Reduced Serum Proteins in Diabetic Children on a Twice-Daily Insulin Schedule

ABSTRACT. The concentrations of selected proteins of transport and nutrition were investigated in 27 diabetic children and 13 healthy controls by an immunodiffusion technique. The diabetic children had significantly lower mean pre-albumin ( p <0.001), albumin ( p <0.01) and orosomucoid levels ( p <0.05) than the healthy controls. No correlation was observed between age or sex and the blood concentrations of the specific proteins analyzed in this series. Haptoglobin and hemopexin showed positive correlations with serum triglycerides (both p <0.01) and slight positive correlations with some of the variables of carbohydrate control. The reduced levels of prealbumin and albumin were not correlated to diabetic control as measured by HbA₁, fasting plasma glucose or urinary glucose excretion. The non-physiological distribution site and the abnormal temporal pattern of insulin offered to diabetic children might be the reason for the protein abnormalities found in this study. This is seemingly the first time reduced serum levels of proteins have been reported in diabetic children .     

Apolipoproteins and lipoproteins in children with type I diabetes: relation to glycosylated serum protein and HbA1

Serum levels of cholesterol (C), triglycerides (TG), lipoprotein-C and apolipoproteins (apo) A-I, A-II and B were measured in 30 children with type I diabetes mellitus (16 boys, 14 girls, aged 11-14 years) and in 26 healthy controls (15 boys, 11 girls, aged 10-13 years). For 19 diabetics controls matched for age, sex and relative body weight were selected. The diabetic patients were considered to be in fair metabolic control according to HbA1 levels and glycosylated serum protein concentrations. Mean serum apo A-I, A-II and B, C, TG, low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) did not differ significantly between diabetic nondiabetic children. Very low density lipoprotein cholesterol (VLDL-C) was significantly higher in diabetic children than in controls. Serum C and LDL-C levels showed close univariate linear correlations with glycosylated serum protein (LDL-C: r = 0.53, p less than 0.01, C: r = 0.58, p less than 0.01) in diabetics. The ratio LDL/HDL-C was significantly correlated to HbA1 levels (r = 0.47, p less than 0.01). By canonical and multiple linear correlation analysis significant relations of a selected set of variables concerning the control and therapy of diabetes (serum glucose, HbA1, glycosylated serum protein, insulin dose) with a set of lipoprotein variables (C, TG, VLDL-C, HDL-C, LDL-C, apo A-I, A-II, B) could be demonstrated. From these data we conclude that significant relations between atherogenic serum lipids and lipoproteins (C, LDL-C) and the degree of metabolic control exist in diabetic children, even in the absence of marked dyslipoproteinemia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Early changes of some serum proteins and metals in diabetic children

Serum concentrations of prealbumin, albumin, orosomucoid, magnesium, zinc and calcium were studied in 30 children with newly diagnosed IDDM aged 3-15 years, during the first two years of the disease, and in 44 healthy control children. On admission serum prealbumin was significantly lower in IDDM children (149 +/- 48 mg/l) (M +/- SD) than in healthy controls (194 +/- 39 mg/l) (p less than 0.001). During the two years follow-up prealbumin increased significantly, but did not reach the level of healthy controls. Serum albumin was slightly increased at diagnosis (p less than 0.01), but later decreased significantly (p less than 0.01). Orosomucoid concentrations did not differ between diabetics and controls. Serum magnesium was initially within the reference interval but later decreased, and after 2 years of IDDM it was highly significantly reduced (p less than 0.001). Serum zinc was significantly reduced in IDDM children at diagnosis (p less than 0.001), but was within the reference interval after one and 2 years. Serum calcium was increased in the IDDM group at diagnosis (p less than 0.01), but later normalized. It is concluded that in early IDDM there is a decrease in serum prealbumin and albumin, and serum magnesium decreases progressively, while serum zinc is only transiently reduced.     

