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Rodríguez-Narciso S, Martínez-Portilla RJ, Guzmán-Guzmán IP, Careaga-Cárdenas G, Rubio-Navarro BJ, Barba-Gallardo LF, Delgadillo-Castañeda R, Villafan-Bernal JR. Osteocalcin serum concentrations and markers of energetic metabolism in pediatric patients. Systematic review and metanalysis. Front Pediatr 2023; 10:1075738. [PMID: 36714656 PMCID: PMC9878130 DOI: 10.3389/fped.2022.1075738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023] Open
Abstract
Background Osteocalcin plays a role in glucose metabolism in mice, but its relevance in human energetic metabolism is controversial. Its relationship with markers of energetic metabolism in the pediatric population has not been systematically addressed in infants and adolescents. Objective This study aims to assess the mean differences between tOC, ucOC, and cOC among healthy children and children with type 1 or type 2 diabetes (T1D or T2D) and the correlation of these bone molecules with metabolic markers. Methods A systematic review and metanalysis were performed following PRISMA criteria to identify relevant observational studies published in English and Spanish using PubMed, Scopus, EBSCO, and Web of Science databases. The risk of bias was assessed using New Castle-Ottawa scale. Effect size measures comprised standardized mean difference (SMD) and Pearson correlations. Heterogeneity and meta-regressions were performed. Results The 20 studies included were of high quality and comprised 3,000 pediatric patients who underwent tOC, cOC, or ucOC measurements. Among healthy subjects, there was a positive correlation of ucOC with WC and weight, a positive correlation of tOC with FPG, HDL-c, WC, height, and weight, and a negative correlation between tOC and HbA1c. Among diabetic subjects, a negative correlation of ucOC with HbA1c and glycemia in both T1D and T2D was found and a negative correlation between tOC and HbA1c in T1D but not in T2D. The ucOC concentrations were lower in T2D, T1D, and patients with abnormal glucose status than among controls. The serum concentrations of tOC concentrations were lower among T1D than in controls. The patient's age, altitude, and HbA1c influenced the levels of serum tOC. Conclusion Osteocalcin is involved in energy metabolism in pediatric subjects because it is consistently related to metabolic and anthropometric parameters. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42019138283.
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Affiliation(s)
| | - Raigam Jafet Martínez-Portilla
- Clinical Research Division, Evidence-Based Medicine Department, National Institute of Perinatology, Mexico City, Mexico
- Molecular and Maternal-Fetal Medicine, Iberoamerican Research Network in Translational, Mexico City, Mexico
| | | | | | | | | | | | - José Rafael Villafan-Bernal
- Molecular and Maternal-Fetal Medicine, Iberoamerican Research Network in Translational, Mexico City, Mexico
- Investigador por México, National Council of Science and Technology (CONACYT), Mexico City, Mexico
- Laboratory of Immunogenomics and Metabolic Diseases, Mexican National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico
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Farahani F, Ahn J, Nakonezny PA, Wukich DK, Wimberly RL, Riccio AI. Postoperative Outcomes in Diabetic Pediatric Orthopaedic Surgery Patients: A National Database Study. J Pediatr Orthop 2021; 41:e664-e670. [PMID: 34138820 DOI: 10.1097/bpo.0000000000001879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the negative effects of diabetes mellitus (DM) on operative outcomes in orthopaedic surgery is a well-studied topic in adults, little is known about the impact of this disease in children undergoing orthopaedic procedures. This study aims to describe the postoperative complications in pediatric orthopaedic surgery patients with DM. METHODS Pediatric patients with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) were retrospectively identified while selecting for elective orthopaedic surgery cases from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-Pediatric) database from 2012 to 2015. Univariate and multivariate analyses were performed to describe and assess outcomes when