The role of hyperglycemia in FAT/CD36 expression and function

FAT/CD36 is a long-chain fatty acid transporter and scavenger receptor for oxidized LDL. Defects in FAT/CD36 have been linked to the hypertriglyceridemia and insulin resistance. Expression of FAT/CD36 was reported increase in type 1 diabetes; however, it remains unclear whether serum glucose or insulin plays an important role in this regulation. To elucidate the individual contribution of plasma glucose and insulin in the regulation of FAT/CD36 mRNA expression, we induced type 1 diabetes in male Sprague-Dawley rats using streptozotocin (STZ) and compared traditional insulin treatment with administration of the orally absorbed chemical agent vanadate, which reduces blood glucose levels via mechanisms that bypass insulin receptor action. STZ-exposed animals showed significant decreases in body weight (285.5 ± 2.8 vs. 233.1 ± 3.5 g, P < 0.001) and serum insulin levels (9.7 ± 0.7 vs. 2.8 ± 0.6 μU/ml, P < 0.05), accompanied by significant increases in blood glucose (71 ± 3 vs. 433 ± 11 mg/dl, P < 0.001), water intake (38.9 ± 0.9 vs. 205.9 ± 3.3 ml/day, P < 0.001) and food intake (22.0 ± 0.4 vs. 36.9 ± 1.0 g/day, P < 0.001). Diabetic animals demonstrated significant increases in FAT/CD36 mRNA levels in duodenum (2.2-fold), jejunum (1.8-fold), ileum (1.5-fold), adipose tissue (1.7-fold), and heart (2.5-fold) (P < 0.05). Insulin treatment reversed body weight loss and corrected hyperglycemia at diabetic rats as expected. Insulin treatment also corrected increased FAT/CD36 mRNA expression at diabetic rats. Vanadate significantly reduced serum glucose levels without increasing serum insulin or affecting body weight but reversed increased FAT/CD36 mRNA expression in diabetic rats. These data suggest that plasma glucose levels play more important role in the regulation of FAT/CD36 expression than concurrent changes in plasma insulin.     

Inadequate iron availability as a possible cause of low serum carnitine concentrations in patients with phenylketonuria

A previous observation of decreased serum carnitine concentrations in phenylketonuria (PKU) was investigated in 169 patients either on a strict diet (n=107; median: 8.1 years) or off diet (n=62; median: 15.0 years). Fifty-seven metabolically healthy children (median: 8.5 years) served as controls. PKU patients on a strict diet and older than 2 years had significantly lower serum carnitine concentrations (19.4±5.4 mol/l) than those off diet (29.6±6.7 mol/l). PKU patients on diet also had significantly lower concentrations of haemoglobin and serum ferritin than those off diet. A linear correlation existed between total serum carnitine and ferritin concentrations up to 40 g/l (r=0.52;P<0.01). As iron is an essential cofactor of carnitine synthesis we conclude that reduced endogenous carnitine synthesis due to an inadequate availability of iron may be a major cause of low serum carnitine concentrations. The low carnitine content of the strict and highly protein-reduced diet additionally contributes to a decrease in the serum carnitine concentration. Our results show that a further optimization of the PKU diet increasing either iron availability or carnitine intake should be considered.     

Homocysteine and other vascular risk factors in patients with phenylketonuria on a diet

