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Hewage N, Wijesekara U, Perera R. Insulin Resistance-Related Cardiometabolic Risk Among Nondiabetic Childbearing Age Females. Metab Syndr Relat Disord 2024. [PMID: 38603585 DOI: 10.1089/met.2024.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Background: This study evaluates insulin resistance prevalence in young females without diabetes, assessing risk factors and adiposity indices for early detection of cardiometabolic disorders. Methods: A cross-sectional study was conducted, involving 282 females aged 18-35 years from suburban and rural areas of Sri Lanka. Anthropometric measurements [height, weight, waist circumference (WC)] were obtained and biochemical parameters [fasting glucose, insulin, insulin resistance (IR), total cholesterol, high-density lipoproteins, (HDL), low-density lipoproteins, triglycerides] were measured. The anthropometric and biochemical data were compared between the groups of normal weight controls and overweight/obese cases, as well as between females with or without IR. Results: The prevalence of IR in controls and cases were 48.6% and 57.1%, respectively. Both groups had mean Homeostasis Model Assessment-IR values greater than the normal cutoff value of 2.5. Females with IR showed higher prevalence of dyslipidemia than those without IR. Compared to the controls (2.81%), the prevalence of metabolic syndrome (MetS) was substantially greater among cases (46.42%). Both groups showed a statistically significant association between IR and MetS, but the association was considerably stronger in cases [r = 0.616, odds ratio (OR) >8] than in controls (r = 0.175, OR >1). Controls exhibited lower HDL levels, hypertriglyceridemia, and elevated IR levels (P < 0.05), and their ORs for acquiring MetS were >2, <1, and >3, respectively. Importantly, overweight/obese cases exhibited a significant association (P < 0.05) with all the MetS risk variables. Visceral adiposity index (VAI) proves to be a precise measurement for identifying IR and cardiovascular disease (CVD) among young females (Z = -3.651), surpassing the accuracy of other indices. Body mass index, body round index, a body shape index, and WC were also reliable measurements to assess IR and the risk of CVD (P < 0.05). Conclusion: The study underscores the importance of assessing IR in nondiabetic young females to identify early cardiometabolic risks. VAI emerges as a precise measurement for identifying IR and CVD risk, surpassing the accuracy of other indices.
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Affiliation(s)
- Nawoda Hewage
- Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Udaya Wijesekara
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Rasika Perera
- Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Orsso CE, Vieira FT, Basuray N, Duke RL, Pakseresht M, Rubin DA, Ajamian F, Ball GDC, Field CJ, Heymsfield SB, Siervo M, Prado CM, Haqq AM. The metabolic load-capacity model and cardiometabolic health in children and youth with obesity. Pediatr Obes 2024; 19:e13098. [PMID: 38263541 DOI: 10.1111/ijpo.13098] [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: 08/25/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND The metabolic load-capacity index (LCI), which represents the ratio of adipose to skeletal muscle tissue-containing compartments, is potentially associated with cardiometabolic diseases. OBJECTIVES To examine the associations between the LCI and cardiometabolic risk factors in children and youth with obesity. METHODS This is a cross-sectional study including 10-18 years-old participants with a BMI of ≥95th . LCI by air-displacement plethysmography (ADP) was calculated as fat mass divided by fat-free mass, and LCI by ultrasound (US) as subcutaneous adipose tissue divided by skeletal muscle thickness. Sex-specific medians stratified participants into high versus low LCI. Single (inflammation, insulin resistance, dyslipidemia and hypertension) and clustered cardiometabolic risk factors were evaluated. Linear and logistic regression models tested the associations between these variables, adjusted for sexual maturation. RESULTS Thirty-nine participants (43.6% males; 59% mid-late puberty) aged 12.5 (IQR: 11.1-13.5) years were included. LCI by ADP was positively associated with markers of inflammation and dyslipidemia; having a higher LCI predicted dyslipidemia in logistic regression. Similarly, LCI by US was positively associated with markers of dyslipidemia and blood pressure. In mid-late pubertal participants, LCI by US was positively associated with markers of insulin resistance and inflammation. CONCLUSIONS Participants with unfavourable cardiometabolic profile had higher LCI, suggesting its potential use for predicting and monitoring cardiometabolic health in clinical settings.
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Affiliation(s)
- Camila E Orsso
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Flavio T Vieira
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Nandini Basuray
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Reena L Duke
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammadreza Pakseresht
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
- Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - Daniela A Rubin
- Department of Kinesiology, California State University Fullerton, Fullerton, California, USA
| | - Faria Ajamian
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Steven B Heymsfield
- Pennington Biomedical Research Center Baton Rouge, Baton Rouge, Louisiana, USA
| | - Mario Siervo
- School of Population Health, Curtin University, Perth, Australia
- Curtin Dementia Centre of Excellence, enAble Institute, Curtin University, Perth, Australia
| | - Carla M Prado
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea M Haqq
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Czeck MA, Juckett WT, Kelly AS, Dengel DR. Muscle-to-Bone and Soft Tissue-to-Bone Ratio in Children and Adolescents with Obesity. J Clin Densitom 2023; 26:101360. [PMID: 36931949 PMCID: PMC10175141 DOI: 10.1016/j.jocd.2023.02.001] [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: 01/11/2023] [Revised: 01/31/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To explore the total and regional muscle-to-bone ratio in children and adolescents with obesity and compare the muscle-to-bone ratio (MBR) and soft tissue-to-bone ratio (SBR) to their peers with normal weight or overweight. STUDY DESIGN A total of 219 male and female pediatrics (mean age=12.3±2.5 years) participated in this study. Body composition was assessed with a total body dual X-ray absorptiometry. The MBR was calculated by dividing lean mass by bone mineral content. The SBR was determined by dividing the soft tissue mass (i.e., lean mass+fat mass) by bone mineral content. Differences in total and regional body composition measures between body mass index (BMI) percentile groups was assessed by ANOVA. RESULTS The obesity group had significantly higher MBR compared to the normal weight group for total (19.24±1.56 vs. 18.26±1.64), arm (17.11±1.67 vs. 15.88±1.81), and leg (18.41±1.68 vs. 16.62±1.55). Similarly, the obesity group had significantly higher MBR in the leg (18.41±1.68) compared to the overweight group (17.24±1.45). However, the overweight group was not significantly different from the normal weight or the obesity group for total and arm MBR. The total, arm, and leg SBR was significantly different between all BMI groups. Across the entire sample, MBR and SBR were negatively associated with high-density lipoprotein. SBR was positively associated with insulin, HOMA-IR, low-density lipoprotein, very low-density lipoprotein, triglycerides, and systolic blood pressure. CONCLUSIONS Children with obesity had a higher MBR and SBR compared to their normal weight peers. In addition, there were significant associations between SBR, higher levels of insulin, atherogenic lipoproteins, and increased systolic blood pressure. Thus, SBR may be useful as a marker for increased cardiometabolic disease risk, though more research in this area is warranted.
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Affiliation(s)
- Madeline A Czeck
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, United States.
| | - William T Juckett
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, United States
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN 55414, United States; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, United States
| | - Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, United States; Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN 55414, United States; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, United States
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Ma CM, Lu N, Zhang MM, Kong FS, Lu Q, Yin FZ, Zhang X, Wang R. The relationship between obesity and bone mineral density in children and adolescents: analysis of the National Health and Nutrition Examination Survey. Arch Osteoporos 2023; 18:25. [PMID: 36689089 DOI: 10.1007/s11657-022-01208-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 12/20/2022] [Indexed: 01/24/2023]
Abstract
Childhood and puberty are important period for the skeleton grows. Fat mass, especially visceral adipose tissue, was negatively correlated with areal bone mineral density in children and adolescents. The present study suggests that fat mass, especially visceral adipose tissue, has a slightly negative association with bone development in children and adolescents. PURPOSE This study observed the relationship between fat mass and distribution, and areal bone mineral density (aBMD) in children and adolescents. METHODS A retrospective study was conducted on US children and adolescents aged 8-19 years. Whole body (less head) aBMD was evaluated. Height (Ht) adjusted Z-scores for aBMD were calculated. RESULTS After controlling for age, gender, race, and lean body mass index (LBMI) Z-score, there were significant negative associations between fat mass index (FMI) Z-score and aBMD Ht-Z-adjusted Z-score (β = - 0.272, P < 0.001, R2 = 0.033). In the linear regression models with aBMD Ht-Z-adjusted Z-score as the dependent variable, the regression coefficients of android fat mass were - 0.241 (P < 0.05, R2 = 0.002), - 0.473 (P < 0.001, R2 = 0.036), and - 0.474 (P < 0.001, R2 = 0.038) for healthy weight, overweight, and obesity group, respectively. The regression coefficients of visceral adipose tissue (VAT) mass were - 0.218 (P > 0.05, R2 = 0.001), - 2.025 (P < 0.001, R2 = 0.044), and - 1.826 (P < 0.001, R2 = 0.039), and the regression coefficients of subcutaneous adipose tissue (SAT) mass were - 0.467 (P < 0.001, R2 = 0.004), - 0.339 (P < 0.01, R2 = 0.024), and - 0.347 (P < 0.001, R2 = 0.018) for healthy weight, overweight, and obesity group, respectively. CONCLUSIONS The present study suggests that fat mass has a slightly negative association with bone development in children and adolescents. Trunk fat accumulation, especially visceral adipose tissue, was correlated with the lower level of aBMD. This association was obvious in overweight and obese children.