Serum albumin, retinol-binding protein, thyroxin-binding prealbumin and acute phase reactants as indicators of undernutrition in children with undue susceptibility to acute infections

This study was conducted in order to test the usefulness of measuring the concentrations of selected serum proteins and acute phase reactants in assessing the nutritional status of children with undue susceptibility to acute infections. The concentrations of serum proteins were determined by an immunodiffusion technique in 28 children with undue susceptibility to infections and were compared with those in healthy children. The patients were grouped according to the clinical pattern, i.e. into children with mainly upper respiratory tract infections, with frequent middle ear infections and with lower respiratory tract infections. The total group and all three subgroups of patients had not only significantly lower (p less than 0.001 or p less than 0.01) mean serum levels of albumin and retinol-binding protein, but also of the acute phase reactants alpha 2-macroglobulin and ceruloplasmin (p less than 0.01) than the controls. No differences were observed between the patients and the controls in respect of the acute phase reactant orosomucoid. This study indicates that the concentrations of albumin and RBP along with selected acute phase reactants are rapidly influenced by altered nutritional status in children with undue susceptibility to acute infections.     

Apolipoproteins and Lipoproteins in Children with Type I Diabetes: Relation to Glycosylated Serum Protein and HbA1

ABSTRACT. Serum levels of cholesterol (C), triglycerides (TG), lipoprotein-C and apolipoproteins (apo) A-I, A-II and B were measured in 30 children with type I diabetes mellitus (16 boys, 14 girls, aged 11–14 years) and in 26 healthy controls (15 boys, 11 girls, aged 10–13 years). For 19 diabetics controls matched for age, sex and relative body weight were selected. The diabetic patients were considered to be in fair metabolic control according to HbA₁ levels and glycosylated serum protein concentrations. Mean serum apo A-I, A-II and B, C, TG, low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) did not differ significantly between diabetic and nondiabetic children. Very low density lipoprotein cholesterol (VLDL-C) was significantly higher in diabetic children than in controls. Serum C and LDL-C levels showed close univariate linear correlations with glycosylated serum protein (LDL-C: r =0.53, p <0.01, C: r =0.58, p <0.01) in diabetics. The ratio LDL/HDL-C was significantly correlated to HbA₁ levels ( r =0.47, p <0.01). By canonical and multiple linear correlation analysis significant relations of a selected set of variables concerning the control and therapy of diabetes (serum glucose, HbA₁, glycosylated serum protein, insulin dose) with a set of lipoprotein variables (C, TG, VLDL-C, HDL-C, LDL-C, apo A-I, A-II, B) could be demonstrated. From these data we conclude that significant relations between atherogenic serum lipids and lipoproteins (C, LDL-C) and the degree of metabolic control exist in diabetic children, even in the absence of marked dyslipoproteinemia. The close relation of LDL-C and total C with glycosylated serum protein in the diabetics might be due to glycosylation of LDL .     

Early Changes of Some Serum Proteins and Metals in Diabetic Children

ABSTRACT. Serum concentrations of prealbumin, albumin, orosomucoid, magnesium, zinc and calcium were studied in 30 children with newly diagnosed IDDM aged 3–15 years, during the first two years of the disease, and in 44 healthy control children. On admission serum prealbumin was significantly lower in IDDM children (149±48 mg/1) (M±SD) than in healthy controls (194±39 mg/1) ( p <.001). During the two years follow-up prealbumin increased significantly, but did not reach the level of healthy controls. Serum albumin was slightly increased at diagnosis ( p <0.01), but later decreased significantly ( p <0.01). Orosomucoid concentrations did not differ between diabetics and controls. Serum magnesium was initially within the reference interval but later decreased, and after 2 years of IDDM it was highly significantly reduced ( p <0.001). Serum zinc was significantly reduced in IDDM children at diagnosis ( p <0.001), but was within the reference interval after one and 2 years. Serum calcium was increased in the IDDM group at diagnosis ( p <0.01), but later normalized. It is concluded that in early IDDM there is a decrease in serum prealbumin and albumin, and serum magnesium decreases progressively, while serum zinc is only transiently reduced.     