The aim of this study was to investigate the known risk factors, such as lipids, homocysteine and endothelin, for the development of coronary artery disease (CAD) in phenylketonuria (PKU) patients, depending on their diet. The PKU patients (n = 74) were divided into two groups. Group A (n = 34; mean age 6.78 +/- 1.5 y) adhered strictly to a diet and group B (n = 40; mean age 8.0 +/- 3.2 y) did not comply with the diet. The control group comprised 50 healthy non-PKU children. All groups were evaluated for blood levels of homocysteine and vitamin B6 by high-performance liquid chromatography, vitamin B12 and folate in serum by a radioassay, lipids by a routine method, and lipoprotein(a) and endothelin-1 with an immunoassay. Homocysteine levels (28.65 +/- 3.3 micromol l(-1)) were increased in group A compared with group B (6.86 +/- 1.6 micromol l(-1)) and the controls (6.9 +/- 2.0 micromol l(-1)) (p < 0.001). Vitamin B6 (10.7 +/- 10.9 nmol l(-1)), vitamin B12 (98.5 +/- 22.3 pmol l(-1)), folate (2.35 +/- 1.3 nmol l(-1)) and lipids were decreased in group A. The other vascular risk factors, which were not dependent on diet [lipoprotein(a) and endothelin-1], did not differ among the three groups. Conclusion: PKU patients on a strict diet had low vitamin B6, vitamin B12 and folate levels resulting in moderate hyperhomocysteinaemia. The evaluation of these vitamins at short intervals and their supplementation could be an early measure in the prevention of CAD.     

8-hydroxy-2-desoxyguanosine serum concentrations as a marker of DNA damage in patients with classical galactosaemia

BACKGROUND: Classical galactosaemia is caused by a deficiency of galactose-1-phosphate uridyl transferase, resulting in high galactose (Gal), galactose-1-phosphate (Gal-1-P) and galactitol blood levels. Galactose/lactose restriction intake is the only treatment. 8-hydroxy-2-desoxyguanosine (8-OHdG) is a marker of oxidized DNA damage. AIM: Since galactosaemia outcome is closely related to restriction of Gal intake, we aimed to evaluate correlations between Gal-1-P, total antioxidant status (TAS) and 8-OHdG blood levels in galactosaemic patients on poor or strict diet. METHODS: Venous blood samples were obtained from galactosaemic patients (n = 11) on poor diet (group A) and after 30 d on strict diet (group B). Twenty-eight healthy children were the controls. Gal-1-P and TAS were evaluated in their blood spectrophotometrically and 8-OHdG with an immunoassay. Results: TAS was significantly decreased (905 +/- 112 micromol/l) in patients on a "loose diet" (group A) as compared to those when restored to their diet (group B) (1,340 +/- 112 micromol/l, p < 0.001) and controls (1,558 +/- 115 micromol/l, p < 0.001). As expected, Gal-1-P levels were remarkably increased in group A. 8-OHdG level was twofold higher (0.25 +/- 0.03 ng/ml) in group A than that of group B (0.11 +/- 0.04 ng/ml) and threefold higher than that of the controls (0.08 +/- 0.02 ng/ml). TAS and Gal-1-P inversely correlated to 8-OHdG (r= -0.802, p < 0.001), whereas Gal-1-P positively correlated to 8-OHdG (r = 0.820, p < 0.001) in all the groups. CONCLUSION: a) Low TAS and high Gal-1-P levels are implicated with high 8-OHdG blood levels in galactosaemic patients; b) 8-OHdG may be a sensitive biomarker of DNA damage in patients with classical galactosaemia.     

Serum Carnitine Level in Phenylketonuric Children under Dietary Control in Greece

ABSTRACT. Although total, free and esterified carnitine blood levels were found to be low (p < 0.001) in phenylketonuric patients under dietary treatment compared to controls, no clinical signs of carnitine deficiency were noticed. Exclusion from the PKU diet of nutrients rich in carnitine has been suggested. Supplementation of the diets with carnitine or preferably enrichment of the PKU formulas with carnitine will rectify the restriction of extrinsic carnitine in PKU dietary treatment.     

Emollients improve treatment results with topical corticosteroids in childhood atopic dermatitis: a randomized comparative study