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Affiliation(s)
- Chun-Ming Ma
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Na Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Meng-Meng Zhang
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Fan-Shuo Kong
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Qiang Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Fu-Zai Yin
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Xu Zhang
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Rui Wang
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China.
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Liu Z, Asuzu P, Patel A, Wan J, Dagogo-Jack S. Association of bone mineral density with prediabetes risk among African-American and European-American adult offspring of parents with type 2 diabetes. Front Endocrinol (Lausanne) 2023; 13:1065527. [PMID: 36686435 PMCID: PMC9849381 DOI: 10.3389/fendo.2022.1065527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is associated with alterations in bone mineral density (BMD), but association between prediabetes and BMD is unclear. Methods We analyzed BMD among the initially normoglycemic participants in the Pathobiology of Prediabetes in a Biracial Cohort (POP-ABC) study in relation to incident prediabetes during 5 years of follow-up. Results and Discussion A total of 343 participants (193 Black, 150 White) underwent DEXA during Year 1 of POP-ABC and were followed quarterly for 5 years. The mean age was 44.2 ± 10.6 years; BMI was 30.2 ± 7.23 kg/m2. At baseline, the mean BMD was 1.176 ± 0.135 g/cm2 (1.230 ± 0.124 g/cm2 in men vs. 1.154 ± 0.134 g/cm2 in women, P<0.0001; 1.203 ± 0.114 g/cm2 in Black vs. 1.146 ± 0.150 g/cm2 in White participants, P=0.0003). During 5 years of follow-up, 101 participants developed prediabetes and 10 subjects developed T2DM (progressors); 232 were nonprogressors. Progressors to prediabetes had numerically higher baseline BMD and experienced lower 1-year decline in BMD (P<0.0001) compared with nonprogressors. From Kaplan-Meier analysis, the time to 50% prediabetes survival was 2.15 y among participants in the lowest quartile of baseline BMD, longer than those in higher quartiles (1.31 - 1.41 y). Values for BMD correlated inversely with age and adiponectin levels, and positively with BMI. In logistic regression analysis, BMD z score significantly predicted incident prediabetes: more negative BMD z scores were associated with decreased incident prediabetes (odds ratio 0.598 [95% confidence interval 0.407 - 0.877], P=0.0085), after controlling for age, BMI, change in BMI, ethnicity, blood glucose and adiponectin. Conclusions Among initially normoglycemic individuals, higher baseline BMD was associated with higher risk of incident prediabetes during 5 years of follow-up.
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Affiliation(s)
- Zhao Liu
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Peace Asuzu
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Avnisha Patel
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Jim Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sam Dagogo-Jack
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
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Mengel E, Tamme R, Remmel L, Purge P, Mäestu E, Jürimäe J, Tillmann V. Pubertal increment in insulin resistance is negatively related to lumbar bone mineral density in 18-year-old males. Osteoporos Int 2023; 34:161-170. [PMID: 36367566 DOI: 10.1007/s00198-022-06591-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
UNLABELLED Transient insulin resistance seen during puberty is expected to favour body growth, but our results show that increment in insulin resistance even in physiological ranges during puberty might compromise lumbar spine bone mineral density accrual independently of body composition parameters, and therefore adult bone quality might be challenged. INTRODUCTION Insulin resistance (IR) might have a compromising effect on growing bone, and therefore adult bone quality might be challenged. The aim of the present study was to identify whether increases in IR during puberty contribute to bone mineral characteristics in males independently of body composition parameters. METHODS This is a retrospective cohort-based longitudinal observational study. Data from 85 subjects were included. Boys were studied annually during their pubertal years (12 years at baseline) and at follow-up at the age of 18 years. Anthropometry, bone age, fasting blood samples, body composition, total body, and lumbar spine bone mineral characteristics were measured. Insulin resistance was determined by homeostatic model assessment of IR (HOMA-IR). Multiple regression analysis was performed to determine the effect of changes in HOMA-IR during pubertal years as a longitudinal predictor to fixed bone mineral outcome variables at the age of 18 years. All models were adjusted to potential clinically justified confounding variables. RESULTS After adjustment to baseline bone indices and body composition-related predictors, the pubertal increment in the HOMA-IR was a negative independent predictor of lumbar spine bone mineral areal density (β = - 0.202, p = 0.005) and lumbar spine bone mineral apparent density (β = - 0.235, p = 0.005) in 18-year-old males. CONCLUSIONS Pubertal increment in IR has a potential diminishing effect on lumbar spine bone mineral density accrual independently of body composition parameters. Further studies are needed to clarify whether monitoring HOMA-IR during puberty may identify subjects at increased risk of low peak bone mass and possible osteoporosis in the future.
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Affiliation(s)
- Eva Mengel
- Institute of Clinical Medicine, University of Tartu, 51007, Tartu, Estonia.
- Tartu Health Care College, 50411, Tartu, Estonia.
| | - Reeli Tamme
- Institute of Clinical Medicine, University of Tartu, 51007, Tartu, Estonia
- Children's Clinic of Tartu University Hospital, 50406, Tartu, Estonia
| | - Liina Remmel
- Institute of Sports Sciences and Physiotherapy, University of Tartu, 51007, Tartu, Estonia
| | - Priit Purge
- Institute of Sports Sciences and Physiotherapy, University of Tartu, 51007, Tartu, Estonia
| | - Evelin Mäestu
- Institute of Sports Sciences and Physiotherapy, University of Tartu, 51007, Tartu, Estonia
| | - Jaak Jürimäe
- Institute of Sports Sciences and Physiotherapy, University of Tartu, 51007, Tartu, Estonia
| | - Vallo Tillmann
- Institute of Clinical Medicine, University of Tartu, 51007, Tartu, Estonia
- Children's Clinic of Tartu University Hospital, 50406, Tartu, Estonia
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Akduman F, Şıklar Z, Özsu E, Doğan Ö, Kır MK, Berberoğlu M. Fibroblast Growth Factor 21 Levels and Bone Mineral Density in Metabolically Healthy and Metabolically Unhealthy Obese Children. J Clin Res Pediatr Endocrinol 2022; 14:433-443. [PMID: 35859690 PMCID: PMC9724058 DOI: 10.4274/jcrpe.galenos.2022.2022-1-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The harmful or beneficial effect of obesity on bone mineral density (BMD) remains controversial in children and adolescents. Fibroblast growth factor 21 (FGF21) is a metabolic factor that plays a specific role in the regulation of carbohydrate and lipid metabolism. However, the role of FGF21 in bone metabolism appears paradoxical and is complex. To determine whether serum FGF21 level was associated with BMD in obese children and adolescents. METHODS The study was conducted with the participation of children and adolescents aged 8-18 years. Ninety-eight obese children were included in the study group and 44 children were included in the control group. BMD, in addition to the routine obesity workup, which includes fasting blood glucose, fasting insulin levels, lipid profile, and liver enzymes; serum FGF21 levels have been analyzed. RESULTS The mean age of the obese group (n=98) was 13.34±2.24 years and the mean age of controls (n=44) was 13.48±2.87 years. Based on International Diabetes Federation criteria, 15 of 98 (15.3%) patients were metabolically unhealthy. FGF21 levels were 193.54±139.62 mg/dL in the obese group and 158.69±151.81 mg/dL in the control group (p=0.06). There was no difference between the FGF21 and BMD z-score values of girls and boys in the obese and control groups (p>0.05). CONCLUSION BMD-z-score was increased in obese children compared to healthy control. Moreover, BMD-z-score tended to be higher when more metabolic risk factors were present. However, there was no significant relationship between FGF21 levels and BMD z-score values in obese children.
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Affiliation(s)
- Filiz Akduman
- Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey,* Address for Correspondence: Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey Phone: +90 507 443 24 42 E-mail:
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Elif Özsu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Özlem Doğan
- Ankara University Faculty of Medicine, Department of Clinical Biochemistry, Ankara, Turkey
| | - Metin Kemal Kır
- Ankara University School of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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The Relationship between Anthropometric Measurements and Vitamin D Levels and Insulin Resistance in Obese Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121837. [PMID: 36553281 PMCID: PMC9776708 DOI: 10.3390/children9121837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
Objective: Our investigation aimed to determine the effect of vitamin D levels on the development of insulin resistance in obese adolescents and children and the influences of anthropometric measurements on predicting the development of insulin resistance. Materials and Methods: In this study, demographic data, laboratory findings, and anthropometric measurements of 150 adolescents and children that had obesity diagnoses between May 2021 and September 2022 were evaluated retrospectively. Those with and without insulin resistance were studied with regard to vitamin D levels, biochemical parameters, and anthropometric measurements. Three groups of patients were created: those with low levels of vitamin D (<20 ng/mL), those with insufficient levels (20−30 ng/mL), and those having normal levels (≥30 ng/mL). Groups were compared in terms of homeostatic model score (HOMA-IR) and anthropometric measurements. Correlation analysis was carried out to ascertain the correlation of anthropometric measurements with HOMA-IR. To ascertain the cutoff, specificity, and sensitivity values of anthropometric parameters in predicting insulin resistance in patients, receiver operating characteristic (ROC) analysis was carried out. Results: Vitamin D levels of obese adolescents and children with insulin resistance were substantially lower than those without insulin resistance (p < 0.001). As the vitamin D level increased, all anthropometric measurements except for the body fat percentage decreased significantly with the HOMA-IR score (p < 0.05). HOMA-IR demonstrated a strong positive relation with waist circumference (rs = 0.726, p < 0.001). Waist circumference had high specificity and sensitivity in predicting insulin resistance (87.3% and 87.4%, respectively). Conclusions: A significant relationship was observed between insulin resistance development and low levels of vitamin D in obese children and adolescents. As vitamin D levels increase, anthropometric measurements are more stable and do not increase. Waist circumference is the most effective anthropometric measurement for predicting the development of insulin resistance in obese adolescents and children.