HYPOMAGNESEMIA IN DIABETIC CHILDREN

ABSTRACT. Serum concentrations of iron, copper, zinc and magnesium were determined in 27 Swedish children with well controlled diabetes without longterm diabetic complications. Thirteen of the diabetic children had age- and sex-matched healthy controls. Significantly lower serum magnesium concentrations were found in the diabetic children than in the matched healthy controls ( p <0.01). The levels of iron, copper and zinc did not differ in the diabetic children from those in the controls. A negative correlation between serum magnesium level and duration of diabetes was found ( p <0.05). This is seemingly the first report of hypomagnesemia in diabetic children.     

Elevated serum selenium in diabetic children

Twenty-seven diabetic children, 16 girls and 11 boys, 5-18 years of age, with a duration of the disease ranging from 2-15 years, comprised the study group. Thirteen children with a similar age and sex distribution, living in the same area served as healthy controls. All 40 children had a normal growth pattern. The mean serum selenium concentration in the diabetic children, determined by neutron activation analysis, was 7.4 +/- 0.8 micrograms/100 ml (mean +/- SD) and in the healthy controls 6.5 +/- 0.8 micrograms/100 ml. The difference between the two groups was statistically highly significant (p less than 0.01). Boys and girls in both groups had nearly identical mean serum selenium levels and no correlation was observed between the selenium concentrations and either the age, weight or height of the children or the indicators of diabetic control. The selenium status in diabetic children has not been reported previously. The possibility of elevated serum selenium in diabetic children in response to altered lipid metabolism is discussed.     

Dietary Intake, Trace Elements and Serum Protein Status in Young Diabetics

ABSTRACT. Dietary intake of energy and nutrients and its relation to trace element and protein status, as observed in 27 diabetic children and 13 healthy controls are discussed. The diabetic children had consistently higher intakes than the healthy controls in nearly all respects, except for carbohydrate and ascorbic acid. In spite of this, the diabetic children had a significantly lower mean serum magnesium than the healthy controls. It is suggested that hypomagnesemia in diabetic children may be the result of increased urinary loss or diversion of magnesium from normal metabolic pathways in this disease. This review also revealed a significantly higher mean serum selenium level in the diabetic children than in the healthy controls. However, no significant correlation WBS observed between serum selenium concentrations and protein intake, suggesting that a factor other than protein intake underlay the elevated levels of serum selenium. The diabetic children as a group had significantly lower levels of selected serum proteins than the controls, in spite of a significantly higher intake of protein by the diabetic group. It is suggested that both reduced serum proteins and elevated levels of serum selenium in the diabetic children are an expression of altered metabolism in combination with the effects of current modes of insulin treatment in this disease.     

Selected trace elements and proteins in serum of apparently healthy newborn infants of mothers who smoked during pregnancy

The serum concentrations of selected trace elements and proteins in cord blood from 17 newborn infants whose mothers were habitual smokers were compared with values from 22 infants of non-smoking mothers. All the mothers were healthy with normal pregnancies and deliveries. Cigarette smoke exposure was verified by determinations of nicotine, cotinine and thiocyanate concentrations in cord blood. Infants of smoking mothers had a slightly lower mean birth weight (3490 +/- 430 g) than control infants (3780 +/- 460 g). Infants of smokers had lower serum iron (p = 0.05) and prealbumin (p less than 0.05), but higher serum copper (p less than 0.05) and ceruloplasmin (p less than 0.01) levels than the controls. Infants of smoking mothers tended to have higher levels of the acute-phase reactants alpha-2-macroglobulin and orosomucoid, but lower levels of albumin, transferrin and retinol-binding-protein, although differences were not statistically significant.     