The aim of the study was to investigate whether adding emollients to the standard topical corticosteroid therapy influences the outcome of children with atopic dermatitis. Fifty‐two children aged between 2 and 12 yr were divided randomly in two subgroups consisting of 26 children each. Both groups applied 0.1% methylprednisolone aceponate cream on lesional atopic skin once daily for 2 wk and were observed for another 4 wk after treatment discontinuation. Group B used additionally emollients for the whole study period. Patients were evaluated at days 0 (baseline), 7, 14 (end of therapy), 28 and 42 (follow‐up). Both groups demonstrated significant improvement of disease severity according to EASI (Eczema Area and Severity Index) scale (group A: 6.8 ± 3.59 before and 0.87 ± 1.25 after therapy, p < 0.001; group B: 9.6 ± 8.39 before and 1.11 ± 2.37 after therapy, p < 0.001). Xerosis improved significantly better in group B compared to group A, both clinically (group A: 1.38 ± 0.57 scores before and 1.5 ± 0.58 scores after therapy, p = 0.11; group B: 1.62 ± 0.64 scores before and 0.12 ± 0.33 scores after therapy, p < 0.001), and by corneometry assessment (group A: 41.7 ± 9.1 units before and 51.3 ± 11.3 units after therapy, p < 0.001; group B: 38.9 ± 12.9 units before and 58.2 ± 13.5 units after therapy, p < 0.001). A trend towards faster resolving of pruritus in group B (group A: 5.44 ± 2.6 scores before and 3.22 ± 2.31 scores after therapy, p = 0.001; group B: 5.87 ± 2.79 scores before and 2.24 ± 1.59 scores after therapy, p < 0.001) was also observed. In group B, the improvement was maintained for couple of weeks after treatment discontinuation, while in group A recurrence of the disease was noted (EASI at day 42 in group A vs. group B: 5.29 ± 5.6 vs. 1.25 ± 1.4, p = 0.01). Similar results were also observed for xerosis (p < 0.001) and pruritus (p = 0.002). Concomitant usage of emollients significantly improves xerosis and pruritus during corticosteroid treatment of atopic dermatitis and enables to maintain clinical improvement after therapy discontinuation.     

Cord Blood Lipid Profile in a Population of Iranian Term Newborns

Premature coronary artery disease (CAD) and its risk factors are highly prevalent in Iran. It is well documented that atherosclerosis starts in childhood and there is evidence that this association with adult levels may originate at birth, so assessment of serum lipid levels in neonates might be of importance. In this study we aimed to measure serum lipoprotein and apolipoprotein levels in a representative sample of Iranian newborns. Cord blood lipid profile, apolipoprotein A, apolipoprotein B, and lipoprotein a (LPa) were analyzed in 378 full-term, Iranian newborns. The mean values of total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A, apolipoprotein B, and Lpa in girls were 81.4 ± 28.3, 35.9 ± 22.4, 31.1 ± 9.9, 87.9 ± 20.2, 34.2 ± 18.2, and 21.0 ± 2.8 mg/dL, respectively; these values in boys were 75.2 ± 21.1, 32.1 ± 16.3, 28.8 ± 8.7, 84.3 ± 16.0, 32.6 ± 14.2, and 19.5 ± 2.7 mg/dL, respectively. Median values of triglycerides (TGs) in boys and girls were 61 and 62 mg/dL, respectively. Female neonates had significantly higher concentrations of TC and HDL-C than males (81.4 ± 28.3 vs. 75.2 ± 21.1, p = 0.02, and 31.18 ± 9.97 vs. 28.8 ± 8.7, p = 0.02, respectively). Other biochemical factors were not significantly different between genders. The mean and median concentrations of LPa were 20.3 and 18.7 mg/dL, respectively, which are almost five times higher than those reported in some other studies. The TG concentration was 1.5–2 times higher than those previously reported. Our findings indicate that serum concentrations of LPa and TG in Iranian neonates are higher than those in previous studies; this disorder, which is likely placing Iranians at increased risk for future CADs, needs to be assessed in longitudinal studies.     

