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Zhang S, Yan H, Sun W, Li J, Xu J, Cao D, Song B, Wu X. Global hotspots and trends in Acanthosis nigricans research: A bibliometric and visualized analysis. Skin Res Technol 2024; 30:e70054. [PMID: 39258800 PMCID: PMC11388607 DOI: 10.1111/srt.70054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 08/28/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND Acanthosis nigricans (AN) is a common skin disease characterized by clear pigmented patches on the folds of the skin. However, the AN research field lacks scientific and comprehensive bibliometric analysis. This article aims to use bibliometric methods to summarize and visualize the distribution patterns, research hotspots, and development trends of AN literature. METHODS Literature from 1900 to 2024 was retrieved from the Web of Science Core Collection database through AN's thematic search. Using CiteSpace, VOSviewer, and Excel 2019, conduct a comprehensive analysis of the number of publications, countries/regions, institutions, authors, journals, highly cited literature, keywords, and so on, and sort out the hotspots and directions of AN. RESULTS From 1900 to 2024, 1675 publications were included in the bibliometric analysis, showing a steady annual increase in the number of publications. The United States leads in this research field, with the University of Texas System being a key research institution. The Journal of Clinical Endocrinology & Metabolism has the highest number of published papers. The most cited article is "Syndromes of Insulin Resistance and Acanthosis Nigricans: Insulin-Receptor Disorders in Man" (1976). The author Taylor, SI, has published the most papers. "Acanthosis nigricans" is the most frequently occurring keyword. The main research hotspots and frontier areas in AN research are as follows: (1) The relationship between AN and other diseases is a popular research topic; (2) The connection between AN and insulin resistance (IR) is a current research focus; (3) Treatment of AN, with an emphasis on addressing the underlying causes and improving local skin conditions, represents the cutting edge of this field. CONCLUSION This study summarizes the research trends and hotspots in the field of AN, offering valuable information and insights for scholars focused on AN scientific research, and providing a reference for future research directions.
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Affiliation(s)
- Shaobo Zhang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, Jilin, P.R. China
| | - Huixin Yan
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, Jilin, P.R. China
| | - Weichen Sun
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, Jilin, P.R. China
| | - Jingnan Li
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, Jilin, P.R. China
| | - Jing Xu
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, Jilin, P.R. China
| | - Di Cao
- School of Basic Medical Sciences, Hubei University of Chinese Medicine, Wuhan, Hubei, P.R. China
| | - Bailin Song
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, Jilin, P.R. China
| | - Xingquan Wu
- Department of Tuina, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, P.R. China
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Araújo D, Morgado C, Correia-Pinto J, Antunes H. Predicting Insulin Resistance in a Pediatric Population With Obesity. J Pediatr Gastroenterol Nutr 2023; 77:779-787. [PMID: 37608437 DOI: 10.1097/mpg.0000000000003910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Insulin resistance (IR) affects children and adolescents with obesity and early diagnosis is crucial to prevent long-term consequences. Our aim was to identify predictors of IR and develop a multivariate model to accurately predict IR. METHODS We conducted a cross-sectional analysis of demographical, clinical, and biochemical data from a cohort of patients attending a specialized Paediatric Nutrition Unit in Portugal over a 20-year period. We developed multivariate regression models to predict IR. The participants were randomly divided into 2 groups: a model group for developing the predictive models and a validation group for cross-validation of the study. RESULTS Our study included 1423 participants, aged 3-17 years old, randomly divided in the model (n = 879) and validation groups (n = 544). The predictive models, including uniquely demographic and clinical variables, demonstrated good discriminative ability [area under the curve (AUC): 0.834-0.868; sensitivity: 77.0%-83.7%; specificity: 77.0%-78.7%] and high negative predictive values (88.9%-91.6%). While the diagnostic ability of adding fasting glucose or triglycerides/high density lipoprotein cholesterol index to the models based on clinical parameters did not show significant improvement, fasting insulin appeared to enhance the discriminative power of the model (AUC: 0.996). During the validation, the model considering demographic and clinical variables along with insulin showed excellent IR discrimination (AUC: 0.978) and maintained high negative predictive values (90%-96.3%) for all models. CONCLUSION Models based on demographic and clinical variables can be advantageously used to identify children and adolescents at moderate/high risk of IR, who would benefit from fasting insulin evaluation.
