Decreased insulin sensitivity and increased oxidative damage in wasting adipose tissue depots of wild-type mice

Unintentional weight loss (wasting) in the elderly is a major health concern as it leads to increased mortality. Several studies have focused on muscle loss, but little is known about the mechanisms giving rise to loss of fat mass at old ages. To investigate potential mechanisms, white adipose tissue (WAT) characteristics and proteomic profiles were compared between adult (10-12-month-old) and aged (22-24-month-old) wild-type mice. Four individual WAT depots were analyzed to account for possible depot-specific differences. Proteomic profiles of WAT depots, along with body weights and compositions, plasma levels of insulin, leptin and adiponectin, insulin tolerance, adipocyte sizes, and products of oxidative damage in each WAT depot were determined. We found that lean mass remained constant while fat mass and insulin tolerance were decreased in old age, as were adipocyte sizes in the WAT depots. Proteomic results showed increased levels of enolase, pyruvate dehydrogenase E1β, NAD(+)-dependent isocitrate dehydrogenase α, and ATP synthase subunit β, and decreased levels of carbonic anhydrase 3 in WAT of aged mice. These data suggest increased aerobic glucose oxidation in wasting WAT, consistent with decreased insulin signaling. Also, Cu/Zn superoxide dismutase and two chaperones were increased in aged WAT depots, indicating higher stress resistance. In agreement, lipid peroxidation (HNE-His adducts) increased in old age, although protein oxidation (carbonyl groups) showed no increase. In conclusion, features of wasting WAT were similar in the four depots, including decreased adipocyte sizes and alterations in protein expression profiles that indicated decreased insulin sensitivity and increased lipid peroxidation.     

Mineralocorticoid replacement during infancy for salt wasting congenital adrenal hyperplasia due to 21-hydroxylase deficiency

OBJECTIVE:

The protocols for glucocorticoid replacement in children with salt wasting 21-hydroxylase deficiency are well established; however, the current recommendation for mineralocorticoid replacement is general and suggests individualized dose adjustments. This study aims to retrospectively review the 9-∝-fludrocortisone dose regimen in salt wasting 21-hydroxylase deficient children who have been adequately treated during infancy.

METHODS:

Twenty-three salt wasting 21-hydroxylase deficient patients with good anthropometric and hormonal control were followed in our center since diagnosis. The assessments of cortisone acetate and 9-∝-fludrocortisone doses, anthropometric parameters, and biochemical and hormonal levels were rigorously evaluated in pre-determined intervals from diagnosis to two years of age.

RESULTS:

The 9-∝-fludrocortisone doses decreased over time during the first and second years of life; the median fludrocortisone doses were 200 μg at 0-6 months, 150 μg at 7-18 months and 125 μg at 19-24 months. The cortisone acetate dose per square meter was stable during follow-up (median = 16.8 mg/m²/day). The serum sodium, potassium and plasma rennin activity levels during treatment were normal, except in the first month of life, when periodic 9-∝-fludrocortisone dose adjustments were made.

CONCLUSIONS:

The mineralocorticoid needs of salt wasting 21-hydroxylase deficient patients are greater during early infancy and progressively decrease during the first two years of life, which confirms that a partial aldosterone resistance exists during this time. Our study proposes a safety regiment for mineralocorticoid replacement during this critical developmental period.     

Evaluation of cardiovascular risk factors in HIV-1 infected patients using carotid intima-media thickness measurement

