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Bugajska J, Berska J, Wójcik M, Sztefko K. Amino acid profile in overweight and obese prepubertal children - can simple biochemical tests help in the early prevention of associated comorbidities? Front Endocrinol (Lausanne) 2023; 14:1274011. [PMID: 37964971 PMCID: PMC10641253 DOI: 10.3389/fendo.2023.1274011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/27/2023] [Indexed: 11/16/2023] Open
Abstract
Background It is accepted that plasma branched-chain amino acids (BCAAs) and aromatic amino acids (AAAs) are closely related to metabolic risk. Arterial hypertension, metabolic syndrome, endothelial dysfunction, inflammation, and metabolic dysfunction-associated fatty liver disease (MAFLD) are frequently seen in obese patients. Many attempts have been made to find biochemical indicators for the early detection of metabolic complications in children. It is not known if different amino acid profiles and BCAA and AA concentrations in overweight and obese children correlate with chemerin, proinflammatory, and simple biochemical markers. Thus, the study aimed to find out the early markers of cardiovascular disease and MAFLD in overweight and obese children. Materials and methods The study included 20 overweight and obese children (M/F 12/8; mean age 7.7 ± 2.3 years; BMI 26.8 ± 5.0 kg/m2) and 12 non-obese children (control group) (M/F 4/8; mean age 6.5 ± 2.2 years; BMI 14.8 ± 1.5 kg/m2). The following plasma amino acids were measured: aspartic acid, glutamic acid, serine, asparagine, glycine, glutamine, taurine, histidine, citrulline, threonine, alanine, arginine, proline, tyrosine, methionine, valine, isoleucine, leucine, phenylalanine, tryptophan, ornithine, and lysine. Chemerin, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and basic biochemistry parameters were measured. Results The mean plasma levels of leucine, isoleucine, valine, phenylalanine, tyrosine, glutamic acid, and alanine were significantly higher in overweight and obese children than in the control group (p<0.03-p<0.0004). Conversely, the mean values of serine, asparagine, glutamine, and citrulline were significantly lower in overweight and obese children than in the control group (p<0.03-p<0.0007). Isoleucine, leucine, valine (BCAAs) tyrosine, and phenylalanine (AAAs) levels showed a positive correlation with uric acid, ALT, hs-CRP, and chemerin (r=0.80-0.36; p<0.05-p<0.00001), but not with IL-6. The mean values of glucose, IL-6, hs-CRP, chemerin, uric acid, and ALT were significantly higher in overweight and obese children than in the control group (p<0.03-p<0.00002). In contrast, the lipid profile did not differ between groups. Conclusion An abnormal amino acid profile in overweight and obese pre-pubertal children, accompanied by elevated ALT and UA observed in the studied cohort, may suggest early metabolic disturbances that can potentially lead to metabolic syndrome, or MAFLD, and increased cardiovascular risk.