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Affiliation(s)
- Daniela Araújo
- From the Pediatrics Department, Hospital de Braga, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- School of Medicine, University of Minho, Braga, Portugal
| | - Carla Morgado
- the Department of Neurology, Hospital of Braga, Braga, Portugal
- CEREBRO - Brain Health Center, Braga, Portugal
- ISAVE, Higher Institute of Health, Braga, Portugal
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- School of Medicine, University of Minho, Braga, Portugal
- the Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
- ICVS/3B's Associate Laboratory, University of Minho, Braga/Guimarães, Portugal
| | - Henedina Antunes
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- School of Medicine, University of Minho, Braga, Portugal
- the Gastroenterology, Hepatology and Nutrition Unit, Pediatric Department and Academic Clinical Center (2CA Braga), Hospital de Braga, Braga, Portugal
- ICVS/3B's Associate Laboratory, University of Minho, Braga/Guimarães, Portugal
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Zhu C, Wen X, You H, Lu L, Du L, Qian C. Improved Insulin Secretion Response and Beta-cell Function Correlated with Increased Prolactin Levels After Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with Acanthosis Nigricans. Obes Surg 2023; 33:2405-2419. [PMID: 37338797 DOI: 10.1007/s11695-023-06686-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To explore insulin secretion patterns, β-cell function, and serum prolactin (PRL) concentrations in Chinese morbidly obese patients with Acanthosis nigricans (AN) and their alterations after laparoscopic sleeve gastrectomy (LSG). METHODS A total of 138 morbidly obese subjects undergoing LSG were categorized as simple obesity without AN (OB group, n = 55) and obesity with AN (AN group, n = 83). Oral glucose tolerance test (OGTT), PRL, and related metabolic indices were performed pre- and 12 months post-LSG. Insulin secretion patterns were derived from insulin secretion peak time during OGTT: type I (peak at 30 or 60 min) and type II (peak at 120 or 180 min). RESULTS Preoperatively, AN group showed significantly higher proportions of type II insulin secretion pattern, fasting insulin (FINS), and homeostatic model assessment of insulin resistance (HOMA-IR) whereas lower oral glucose insulin sensitivity (OGIS), insulinogenic index (IGI), and disposition index (DI) than OB group, which were improved significantly at 12 months postoperatively in both groups, more pronounced in AN group. Intriguingly, serum PRL declined substantially in AN group than OB group at baseline whereas elevated only in the AN group post-LSG. After adjusting for confounding factors, elevated PRL correlated significantly with increased IGI and DI, and decreased HOMA-IR in both genders, as well as increased OGIS in females, which was detected only in the AN group CONCLUSION: Morbidly obese patients with AN presented delayed insulin secretion response, impaired insulin secretion, and β-cell dysfunction, which were significantly improved by LSG and might benefit from elevated PRL.
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Affiliation(s)
- Cuiling Zhu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Xin Wen
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Hui You
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Liesheng Lu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Lei Du
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Chunhua Qian
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China.
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Berg EA, Huang Z, Wang Y, Baidal JW, Fennoy I, Lavine JE, Zitsman J, Shen W. Magnetic Resonance Imaging to Assess Body Composition Change in Adolescents With Obesity After Sleeve Gastrectomy. J Pediatr Gastroenterol Nutr 2022; 75:761-767. [PMID: 36070531 PMCID: PMC9675718 DOI: 10.1097/mpg.0000000000003607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Metabolic and bariatric surgery is the most effective weight loss treatment for severe obesity. The number of adolescents undergoing sleeve gastrectomy is increasing. We investigated changes in body composition in adolescents undergoing sleeve gastrectomy 12-26 weeks post-operatively using whole-body magnetic resonance imaging (WB-MRI). METHODS This prospective cohort study assessed changes in adipose tissue compartments (ie, visceral, subcutaneous, and intermuscular) and muscle in 18 obese adolescents, ages 14-19, 89% female, with body mass index z -score of 2.6 ± 0.25 (range 2.16-3.2). All underwent WB-MRI 1.5-17 weeks pre-operatively and 12-26 weeks post-operatively. RESULTS Pre- and post-operative WB-MRI showed decreases in all adipose tissue compartments, as well as decreased skeletal muscle and liver fat fraction ( P < 0.0001). The post-operative percentage loss of adipose tissue in subcutaneous, visceral, and intermuscular compartments (89.0%, 5.8%, 5.2%, respectively) was similar to the pre-operative percentages of corresponding adipose tissue compartments (90.5%, 5.0%, 4.5%, respectively). Of note, participants with obstructive sleep apnea had significantly higher pre-operative volume of subcutaneous and intermuscular adipose tissue than participants without obstructive sleep apnea ( P = 0.003). CONCLUSIONS We found, contrary to what is reported to occur in adults, that pre-operative percentage loss of adipose tissue in subcutaneous, visceral, and intermuscular compartments was similar to the post-operative percentage loss of corresponding adipose tissue compartments in adolescents 12-26 weeks after sleeve gastrectomy.