BACKGROUND. Highly active antiretroviral therapies (HAART) in HIV-infected patients are often associated with lipodystrophy syndrome and metabolic disorders. Atherogenic lipid profile could expose these patients to atheromatous cardiovascular disease. We describe carotid artery intima-media thickness (IMT), a surrogate marker of atherosclerosis, according to HIV status, antiretroviral treatment, lipodystrophy and conventional cardiovascular risk factors. METHOD. In a multicenter prospective cohort study we have surveyed HIV-infected subjects with a carotid IMT measurement by B-mode ultrasonography. We collected information on lipodystrophy clinical manifestations, age, gender, body mass index (BMI), smoking habits, alcohol intake, systolic blood pressure, HIV transmission category, AIDS stage, type and duration of HAART, CD4 + cell count, plasma HIV-1 RNA, glucose, insulin, total cholesterol and homocysteine. RESULTS. Four hundred and twenty-three HIV-infected patients were studied. The median carotid IMT measurement was 0.54 mm (range: 0.50-0.60). Lipodystrophy syndrome was diagnosed in 161 HIV-infected patients (38.1%). In univariate linear regression, IMT was significantly higher (P < 0.05) with older age, male gender, higher body mass index, higher waist-to-hip ratio, increased systolic blood pressure, total cholesterol, glucose disorders and homocysteine, regular smoking and alcohol consumption, lipo dystrophy and HAART. In a multivariate analysis, the effect of lipodystrophy and HAART disappeared after adjustment for other cardiovascular risk factors. CONCLUSIONS. It was concluded that only conventional cardiovascular risk factors are independently associated with increased IMT in HIV-infected patients.     

2017年北京市中小学生营养状况及饮食行为分析

目的 本次调查旨在分析2017年北京市中小学生肥胖、消瘦及一些营养相关行为的流行情况,为制定更有效的干预措施提供依据。方法 采用多阶段分层整群抽样方法,共调查18所学校3488名学生,其中城区学生1782名(51.09%),农村学生1706名(48.91%)。小学生2262名(64.85%),中学生1226名(35.15%);男生1786名(51.20%),女生1702名(48.80%)。结果 北京市中小学生肥胖率为12.76%,消瘦率为13.39%。城乡学生肥胖率分别为10.83%、14.77%,农村高于城区(P<0.001)。男女生肥胖率分别为16.52%、8.81%,男生高于女生(P<0.001)。小学生的肥胖率和消瘦率都高于中学生(χ2=4.259,P=0.039;χ2=14.171,P<0.001)。16.40%的学生报告早餐常吃不饱。女生饮水不足率为18.20%,将近是男生的2倍,而男生经常喝饮料率高达35.05%,女生中也有28.32%经常喝饮料。小学生比中学生盲目吃减肥药的多(χ2=9.363,P=0.002)。46例体重正常的学生和50例消瘦的学生报告盲目吃减肥药。结论 北京市中小学生的营养状况不容乐观,肥胖和营养不良并存。     

Nutritional deficiencies in the developing world: current status and opportunities for intervention

Several contributory factors such as poverty, lack of purchasing power, household food insecurity, and limited general knowledge about appropriate nutritional practices increase the risk of undernutrition in developing countries. The synergistic interaction between inadequate dietary intake and disease burden leads to a vicious cycle that accounts for much of the high morbidity and mortality in these countries. Three groups of underlying factors contribute to inadequate dietary intake and infectious disease: inadequate maternal and child care, household food insecurity, and poor health services in an unhealthy environment.     

Promoting the awareness of hospital malnutrition in children: ePINUT 10th anniversary in 2020

ObjectiveThe year 2020 marks the 10th consecutive year of the ePINUT study which is used for promoting awareness of hospital malnutrition in paediatric wards. The present article describes the methods and the studied population.Materials and methodsePINUT is a cross-sectional study gathering data each year over 2 weeks in March. Any child up to 18 years old, hospitalized except in neonatal and intensive care units could be included in this study. Length of hospitalization, weight variations and height were measured. An online calculator was made available for nutritional indices (http://www.epinut.fr/), in accordance with the French Paediatric Society guidelines. A geographic grouping was done based on university inter-regions.ResultsA total of 13,332 entries in France were included from 2010 to 2019. On a geographic level, 6 of the 7 regions contributed yearly to 10 to 15% of these entries, while the western region accounted for 25% of the entries (P < 0.001). Ninety-two cities participated, with 36% participating 5 to 9 years, 39% participating 2 to 4 years, and 26% participating once. The median age was 4 years old, 10.2% of children had a Weight-for-Height z-score smaller than ?2 at admittance. These children stayed longer in the hospital (8.3 ± 11.3 vs. 6.4 ± 9.3 days, P = 0.02) and had a greater percent weight change during hospitalization (2.8 ± 4.7 vs. 0.4 ± 3.8%, P < 0.0001).ConclusionSuch a long-term promotion of awareness about hospital malnutrition is unique. The future aim is to empower young patients and their parents and to get them involved in reducing hospital malnutrition in children.