High-resolution CT pulmonary findings in children with severe asthma

ObjectiveTo compare quantitative CT parameters between children with severe asthma and healthy subjects, correlating to their clinical features.MethodsWe retrospectively analyzed CT data from 19 school-aged children (5–17 years) with severe asthma and 19 control school-aged children with pectus excavatum. The following CT parameters were evaluated: total lung volume (TLV), mean lung density (MLD), CT air trapping index (AT%) (attenuation ≤856 HU), airway wall thickness (AWT), and percentage of airway wall thickness (AWT%). Multi-detector computed tomography (MDCT) data were correlated to the following clinical parameters: forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow at 25–75% (FEF 25–75%), FEV1/FVC ratio, sputum and bronchoalveolar lavage analysis, serum IgE levels, and previous hospitalizations due to asthma.ResultsAsthma patients presented higher mean values of AT% (23.8 ± 6.7% vs. controls, 9.7 ± 3.2%), AWT (1.46 ± 0.22 mm vs. controls, 0.47 ± ?735 ± 28 HU vs. controls, ?666 ± 19 HU). Mean AT% was 29.0 ± 4.7% in subjects with previous hospitalization against 19.2 ± 5.0% in those with no prior hospitalization (p < 0.001). AT% presented very strong negative correlations with FVC (r = ?0.933, p < 0.001) and FEV1 (r = ?0.841, p < 0.001) and a moderate correlation with FEF 25–75% (r = ?0.608, p = 0.007). AT% correlation with FEV1/FVC ratio and serum IgE was weak (r = ?0.184, p = 0.452, and r = ?0.363, p = 0.202)ConclusionChildren with severe asthma present differences in quantitative chest CT scans compared to healthy controls with strong correlations with pulmonary function tests and previous hospitalizations due to asthma.     

Changes in growth, growth hormone, and insulin-like growth factor-I (IGF-I) after orthotopic liver transplantation

Growth failure is an important consequence of chronic liver disease in childhood. Insulin-like growth factor-I (IGF-I), which is synthesized and released by the liver, plays an important role as a growth regulator in humans. We examined the growth hormone (GH)/IGF-I axis before and after orthotopic liver transplantation (LT) in 14 children aged between 2 and 11 years (mean 5.6 ± 1.1 years). Pre-transplantation serum GH levels (7.5 ± 1.2 ng/ml) were significantly higher (P < 0.001) compared with controls (5 ± 0.5 ng/ml). However, post-transplantation levels (1.8 ± 0.8 ng/ml) did not differ from those in the control group. Serum IGF-I levels showed a statistically significant increase after LT (20.1 ± 9.4 vs 190 ± 66.2 ng/ml; P < 0.001) and became indistinguishable from the levels in the control group (180 ± 96 ng/ml). In comparison with pre-transplantation data (z− 2.70), there was an increase in height 4 years postoperatively (z− 1.68). Catch-up growth was highly significant, in particular during the 1st year after LT (z−1.58 ± 1.63 vs 2.59 ± 5.29; P < 0.01). We conclude that a GH resistance state found in patients with severe chronic liver disease reverted following LT. Given that IGF-1 depends upon liver function, this could be one of the main factors in the significant catch-up growth in pediatric LT recipients.     

Homocysteine,folate, vitamin B12 and B6 in mothers of children with neural tube defects in Xinjiang,China

Aim: To investigate the maternal homocysteine (Hcy), folate, vitamin B₁₂ and B₆, and their relations to neural tube defects (NTDs). Methods: Thirty mothers of NTDs offspring and another 60 mothers of normal children were enrolled as the patient and control groups from Xinjiang, China, from January 2008 to May 2011. The plasma levels of Hcy, folate, vitamin B₁₂ and B₆ were measured and compared between the two groups. Results: The morbidity of NTDs was 2.44% in Xinjiang. The Hcy was significantly higher in patient group than in control group (15.1 ± 7.8 vs. 8.5 ± 4.0 μmol/L, p < 0.001). The folate in patient group (9.7 ± 8.1 μg/L) was lower than in control group (15.0 ± 8.1 μg/L, p < 0.001). The vitamin B₁₂ was 181.3 ± 107.7 and 394.3 ± 386.3 ng/L in patient and control groups, respectively, with a significant difference (p < 0.001). The abnormal frequency of Hcy and vitamin B₁₂ was statistically different in two groups. The difference of vitamin B₆ between the patients and controls was marginal (48.7 ± 16.5 vs. 42.0 ± 10.5 mg/L, p = 0.051). Moreover, folate and vitamin B₁₂ levels were negatively correlated with Hcy while vitamin B₆ was positively correlated with Hcy. Positive correlation was observed between folate and vitamin B₁₂ levels. Conclusion: Our data confirm that higher Hcy, lower folate and vitamin B₁₂ are risk factors for NTDs. Besides folate, vitamin B₁₂ should be supplied to decrease NTDs occurrence. Further study is required to investigate the levels and accurate role of vitamin B₆.     

