Evaluation of the correlation between serum tumor necrosis factor-alpha and relative body mass index (RBMI) in childhood

Biomarkers of cardiometabolic complications in survivors of childhood acute lymphoblastic leukemia

Survivors of childhood acute lymphoblastic leukemia (cALL) are at higher risk of developing cardiometabolic complications. We aimed at exploring the associations between biomarkers of inflammation, oxidative stress, endothelial function, endotoxemia and cardiometabolic risk factors. We conducted a cross-sectional analysis in 246 cALL survivors (mean age, 22.1 ± 6.3 years; mean time since diagnosis, 15.5 ± 5.2 years) and evaluated the associations using a series of logistic regressions. Using structural equation models, we also tested if the relationship between endotoxemia and cardiometabolic complications was mediated by the latent (unobserved) variable inflammation inferred from the observed biomarkers CRP, TNF-α and IL-6. High leptin-adiponectin ratio was associated with obesity [adjusted OR = 15.7; 95% CI (6.2–39.7)], insulin resistance [20.6 (5.2–82.1)] and the metabolic syndrome [11.2 (2.6–48.7)]. Higher levels of plasminogen activator inhibitor-1 and tumor necrosis factor-α were associated with obesity [3.37 (1.6–7.1) and 2.34 (1.3–4.2), respectively] whereas high C-reactive protein levels were associated with insulin resistance [3.3 (1.6–6.8)], dyslipidemia [2.6 (1.4–4.9)] and MetS [6.5 (2.4–17.9)]. Our analyses provided evidence for a directional relationship between lipopolysaccharide binding protein, related to metabolic endotoxemia, inflammation and cardiometabolic outcomes. Identification of biomarkers and biological mechanisms could open new avenues for prevention strategies to minimize the long-term sequelae, improve follow-up and optimize the quality of life of this high-risk population.

Obesity and inflammation in children

Systemic inflammation is present in children and adults with obesity. Inflammation associated with obesity appears to be central to the development of insulin resistance and atherosclerosis and may be important in the pathogenesis of other comorbid conditions. Although generally considered an inert energy storage tissue, white adipose tissue is a metabolically active organ. It produces a number of inflammatory cytokines and acute-phase reactants. Inflammation associated with obesity declines after weight loss and with exercise. It may also be possible to modify obesity-associated inflammation with medications, reducing comorbidities without weight loss. The study of inflammation in the context of excessive adipose tissue is central to understanding obesity and modifying its impact on patients.

Diagnosis and management of cerebral salt wasting (CSW) in children: the role of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)

OBJECTIVE

The aim of this study is to report our experience with diagnosis and management of cerebral salt wasting (CSW) in children and to evaluate the role of atrial natriuretic peptide/brain natriuretic peptide (ANP/BNP) in pediatric patients.

MATERIALS AND METHODS

We present nine children suffering from prevalent cerebral disease--seven of whom underwent anesthesia and surgical procedures--with features of CSW, seen within a 22-month period. The symptoms, patient characteristics (including hormone status), monitoring, treatment protocol, and outcome are described.

RESULTS

Natriuresis (urine Na+ concentrations 131 to >250 mmol/l) and polyuria (5.5+/-1.5 ml/kg/h) with increased Na+ turnover (maximum Na+ loss: median 1.50 mmol Na+/kg/h, range 0.47 to >3.50) vanished within 2 weeks in 6/9 patients (increase in serum Na+ from 127+/-2 mmol/l to 136+/-1). K+ excretion was also high (maximum K+ loss: median 0.18 mmol K+/kg/h, range 0.09-0.53). ANP/BNP as suspected causes of salt wasting were elevated only in 1/6 and 2/7 patients, respectively. Plasma renin activities and aldosterone levels were either suppressed or in the low normal range.

CONCLUSION

Natriuresis and polyuria are the main diagnostic criteria for CSW. The fluid balance in CSW is negative, in contrast to a positive fluid balance in SIADH. The length of the disease is self-limited and generally ceases within 2 weeks, while Na+, K+, and fluid turnover should be monitored carefully. Only a minority of our children showed elevated ANP/BNP levels. A dose/effect relationship for natriuretic peptide levels and increased Na+ turnover could not be established.