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Affiliation(s)
- Jolanta Bugajska
- Department of Clinical Biochemistry, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Berska
- Department of Clinical Biochemistry, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Krystyna Sztefko
- Department of Clinical Biochemistry, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
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Rhynehart A, Dunlevy C, Hayes K, O'Connell J, O'Shea D, O'Malley E. The Association of Physical Function Measures With Frailty, Falls History, and Metabolic Syndrome in a Population With Complex Obesity. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:716392. [PMID: 36188769 PMCID: PMC9397832 DOI: 10.3389/fresc.2021.716392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022]
Abstract
Background: Frailty, falls and metabolic syndrome are known to be associated with poorer physical function. This study builds on available research by further investigating the relationship between physical function measures, including those comprising frailty, with metabolic syndrome (MetS) and falls, in the context of complex obesity. Methods: Participants were recruited from the national Level 3 weight management service in Ireland. A retrospective audit of data gathered at initial assessment was performed. Data included past medical history, blood tests, blood pressure measurement, anthropometrics, falls history, self-reported physical activity levels (PALs) and physical function measures, including hand grip strength (HGS), “timed up and go” (TUG), functional reach (FR), sit to stand (STS) and gait speed. A modified version of the Fried Frailty Index was employed. Results: Of the 713 participants, 65.1% (n = 464) were female and 34.9% (n = 249) were male with a mean age of 44.2 (±11.7) years and body mass index (BMI) of 50.6 kg/m2 (±8.2). Frailty was identified in 3.4% (n = 24), falls in 28.8% (n = 205) and MetS in 55.1% (n = 393). Frailty was associated with older age (53.8 ± 14.3 vs. 43.9 ± 11.5 years), poorer PALs (27.29 ± 46.3 vs. 101.1 ± 147.4 min/wk), reduced grip strength (17.7 ± 4.6 vs. 34.2 ± 11.0 Kg) longer STS (21.7 ± 6.6 vs. 13.7 ± 5.7 s), shorter functional reach (29.7 ± 7.9 vs. 37.9 ± 8.2 cm) and slower gait speed (0.6 ± 0.2 vs. 1.1 ± 0.5 m/s). Those reporting a falls history had a reduced FR (35.8 ± 8.9 vs. 38.3 ± 7.8 cm) and slower STS (15.4 ± 8.0 vs. 13.3 ± 4.7 s). Participants with MetS had lower PALs (83.2 ± 128.2 vs. 119.2 ± 157.6) and gait speed (1.1 ± 0.3 vs. 1.2 ± 0.7 m/s). There was no difference in BMI between fallers and non-fallers (51.34 ± 8.44 vs. 50.33 ± 8.13 Kg/m2, p = 0.138), nor between those with or without MetS. Significant associations were found between BMI and all physical function measures except the TUAG. Conclusion: The associations between frailty, falls and MetS and their combined impact on physical function in people living with obesity demonstrates the need for appropriate screening. Utilising grip strength and gait speed to identify frailty in those with obesity and metabolic syndrome could help target therapies aimed at improving strength, physical function and ultimately quality of life.
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Affiliation(s)
- Amanda Rhynehart
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
- *Correspondence: Amanda Rhynehart ;
| | - Colin Dunlevy
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
| | - Katie Hayes
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
| | - Jean O'Connell
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
- Obesity Research Group, St Vincent's University Hospital, Dublin, Ireland
| | - Donal O'Shea
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
- Obesity Research Group, St Vincent's University Hospital, Dublin, Ireland
| | - Emer O'Malley
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
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Park Y, Oh CU. Association of lead, mercury, and cadmium with metabolic syndrome of young adults in South Korea: The Korea National Health and Nutrition Examination Survey (KNHANES) 2016. Public Health Nurs 2020; 38:232-238. [PMID: 33368607 DOI: 10.1111/phn.12855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study examines the relations between blood lead, mercury, and cadmium levels, affect metabolic syndrome of young adults. STUDY DESIGN AND PARTICIPANTS This study is a descriptive study on verifying the relation between blood lead, mercury, cadmium level, and subcategories of metabolic syndrome. A total of 823 respondents' data of 19~29 years were sampled of the Korea National Health and Nutrition Examination Survey 2016 conducted under the National Health Promotion Law. MEASUREMENT To identify the predictive risk factors of metabolic syndromes, the subcategories of metabolic syndromes and the lead, mercury, and cadmium levels were analyzed using logistic regression. Pearson's correlation was used to identify correlations among the factors. RESULTS An analysis of the correlations among the metabolic syndromes and blood levels of lead, mercury, and cadmium showed significant relationships between blood lead level and systolic pressure, diastolic pressure, waist circumference, and triglyceride level; also between blood mercury level and waist measurement and triglyceride level; and between blood cadmium level and waist circumference and triglyceride level (p < .05). CONCLUSION This study is significant in that it provides basic data on the correlation between metabolic syndromes and heavy metals among young adults.