Iron metabolism in burned children

The administration of iron supplementation in children with burns has been a subject of controversy. Recent studies argue against its use in the acute phase of stress. To assess whether iron metabolism parameters show significant differences in the acute phase and the recovery phase of burn, 21 patients (age range: 17 months to 13 years) with burns of more than 10% of body surface who had not received blood transfusions or iron supplementation were studied. Sideraemia, ferritin, transferrin, transferrin saturation index (TSI) and C-reactive protein (CRP) were assessed both in the acute and the recovery phase after burn. Sideraemia, transferrin, and TSI were significantly lower in the acute than in the recovery phase (17.3 ± 3 vs 53.8 ± 6.6 μg/dL, 190.5 ± 15 vs 287.9 ± 14.3 mg/dL and 7.7 ± 1.3 vs 15.4 ± 1.6%, P < 0.0001, P < 0.001 and P = 0.0006, respectively) while plasma ferritin and CRP were significantly higher (84.7 ± 8.8 vs 43.1 ± 8.5 ng/mL and 9.5 ± 1.5 vs 0.7 ± 0.2 mg/dL, P = 0.016 and P < 0.0001, respectively). When the above parameters were analysed based on age (≤ 2 years, >2 years), the observed differences persisted. Conclusion Hyposideraemia is a frequent finding in the acute phase of paediatric burns and is accompanied by increased ferritin levels and decreased transferrin concentrations. The low iron values tend to recover without the use of iron supplementation suggesting an endogenous block of iron release in the acute phase and indicates that iron therapy should be not recommended in the initial period of stress of the burned patient. Received: 12 March 1998 / Accepted in revised form: 2 September 1998     

Serum prolactin and cortisol in children with some paroxysmal disorders

Postictal serum prolactin and cortisol levels were estimated in 73 children having either epilepsy, febrile seizures, breath-holding spells, or fever without other manifestation and in 20 normal controls. Mean serum prolactin levels (28.6±2.3 ng/ml) were significantly higher (p < 0.001) in the epileptic group than in the group with febrile seizures (12.7±2.8 ng/ml), non-specific febrile illness (12.2±2.4 ng/ml), breath-holding spells (8.8±1.1 ng/ml) and normal controls (9.8±2.6 ng/ml) Mean serum cortisol levels were non-specifically elevated in children with epilepsy (32.8±2.2 ug/dl), febrile convulsion (34.2±4.1 ug/dl) and non-specific febrile illness (30.6±2.4 ug/dl). Our observations suggest that elevated prolactin levels associated with afebrile epileptic seizures may help in differentiating epilepsy from febrile seizures and breath-holding spells. Cortisol levels appear to be non-specifically elevated in all stressful conditions.     

Iron deficiency in Indian children with attention deficit hyperactivity disorder

A case control study was conducted at the Child Development and Early Intervention Clinic to determine the body iron status of children with ADHD, and study the correlation between the body iron status and ADHD symptoms. Serum ferritin was measured in newly diagnosed cases with ADHD and compared with that of controls. Correlation was studied between serum ferritin levels and the severity of ADHD symptoms as determined by Conners’ Rating Scale. Serum ferritin was found to be significantly lower in children with ADHD (6.04 ± 3.85 ng/mL) as compared to controls (48.96 ± 41.64 ng/mL, P value<0.001). There was a significant negative correlation between serum ferritin levels and oppositional subscore on Conners’ Rating Scale.     