compared with nondiabetic patients undergoing similar procedures. RESULTS Of the 17,647 patients identified, 105 (0.60%) had DM. Of those 105 patients, 68 had IDDM and 37 had NIDDM. The median age of DM patients was 13.8 years (11.9 to 15.5 y) and 37.1% of all DM patients were male. Comparing DM to non-DM patients, no significant differences were noted in the overall complications (1.4% vs. 1.9%, P>0.05) or reoperation rates (1.2% vs. 1.9%, P>0.05); however, DM patients did have a higher occurrence of unplanned readmissions (4.8% vs. 1.7%; P=0.037). Diabetic patients were statistically more likely to have an unplanned readmission with 30 days (adjusted odds ratio=3.34; 95% confidence interval=1.21-9.24, P=0.021). when comparing IDDM to NIDDM, there was no significant difference in outcomes. Comparing NIDDM to non-DM patients, there was an increased incidence of nerve injury (5.6% vs. 0.18%; P=0.023), readmission rate (11.1% vs. 1.8%; P=0.043), and reoperation rate (11.1% vs. 1%; P=0.013) in nonspinal procedures and an increased incidence of pulmonary embolism (10% vs. 0%; P=0.002) in spinal arthrodesis procedures. NIDDM predicted longer hospital stays (adjusted odds ratio=1.49; 95% confidence interval=1.04, 2.14; P=0.028) compared with nondiabetic patients in extremity deformity procedures. CONCLUSIONS The 30-day complication, reoperation, and readmission rates for NIDDM patients were higher than that of non-DM patients. Furthermore, NIDDM is a predictor of longer hospital stays while DM is a predictor of unplanned readmissions. No statistical differences were noted when comparing outcomes of NIDDM to IDDM patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Farzam Farahani
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
| | - Junho Ahn
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
| | - Paul A Nakonezny
- Department of Clinical Science, Division of Biostatistics, University of Texas Southwestern Medical Center
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
| | - Robert L Wimberly
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children
| | - Anthony I Riccio
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children
- Department of Orthopedics, Children's Medical Center in Dallas, Dallas, TX
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Takaya J, Tanabe Y, Kaneko K. Increased lipocalin 2 levels in adolescents with type 2 diabetes mellitus. J Pediatr Endocrinol Metab 2021; 34:979-985. [PMID: 34118796 DOI: 10.1515/jpem-2021-0216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/02/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Bone can act as an endocrine organ through the secretion of bone-specific hormones, i.e., osteokines. Recent research has demonstrated that lipocalin 2 (LCN2) secreted by osteoblasts are part of an important endocrine system that is finely tuned with other organs to ensure homeostatic balance and health. The aim of this study was to explore the association between bone and glucose metabolism in adolescents with obesity and type 2 diabetes mellitus (DM2). METHODS The participants were 8 adolescents with DM2 (5 males, 3 females; age: 17.0 (14.0-20.0) years, median (interquartile range)), 14 adolescents with simple obesity (9 males, 5 females; age: 13.5 (12.4-15.5) years), and 15 controls (6 males, 9 females; age: 13.3 (11.0-15.0) years). Serum LCN2 and under-carboxylated osteocalcin (un-OC) levels were measured using enzyme-linked immunosorbent assays. RESULTS The LCN2 levels were higher in patients with DM2 (58.1 (34.2-95.0) ng/mL; median (interquartile range)), but not in those with obesity (30.8 (23.1-38.3) ng/mL), when compared to the controls (18.2 (9.8-25.7) ng/mL). In the whole study group overall, serum LCN2 was positively correlated with the Model Assessment of Insulin Resistance score (r=0.339, p=0.046) and body mass index (r=0.580, p<0.0001), and negatively correlated with adiponectin (r=-0.462, p=0.005). A multiple stepwise regression model showed that serum adiponectin was an independent predictor of serum LCN2. CONCLUSIONS The results of this study indicate that further investigations are warranted to determine whether LCN2 may act as a sensitive indicator of early-stage insulin resistance.