Pediatric obesity and insulin resistance: chronic disease risk and implications for treatment and prevention beyond body weight modification

The study of childhood obesity has continued to grow exponentially in the past decade. This has been driven in part by the increasing prevalence of this problem and the widespread potential effects of increased obesity in childhood on lifelong chronic disease risk. The focus of this review is on recent findings regarding the link between obesity and disease risk during childhood and adolescence. We describe recent reports relating to type 2 diabetes in youth (2), prediabetes (69, 166), metabolic syndrome (33, 35), polycystic ovarian syndrome (77), and nonalcoholic fatty liver disease (58, 146), and the mediating role of insulin resistance in these conditions. In addition, we review the implications of this research for the design of more effective treatment and prevention strategies that focus more on the improvement of obesity-related metabolic abnormalities and chronic disease risk reduction than on the conventional energy balance approach that focuses on weight management.

Relationship between plasma leptin, insulin and tumor necrosis factor alpha in obese children

OBJECTIVES

1. To evaluate the relationship between plasma leptin and TNFalpha concentrations in obese children and to assess the differences between hyperinsulinemic and normoinsulinemic groups. 2. To evaluate the relationship between plasma leptin and insulin levels in obese children. 3. To investigate the TNFalpha G308A mutation in obese children.

METHODS

Body mass index (BMI), fasting plasma glucose and insulin levels, oral glucose tolerance test results, homeostasis model assessment of insulin resistance (HOMA-IR) results, and plasma leptin and TNFalpha concentrations were evaluated in obese children (n = 45) and age- and gender-matched, lean healthy controls (n = 40).

RESULTS

In obese children the fasting insulin, HOMA-IR results, plasma leptin and TNFalpha concentrations were significantly higher than in controls (p <0.05). Furthermore, obese females showed higher plasma leptin and insulin resistance compared to obese males. While plasma leptin, TNFalpha levels and HOMA-IR results were similar in the prepubertal and pubertal groups, insulin levels were significantly higher in the pubertal group. Plasma leptin and TNFalpha concentrations were similar in hyperinsulinemic and normoinsulinemic obese children. In control children, plasma leptin concentrations showed a positive correlation with BMI, age, fasting insulin and HOMA-IR results. In obese children, plasma leptin levels did not correlate with BMI, fasting insulin or TNFalpha.

CONCLUSION

Plasma leptin concentrations did not show any correlation with TNFalpha levels in obese children. Furthermore, plasma leptin and TNFalpha concentrations were similar in hyperinsulinemic and normoinsulinemic obese children.

Serum tumor necrosis factor-alpha levels and components of the metabolic syndrome in obese adolescents

Tumor necrosis factor-alpha (TNF-alpha) seems to be increased in obese subjects, suggesting its role as a proinflammatory cytokine to insulin resistance and metabolic abnormalities in obesity. The aim of this study was to evaluate the relationship between serum TNF-alpha, soluble TNF-alpha receptor 1 (sTNF-R1), TNF-alpha receptor 2 (sTNF-R2), and metabolic syndrome (MS) components and anthropometric indices in obese and non-obese adolescents. A cross-sectional study was performed on obese and non-obese adolescents. We studied 71 adolescents (age, 15 to 16 years old); 39 were obese (obese group; 14 males and 25 females) and 32 were non-obese adolescents (non-obese lean group; 12 males and 20 females). The body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were determined in each subject. The serum TNF-alpha, sTNF-R1, sTNF-R2, fasting plasma glucose (FPG), and lipid profile were also measured. The mean serum TNF-alpha, sTNF-R1, and sTNF-R2 were significantly higher in the obese than the non-obese group (TNF-alpha, 18.15 v 5.88 pg/mL, P < .001; sTNF-R1, 2.01 v 1.40 ng/mL, P < .001; sTNF-R2, 6.06 v 3.70 pg/mL, P < .001). The serum TNF-alpha concentrations were positively correlated with the BMI (TNF-alpha, r = 0.346, P < .05; sTNF-R1, r = 0.624, P < .001; sTNF-R2, r = 0.482, P < .001, respectively) and WC (TNF-alpha, r = 0.525, P < .05; sTNF-R1, r = 0.700, P < .001; sTNF-R2, r = 0.669, P < .001, respectively). The serum TNF-alpha was positively correlated with triglyceride (TG) and DBP, and negatively with high-density lipoprotein-cholesterol (HDLC). The sTNF-R1 and sTNF-R2 were correlated with TG and DBP, and TG, respectively. Obese compared with non-obese adolescents exhibited higher concentrations of TNF-alpha and its soluble receptors, and the higher TNF-alpha concentrations were associated with several components of MS in obese adolescents.