Myeloperoxidase Is an Early Biomarker of Inflammation and Cardiovascular Risk in Prepubertal Obese Children

OBJECTIVE

Obesity is associated with a state of chronic low-grade inflammation. Myeloperoxidase (MPO) plays an important role in the initiation and progression of acute and chronic inflammatory diseases, such as cardiovascular disease (CVD). The objectives of the current study were to evaluate plasma MPO levels in prepubertal obese children and to determine whether MPO could be an early biomarker of inflammation and CVD risk.

RESEARCH DESIGN AND METHODS

In a prospective multicenter case-control study paired by age and sex of 446 Caucasian prepubertal children ages 6–12 years, 223 normal-weight and 223 obese children were recruited. Blood pressure, waist circumference, weight, and height were measured. In addition to MPO, glucose, insulin, metabolic lipid parameters, oxidized low-density lipoproteins, adiponectin, leptin, resistin, C-reactive protein (CRP), interleukin 6, tumor necrosis factor α, matrix metalloproteinase-9 (MMP-9), and plasminogen activator inhibitor 1 were determined.

RESULTS

We found that MPO was elevated in prepubertal obese children and that this enzyme was associated with such proinflammatory and cardiovascular risk biomarkers as CRP, MMP-9, and resistin. Insulin resistance calculated by the homeostatic assessment model was the best predictor of MPO.

CONCLUSIONS

MPO is an early biomarker of inflammation associated with CVD risk in obese children at the prepubertal age.Obesity is characterized by a chronic low-grade inflammation (1). Obese children have been shown to develop many proinflammatory and proatherogenic changes associated with vascular diseases in adults, including high plasma levels of C-reactive protein (CRP) (2), interleukin 6, and tumor necrosis factor-α (TNF-α) (3). In addition, it has been demonstrated that some factors involved in vascular homeostasis, such as plasminogen activator inhibitor 1 (PAI-1) (4), and in angiogenesis, such as matrix metalloproteinase 9 (MMP-9) (5), are elevated in the plasma of obese children, whereas others, such as adiponectin, are decreased.Myeloperoxidase (MPO) is an enzyme most abundantly expressed in neutrophils and, to a lesser extent, in monocytes (6). This enzyme has long been viewed as functioning primarily as a bactericidal agent (7), generating reactive oxygen species that contribute to the destruction and killing of the engulfed pathogens (6). It has been demonstrated that MPO is involved in cellular homeostasis and plays an important role in the initiation and progression of acute and chronic inflammatory diseases, fundamentally cardiovascular diseases (CVD). Recent studies have reported elevated MPO levels in obese adults (8,9). Furthermore, some studies in children have shown that MPO is elevated in subjects with diabetes mellitus type 1 (10) and with hypercholesterolemia (11), although as far as we know, no data have been reported in obese children at the prepubertal period. The objectives of the current study were therefore to evaluate plasma MPO levels in prepubertal obese children and to determine whether MPO could be an early biomarker of inflammation and CVD risk.     

Adherence to the Mediterranean diet reduces mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain)

Epidemiological studies show that adherence to a Mediterranean diet (MD) increases longevity; however, few studies are restricted to Mediterranean populations or explore the effect of a MD pattern that directly incorporates olive oil. Therefore the relationship between adherence to the MD and mortality was studied within the the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The EPIC-Spain analysis included 40 622 participants (37·7?% males) aged 29-69 years who were recruited from five Spanish regions in 1992-1996. During a mean follow-up of 13·4 years, 1855 deaths were documented: 913 from cancer, 399 from CVD, 425 from other causes and 118 from unknown causes of death. Risk of all-cause and cause-specific mortality was assessed according to the level of adherence to a relative MD (rMED) score, measured using an 18-unit scale incorporating nine selected dietary components. A high compared with a low rMED score was associated with a significant reduction in mortality from all causes (hazard ratio (HR) 0·79; 95?% CI 0·69, 0·91), from CVD (HR 0·66; 95?% CI 0·49, 0·89), but not from overall cancer (HR 0·92; 95?% CI 0·75, 1·12). A 2-unit increase in rMED score was associated with a 6?% (P?相似文献   

Quality of life among caregivers of patients with eating disorders

Purpose  

To analyse health-related quality of life (HRQoL) and its associated social and clinical variables among a sample of caregivers of patients with eating disorders (ED).     

