex public health issue. Recent data indicate the increasing prevalence and severity of obesity in children. Severe obesity is a real chronic condition for the difficulties of long-term clinical treatment, the high drop-out rate, the large burden of health and psychological problems and the high probability of persistence in adulthood. A staged approach for weight management is recommended. The establishment of permanent healthy lifestyle habits aimed at healthy eating, increasing physical activity and reducing sedentary behavior is the first outcome, because of the long-term health benefits of these behaviors. Improvement in medical conditions is also an important sign of long-term health benefits. Rapid weight loss is not pursued, for the implications on growth ad pubertal development and the risk of inducing eating disorders. Children and adolescents with severe obesity should be referred to a pediatric weight management center that has access to a multidisciplinary team with expertise in childhood obesity. This article provides pediatricians a comprehensive and evidence based update on treatment recommendations of severe obesity in children and adolescents.


Assuntos
Terapia Comportamental , Dieta Redutora , Exercício Físico , Obesidade Mórbida/terapia , Redução de Peso , Adolescente , Terapia Comportamental/métodos , Índice de Massa Corporal , Criança , Medicina Baseada em Evidências , Humanos , Itália/epidemiologia , Estilo de Vida , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/epidemiologia , Prevalência , Índice de Gravidade de Doença , Resultado do Tratamento
16.
Acta Diabetol ; 49(6): 435-43, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22391936

RESUMO

Adults with normal glucose tolerance (NGT) but exaggerated plasma glucose excursion at 1 h (1HPG) following the oral glucose tolerance test (OGTT) have significantly higher risk of developing impaired glucose tolerance (IGT) or diabetes. Aim of the study will be to characterize the metabolic phenotype of NGT obese youth according to values of 1HPG. To accomplish this aim, obese patients (N = 1,454; 761 men; 79 IGT; BMI z-score 2.56 ± 0.16 SDS; age 11 ± 0.7 years) from two data sets were analyzed. In all patients, empirical parameters of insulin metabolism were calculated in fasting condition and following an OGTT (1.75 mg of glucose per kilogram/body weight). Receiver-operating characteristic (ROC) analysis was performed in the first group (training set, N = 920) to establish the cutoff value of 1HPG best identifying IGT. The second set (validation set, N = 534) served to verify the goodness of the model and the identified cutoff values. 1HPG ≥ 132.5 mg/dl identified IGT with 80.8% sensitivity and 74.3% specificity in the training set (AUC 0.855, 95% CI 0.808-0.902, p < 0.0001), and 70.3% sensitivity and 80% specificity in the validation set (AUC 0.81, 95% CI 0.713-0.907, p < 0.0001), respectively. NGT patients with 1HPG ≥ 132.5 mg/dl had a metabolic phenotype (triglycerides, insulin action, and secretion) that was in between those of NGT patients with 1HPG below the threshold and IGT patients (p < 0.0001 for all the comparisons). 1HPG ≥ 132.5 mg/dl seems to be associated with increased metabolic risk in obese youth, identifying patients with lower insulin sensitivity, early secretion, and higher total insulin secretion than in obese mates with lower 1HPG.


Assuntos
Glicemia/análise , Obesidade/sangue , Adolescente , Fatores Etários , Glicemia/metabolismo , Criança , Pré-Escolar , Feminino , Intolerância à Glucose/sangue , Intolerância à Glucose/diagnóstico , Intolerância à Glucose/epidemiologia , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Insulina/metabolismo , Resistência à Insulina , Secreção de Insulina , Masculino , Obesidade/epidemiologia , Sensibilidade e Especificidade , Fatores de Tempo
17.
Infection ; 40(5): 485-91, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22367777

RESUMO

OBJECTIVES: The introduction of vaccination against hepatitis B initially reduced the number of HBV (hepatitis B virus) and HDV (hepatitis delta virus) infections, but the decreasing trend of HDV infection seems to have stopped. The aim of this study was to assess the prevalence of HDV infection in the general population living in the catchment area of Legnano Hospital in northern Italy. METHODS: Of the 22,758 subjects tested in 2007-2008, the 488 who were HBsAg (hepatitis B surface antigen)-positive [including 107 (21.9%) of non-Italian origin] were subsequently tested for anti-HDV antibodies. RESULTS: Of the 488 subjects who tested positive for HBsAg, 24 (4.9%) were anti-HDV positive, all aged between 30 and 60 years. The difference in prevalence between males (7.1%) and females (1.9%) was statistically significant (p < 0.05), but not that between Italian (5.0%) and non-Italian patients (4.7%). The differences in anti-HDV seropositivity between the patients with acute (0%) and chronic infections (6.3%), and between the incident (2.5%) and prevalent cases (7.4%), were not statistically significant, but there was a significant difference (p < 0.01) between those with asymptomatic (2.1%) and clinically symptomatic infections (10.3%). Intravenous drug abuse was the main source of infection. CONCLUSIONS: In the catchment area of our hospital, the prevalence of HDV infection does not seem to be due to patients of non-Italian origin, but to Italian patients who are not vaccinated against HBV and who survived the HDV epidemic of the 1970s and 1980s. Nevertheless, the increase in the number of immigrants from non-EU countries in recent years is soon likely to lead to a change in the epidemiology of HDV.