Exercise Testing and 24-Hour Ambulatory Blood Pressure Monitoring in Children with Williams Syndrome

The aim of the study was to assess workload capacity and blood pressure (BP) response to treadmill exercise and 24-hour BP monitoring in children with Williams syndrome. Seventeen children were examined (8 males and 9 females) whose mean age was 13.8 ± 3.6 years. Six patients were on antihypertensive therapy. Each patient underwent clinical examination and measurement of BP at rest, during exercise, and during 24-hour monitoring. Two-dimensional echocardiogram and echo-Doppler of renal arteries were performed. The test was stopped for muscular fatique or reduced cooperation. The patients, when compared to a population of healthy children, had reduced total time of exercise (7.3 ± 1.9 vs 14.3 ± 2.6 min, p < 0.001) and, at the same workload, increased heart rate (167 ± 19 vs 145 ± 16 beats/min, p < 0.001) and increased maximum systolic BP (146 ± 27 vs 128 ± 12 mmHg, p = 0.01). Ambulatory blood pressure measurement values showed higher systolic blood pressure both during daytime and nighttime. Our study confirms that children and adolescents with Williams syndrome are at high risk for hypertension, probably related to the alterations of large arteries. The data relating to the synthesis of elastin may have a direct relationship to the compliance of the arterial system, leading to hypertension.     

Serum levels of IGF1 are a useful predictor of retinopathy of prematurity

Objective: To ascertain whether insulin‐like growth factor 1 (IGF1) is associated with retinopathy of prematurity (ROP) and is a useful predictor of the disease. Although its aetiopathogenesis is multifactorial, development of the disease appears to be related to a deficiency in IGF1, a hormone that acts together with vascular endothelial growth factor in the normal angiogenesis in the retina. Design: Prospective study for a 30‐month period. Participants: A total of 74 premature newborn babies, of less than 1500 g and/or 32 weeks’ gestational age or less. Testing: To determine the development and severity of ROP. Main outcome measures: Serum levels of IGF1 were measured once a week from birth until 40 weeks corrected gestational age in each subject. Results: Of our subjects, 32.4% developed some form of ROP, and all those ROP patients had the following characteristics at birth (median ± standard deviation scores): low weight (1098 ± 188 vs. 1393 ± 285 g), short length (36.74 ± 1.77 vs. 38.89 ± 3.08 cm), small cranial perimeter (26.03 ± 1.74 vs. 27.93 ± 1.81 cm) and young gestational age (29.7 ± 1.78 vs. 31.3 ± 1.79 weeks) (p < 0.05). Other factors previously associated with ROP that were also observed with statistically significant frequency in our ROP patients were bronchopulmonary dysplasia, intracranial haemorrhage, the need for erythrocyte transfusion or treatment with erythropoietin and sepsis (all p < 0.05). Levels of IGF1 at the 3rd week post‐partum, independent of gestational age at birth, were clearly lower in the group who developed ROP (29.13 vs. 43.16 ng/mL, p < 0.05). A value of 30 ng/mL of IGF1 in the third week post‐partum was found to have a 90% sensitivity in the diagnosis of ROP. A rapid rise in IGF1 levels between the 3rd and 5th weeks appeared to be related to the development of a higher stage of ROP. Conclusion: Determination of IGF1 serum levels in the 3rd week post‐partum, independent of gestational age at birth, provides a sufficient and reliable prognostic tool and allows the identification of a group of patients at high risk of developing the disease.     

Impact of Postoperative Hyperglycemia following Surgical Repair of Congenital Cardiac Defects

The objective of this study was to determine the prevalence of postoperative hyperglycemia in pediatric patients following surgery for congenital cardiac defects and its impact on morbidity and mortality. It was designed as a retrospective cohort study in a pediatric intensive care unit of a university-affiliated free-standing children’s hospital. A cohort of 213 patients who underwent 237 surgical procedures for repair or palliation of congenital cardiac defects comprised the study. Postoperative blood glucose measurements and all clinical and laboratory data were compiled for the first 10 days after surgery. The intensity and duration of hyperglycemia were analyzed for association with hospital morbidities and mortality. Mild and severe hyperglycemia were highly prevalent in our cohort (97% and 78%, respectively). Survivors had significantly lower peak (289.7 ± 180.77 mg/dl vs. 386 ± 147.95 mg/dl), mean (110.13 ± 36.22 mg/dl vs. 146.75 ± 57.12 mg/dl), and duration (2.59 ± 2.3 days vs. 5.35 ± 2.8 days) of hyperglycemia compared to nonsurvivors. Duration of hyperglycemia was independently associated with morbidity [odds ratio (OR): 1.95; p < 0.001] and mortality (OR: 1.41; p = 0.03) by multivariate logistic regression. Hyperglycemia is common in children following surgical repair or palliation of congenital cardiac defects. Postoperative hyperglycemia is associated with increased morbidity and mortality in these patients.     