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Affiliation(s)
- Junji Takaya
- Department of Pediatrics, Kawachi General Hospital, Higashi-Osaka, Osaka, 578-0954, Japan.,Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yuko Tanabe
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
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4
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Redondo MJ, Shirkey BA, Fraga DW, Gaber AO, Sabek OM. Serum undercarboxylated osteocalcin correlates with hemoglobin A1c in children with recently diagnosed pediatric diabetes. Pediatr Diabetes 2017; 18:869-873. [PMID: 28093839 DOI: 10.1111/pedi.12501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/01/2016] [Accepted: 12/16/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Osteocalcin (OC), a hormone secreted by osteoblasts, improves beta-cell function in vitro and in vivo. We aimed to understand the relationship between OC and hemoglobin A1c (HbA1c) in pediatric diabetes. METHODS Children (n = 70; mean [SD] age = 11.8 years [3.1]; 34.3% non-Hispanic white, 46.3% Hispanic, 14.9% African-American, 4.5% other) newly diagnosed with diabetes (69.1% type 1 diabetes [T1D], 30.9% type 2 diabetes [T2D]) were studied. We collected clinical data at diagnosis and first clinical visit (V1) 9 weeks later (interquartile range [IQR] = 7.9-12.0). Serum undercarboxylated OC (uOC) and carboxylated OC (cOC) were measured 7.0 weeks (IQR 4.3-8.9) after diagnosis. RESULTS Mean [SD] uOC was 20.3 (19.6) ng/mL, cOC 29.7 [13.7] ng/mL and u/cOC 0.68 [0.81]. uOC, cOC, or u/cOC were not different by gender, race/ethnicity, age, diabetes type, BMI percentile, or random C-peptide, glucose or HbA1c at diagnosis. However, among 61 children with V1 within 4 months of diagnosis, uOC was higher in those with V1 HbA1c < 7.5% (HbA1c < 58 mmol/mol) (uOC=33.1 [22.0]) compared with children with HbA1c ≥ 7.5% (uOC=17.4 [2.3], P = .0004). The difference was larger among patients with T2D (34.6 and 4.7 ng/mL, respectively, P = .0001) than T1D (32.2 and 19.3, P = .0169), and in males (36.1 and 17.4, P = .018) than females (27.6 and 17.3, P = .072). Analysis for u/cOC were similar while there were no differences in cOC. uOC was inversely correlated with HbA1c at V1 (Spearman's rho = -0.29, P = .02). CONCLUSION Our findings suggest that serum uOC is inversely related to HbA1c shortly after diagnosis of pediatric diabetes. This potentially modifiable factor of glucose metabolism warrants further studies.
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Affiliation(s)
- Maria J Redondo
- Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Beverly A Shirkey
- Center for Outcomes Research, Methodist Hospital Research Institute, Houston, Texas
| | - Daniel W Fraga
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - A Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Omaima M Sabek
- Department of Surgery, Houston Methodist Hospital, Houston, Texas.,Cell and Molecular Biology Weill Cornell Medical College, New York, New York
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Le Doan V, Marcil V. [Osteocalcin and glucose metabolism: assessment of human studies]. Med Sci (Paris) 2017; 33:417-422. [PMID: 28497738 DOI: 10.1051/medsci/20173304012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Osteocalcin, a protein secreted by osteoblasts, is recognized as a biomarker of bone mineralization. Besides, animal experimental studies have shown that osteocalcin could play an important role in glucose metabolism. Over the course of the last decade, this theory has been investigated in several human studies. Most of the results obtained from these reports support a positive correlation between total and undercarboxylated osteocalcin and insulin secretion/sensitivity. Studies also corroborate a reverse association with glycemic parameters such as fasting glucose and glycated hemoglobin. Nevertheless, because most of the studies published are observational, it is not possible to yet confirm a direct cause-effect relationship. Research in the field will surely contribute to the development of new pharmacological strategies for the treatment of endocrine diseases.