Serum Albumin, Retinol-binding Protein, Thyroxin-binding Prealbumin and Acute Phase Reactants as Indicators of Undernutrition in Children with Undue Susceptibility to Acute Infections

ABSTRACT. This study was conducted in order to test the usefulness of measuring the concentrations of selected serum proteins and acute phase reactants in assessing the nutritional status of children with undue susceptibility to acute infections. The concentrations of serum proteins were determined by an immunodiffusion technique in 28 children with undue susceptibility to infections and were compared with those in healthy children. The patients were grouped according to the clinical pattern, i.e. into children with mainly upper respiratory tract infections, with frequent middle ear infections and with lower respiratory tract infections. The total group and all three subgroups of patients had not only significantly lower ( p < 0.001 or p < 0.01) mean serum levels of albumin and retinol-binding protein, but also of the acute phase reactants α₂-macroglobulin and ceruloplasmin ( p < 0.01) than the controls. No differences were observed between the patients and the controls in respect of the acute phase reactant orosomucoid. This study indicates that the concentrations of albumin and RBP along with selected acute phase reactants are rapidly influenced by altered nutritional status in children with undue susceptibility to acute infections.     

Serum apolipoproteins A-I, A-II and B in diabetic children and matched healthy controls

Serum concentrations of apolipoprotein (apo) A-I. A-II and B were determined in 28 diabetic children (age 3-16 years) and 14 healthy matched controls. In the healthy children the serum apo A-I concentration was 120 +/- 20 arbitrary units (A.U.) (mean +/- S.D.), apo A-II 111 +/- 14 A.U. and apo B 100 +/- 34 A.U. (100 A.U. = mean concentration in adult blood donors). The apo A-I concentration was significantly higher in the diabetic children (134 +/- 13; p less than 0.02) than in the healthy controls. In diabetics apo A-II was 116 +/- 14 A.U. and apo B 106 +/- 21 A.U., values not significantly different from those in the controls. The serum cholesterol concentration in the healthy children correlated strongly to apo A-I and apo A-II, which was not the case in the diabetics. The differences between diabetic and healthy children with respect to correlations between the apolipoproteins and the serum lipids might indicate a different apolipoprotein/lipoprotein lipid relationship in diabetics.     

Assessment of magnesium status in newly diagnosed diabetic children: measurement of erythrocyte magnesium level and magnesium tolerance testing

The aim of this study was to investigate the relationship between serum, erythrocyte and urine magnesium levels and retained magnesium percentage in newly diagnosed diabetic children. In a cross-sectional study, 34 children with insulin dependent diabetes mellitus (IDDM) and 21 healthy age- and sex-matched control subjects were screened for their serum, erythrocyte, and urine magnesium levels. Magnesium tolerance test was performed on diabetic and control subjects. Serum and erythrocyte magnesium levels in diabetic children were significantly lower than in healthy controls (plasma magnesium, p<0.05; erythrocyte magnesium, p<0.001); however, serum magnesium level was in normal range in diabetics and controls. Erythrocyte magnesium levels in diabetic children showed an inverse correlation with percentage of retained magnesium load (r=-0.44, p<0.01). Urine magnesium excretion in diabetic children (7.12 +/- 2.18 mmol/g creatinine/24-hr) was significantly higher than in healthy controls (4.0 +/- 1.35 mmol/g creatinine/24-hr) (p<0.001). There was a negative correlation between erythrocyte magnesium (2.07 +/- 0.62 mmol/L) and urine magnesium (7.12 +/- 2.18 mmol/g creatinine/24-hr) (r=-0.68 p<0.01) in diabetic children. Magnesium tolerance test showed that percentage of retained magnesium in diabetic children (66 +/- 26%) was significantly higher than in controls (16 +/- 7%) (p<0.001). This study is the first study to simultaneously investigate serum, erythrocyte and urine magnesium levels and magnesium tolerance test in newly diagnosed diabetic children. In conclusion, erythrocyte magnesium levels decrease earlier than serum magnesium in diabetic children. The follow-up parameters in diabetics may include the policy of monitoring magnesium status. Erythrocyte magnesium measurement is preferred to serum magnesium. Magnesium tolerance test is a reliable and sensitive method, which may be used as an alternative to erythrocyte magnesium measurement or in combination with it in hospitalized diabetic children.     