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Wang XX, Lin KN, Xu WC, Chen H. The causal relationship between abdominal obesity and lower bone mineral density: A two-sample mendelian randomization study. Front Genet 2022; 13:970223. [PMID: 36313427 PMCID: PMC9606644 DOI: 10.3389/fgene.2022.970223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
Aims: The purpose of this study was to assess the causal effect of abdominal obesity on bone mineral density by two-sample Mendelian randomization (MR). Methods: Abdominal obesity was chosen as exposure in this study. Single nucleotide polymorphisms, extracted from Genome-wide association analysis (GWAS) data, which are closely associated with waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR) were used as instrumental variables to perform MR studies. Different site bone mineral density, such as total bone mineral density (TBMD) and forearm bone mineral density (FBMD) were chosen as outcomes. Inverse variance weighted (IVW) was used as the primary method to assess this causality. Results: According to the IVW method (β = −0.177; 95% CI = −0.287, −0.067; p = 1.52 × 10–3), WC had a negative causal relationship with TBMD, besides, with one standard deviation (SD) higher in HC, there was a 0.195 SD decrease in TBMD (95% CI = −0.279, −0.110; p = 6.32 × 10–6), and with an increase of one SD in HC was related to a decrease of 0.312 SD in FBMD analyzed by the IVW. Conclusion: This study showed that abdominal obesity has a negative effect on bone mineral density.
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Affiliation(s)
- Xiang-xuan Wang
- Department of Pediatric Orthopedics, Fujian Branch of Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, China
- Department of Pediatric Orthopedics, Fujian Children’s Hospital, Fuzhou, China
- Department of Pediatric Orthopedics, Fujian Children’s Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Kai-nan Lin
- Department of Pediatric Orthopedics, Fujian Branch of Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, China
- Department of Pediatric Orthopedics, Fujian Children’s Hospital, Fuzhou, China
- Department of Pediatric Orthopedics, Fujian Children’s Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wen-chen Xu
- Department of Pediatric Orthopedics, Fujian Branch of Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, China
- Department of Pediatric Orthopedics, Fujian Children’s Hospital, Fuzhou, China
- Department of Pediatric Orthopedics, Fujian Children’s Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hui Chen
- Department of Pediatric Orthopedics, Fujian Branch of Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, China
- Department of Pediatric Orthopedics, Fujian Children’s Hospital, Fuzhou, China
- Department of Pediatric Orthopedics, Fujian Children’s Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- *Correspondence: Hui Chen,
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Shawar RS, Puyau M, Shypailo R, Musaad S, Butte NF, Bacha F. Adiposity, Insulin Resistance, Cardiorespiratory Fitness, and Bone Health in Hispanic Children. J Clin Endocrinol Metab 2022; 107:e3797-e3804. [PMID: 35662345 PMCID: PMC9387690 DOI: 10.1210/clinem/dgac344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Childhood obesity disproportionately affects Hispanic youth. The skeletal system appears to be a target organ of the adverse effects of obesity. Yet, the relationship between adiposity and bone health in youth and the modulating factors are not well understood. OBJECTIVE This work aims to examine the relationship between adiposity, insulin resistance (IR), cardiorespiratory fitness (CRF), and bone mass in Hispanic youth. METHODS A total of 951 Hispanic youth (50% male), aged 4 to 19 years, participated in this cross-sectional design study from the Viva La Familia Study at Children's Nutrition Research Center. Bone mineral content (BMC) and density (BMD), lean mass (LM), total body fat mass (FM), truncal FM were obtained using dual-energy x-ray absorptiometry. Fasting glucose and insulin were obtained and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. CRF was measured using a treadmill ramp protocol. We applied linear regression models and mediation analyses. RESULTS Adiposity measures were negatively related to BMC and BMD after accounting for LM and sex. IR negatively contributed whereas CRF positively contributed to the variance in BMC and BMD, more notably in the pubertal age group. In mediation analysis, HOMA-IR partially mediated the negative relationship of adiposity to BMC (standardized indirect effect [IE] = -0.0382; 95% CI, -0.0515 to -0.0264) whereas the sequential IE of HOMA-IR and CRF partially attenuated (IE = -0.0026; 95% CI, -0.0053 to -0.0005) this relationship. Similar findings were seen with BMD as the primary outcome. CONCLUSION IR mediates the negative relationship between adiposity and bone mass whereas CRF may partially attenuate it.
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Affiliation(s)
- Reem S Shawar
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
- Division of Pediatric Endocrinology and Diabetes, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Maurice Puyau
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Roman Shypailo
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Salma Musaad
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Nancy F Butte
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Fida Bacha
- Correspondence: Fida Bacha, MD, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, 1100 Bates S, Houston, TX 77030, USA.
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11
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Ma CM, Lu N, Kong FS, Zhang X, Wang R, Yin FZ. The relationship between metabolic syndrome and bone mineral density in adolescents: analysis of the National Health and Nutrition Examination Survey. J Pediatr Endocrinol Metab 2022; 35:901-912. [PMID: 35660132 DOI: 10.1515/jpem-2022-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to observe the relationship between metabolic syndrome (MetS) and height (Ht) adjusted Z-scores for areal bone mineral density (aBMD) in adolescents. METHODS A retrospective study was conducted on the United States adolescents aged 12-17 years. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2011-2012, 2013-2014 and 2015-2016 cycles. Ht adjusted Z-scores for aBMD were calculated. RESULTS A total of 969 adolescents (493 boys and 476 girls), aged 14.5 ± 1.7 years were enrolled in this study. After control for age, gender, race, 25-hydroxyvitamin D [25(OH)D], and lean body mass index (LBMI) Z-score, adolescents with MetS had significantly lower levels of total body (less head) aBMD Ht-Z-adjusted Z-score than adolescents with one, two components of MetS and without component of MetS (p<0.05) and significantly lower levels of lumbar spine aBMD Ht-Z-adjusted Z-score than adolescents with one component of MetS and without component of MetS (p<0.05). There were significantly negative associations between total body (less head) aBMD Ht-Z-adjusted Z-score and waist circumference (WC) (β=-0.027, p<0.001, R2=0.057) and homeostasis model assessment insulin resistance (HOMA-IR) (β=-0.225, p<0.001, R2=0.016). There were significantly negative associations between lumbar spine aBMD Ht-Z-adjusted Z-score and WC (β=-0.039, p<0.001, R2=0.058) and HOMA-IR (β=-0.251, p<0.001, R2=0.008). CONCLUSIONS The present study demonstrates that MetS may have a negative effect on bone mineral density in adolescents. Abdominal obesity and insulin resistance play a major role on the decline of aBMD in adolescents.
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Affiliation(s)
- Chun-Ming Ma
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, P.R. China
| | - Na Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, P.R. China
| | - Fan-Shuo Kong
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, P.R. China
| | - Xu Zhang
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, P.R. China
| | - Rui Wang
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, P.R. China
| | - Fu-Zai Yin
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, P.R. China
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Chen F, Liu J, Hou D, Li T, Chen Y, Liao Z, Wu L. The Relationship between Fat Mass Percentage and Glucose Metabolism in Children and Adolescents: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14112272. [PMID: 35684072 PMCID: PMC9183098 DOI: 10.3390/nu14112272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 12/04/2022] Open
Abstract
To assess the relationship between fat mass percentage (FMP) and glucose metabolism in children aged 0−18 years we performed a systematic review of the literature on Medline/PubMed, SinoMed, Embase and Cochrane Library using the PRISMA 2020 guidelines up to 12 October 2021 for observational studies that assessed the relationship of FMP and glucose metabolism. Twenty studies with 18,576 individuals were included in the meta-analysis. The results showed that FMP was significantly associated with fasting plasma glucose (FPG) (r = 0.08, 95% confidence interval (CI): 0.04−0.13, p < 0.001), fasting plasma insulin (INS) (r = 0.48, 95% CI: 0.37−0.57, p < 0.001), and homeostasis model assessment (HOMA)- insulin resistance (IR) (r = 0.44, 95% CI: 0.33−0.53, p < 0.001). The subgroup analysis according to country or overweight and obesity indicated that these associations remained significant between FMP and INS or HOMA-IR. Our results demonstrated that there is a positive relationship between FMP and FPG. Moreover, subgroup analysis according to country or overweight and obesity indicated that FMP is significantly associated with INS and HOMA-IR. This is the first known systematic review and meta-analysis to determine the associations of FMP with glucose metabolism in children and adolescents.