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Affiliation(s)
- Valérie Le Doan
- Centre de recherche, CHU Sainte-Justine et Département de Nutrition, Université de Montréal, 3175 Côte Sainte-Catherine, Montréal, Québec, H3T 1C5 Canada
| | - Valérie Marcil
- Centre de recherche, CHU Sainte-Justine et Département de Nutrition, Université de Montréal, 3175 Côte Sainte-Catherine, Montréal, Québec, H3T 1C5 Canada
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Giudici KV, Kindler JM, Martin BR, Laing EM, McCabe GP, McCabe LD, Hausman DB, Martini LA, Lewis RD, Weaver CM, Peacock M, Hill Gallant KM. Associations among osteocalcin, leptin and metabolic health in children ages 9-13 years in the United States. Nutr Metab (Lond) 2017; 14:25. [PMID: 28286536 PMCID: PMC5341348 DOI: 10.1186/s12986-017-0171-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to investigate the relationships among osteocalcin, leptin and metabolic health outcomes in children ages 9–13 years. Methods This was a cross-sectional analysis of baseline data from 161 boys and 157 girls (ages 9–13 years) who previously participated in a double-blinded randomized placebo controlled trial of vitamin D supplementation. Relationships among fasting serum total osteocalcin (tOC), undercarboxylated osteocalcin (ucOC), leptin, and metabolic health outcomes were analyzed. Results Approximately 52% of study participants were obese based on percent body fat cutoffs (>25% for boys and >32% for girls) and about 5% had fasting serum glucose within the prediabetic range (i.e. 100 to 125 mg/dL). Serum tOC was not correlated with leptin, glucose, insulin, HOMA-IR, or HOMA-β after adjusting for percent body fat. However, serum ucOC negatively correlated with leptin (partial r = −0.16; p = 0.04) and glucose (partial r = −0.16; p = 0.04) after adjustment for percent body fat. Leptin was a positive predictor of insulin, glucose, HOMA-IR, and HOMA-β after adjusting for age, sex and percent body fat (all p < 0.001). Conclusions These data depict an inverse relationship between leptin and various metabolic health outcomes in children. However, the notion that tOC or ucOC link fat with energy metabolism in healthy children was not supported. Clinical trial registration number NCT00931580.
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Affiliation(s)
- Kelly Virecoulon Giudici
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Doutor Arnaldo 715, São Paulo, CEP 01246-904 Brazil
| | - Joseph M Kindler
- Department of Foods and Nutrition, University of Georgia, 305 Sanford Dr, Athens, GA 30602 USA
| | - Berdine R Martin
- Department of Nutrition Science, Purdue University, 700 W. State Street, West Lafayette, IN 47907 USA
| | - Emma M Laing
- Department of Foods and Nutrition, University of Georgia, 305 Sanford Dr, Athens, GA 30602 USA
| | - George P McCabe
- Department of Statistics, Purdue University, 150 N. University Street, West Lafayette, IN 47907 USA
| | - Linda D McCabe
- Department of Nutrition Science, Purdue University, 700 W. State Street, West Lafayette, IN 47907 USA
| | - Dorothy B Hausman
- Department of Foods and Nutrition, University of Georgia, 305 Sanford Dr, Athens, GA 30602 USA
| | - Lígia Araújo Martini
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Doutor Arnaldo 715, São Paulo, CEP 01246-904 Brazil
| | - Richard D Lewis
- Department of Foods and Nutrition, University of Georgia, 305 Sanford Dr, Athens, GA 30602 USA
| | - Connie M Weaver
- Department of Nutrition Science, Purdue University, 700 W. State Street, West Lafayette, IN 47907 USA
| | - Munro Peacock
- Department of Medicine, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN 46202 USA
| | - Kathleen M Hill Gallant
- Department of Nutrition Science, Purdue University, 700 W. State Street, West Lafayette, IN 47907 USA
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