Elevated Serum Selenium in Diabetic Children

ABSTRACT. Twenty-seven diabetic children, 16 girls and 11 boys, 5–18 years of age, with a duration of the disease ranging from 2–15 years, comprised the study group. Thirteen children with a similar age and sex distribution, living in the same area served as healthy controls. All 40 children had a normal growth pattern. The mean serum selenium concentration in the diabetic children, determined by neutron activation analysis, was 7.4 ± 0.8 μg/100 ml (mean ± SD) and in the healthy controls 6.5 ± 0.8 μg/100 ml. The difference between the two groups was statistically highly significant ( p < 0.01). Boys and girls in both groups had nearly identical mean serum selenium levels and no correlation was observed between the selenium concentrations and either the age, weight or height of the children or the indicators of diabetic control. The selenium status in diabetic children has not been reported previously. The possibility of elevated serum selenium in diabetic children in response to altered lipid metabolism is discussed.     

Selected Trace Elements and Proteins in Serum of Apparently Healthy Newborn Infants of Mothers Who Smoked during Pregnancy

ABSTRACT. The serum concentrations of selected trace elements and proteins in cord blood from 17 new-bom infants whose mothers were habitual smokers were compared with values from 22 infants of non-smoking mothers. All the mothers were healthy with normal pregnancies and deliveries. Cigarette smoke exposure was verified by determinations of nicotine, cotinine and thiocyanate concentrations in cord blood. Infants of smoking mothers had a slightly lower mean birth weight (3490±430 g) than control infants (3780±460 g). Infants of smokers had lower serum iron ( p =0.05) and prealbumin ( p ≤0.05), but higher serum copper ( p ≤0.05) and ceruloplasmin ( p ≤0.01) levels than the controls. Infants of smoking mothers tended to have higher levels of the acute-phase reactants alpha-₂-macroglobulin and orosomucoid, but lower levels of albumin, transferrin and retinol-binding-protein, although differences were not statistically significant.     

Serum soluble endothelial-cell specific adhesion molecules in children with insulin-dependent diabetes mellitus

Endothelial-cell specific adhesion molecules are reported to be elevated in patients with diabetes mellitus and related to diabetic vascular complications. We studied serum concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), endothelial-leukocyte adhesion molecule (sE-selectin) in 30 healthy children and 35 children with type 1 diabetes without symptomatic vascular complications. sE-selectin levels were higher in diabetics than in controls (p < 0.001). sVCAM-1 and sICAM-1 levels were not different between the groups (p > 0.05). In seven newly diagnosed diabetics with ketoacidosis, concentrations of these molecules were not different before and after one month of insulin therapy (p > 0.05). In the combined group, only sE-selectin was correlated positively with serum glucose, HbA1c (r = 0.3, p < 0.05 for both) and negatively with C-peptide levels (r = -0.4, p < 0.05). In diabetic children without symptomatic vascular complications, sE-selectin but not sICAM and sVCAM levels was elevated; this finding might reflect ongoing endothelial-cell activation rather than endothelial damage.     