Assuntos
Hepatite D/epidemiologia , Vírus Delta da Hepatite/isolamento & purificação , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Anticorpos Anti-Hepatite/sangue , Hepatite B/epidemiologia , Antígenos de Superfície da Hepatite B/sangue , Vacinas contra Hepatite B/administração & dosagem , Hepatite D Crônica/epidemiologia , Humanos , Lactente , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Abuso de Substâncias por Via Intravenosa/epidemiologia , População Urbana/estatística & dados numéricos
18.
Nutr Metab Cardiovasc Dis ; 22(2): 120-6, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20880682

RESUMO

BACKGROUND AND AIMS: Early onset type 2 diabetes mellitus (T2DM) is associated with obesity, insulin resistance and impaired beta-cell function. Non-alcoholic fatty liver disease (NAFLD) may be an independent risk factor for T2DM. We investigated the relationship between NAFLD and glucose metabolism in a large sample of obese children. METHODS AND RESULTS: A total of 571 obese children (57% males and 43% females) aged 8-18 years were consecutively studied at a tertiary care centre specialised in paediatric obesity. Liver ultrasonography was used to diagnose NAFLD after exclusion of hepatitis B and C and alcohol consumption. Oral-glucose tolerance testing (OGTT) was performed; insulin sensitivity was evaluated by using the insulin sensitivity index (ISI) and beta-cell function by using the ratio between the incremental areas under the curve (AUC) of insulin and glucose (incAUCins/incAUCglu). A total of 41% of the obese children had NAFLD. Impaired glucose tolerance or T2DM was present in 25% of the children with NAFLD versus 8% of those without it (p<0.001). Children with NAFLD had higher body mass index (BMI), fasting glucose, 120-min OGTT glucose, incAUCins/incAUCglu and lower ISI as compared with children without NAFLD (p≤0.002). At bootstrapped multivariable median regression analysis controlling for gender, age, pubertal status and BMI, NAFLD was an independent predictor of 120-min OGTT glucose and ISI, but not of incAUCins/incAUCglu. Similar findings were obtained using continuous liver steatosis as the predictor, instead of dichotomous NAFLD. CONCLUSION: NAFLD was present in 41% of our obese children and was associated with higher insulin resistance, but not with impaired beta-cell function.


Assuntos
Glicemia/metabolismo , Fígado Gorduroso/fisiopatologia , Obesidade/fisiopatologia , Adolescente , Área Sob a Curva , Índice de Massa Corporal , Criança , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Fígado Gorduroso/complicações , Fígado Gorduroso/diagnóstico por imagem , Feminino , Intolerância à Glucose/complicações , Intolerância à Glucose/fisiopatologia , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Resistência à Insulina , Células Secretoras de Insulina/metabolismo , Fígado/diagnóstico por imagem , Fígado/metabolismo , Fígado/fisiopatologia , Masculino , Hepatopatia Gordurosa não Alcoólica , Obesidade/complicações , Ultrassonografia
20.
Clin Microbiol Infect ; 17(6): 935-40, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20874813

RESUMO

The distribution of the different subtypes of HIV varies from one region of the world to another. Subtype B is predominant in Europe and the USA, but there has been a gradual increase in non-B subtypes as a result of migration from regions where they are endemic, and this may have important implications for the control of HIV-1. The aim of this study was to assess the prevalence of HIV-1 subtypes in an urban area of northern Italy in the period 1997-2008. Forty-nine (12.2%; 95% CI, 9.00-15.40) of 401 patients investigated carried a non-B subtype, the prevalence of which was 7.7% (95% CI, 4.96-10.44) among native Italians and 55.3% (95% CI, 39.49-71.11) among non-Italians, 1.6% (95% CI, 0.00-3.81) among ex-intravenous drug addicts, 7.6% (95% CI, 1.21-13.99) among homosexual/bisexual men and 20.5% (95% CI, 14.83-26.17) among heterosexuals, 6.8% (95% CI, 3.37-10.23) among Italians infected as a result of sexual contacts in Italy, and 55.0% (95% CI, 33.20-76.80) among Italians infected abroad or by foreign partners. Overall prevalence increased from 2.9% (95% CI, 0.00-6.11) before 1993 to 23.0% (95% CI, 16.31-29.69) in the period 2001-2008. The results demonstrate that there has been an increase in non-B subtypes (especially sexually transmitted infections), particularly among patients infected abroad or by foreign partners.


Assuntos
Infecções por HIV/epidemiologia , HIV-1/classificação , HIV-1/isolamento & purificação , RNA Viral/genética , Adolescente , Adulto , Idoso , Feminino , Genótipo , Infecções por HIV/virologia , HIV-1/genética , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Tipagem Molecular , Prevalência , Fatores de Risco , População Urbana , Adulto Jovem
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