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Affiliation(s)
- Fangfang Chen
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China; (F.C.); (Y.C.)
| | - Junting Liu
- Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing 100020, China; (J.L.); (D.H.); (T.L.)
| | - Dongqing Hou
- Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing 100020, China; (J.L.); (D.H.); (T.L.)
| | - Tao Li
- Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing 100020, China; (J.L.); (D.H.); (T.L.)
| | - Yiren Chen
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China; (F.C.); (Y.C.)
| | - Zijun Liao
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing 100020, China;
| | - Lijun Wu
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China; (F.C.); (Y.C.)
- Correspondence: ; Tel.: +86-10-85695537
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Flores L, Fragoso I, De León LG, Ortiz-Rodríguez B, Candia-Luján R, Carrasco-Legleu C. Moderating effect of bone maturation on the relationship between body fat and insulin resistance. J Pediatr Endocrinol Metab 2022; 35:577-583. [PMID: 35325514 DOI: 10.1515/jpem-2021-0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/19/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the present study was to analyze the moderating effect of maturation on the relationship between body fat and insulin resistance, in children from 9 to 12 years. METHODS Maturity offset, homeostasis model assessment index of insulin resistance (HOMA-IR), and body fat percentage (BF%) were estimated in 127 children. Skeletal maturation indicator (SMI) was estimated in 105 participants. A moderation analysis based on a linear regression and on Johnson-Neyman technique was performed using a 95% confidence level. RESULTS BF%, insulin levels, and HOMA-IR values were lower in late maturers than on-time maturers (p<0.05). SMI moderated the relationship between BF% and HOMA-IR index in 11.1% of boys and in 32.5% of girls (p<0.05). Also, the highest values of HOMA-IR index were observed at -1 year to achieve the peak height velocity, in girls (p<0.05). CONCLUSIONS Maturation process has a moderation effect on the relationship BF% and insulin resistance, particularly in early maturers; furthermore, it was independently associated with HOMA-IR.
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Affiliation(s)
- Luis Flores
- Facultad de Ciencias de la Cultura Física, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Isabel Fragoso
- Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - Lidia G De León
- Facultad de Ciencias de la Cultura Física, Universidad Autónoma de Chihuahua, Chihuahua, México
| | | | - Ramón Candia-Luján
- Facultad de Ciencias de la Cultura Física, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Claudia Carrasco-Legleu
- Facultad de Ciencias de la Cultura Física, Universidad Autónoma de Chihuahua, Chihuahua, México
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Shi M, Ji X, Xie Y, Zhong T, Tang R, Fan L, Li X. Using Glycated Albumin and Stimulated C-Peptide to Define Partial Remission in Type 1 Diabetes. Front Endocrinol (Lausanne) 2022; 13:938059. [PMID: 35928900 PMCID: PMC9344919 DOI: 10.3389/fendo.2022.938059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To propose a new definition of partial remission (PR) for patients with type 1 diabetes (T1D) of all-ages using insulin dose and glycated albumin (GA), and find the optimal cut-off values for stimulated C-peptide to diagnose PR in different age-groups. RESEARCH DESIGN AND METHODS Patients with newly diagnosed T1D (n=301) were included. GA/insulin dose was used to diagnose PR, and insulin dose-adjusted glycated albumin (IDAGA) was proposed to facilitate clinical application. The optimal diagnostic levels of IDAGA and stimulated C-peptide were determined in different age-groups (≤ 12y, 12-18y and ≥ 18y). Furthermore, the diagnostic consistency between different PR definitions was studied. RESULTS GA≤ 23%/insulin dose ≤ 0.5u/kg/day was used to define PR, and IDAGA (GA (%) + 40 * insulin dose(u/kg/day)) ≤ 40 was feasible in all age-groups. Whereas, the optimal diagnostic level showed difference for stimulated C-peptide (265.5, 449.3 and 241.1 pmol/L for the ≤ 12y, 12-18y and ≥ 18y age-group, respectively). About 40% of patients met the PR definition by stimulated C-peptide but not GA/insulin dose or IDAGA, who showed dyslipidemia and higher insulin resistance. CONCLUSIONS A new definition of the PR phase is proposed using GA/insulin dose, and the calculated IDAGA≤ 40 applies to all age-groups. The stimulated C-peptide to diagnose PR is the highest in the 12-18y age-group, which reflects the effect of puberty on metabolism. For patients with insulin resistance, it is not recommended to use stimulated C-peptide alone to diagnose PR.
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Parcha V, Heindl B, Kalra R, Li P, Gower B, Arora G, Arora P. Insulin Resistance and Cardiometabolic Risk Profile Among Nondiabetic American Young Adults: Insights From NHANES. J Clin Endocrinol Metab 2022; 107:e25-e37. [PMID: 34473288 PMCID: PMC8684535 DOI: 10.1210/clinem/dgab645] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The burden of insulin resistance (IR) among young American adults has not been previously assessed. We evaluated (1) the prevalence and trends of IR and cardiometabolic risk factors and (2) the association between measures of adiposity and IR among adults 18 to 44 years of age without diabetes and preexisting cardiovascular disease. METHODS Cross-sectional survey data from six consecutive National Health and Nutrition Examination Survey (2007-2008 to 2017-2018) cycles were analyzed. IR was defined by the homeostatic model assessment for IR (HOMA-IR) of ≥2.5. The temporal trends of IR, cardiometabolic risk factors, and the relationship between IR and measures of adiposity were assessed using multivariable-adjusted regression models. RESULTS Among 6247 young adults 18 to 44 years of age, the prevalence of IR was 44.8% (95% CI: 42.0%-47.6%) in 2007-2010 and 40.3% (95% CI: 36.4%-44.2%) in 2015-2018 (P for trend = 0.07). There was a modest association of HOMA-IR with higher body mass index (BMI), waist circumference, total lean fat mass, and total and localized fat mass (all Ps < 0.001). Participants with IR had a higher prevalence of hypertension [31.3% (95% CI: 29.2%-33.5%) vs 14.7% (95% CI: 13.2%-16.2%)], hypercholesterolemia [16.0% (95% CI: 12.4%-19.5%) vs 7.0% (95% CI: 5.8%-8.5%)], obesity [56.6% (95% CI: 53.9%-59.3%) vs 14.7% (95% CI: 13.0%-16.5%)], and poor physical activity levels [18.3% (95% CI: 16.4%-20.2%) vs 11.7% (95%CI: 10.3-13.1%)] compared to participants without IR (all Ps < 0.05). CONCLUSIONS Four-in-10 young American adults have IR, which occurs in a cluster with cardiometabolic risk factors. Nearly half of young adults with IR are nonobese. Screening efforts for IR irrespective of BMI may be required.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brittain Heindl
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, AL, USA
| | - Barbara Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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16
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McGraw MB, Kohler LN, Shaibi GQ, Mandarino LJ, Coletta DK. A performance review of novel adiposity indices for assessing insulin resistance in a pediatric Latino population. Front Pediatr 2022; 10:1020901. [PMID: 36275055 PMCID: PMC9582658 DOI: 10.3389/fped.2022.1020901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Body mass index (BMI) percentile or BMI adjusted for age and sex is the most common anthropometric index to monitor and assess obesity in children. However, the ability of BMI to accurately predict insulin resistance (IR) in youth is debated. Determining the best method to noninvasively measure IR in the pediatric population is especially important due to the growing prevalence of type 2 diabetes mellitus (T2DM), which is more likely to develop in people with IR. Therefore, this study analyzed the performance of BMI against newer anthropometric indices in assessing IR in a pediatric Latino identifying sample. METHODS We studied 127 pediatric Latino participants from the Arizona Insulin Resistance (AIR) registry and performed linear regression analyses between various measures of IR and adiposity indices, including body mass index (BMI), triponderal mass index (TMI), body adiposity index (BAI), pediatric body adiposity index (pBAI), a body shape index (ABSI), abdominal volume index (AVI), waist to height ratio (WtHR) and waist to hip ratio (WHR). Log transformations of each index adjusted for age and sex and IR were used for the linear regressions. Additionally, we generated receiver operating characteristics (ROC) from logistic regressions between HOMA-IR and HOMA2IR against the same indices. RESULTS Using the homeostatic assessment of insulin resistance (HOMA-IR), HOMA2IR, the quantitative insulin-sensitivity check index (QUICKI), fasting serum insulin, and FPG/FSI to measure IR, we showed that BMI adjusted for age and sex performs similarly to many of the newer indices in our sample. The correlation coefficients for pBAI [R2: 0.27, 95% confidence interval: 0.88-1.81, p < 0.001] and BMI [R2: 0.27, 95% confidence interval: 0.92-1.92, p < 0.001] were the highest for HOMA-IR. Similarly, pBAI [R2: 0.29, 95% confidence interval: 0.88-1.72, p < 0.001] and BMI [R2: 0.29, 95% confidence interval: 0.93-1.83, p < 0.001] were the highest for HOMA2IR. A similar trend was observed with QUICKI, FSI, and FPG/FSI. ABSI had the lowest R 2 value for all measures of IR. Area under the curve (AUC) values for the receiver operating characteristics (ROC) for HOMA-IR and HOMA2IR support these conclusions. CONCLUSIONS BMI adjusted for age and sex, despite its usage and simplicity, still stacks up well against newer indices in our Latino sample. Testing these indices across larger samples is necessary to generalize these findings and translate performance to adults.