Exercise Tolerance and Blood Pressure Response to Exercise Testing in Children and Adolescents After Renal Transplantation

The aim of the study was to assess exercise tolerance and blood pressure (BP) response to treadmill exercise in children after renal transplantation. Forty-five children were selected (29 males and 16 females) whose mean age was 14.3 ± 4.2 years. All children had Hb ≥ 10 g/dl and creatinine clearance ≥40 ml/min/1.73 m². They were at least 6 months posttransplantation and were on triple immunosuppressive therapy. Twenty-seven were also on various antihypertensive medications. Each underwent clinical examination and measurement of BP, both at rest and during exercise testing on treadmill. The test was stopped on muscular fatigue or exhaustion. The patients were divided into two groups: those off (A) or on (B) antihypertensive therapy. When compared to a population of healthy children the patients had reduced exercise tolerance (10.1 ± 2.1 vs 15.1 ± 1.7 min, p < 0.001) (67 ± 16%), increased heart rate (174 ± 19 vs 161 ± 19 beats/min, p < 0.001) (109 ± 15%), and increased maximum systolic BP (150 ± 26 vs 134 ± 13 mmHg, p < 0.001) (113 ± 19%) at comparable workloads. Within the two patient groups, significant differences were observed during exercise testing for maximum heart rate, which was lower in group B (p= 0.03), and maximum systolic BP, which was higher in group A (p= 0.04). Our study confirms that children and adolescents on immunosuppressive therapy after renal transplantation have a hypertensive response during exercise, probably related to medication-induced peripheral vascular tone.     

Fat-modified diets during pregnancy and lactation and serum lipids after birth

Objective : This study investigated the influence of modifying the maternal dietary fat on the serum lipids of infants at birth and at one year of age.Methods : This single-blind randomized clinical trial was done on 180 4-month-pregnant women. All subjects proved to have a fat-unmodified diet through a 4-day food record dietary questionnaire. They were divided randomly into two groups. The intervention group was kept on a fat-modified diet including saturated fatty acid (SFA) <10%, monounsaturated fatty acids: (MUFA) 10-5%, polyunsaturated fatty acid (PUFA) upto 10% and cholesterol <300 mg/day with dietary advice for the pregnancy period. The control group was given only the latter advice. All subjects were followed up monthly. The serum lipids including total cholesterol (T.cho), triglyceride (TG), and HDL cholesterol (HDL-C) were analyzed through enzymatic methods. The level of LDL-cholesterol (LDL-C) was calculated by Friedewald formula. The comparison of mean cord and one-year-old infant serum lipids were done through unpaired T-test in two groups.Results: The mean level of T.cho in the intervention and control group was (70.3±15.9, vs 81.4±17.2, P<0.009), TG (85.3 ± 16.7 vs 97.5 ± 18.2, P<0.007), LDL-C (27.8 ± 15.2 vs 34.8 ±17.1, P<0.04) and non-HDL-C (44.5±7.2 vs 54.5 ± 8.1, P<0.02) and in one year old infant the comparison of serum lipids were as follows. T.cho (145.7 ± 51.4 vs 161.4 + 56.2, P<0.003), TG (90.1 ± 31.8 vs 98.3 ± 33.1, P<0.02), LDL-C (85.6 ± 20.4 vs 92.3 ± 19.6, P<0,05) and non-HDL-C (113.6 ± 30.2 vs 128.8 ± 34.8, P<0.04). However, there was no significant difference in HDL-C of both groups.Conclusion : There is a significant decrease of T.cho, TG, LDL-C and non-HDL-C levels with no significant increase of HDL-C in the intervention group with the fat-modified diet. Maternal fatmodified diet could be suitable way to prevent cardiovascular disease among infants from the beginning of the life.     