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Affiliation(s)
- YoonJin Park
- Joongbu University, Geumsan-gun, Republic of Korea
| | - Chung Uk Oh
- Kangwon National University, Samcheok-si, Republic of Korea
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Dushnicky MJ, Nazarali S, Mir A, Portwine C, Samaan MC. Is There A Causal Relationship between Childhood Obesity and Acute Lymphoblastic Leukemia? A Review. Cancers (Basel) 2020; 12:E3082. [PMID: 33105727 PMCID: PMC7690432 DOI: 10.3390/cancers12113082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022] Open
Abstract
Childhood obesity is a growing epidemic with numerous global health implications. Over the past few years, novel insights have emerged about the contribution of adult obesity to cancer risk, but the evidence base is far more limited in children. While pediatric patients with acute lymphoblastic leukemia (ALL) are at risk of obesity, it is unclear if there are potential causal mechanisms by which obesity leads to ALL development. This review explores the endocrine, metabolic and immune dysregulation triggered by obesity and its potential role in pediatric ALL's genesis. We describe possible mechanisms, including adipose tissue attraction and protection of lymphoblasts, and their impact on ALL chemotherapies' pharmacokinetics. We also explore the potential contribution of cytokines, growth factors, natural killer cells and adipose stem cells to ALL initiation and propagation. While there are no current definite causal links between obesity and ALL, critical questions persist as to whether the adipose tissue microenvironment and endocrine actions can play a causal role in childhood ALL, and there is a need for more research to address these questions.
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Affiliation(s)
- Molly J. Dushnicky
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; (M.J.D.); (S.N.); (A.M.); (C.P.)
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Samina Nazarali
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; (M.J.D.); (S.N.); (A.M.); (C.P.)
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada
| | - Adhora Mir
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; (M.J.D.); (S.N.); (A.M.); (C.P.)
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada
| | - Carol Portwine
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; (M.J.D.); (S.N.); (A.M.); (C.P.)
- Division of Pediatric Hematology/Oncology, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Muder Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada; (M.J.D.); (S.N.); (A.M.); (C.P.)
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
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Excess serum uric acid is associated with metabolic syndrome in obese adolescent patients. J Diabetes Metab Disord 2020; 19:535-543. [PMID: 32548073 PMCID: PMC7270295 DOI: 10.1007/s40200-020-00507-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/06/2020] [Indexed: 01/09/2023]
Abstract
Purpose Obesity is a significant cause of morbidity in adolescents. Excess serum uric acid (SUA) has been associated with metabolic syndrome (MS) among adults. We evaluated the relationship among SUA and markers of insulin resistance (IR) and low-grade inflammation in obese adolescents with and without MS. Methods The study was a retrospective chart review of obese patients seen in the LeBonheur Endocrine clinic seen in clinic between September 2016 and December 2017. MS was defined as according to the International Diabetes Federation. Body mass index standard deviation score (BMI SDS), systolic blood pressure (SBP), diastolic blood pressure (DBP), body composition, fasting lipids, glucose, high sensitivity c-reactive protein (hs-CRP), serum uric acid (SUA), HbA1c, alanine transferase (ALT), aspartate transferase (AST), insulin and homeostatic model assessment for insulin resistance (HOMA-IR) were extracted from the charts of the 100 obese adolescents (57% female). Results Hyperuricemia (SUA >357 umol/L) was present in 41.8% of entire cohort without significant ethnic/racial and/or gender differences. Adolescents with HUA had higher FM, SBP, HbA1c, insulin and HOMA-IR (p < 0.05). While SUA was positively correlated with FM, SBP, HOMA-IR and HbA1c, and triglyceride:HDL-C ratio (TG:HDL-C) (p < 0.05). MS was identified in 32.8% of cohort. MS showed significantly higher FM, SBP, DBP, SUA, ALT, insulin, HOMA-IR, and TG:HDL-c ratio than non-MS subgroup (p < 0.05). FM was positively correlated with SUA, HOMA-IR and hsCRP (p < 0.01). Conclusions In our study, those with hyperuricemia (HUA) showed elevated markers of metabolic syndrome including BP, serum glucoses, IR and triglycerides. In our cohort, SUA appears to correlate with MS comorbidities.