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Affiliation(s)
- Mac B McGraw
- Department of Physiology, The University of Arizona College of Medicine, Tucson, AZ, United States
| | - Lindsay N Kohler
- Center for Disparities in Diabetes, Obesity and Metabolism, The University of Arizona, Tucson, AZ, United States.,Exos, Phoenix, AZ, United States
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ, United States
| | - Lawrence J Mandarino
- Center for Disparities in Diabetes, Obesity and Metabolism, The University of Arizona, Tucson, AZ, United States.,Department of Medicine, Division of Endocrinology, The University of Arizona College of Medicine, Tucson, AZ, United States
| | - Dawn K Coletta
- Department of Physiology, The University of Arizona College of Medicine, Tucson, AZ, United States.,Center for Disparities in Diabetes, Obesity and Metabolism, The University of Arizona, Tucson, AZ, United States.,Department of Medicine, Division of Endocrinology, The University of Arizona College of Medicine, Tucson, AZ, United States
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Constable AM, Vlachopoulos D, Barker AR, Moore SA, Soininen S, Haapala EA, Väistö J, Jääskeläinen J, Voutilainen R, Auriola S, Häkkinen MR, Laitinen T, Lakka TA. The Mediating Role of Endocrine Factors in the Positive Relationship Between Fat Mass and Bone Mineral Content in Children Aged 9-11 Years: The Physical Activity and Nutrition in Children Study. Front Endocrinol (Lausanne) 2022; 13:850448. [PMID: 35399927 PMCID: PMC8987010 DOI: 10.3389/fendo.2022.850448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION We aimed to investigate whether the relationship between fat mass and bone mineral content (BMC) is mediated by insulin, leptin, adiponectin, dehydroepiandrosterone sulphate, testosterone and estradiol in children aged 9-11 years. MATERIALS AND METHODS We utilised cross-sectional data from the Physical Activity and Nutrition in Children study (n = 230 to 396; 112 to 203 girls). Fat mass and BMC were assessed with dual-energy X-ray absorptiometry. Endocrine factors were assessed from fasted blood samples. We applied the novel 4-way decomposition method to analyse associations between fat mass, endocrine factors, and BMC. RESULTS Fat mass was positively associated with BMC in girls (ß = 0.007 to 0.015, 95% confidence interval (CI) 0.005 to 0.020) and boys (ß = 0.009 to 0.015, 95% CI 0.005 to 0.019). The relationship between fat mass and BMC was mediated by free leptin index in girls (ß = -0.025, 95% CI -0.039 to -0.010) and boys (ß = -0.014, 95% CI -0.027 to -0.001). The relationship between fat mass and BMC was partially explained by mediated interaction between fat mass and free leptin index in boys (ß = -0.009, 95% CI -0.013 to -0.004) and by interaction between fat mass and adiponectin in girls (ß = -0.003, 95% CI -0.006 to -0.000). CONCLUSION At greater levels of adiponectin and free leptin index, the fat mass and BMC relationship becomes less positive in girls and boys respectively. The positive association between fat mass with BMC was largely not explained by the endocrine factors we assessed. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/ct2/show/NCT01803776], identifier NCT01803776.
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Affiliation(s)
- Annie M. Constable
- Children’s Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
- *Correspondence: Annie M. Constable,
| | - Dimitris Vlachopoulos
- Children’s Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom
| | - Alan R. Barker
- Children’s Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom
| | - Sarah A. Moore
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Sonja Soininen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
- Social and Health Center, City of Varkaus, Finland
| | - Eero A. Haapala
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Juuso Väistö
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Jarmo Jääskeläinen
- Department of Paediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Raimo Voutilainen
- Department of Paediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Seppo Auriola
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Timo A. Lakka
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
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Ambrosio MR, Aliberti L, Gagliardi I, Franceschetti P, Zatelli MC. Bone health in adolescence. Minerva Obstet Gynecol 2021; 73:662-677. [PMID: 34905874 DOI: 10.23736/s2724-606x.20.04713-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescence is a fundamental period for the formation of the skeleton, because is the stage in which bones grow more in both size and strength, laying a solid foundation for the future health of the skeleton. Any condition interfering with optimal peak bone mass accrual can increase fracture risk later in life. Up to 80% of peak bone mass is genetically determined while the remaining 20% is modulated by environmental factors that, if deleterious, may result in low bone mineral density (BMD) and an increased risk of fracture. The preferred test to assess bone health is dual-energy x-ray absorptiometry (spine or total body less head) using Z scores instead of T scores, even though in short stature or growth delay, should be used the height Z-score. The correction of risk factors is the first treatment for low BMD in children and adolescents. It's necessary having a correct lifestyle for preserving bone health: a proper nutrition, an adequate physical weight-bearing activity and avoidance of alcohol intake and tobacco smoke. Bisphosphonates could be used in children who sustained osteoporotic fractures, impairing quality of life, when spontaneous recovery is low for the persistence of osteoporosis risk factors. This clinical review discusses factors affecting bone health during childhood and adolescence and deals with diagnosis and treatment of low bone mass or osteoporosis in this age group.
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Affiliation(s)
- Maria R Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy -
| | - Ludovica Aliberti
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irene Gagliardi
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paola Franceschetti
- Operative Unit of Endocrinology and Metabolic Diseases, Department of Oncology and Specialty Medicine, Ferrara University Hospital, Ferrara, Italy
| | - Maria C Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Tsukahara Y, Torii S, Yamasawa F, Iwamoto J, Otsuka T, Goto H, Kusakabe T, Matsumoto H, Akama T. Bone parameters of elite athletes with oligomenorrhea and prevalence seeking medical attention: a cross-sectional study. J Bone Miner Metab 2021; 39:1009-1018. [PMID: 34101019 DOI: 10.1007/s00774-021-01234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Since the definition of secondary amenorrhea is cessation of regular menses for more than 3 months, it is likely that athletes with irregular menstrual cycles, including oligomenorrhea, do not consider the condition as serious. However, the consequences of untreated oligomenorrhea have not been investigated in elite track and field athletes. MATERIALS AND METHODS The cohort consisted of 91 elite-level track and field athletes. Body compositions, including bone parameters and bone turnover markers (BTMs), were measured. RESULTS Among the 91 participants, 52 were eumenorrheic and 33 were oligomenorrheic. The eumenorrheic athletes had significantly higher bone mineral density (BMD) and bone mineral content (BMC) of the lumbar spine, lower extremities, and whole body than had the oligomenorrheic athletes (p < 0.01). There were no significant differences in BTMs between the two groups, but oligomenorrheic athletes had significantly lower percent body fat. CONCLUSION More than 40% of the elite-level female track and field athletes in this study reported menstrual disorders with oligomenorrhea as the most common. However, none sought medical attention. As compared to the eumenorrheic athletes, the oligomenorrheic athletes had lower BMC and BMD. Hence, if an athlete is oligomenorrheic, bone parameter measurements are considerably important.
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Affiliation(s)
- Yuka Tsukahara
- Waseda Institute for Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan.
- Institute for Integrated Sports Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-0016, Japan.
| | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Fumihiro Yamasawa
- Marubeni Health Promotion Center, 7-1, Nihonbashi 2-chome, Chuo-ku, Tokyo, 103-6060, Japan
| | - Jun Iwamoto
- Bone and Joint Disease Center, Keiyu Orthopaedic Hospital, 2267 Akoudacho, Tatebayashi, Gunma, 374-0013, Japan
| | - Takanobu Otsuka
- School of Education, Tokai Gakuen University, 901 Nakahira Tempakuku, Nagoya, 468-8514, Japan
| | - Hideyuki Goto
- Department of Health and Fitness, Faculty of Wellness, Shigakkan University, 55 Nakoyama Yokonemachi, Obu, 474-8651, Japan
| | - Torao Kusakabe
- Department of Orthopedic Surgery, Japanese Red-Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Hideo Matsumoto
- Public Interest Incorporated Foundation, Sports Medicine Foundation, 8-1-9 Nishishinjyuku, Shinjyukuku, Tokyo, 160-0023, Japan
| | - Takao Akama
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
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20
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Kyler KE, Lee BR, Glynn EF, Waddell JP, Hoffman MA, Goldman JL. Clinical Outcome and Antibiotic Dosing Differences by Weight in Children With Acute Osteomyelitis. Hosp Pediatr 2021; 11:1112-1120. [PMID: 34593567 DOI: 10.1542/hpeds.2021-005890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate for weight-based differences in clinical outcomes and antibiotic dosing variability for children hospitalized with acute hematogenous osteomyelitis (AHO). METHODS We performed a retrospective cohort study of children aged 2 to 17 years and hospitalized with a primary AHO International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision diagnosis code between 2010 and 2017 using the Cerner Health Facts database. Weight categories (healthy, overweight, obesity) were determined by using Centers for Disease Control and Prevention age- and sex-specific BMI percentiles. Rates of procedures, complications, and length of stay (LOS) were compared between groups. Dosing variability between groups was assessed by comparing the initial milligrams per kilogram per day of prescribed antibiotics. RESULTS We identified 755 children with AHO for inclusion. Children with overweight and obesity were more likely to undergo surgical procedures (19% and 17%, respectively) compared with children with a healthy weight (10%; P = .009). They also had a longer LOS (5.7 and 5.8 days) than children with a healthy weight (4.9 days; P = .03). There were no differences in complication rates between weight categories. Mean weight-adjusted daily dose for the most frequently prescribed antibiotics was different by weight category, with children in higher weight categories more likely to receive lower weight-based doses. CONCLUSIONS Children with overweight and obesity hospitalized for AHO were more likely to undergo procedures, have longer LOS, and receive lower weight-based antibiotic dosing compared with children with a healthy weight. Our findings suggest that weight should be carefully considered when treating children with AHO.