瘦素和血管内皮生长因子在先天性心脏病患儿中的变化

目的：探讨血清瘦素（LEP）和血管内皮生长因子(VEGF)在先天性心脏病（CHD）患儿中的变化与作用。方法：左向右分流型先心病组（非发绀组）48例（心衰组20例,无心衰组28例）,右向左分流型先心病组（发绀组）20例,正常对照组20例。分别测定以上各组儿童血清LEP,VEGF和总蛋白、白蛋白浓度及体重指数（BMI）。结果：先心病患儿各组与对照组之间血清总蛋白、白蛋白浓度差异无显著性(P>0.05),BMI差异有显著性(P<0.01)。发绀组、心衰组、无心衰组及对照组间血清LEP,LEP/BMI及VEGF浓度有明显差异(P<0.01)。与无心衰组比较,发绀组、心衰组LEP,LEP/BMI及VEGF浓度明显升高（P<0.01）。在非发绀组患儿中,心衰组和无心衰组血清LEP与BMI均呈正相关（P<0.01）。在发绀组患儿中,血清LEP与VEGF水平呈正相关（P<0.01）; 血红蛋白含量与VEGF水平呈明显的正相关（P<0.01）;动脉血氧饱和度与血清VEGF及LEP水平呈明显的负相关（P<0.01)。结论：LEP和VEGF参与CHD的病理生理过程。LEP和VEGF与非发绀型CHD的心衰发生有关。［中国当代儿科杂志,2009,11（10）：802-805］     

Biochemical tests during measles

In order to evaluate the role of measles in the development of vitamin A deficiency, biochemical parameters were compared in four groups of patients: a) 31 children in the first week of measles, b) 10 of these children who returned two weeks later, c) 9 patients hospitalized with other infections and d) 6 healthy controls. The average levels of serum iron, carotene, total proteins, albumin and beta-globulins did not differ significantly between these groups. However, during the first week of measles the following significant differences were found: a) an increase in alpha-2 and alpha-1-globulin levels (p less than 0,01), b) a decrease in gamma-globulin level (p less than 0,001), c) a decrease in vitamin A concentration (p less than 0,05) without clinical signs of deficiency. In the 10 patients who came again 2 weeks after the rash these parameters had returned toward control levels.     

Reduced vascular reactivity in diabetic children and its relation to diabetic control

The vascular reactivity in response to ischaemia was studied by a non-invasive method of measuring transcutaneous oxygen tension used at 37 degrees C, in 28 children with type I diabetes mellitus. Postischaemic hyperaemia was significantly reduced in the diabetic children compared with 34 healthy children. The degree of reduction in vascular reactivity correlated to both short-term and long-term diabetic control. Among tested variables, urinary glucose excretion during the night preceding the test showed the highest coefficient of correlation to the peak of the postocclusive reactive hyperaemia (r = -0.59, p less than 0.01). This peak was only weakly correlated to triglycerides and glycosylated haemoglobins and showed no significant correlation to fasting plasma glucose or to the duration of the disease. It was weakly correlated to the total daily insulin dosage but not to the dosage of insulin/kg body weight. Multiple linear regression analysis revealed that urinary glucose excretion, plasma glucose, haemoglobin A1, serum triglyceride and serum cholesterol, duration of diabetes, and insulin dosage per kg body weight together explained 54% of the variation in vascular reactivity. The reduced vascular reactivity found in diabetic children could not be explained by the usual parameters of carbohydrate control alone. This new non-invasive method is able to reveal a reduction in vascular function in diabetic children and should therefore be of value in attempts to find the causes of vascular dysfunction in diabetics.     

Serum alpha 2-HS-glycoprotein levels in neonatal infections

The serum concentration of alpha 2-HS-glycoprotein was determined in 15-infected neonates and 21 age-matched controls using the radial immunodiffusion method. The infected neonates had significantly lower serum alpha 2-HS-glycoprotein concentration than the controls (56.9 +/- 15.1 and 105.6 +/- 25.7, respectively; p less than 0.001) confirming that it also behaves as a negative acute phase reactant in neonates. No correlation was found between alpha 2-HS-glycoprotein and albumin concentrations. The serum glycoprotein concentration in the control neonates was significantly higher than that of healthy older children and reported values in adult controls. The often reported decrease in the opsonic function of the neonatal serum is therefore unlikely to be explained by decreased alpha 2-HS-glycoprotein levels. However, the relatively higher levels of the glycoprotein observed in this study in neonates may be related to the active bone mineralization taking place in the newborn period.