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Niu Z, Zhang P, Li D, Zhu C, Feng L, Xiong G, Song N, Tang P, Liu F. Association of Apolipoprotein E Polymorphisms with White Matter Lesions and Brain Atrophy. Psychiatry Investig 2020; 17:96-105. [PMID: 32000479 PMCID: PMC7047002 DOI: 10.30773/pi.2019.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/28/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Apolipoprotein E (ApoE) is mainly synthesized in the liver. So far, it is unknown the relationship among APOE gene polymorphisms and WML, brain atrophy. Therefore, the aim of the study was to assess the associations of APOE gene polymorphisms in patients with WML and brain atrophy. METHODS A total of 58 patients with WML, 128 patients with brain atrophy, 112 patients with co-occurrence of WML and brain atrophy and 95 healthy elderly volunteers were recruited from Renmin Hospital of WuHan University. RESULTS Allele E3 was the most common allele. The alleles E2 had significantly higher levels of ApoB and lower age in WML group. The alleles E2 was associated with the lower level of ApoB, LDL-Ch, TCh, and sdLDL in co-occurrence group. The E3/E3 genotype has higher level of sdLDL, but lower age and female frequency in WML. The E3/E4 genotype had higher level of TG, but lower age in WML. Gender, Age, E2, Hyperhomocysteinemia and UA were also significantly associated with disease progression. CONCLUSION This study found that clinical data, lipids and metabolic complications were closely related to ApoE genotypes and alleles, and also disease progression and type.
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Affiliation(s)
- ZhiLi Niu
- Department of Laboratory Science, Renmin Hospital of WuHan University, Wuhan, China
| | - PingAn Zhang
- Department of Laboratory Science, Renmin Hospital of WuHan University, Wuhan, China
| | - Dong Li
- Department of Laboratory Science, Renmin Hospital of WuHan University, Wuhan, China
| | - ChengLiang Zhu
- Department of Laboratory Science, Renmin Hospital of WuHan University, Wuhan, China
| | - LiNa Feng
- Department of Laboratory Science, Renmin Hospital of WuHan University, Wuhan, China
| | - Ge Xiong
- Department of Laboratory Science, Renmin Hospital of WuHan University, Wuhan, China
| | - NaNa Song
- Department of Laboratory Science, Renmin Hospital of WuHan University, Wuhan, China
| | - Pei Tang
- Department of Laboratory Science, Renmin Hospital of WuHan University, Wuhan, China
| | - Feng Liu
- Department of Laboratory Science, Renmin Hospital of WuHan University, Wuhan, China
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Kayemba-Kay's S, Maillet O, Hindmarsh P, Heron A. Growth screening in children aged 3-5 years: a useful tool for public health programs in community pediatrics. J Pediatr Endocrinol Metab 2019; 32:727-732. [PMID: 31216265 DOI: 10.1515/jpem-2018-0545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/04/2019] [Indexed: 11/15/2022]
Abstract
Background About 90% of children grow up normally and attain a final height within their genetic target. In children with intrauterine growth restriction (IUGR), up to 10% will not catch up spontaneously. Turner syndrome is often diagnosed late, and a number of growth-stunted children go undiagnosed and untreated. Objectives Our primary aim was to evaluate the prevalence of stunted growth in preschool-aged children. Our secondary aim was to evaluate growth patterns in children belonging to four ethnic groups in Dreux district, France. Methods Body weight, height and body mass index (BMI) were collected for children aged 3-5 years during systematic community visits. Birth variables, family history of short stature, maternal smoking, ethnic origin, etc. were also recorded. Pubertal status was staged as per Tanner's method. Parents were instructed to attend the hospital growth clinics if their child's height was <-2.0 standard deviation score (SDS). Results Five hundred ninety-three children were screened (301 boys, 289 girls). The mean age was 4.33 ± 0.76 standard deviation (SD) years, and 48% were Caucasians, 13.7% were North Africans, 2.5% were Black Africans, 0.8% were Asians, 1.5% included others and the ethnicity was not specified in 33.5% of the cases. 91.5% of children were term-born and 8.5% were preterm. 84.2% of children were appropriate for gestational age (AGA) and 9.4% were small for gestational age (SGA). At 5 years of age, 22.2% of macrosomic North African children were overweight. Catch-up growth was complete in 98% children, 11/540 were short statured, 8/11 attended our growth clinics (seven short statured and one micropenis) and three were started on recombinant human growth hormone (rhGH). Conclusions Growth screening programs are important and useful tools for public health. There is a need for clear objectives, proper training and automated data collection tools, along with easy access to growth specialists.