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Affiliation(s)
- Kathryn E Kyler
- Children's Mercy Kansas City, Kansas City, Missouri .,Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Brian R Lee
- Children's Mercy Kansas City, Kansas City, Missouri
| | - Earl F Glynn
- Children's Mercy Kansas City, Kansas City, Missouri
| | | | - Mark A Hoffman
- Children's Mercy Kansas City, Kansas City, Missouri.,Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.,University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer L Goldman
- Children's Mercy Kansas City, Kansas City, Missouri.,Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
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21
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Bilinski WJ, Szternel L, Siodmiak J, Krintus M, Paradowski PT, Domagalski K, Sypniewska G. Effect of fasting hyperglycemia and insulin resistance on bone turnover markers in children aged 9-11 years. J Diabetes Complications 2021; 35:108000. [PMID: 34384707 DOI: 10.1016/j.jdiacomp.2021.108000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/07/2021] [Accepted: 07/25/2021] [Indexed: 11/18/2022]
Abstract
AIM Impaired regulation of glucose metabolism in childhood adversely affects bone health. We assessed the effect of fasting hyperglycemia and insulin resistance on bone turnover markers in prepubertal children with normal glycemia (<100 mg/dL) and fasting hyperglycemia (100-125 mg/dL). METHODS Glucose, hemoglobin A1c, IGF-I (insulin-like growth factor I), iP1NP (N-terminal propeptide of type I procollagen), CTX-1 (C-terminal telopeptide of type I collagen) and insulin were measured. Bone turnover index (BTI) and HOMA-IR (homeostasis model assessment) were calculated. RESULTS Bone resorption marker (CTX) levels were decreased by 26.5% in boys with hyperglycemia, though only 7% in girls. Hyperglycemia had no effect on the bone formation marker iP1NP. IGF-1, the best predictor of bone marker variance accounted for 25% of iP1NP and 5% of CTX variance. Girls presented significantly higher BTI indicating the predominance of bone formation over resorption. Insulin resistance significantly decreased CTX. In girls, HOMA-IR and IGF-1 predicted 15% of CTX variance. CONSLUSIONS Fasting hyperglycemia and insulin resistance in children impact bone turnover suppressing bone resorption. Hyperglycemia decreased resorption, particularly in boys, while suppression of resorption by insulin resistance was more pronounced in girls. We suggest that the progression of disturbances accompanying prediabetes, may interfere with bone modelling and be deleterious to bone quality in later life.
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Affiliation(s)
- Wojciech J Bilinski
- Department of Orthopaedics and Traumatology, Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland; Department of Orthopaedics, KoMed, Poddebickie Health Center, Poddebice, Poland.
| | - Lukasz Szternel
- Department of Laboratory Medicine Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Joanna Siodmiak
- Department of Laboratory Medicine Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Magdalena Krintus
- Department of Laboratory Medicine Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Przemyslaw T Paradowski
- Department of Orthopaedics and Traumatology, Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland; Department of Surgical and Perioperative Sciences, Division of Orthopedics, Sunderby Research Unit, Umeå University, Umeå, Sweden; Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Krzysztof Domagalski
- Department of Immunology, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, Torun, Poland
| | - Grazyna Sypniewska
- Department of Laboratory Medicine Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
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22
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Orsso CE, Peng Y, Deehan EC, Tan Q, Field CJ, Madsen KL, Walter J, Prado CM, Tun HM, Haqq AM. Composition and Functions of the Gut Microbiome in Pediatric Obesity: Relationships with Markers of Insulin Resistance. Microorganisms 2021; 9:1490. [PMID: 34361925 PMCID: PMC8304481 DOI: 10.3390/microorganisms9071490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/16/2022] Open
Abstract
The gut microbiome is hypothesized to play a crucial role in the development of obesity and insulin resistance (IR); the pathways linking the microbiome to IR in pediatrics have yet to be precisely characterized. We aimed to determine the relationship between the gut microbiome composition and metabolic functions and IR in children with obesity. In a cross-sectional study, fecal samples from children with obesity (10-16 years old) were collected for taxonomical and functional analysis of the fecal microbiome using shotgun metagenomics. The homeostatic model assessment for insulin resistance (HOMA-IR) was determined using fasting glucose and insulin. Associations between HOMA-IR and α-diversity measures as well as metabolic pathways were evaluated using Spearman correlations; relationships between HOMA-IR and β-diversity were assessed by permutational multivariate analysis of variance. Twenty-one children (nine males; median: age = 12.0 years; BMI z-score = 2.9; HOMA-IR = 3.6) completed the study. HOMA-IR was significantly associated with measures of α-diversity but not with β-diversity. Children with higher HOMA-IR exhibited lower overall species richness, Firmicutes species richness, and overall Proteobacteria species Shannon diversity. Furthermore, HOMA-IR was inversely correlated with the abundance of pathways related to the biosynthesis of lipopolysaccharides, amino acids, and short-chain fatty acids, whereas positive correlations between HOMA-IR and the peptidoglycan biosynthesis pathways were observed. In conclusion, insulin resistance was associated with decreased microbial α-diversity measures and abundance of genes related to the metabolic pathways. Our study provides a framework for understanding the microbial alterations in pediatric obesity.
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Affiliation(s)
- Camila E. Orsso
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, 4-002 Li Ka Shing Centre for Health Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; (C.E.O.); (C.M.P.)
| | - Ye Peng
- HKU-Pasteur Research Pole, School of Public Health, University of Hong Kong, Hong Kong 999077, China;
| | - Edward C. Deehan
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2C2, Canada; (E.C.D.); (K.L.M.)
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Qiming Tan
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Catherine J. Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada;
| | - Karen L. Madsen
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2C2, Canada; (E.C.D.); (K.L.M.)
| | - Jens Walter
- APC Microbiome Ireland, School of Microbiology, and Department of Medicine, University College Cork—National University of Ireland, T12 YT20 Cork, Ireland;
| | - Carla M. Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, 4-002 Li Ka Shing Centre for Health Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; (C.E.O.); (C.M.P.)
| | - Hein M. Tun
- HKU-Pasteur Research Pole, School of Public Health, University of Hong Kong, Hong Kong 999077, China;
| | - Andrea M. Haqq
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada;
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23
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Syggelos N, Augoulea A, Armeni E, Kaparos G, Vafaei H, Dontas I, Marinou K, Vaggos G, Raptou P, Lambrinoudaki I, Eleftheriades M, Nicolaides KH. Impact of prenatal and postnatal nutritional manipulation on bone quality in adult Wistar rats offspring. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.nutos.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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24
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Ma CM, Yin FZ. The Relationship Between Prediabetes and Bone Mass in Adolescents: Analysis of the National Health and Nutrition Examination Survey From 2005 to 2010. Front Endocrinol (Lausanne) 2021; 12:749998. [PMID: 34754289 PMCID: PMC8572624 DOI: 10.3389/fendo.2021.749998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/04/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to observe the relationship between impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and bone mineral density (BMD) in different sites in adolescents. METHODS A retrospective study was conducted on adolescents age 12-19 years of the United States. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2005-2006, 2007-2008, and 2009-2010 cycles. IFG was defined as fasting plasma glucose (FPG) levels that were ≥5.6 and <7.0 mmol/L. IGT was defined as 2-h plasma glucose levels that were ≥7.8 and <11.1 mmol/L after the oral glucose tolerance test (OGTT). RESULTS After controlling for age, gender, race, and body mass index (BMI) Z-score, adolescents in different categories of IGT had significantly different levels of areal BMD (aBMD) and bone mineral apparent density (BMAD) (IGT main effect: P < 0.05 for all, two-way ANOVA). There was no main effect between different categories of IFG with regard to aBMD and BMAD (P > 0.05). There was no interaction between IFG and IGT with regard to aBMD and BMAD (P > 0.05). In multiple regression analysis, the 2-h plasma glucose maintained an independent association with femoral neck aBMD (β = -0.011, 95% CI: -0.017~-0.006, P < 0.001, R2 = 0.012), total femur aBMD (β = -0.015, 95% CI: -0.021~-0.009, P < 0.001, R2 = 0.018), total spine aBMD (β = -0.015, 95% CI: -0.020~-0.010, P < 0.001, R2 = 0.018), and total spine BMAD (β = -0.002, 95% CI: -0.003~0.000, P = 0.006, R2 = 0.003). CONCLUSION The present study demonstrates that BMD was decreased in adolescents with IGT. Two-hour plasma glucose, not FPG, negatively correlated with BMD. The effect of 2-h plasma glucose was consistent across the sites of bone.