Right Ventricular Diastolic Function After Repair of Tetralogy of Fallot

The objective of this study was quantitate diastolic dysfunction in the postoperative phase of tetralogy of Fallot (TOF) and to correlate it with the type of surgical procedure and clinical parameters. Fifty consecutive patients (mean age, 5.0 years; mean weight, 13.5 kg), operated for TOF during the period November 2004 to May 2005, were prospectively studied [infundibular resection, 23; infundibular resection and transannular patch (TAP), 19; right ventricle→pulmonary artery conduit, 8). Detailed echocardiography was done on postoperative days 3 and 9 with a focus on Doppler indices of right ventricular (RV) function, Antegrade late diastolic flow in the right ventricular outflow tract (RVOT) was taken as the marker of restrictive RV physiology. The previous parameters were correlated to the type of surgery and clinical indices of RV dysfunction. There was no mortality. Twenty-four patients showed restrictive RV physiology. This finding correlated with lower values of E/A ratio (0.98 ± 0.17 vs 1.33 ± 0.49, p < 0.002), tricuspid valve E-wave deceleration time (86.9 ± 21.7 vs 151.4 ± 152 msec, p < 0.05), index of myocardial performance (0.15 ± 0.06 vs 0.26 ± 0.09, p < 0.001), isovolumic relaxation time (19.4 ± 17 vs 39±30 msec, p < 0.009), and a higher central venous pressure (15.1 ± 1.5 vs 12.7 ± 1.9, p < 0.001). Restrictive RV physiology correlated with prolonged intensive case unit (ICU) stay (5.1 ± 3.7 vs 2.8 ± 2 days, p < 0.015), longer duration of inotropic support (108.3 ± 56.2 vs 55.5 ± 28.3 hours, p < 0.02), and higher dosage of diuretics. RV diastolic dysfunction is demonstrable by Doppler echocardiography in the first week following surgery for TOF and tends to be worse with TAP. Restrictive physiology demonstrated by RVOT pulse Doppler predicts longer duration of inotropic support, prolonged ICU stay, and higher dosage of diuretics.     

Cardiorespiratory fitness predicts clustered cardiometabolic risk in 10–11.9-year-olds

The aim of this study was to investigate levels of clustered cardiometabolic risk and the odds of being ‘at risk’ according to cardiorespiratory fitness status in children. Data from 88 10–11.9-year-old children (mean age 11.05?±?0.51 years), who participated in either the REACH Year 6 or the Benefits of Fitness Circuits for Primary School Populations studies were combined. Waist circumference, systolic blood pressure, diastolic blood pressure, glucose, triglycerides, high-density lipoprotein cholesterol, adiponectin and C-reactive protein were assessed and used to estimate clustered cardiometabolic risk. Participants were classified as ‘fit’ or ‘unfit’ using recently published definitions (46.6 and 41.9 mL/kg/min for boys and girls, respectively), and continuous clustered risk scores between fitness groups were assessed. Participants were subsequently assigned to a ‘normal’ or ‘high’ clustered cardiometabolic risk group based on risk scores, and logistic regression analysis assessed the odds of belonging to the increased cardiometabolic risk group according to fitness. The unfit group exhibited significantly higher clustered cardiometabolic risk scores (p?<?0.001) than the fit group. A clear association between fitness group and being at increased cardiometabolic risk (B?=?2.509, p?=?0.001) was also identified, and participants classed as being unfit were found to have odds of being classified as ‘at risk’ of 12.30 (95 % CI?=?2.64–57.33). Conclusion Assessing cardiorespiratory fitness is a valid method of identifying children most at risk of cardiometabolic pathologies. The ROC thresholds could be used to identify populations of children most at risk and may therefore be used to effectively target a cardiometabolic risk-reducing public health intervention.