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Affiliation(s)
- Simon Kayemba-Kay's
- Department of Pediatrics and Neonatology, Centre Hospitalier du Valais Romand, Rue du Grand Champsec 86, 1950 Sion, Switzerland.,Pediatric Endocrinology Unit, Department of Pediatrics, Victor Jousselin Hospital, Dreux, France.,Clinical Research Unit, Victor Jousselin Hospital, Dreux, France.,Developmental Endocrinology Research Group, University College London, London, UK
| | - Odile Maillet
- Clinical Research Unit, Victor Jousselin Hospital, Dreux, France
| | - Peter Hindmarsh
- Developmental Endocrinology Research Group, University College London, London, UK
| | - Anne Heron
- Clinical Research Unit, Victor Jousselin Hospital, Dreux, France.,Université Paris Descartes, Paris, France
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Ba HJ, Xu LL, Qin YZ, Chen HS. Serum Chemerin Levels Correlate With Determinants of Metabolic Syndrome in Obese Children and Adolescents. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2019; 13:1179556519853780. [PMID: 31217700 PMCID: PMC6557013 DOI: 10.1177/1179556519853780] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 04/26/2019] [Indexed: 12/12/2022]
Abstract
Objectives This study aimed to investigate serum chemerin concentrations in obese children and adolescents and to investigate the associations of chemerin with body mass index (BMI), lipid levels, and insulin sensitivity. Methods Forty-eight obese and 40 nonobese Chinese children and adolescents were included in the study. BMI and levels of chemerin, lipids, glucose, and insulin were measured following an overnight fast. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and BMI standard deviation score (BMI-SDS) were determined for all participants. Results Serum chemerin levels were found to be significantly higher in obese children and adolescents than in control group members (94.83 ± 5.99 ng/mL vs 56.43 ± 4.16 ng/mL, P < .001). There were significant correlations between chemerin and age, BMI, BMI-SDS, total triglyceride (TG) levels, insulin levels, and HOMA-IR. After controlling for age, we found that chemerin levels were also significantly correlated with BMI-SDS (r =+ 0.284, P = .008) and HOMA-IR (r =+ 0.241, P = .034). In a stepwise multiple regression analysis, we observed only BMI-SDS to be an important determinant of chemerin level. Conclusions In our sample of Chinese children and adolescents, chemerin levels were significantly higher in the obese group than in the control group. Chemerin levels were positively correlated with BMI-SDS and HOMA-IR and negatively correlated with age. We thus believe that further study is necessary to investigate the risk of metabolic abnormalities in young obese children and adolescents.
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Affiliation(s)
- Hong-Jun Ba
- Department of pediatric cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ling-Ling Xu
- Pediatric Department, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - You-Zhen Qin
- Department of pediatric cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong-Shan Chen
- Pediatric Department, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Roth CL, Jain V. Rising Obesity in Children: A Serious Public Health Concern. Indian J Pediatr 2018; 85:461-462. [PMID: 29455329 DOI: 10.1007/s12098-018-2639-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Christian L Roth
- Division of Endocrinology and Diabetes, Department of Pediatrics, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Vandana Jain
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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