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25
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Sakka SD, Cheung MS. Management of primary and secondary osteoporosis in children. Ther Adv Musculoskelet Dis 2020; 12:1759720X20969262. [PMID: 33224280 PMCID: PMC7649886 DOI: 10.1177/1759720x20969262] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Abstract
Osteoporosis in children differs from adults in terms of definition, diagnosis, monitoring and treatment options. Primary osteoporosis comprises primarily of osteogenesis imperfecta (OI), but there are significant other causes of bone fragility in children that require treatment. Secondary osteoporosis can be a result of muscle disuse, iatrogenic causes, such as steroids, chronic inflammation, delayed or arrested puberty and thalassaemia major. Investigations involve bone biochemistry, dual-energy X-ray absorptiometry scan for bone densitometry and vertebral fracture assessment, radiographic assessment of the spine and, in some cases, quantitative computed tomography (QCT) or peripheral QCT. It is important that bone mineral density (BMD) results are adjusted based on age, gender and height, in order to reflect size corrections in children. Genetics are being used increasingly for the diagnosis and classification of various cases of primary osteoporosis. Bone turnover markers are used less frequently in children, but can be helpful in monitoring treatment and transiliac bone biopsy can assist in the diagnosis of atypical cases of osteoporosis. The management of children with osteoporosis requires a multidisciplinary team of health professionals with expertise in paediatric bone disease. The prevention and treatment of fragility fractures and improvement of the quality of life of patients are important aims of a specialised service. The drugs used most commonly in children are bisphosphonates, that, with timely treatment, can give good results in improving BMD and reshaping vertebral fractures. The data regarding their effect on reducing long bone fractures are equivocal. Denosumab is being used increasingly for various conditions with mixed results. There are more drugs trialled in adults, but these are not yet licenced for children. Increasing awareness of risk factors for paediatric osteoporosis, screening and referral to a specialist team for appropriate management can lead to early detection and treatment of asymptomatic fractures and prevention of further bone damage.
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Affiliation(s)
- Sophia D Sakka
- Department of Endocrinology and Diabetes, Evelina London Children's Hospital, 3rd Floor, Becket House, Westminster Bridge Road, SE1 7EH, London, UK
| | - Moira S Cheung
- Department of Endocrinology and Diabetes, Evelina London Children's Hospital, London, UK
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26
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Kindler JM, Kelly A, Khoury PR, Levitt Katz LE, Urbina EM, Zemel BS. Bone Mass and Density in Youth With Type 2 Diabetes, Obesity, and Healthy Weight. Diabetes Care 2020; 43:2544-2552. [PMID: 32778556 PMCID: PMC7510020 DOI: 10.2337/dc19-2164] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/09/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Youth-onset type 2 diabetes is an aggressive condition with increasing incidence. Adults with type 2 diabetes have increased fracture risk despite normal areal bone mineral density (aBMD), but the influence of diabetes on the growing skeleton is unknown. We compared bone health in youth with type 2 diabetes to control patients with obesity or healthy weight. RESEARCH DESIGN AND METHODS Cross-sectional study of youth (56% African American, 67% female) ages 10-23 years with type 2 diabetes (n = 180), obesity (BMI >95th; n = 226), or healthy weight (BMI <85th; n = 238). Whole-body (less head) aBMD and lean mass as well as abdominal visceral fat were assessed via DXA. Lean BMI (LBMI) and aBMD SD scores (z scores) were computed using published reference data. RESULTS We observed age-dependent differences in aBMD and LBMI z scores between the healthy weight, obese, and type 2 diabetes groups. In children, aBMD and LBMI z scores were greater in the type 2 diabetes group versus the obese group, but in adolescents and young adults, aBMD and LBMI z scores were lower in the type 2 diabetes group versus the obese group (age interactions P < 0.05). In the type 2 diabetes group and the obese group, aBMD was about 0.5 SDs lower for a given LBMI z score compared with healthy weight control patients (P < 0.05). Further, aBMD was lower in those with greater visceral fat (β = -0.121, P = 0.047). CONCLUSIONS These results suggest that type 2 diabetes may be detrimental to bone density around the age of peak bone mass. Given the increased fracture risk in adults with type 2 diabetes, there is a pressing need for longitudinal studies aimed at understanding the influence of diabetes on the growing skeleton.
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Affiliation(s)
- Joseph M Kindler
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Andrea Kelly
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Philip R Khoury
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lorraine E Levitt Katz
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA .,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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27
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Orsso CE, Colin-Ramirez E, Field CJ, Madsen KL, Prado CM, Haqq AM. Adipose Tissue Development and Expansion from the Womb to Adolescence: An Overview. Nutrients 2020; 12:E2735. [PMID: 32911676 PMCID: PMC7551046 DOI: 10.3390/nu12092735] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/29/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
Prevalence rates of pediatric obesity continue to rise worldwide. Adipose tissue (AT) development and expansion initiate in the fetus and extend throughout the lifespan. This paper presents an overview of the AT developmental trajectories from the intrauterine period to adolescence; factors determining adiposity expansion are also discussed. The greatest fetal increases in AT were observed in the third pregnancy trimester, with growing evidence suggesting that maternal health and nutrition, toxin exposure, and genetic defects impact AT development. From birth up to six months, healthy term newborns experience steep increases in AT; but a subsequent reduction in AT is observed during infancy. Important determinants of AT in infancy identified in this review included feeding practices and factors shaping the gut microbiome. Low AT accrual rates are maintained up to puberty onset, at which time, the pattern of adiposity expansion becomes sex dependent. As girls experience rapid increases and boys experience decreases in AT, sexual dimorphism in hormone secretion can be considered the main contributor for changes. Eating patterns/behaviors and interactions between dietary components, gut microbiome, and immune cells also influence AT expansion. Despite the plasticity of this tissue, substantial evidence supports that adiposity at birth and infancy highly influences its levels across subsequent life stages. Thus, a unique window of opportunity for the prevention and/or slowing down of the predisposition toward obesity, exists from pregnancy through childhood.
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Affiliation(s)
- Camila E. Orsso
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada; (C.E.O.); (C.J.F.); (C.M.P.)
| | | | - Catherine J. Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada; (C.E.O.); (C.J.F.); (C.M.P.)
| | - Karen L. Madsen
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2C2, Canada;
| | - Carla M. Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada; (C.E.O.); (C.J.F.); (C.M.P.)
| | - Andrea M. Haqq
- Department of Pediatrics and Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R7, Canada
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28
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Lu J, Gu Y, Wang L, Li W, Zhang S, Liu H, Leng J, Liu J, Wang S, Baccarelli AA, Hou L, Hu G. Glucose metabolism among obese and non-obese children of mothers with gestational diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e000822. [PMID: 32179515 PMCID: PMC7073815 DOI: 10.1136/bmjdrc-2019-000822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/09/2020] [Accepted: 02/14/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Abdominal obesity is more closely associated with diabetes than general obesity in adults, however, it is unknown which kind of obesity is more closely associated with abnormal glucose metabolism in children. RESEARCH DESIGN AND METHODS We recruited 973 children (aged 3.08±1.06) of mothers with prior gestational diabetes mellitus (GDM). Children's height, weight, waist circumstance, fasting glucose and insulin were measured using standardized methods. Logistic regression models were used to assess the single and joint associations of general and abdominal obesity with the risks of hyperglycemia (the upper quartile of fasting glucose), insulin resistance (the upper quartile of homeostatic model assessment of insulin resistance (HOMA-IR)), and β-cell dysfunction (the lower quartile of HOMA-%β). RESULTS Compared with normal weight children, children with general overweight/obesity had higher levels of HOMA-IR and HOMA-%β, higher ORs for hyperglycemia (1.56, 95% CI 1.06 to 2.30) and insulin resistance (3.44, 95% CI 2.32 to 5.09), but a lower OR for β-cell dysfunction (0.65, 95% CI 0.41 to 1.04). Children with abdominal obesity had an increased risk of insulin resistance (2.54, 95% CI 1.71 to 3.76) but not hyperglycemia and β-cell dysfunction compared with children with normal waist circumstance. In the joint analyses, general overweight children with and without abdominal obesity had an increased risk of hyperglycemia and insulin resistance compared with normal weight children. CONCLUSIONS General obesity was more closely associated with abnormal glucose metabolism than abdominal obesity in children of mothers with GDM.