Comparison of plasma ctDNA and tissue/cytology-based techniques for the detection of <Emphasis Type="Italic">EGFR</Emphasis> mutation status in advanced NSCLC: Spanish data subset from ASSESS

Purpose

The analysis of epidermal growth factor receptor (EGFR) mutations in many patients with advanced non-small-cell lung cancer (aNSCLC) has provided the opportunity for successful treatment with specific, targeted EGFR tyrosine kinase inhibitors. However, this therapeutic decision may be challenging when insufficient tumor tissue is available for EGFR mutation testing. Therefore, blood surrogate samples for EGFR mutation analysis have been suggested.

Methods

Data were collected from the Spanish cohort of patients in the large, non-interventional, diagnostic ASSESS study (NCT01785888) evaluating the utility of circulating free tumor-derived DNA from plasma for EGFR mutation testing. The incidence of EGFR mutation in Spain and the level of concordance between matched tissue/cytology and plasma samples were evaluated.

Results

In a cohort of 154 eligible patients, EGFR mutations were identified in 15.1 and 11.0% of tumor and plasma samples, respectively. The most commonly used EGFR mutation testing method for the tumor tissue samples was the QIAGEN Therascreen^® EGFR RGQ PCR kit (52.1%). Fragment Length Analysis?+?PNA LNA Clamp was used for the plasma samples. The concordance rate for EGFR mutation status between the tissue/cytology and plasma samples was 88.8%; the sensitivity was 45.5%, and the specificity was 96.7%.

Conclusions

The high concordance between the different DNA sources for EGFR mutation testing supports the use of plasma samples when tumor tissue is unavailable.

     

Socioeconomic position and type 2 diabetes mellitus in Europe 1999-2009: a panorama of inequalities

The aim of the present review is to synthesis findings from studies on the relationship between socioeconomic position (SEP) and incidence, prevalence and mortality of type 2 diabetes mellitus (T2DM) in Europe between the years 1999 and 2009. A systematic search was carried out in the National Library of Medicine's PubMed database. The search was limited to articles published between January 1999 and December 2009, in English or Spanish. Additional requirements for inclusion were: (i) presentation of empirical results directly related with SEP and the prevalence, incidence or mortality of diabetes, (ii) dealing with T2DM, (iii) carried out in Europe, and (iv) mainly focused only on diabetes. Of the 19 articles found, twelve studied the relationship between SEP and the prevalence of T2DM, two dealt with diabetes incidence, three with mortality and two studied both inequalities in mortality and prevalence. People with more deprived SEP have greater incidence, more prevalence and higher mortality due to T2DM, although the magnitude and significance of the associations varied from one study to another. Part of these inequalities is explained by SEP differences in the prevalence of the established T2DM risk factors. SEP inequalities in T2DM tended to be greater in women than in men. There is consistent evidence that SEP inequalities in T2DM incidence, prevalence and mortality are present in Europe, especially among women. Improving accessibility of physical activity in terms of both price and availability, access to healthy food, and access to health services, will be key to achieving a reduction of SEP related diabetes inequalities in Europe.     

Health Literacy and Control in the Medical Encounter: A Mixed-Methods Analysis

BackgroundPhysician-patient communication can be described according to 4 prototypes of control—paternalism, mutuality, consumerism, or default. Patients with inadequate health literacy skills may be less-active participants in their care and more likely to have paternalistic encounters.MethodsTwo independent coders analyzed 31 transcribed outpatient medical visits between physicians and African American patients with diabetes according to the 4 prototypes of control. Differences in communication and the balance of power by level of patients’ health literacy were analyzed by quantitative and qualitative methods.ResultsFourteen patients (45%) had inadequate health literacy, and most of them (N=8, 57%) had paternalistic encounters. Among patients with marginal or adequate health literacy skills, only 4 (23%) had paternalistic visits (p = .06), and encounters marked by mutuality were most common (N = 9, 53%).ConclusionPatients with inadequate health literacy appear more likely to have paternalistic interactions with their physicians.