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Affiliation(s)
- Jun Lu
- Department of Endocrinology and Metabolism, Fengxian Hospital Affiliated to Southern Medical University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai University of Medicine and Health Sciences Affiliated Shanghai Sixth People's Hospital South Campus, Shanghai, China
- Chronic Disease Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Yuying Gu
- Chronic Disease Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Department of Mathematics, Shanghai Business School-Fengpu Campus, Shanghai, China
| | - Leishen Wang
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Weiqin Li
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Shuang Zhang
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Huikun Liu
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Junhong Leng
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Jin Liu
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Shuo Wang
- Tianjin Health and Family Planning Commission, Tianjin, China
| | - Andrea A Baccarelli
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gang Hu
- Chronic Disease Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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29
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Mak IL, Cohen TR, Vanstone CA, Weiler HA. Arachidonic acid status negatively associates with forearm bone outcomes and glucose homeostasis in children with an overweight condition or obesity. Appl Physiol Nutr Metab 2020; 45:146-154. [PMID: 31269410 DOI: 10.1139/apnm-2019-0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2023]
Abstract
Long-chain polyunsaturated fatty acids are implicated in musculoskeletal health in adults. This study examined whether fatty acid status relates to bone health outcomes in children with overweight condition or obesity (body mass index z score, 3.1 ± 0.1; age, 9.0 ± 0.2 years; n = 108). Nondominant forearm bone density (distal one-third), geometry (4% site), and soft tissue composition (66%) were assessed using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Red blood cell (RBC) fatty acid profile and indices of glucose homeostasis were measured. Differences in outcomes among RBC arachidonic acid (AA, C20:4n-6) tertiles were tested using mixed-model ANOVA. Ultra-, mid-, and total-distal forearm bone mineral content, adjusted for sex, age, percentage body fat, race, and forearm length, were 10% to 13% greater in children in the first AA tertile relative to the third. Children in the second tertile had the highest bone cross-sectional area and estimated strength at the 66% radius. Muscle cross-sectional area was 15% lower in the third tertile compared with the first, along with higher fasting insulin concentrations (27%) and homeostasis model of assessment estimate of insulin resistance (31%). Higher RBC AA status aligns with deficits in forearm bone mass, geometry, and muscle mass in children with excess adiposity and early signs of insulin resistance. Novelty Higher arachidonic acid status is associated with lower forearm bone mass in children with overweight condition or obesity. Children with higher arachidonic acid status had increased fasting insulin concentrations and indices of insulin resistance.
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Affiliation(s)
- Ivy L Mak
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada
| | - Tamara R Cohen
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada
- PERFORM Centre, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Catherine A Vanstone
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada
| | - Hope A Weiler
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada
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Annexstad EJ, Bollerslev J, Westvik J, Myhre AG, Godang K, Holm I, Rasmussen M. The role of delayed bone age in the evaluation of stature and bone health in glucocorticoid treated patients with Duchenne muscular dystrophy. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2019; 2019:4. [PMID: 31889957 PMCID: PMC6927168 DOI: 10.1186/s13633-019-0070-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/23/2019] [Indexed: 12/17/2022]
Abstract
Background Low bone mineral density and an increased risk of appendicular and vertebral fractures are well-established consequences of Duchenne muscular dystrophy (DMD) and the risk of fractures is exacerbated by long-term glucocorticoid treatment. Monitoring of endocrine and skeletal health and timely intervention in at-risk patients is important in the management of children with DMD. Methods As part of the Norwegian Duchenne muscular dystrophy cohort study, we examined the skeletal maturation of 62 boys less than 18 years old, both currently glucocorticoid treated (n = 44), previously treated (n = 6) and naïve (n = 12). The relationship between bone age, height and bone mineral density (BMD) Z-scores was explored. Results The participants in the glucocorticoid treated group were short in stature and puberty was delayed. Bone age was significantly delayed, and the delay increased with age and duration of treatment. The difference in height between glucocorticoid treated and naïve boys was no longer significant when height was corrected for delayed skeletal maturation. Mean BMD Z-scores fell below − 2 before 12 years of age in the glucocorticoid treated group, with scores significantly correlated with age, duration of treatment and pubertal development. When BMD Z-scores were corrected for by retarded bone age, the increase in BMD Z-scores was significant for all age groups. Conclusion Our results suggest that skeletal maturation should be assessed in the evaluation of short stature and bone health in GC treated boys with DMD, as failing to consider delayed bone age leads to underestimation of BMD Z-scores and potentially overestimation of fracture risk.
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Affiliation(s)
- E J Annexstad
- 1Department of Neurology, Unit for Congenital and Inherited Neuromuscular Disorders, Oslo University Hospital, PoBox 4950, Nydalen, 0424 Oslo, Norway.,2Faculty of Medicine, University of Oslo, Oslo, Norway.,3Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway.,8Children's Department, Ostfold Hospital Trust, Sarpsborg, Norway
| | - J Bollerslev
- 4Department of Endocrinology, Section of Specialized Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,2Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J Westvik
- 5Department of Radiology, Section for Paediatric Radiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - A G Myhre
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway
| | - K Godang
- 4Department of Endocrinology, Section of Specialized Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - I Holm
- 2Faculty of Medicine, University of Oslo, Oslo, Norway.,7Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - M Rasmussen
- 1Department of Neurology, Unit for Congenital and Inherited Neuromuscular Disorders, Oslo University Hospital, PoBox 4950, Nydalen, 0424 Oslo, Norway.,3Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
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Hofmann C, Girschick H, Lapa C, Semler O, Jakob F. [Fractures and bone mineral density in childhood]. Z Rheumatol 2019; 78:636-644. [PMID: 31338681 DOI: 10.1007/s00393-019-0671-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In juvenile idiopathic arthritis and related chronic inflammatory diseases, proinflammatory cytokines inhibit bone formation and stimulate bone resorption. Anti-inflammatory drugs, such as glucocorticoids and nonsteroidal antirheumatic drugs (NSARD) have as a side effect the potential to inhibit growth and maintenance of bone. These issues are of particular importance for the growing skeleton in childhood and adolescence. OBJECTIVE This article presents a narrative overview about the dimension of the problem, a critical evaluation of diagnostic procedures and a discussion of available countermeasures. METHODS A systematic literature search was carried out and the available evidence was evaluated based on the authors' knowledge and clinical experience as experts in the field. RESULTS AND CONCLUSION In recent years solid data have been accumulated with respect to the interpretation of bone mineral density (BMD) measurements in children and adolescents. Based on these data from the literature and given that the radiation exposure is also very low, it is now possible to clinically apply BMD measurements in this population using dual energy X‑ray absorption (DXA) technology for risk evaluation and diagnosis, taking the respective phase of development and body length into consideration. Dynamic measurements over time appear to be especially valuable in the context of individual clinical data. Hence, BMD measurements can be helpful in monitoring bone health, especially in juvenile idiopathic arthritis and other related inflammatory diseases. Apart from the specific indications for extended diagnostics and bone targeted pharmacological treatment, this method can also contribute to the management of preventive measures, such as sufficient calcium and vitamin D intake and targeted exercise interventions. Even in times of extremely effective antirheumatic drugs, children with chronic inflammatory diseases still bear a risk for bone health.
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Affiliation(s)
- Christine Hofmann
- Kinderklinik und Poliklinik, Pädiatrische Rheumatologie und Osteologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Herrmann Girschick
- Klinik für Kinder- und Jugendmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - Constantin Lapa
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Oliver Semler
- Medizinische Fakultät und Uniklinik Köln, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universität zu Köln, Köln, Deutschland
| | - Franz Jakob
- Orthopädische Klinik im König-Ludwig-Haus, Bernhard-Heine-Centrum für Bewegungsforschung, Brettreichstr. 11, 97074, Würzburg, Deutschland.
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Dimitri P. The Impact of Childhood Obesity on Skeletal Health and Development. J Obes Metab Syndr 2019; 28:4-17. [PMID: 31089575 PMCID: PMC6484936 DOI: 10.7570/jomes.2019.28.1.4] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 01/24/2019] [Accepted: 02/18/2019] [Indexed: 12/26/2022] Open
Abstract
Increased risk of fracture identified in obese children has led to a focus on the relationship between fat, bone, and the impact of obesity during skeletal development. Early studies have suggested that despite increased fracture risk, obese children have a higher bone mass. However, body size corrections applied to account for wide variations in size between children led to the finding that obese children have a lower total body and regional bone mass relative to their body size. Advances in skeletal imaging have shifted the focus from quantity of bone in obese children to evaluating the changes in bone microarchitecture that result in a change in bone quality and strength. The findings suggest that bone strength in the appendicular skeleton does not appropriately adapt to an increase in body size which results in a mismatch between bone strength and force from falls. Recent evidence points to differing influences of fat compartments on skeletal development-visceral fat may have a negative impact on bone which may be related to the associated adverse metabolic environment, while marrow adipose tissue may have an independent effect on trabecular bone development in obese children. The role of brown fat has received recent attention, demonstrating differences in the influence on bone mass between white and brown adipose tissues. Obesity results in a shift in growth and pubertal hormones as well as influences bone development through the altered release of adipokines. The change in the hormonal milieu provides an important insight into the skeletal changes observed in childhood obesity.
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Affiliation(s)
- Paul Dimitri
- Academic Unit of Child Health, The University of Sheffield, Sheffield, UK
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