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Affiliation(s)
- Elizabeth A. Berg
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center
| | - Zixing Huang
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center
| | - Youya Wang
- Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center
| | - Jennifer Woo Baidal
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center
| | - Joel E. Lavine
- Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center
| | - Jeffrey Zitsman
- Division of Pediatric Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center
| | - Wei Shen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center
- Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center
- Columbia Magnetic Resonance Research Center (CMRRC), Columbia University
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Dinh Le T, Minh Bui T, Hien Vu T, Phi Thi Nguyen N, Thanh Thi Tran H, Nguyen ST, Ho Thi Nguyen L, Van Ngo M, Huy Duong H, Thanh Vu B, Dinh HT, Nhu Do B, Le DC, Thi Nguyen H, Trung Nguyen K. Insulin Resistance in Gestational Diabetes Mellitus and Its Association With Anthropometric Fetal Indices. Clin Med Insights Endocrinol Diabetes 2022; 15:11795514221098403. [PMID: 35601878 PMCID: PMC9121510 DOI: 10.1177/11795514221098403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: In pregnant women with gestational diabetes mellitus (GDM), insulin
resistance (IR) increases the risk of developing manifest type 2 diabetes
mellitus and is associated with complications in both mother and fetus. Objectives: This research aimed to evaluate the associations between IR evaluated by 3
indices (namely updated homeostasis model assessment model (HOMA2), QUICKI,
and McAuley’s index) and the diabetes risk factors and the fetal growth
indices in Vietnamese women with GDM. Methods: A cross-sectional descriptive study was conducted on 370 women with GDM and
40 healthy pregnant women from January 2015 to May 2019. IR was calculated
by HOMA2 (HOMA2-IR), QUICKI, and McAuley’s index. Fetal anthropometric
measurements were assessed via ultrasound which was performed and
interpreted by ultrasound experts. Results: In the simple regression analysis, McAuley’s index illustrated had
statistically significant correlations to the highest number of risk factors
of diabetes mellitus compared with HOMA2-IR and QUICKI indices. Moreover,
McAuley’s index correlated statistically significantly to the highest number
of fetal ultrasound measurements factors such as including biparietal
diameter (BPD) (r = −0.271, P < .001),
head circumference (HC) (r = −0.225,
P < .001), abdominal circumference (AC)
(r = −0.214, P < .001), femur
length (FL) (r = −0.231, P < .001),
estimated fetal weight (EFW) (r = −0.239,
P < .001) and fetal estimated age
(r = −0.299, P < .001). In the
multivariable analysis, the McAuley’s index contributed the greatest to AC
(Standardized B of −0.656, P < .001). Conclusion: The McAuley’s index was significantly associated with a higher number of more
risk factors for diabetes mellitus as well as fetal ultrasound sonography
findings measurements than compared with HOMA2-IR and QUICKI indices.
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Affiliation(s)
- Tuan Dinh Le
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Ha Noi, Vietnam.,Department of Rheumatology and Endocrinology, Military Hospital 103, Ha Noi, Vietnam.,Vietnam Military Medical University, Ha Noi, Vietnam
| | - Tien Minh Bui
- Department of Obstetrics and Gynecology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | | | - Nga Phi Thi Nguyen
- Department of Rheumatology and Endocrinology, Military Hospital 103, Ha Noi, Vietnam.,Vietnam Military Medical University, Ha Noi, Vietnam
| | | | - Son Tien Nguyen
- Department of Rheumatology and Endocrinology, Military Hospital 103, Ha Noi, Vietnam.,Vietnam Military Medical University, Ha Noi, Vietnam
| | | | - Manh Van Ngo
- Postgraduate Training Management Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Hoang Huy Duong
- Department of Neurology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Binh Thanh Vu
- Department of Internal Medicine, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Hoa Trung Dinh
- Departmen of Requested Treatment, National Hospital of Endocrinology, Ha Noi, Vietnam
| | - Binh Nhu Do
- Division of Military Science, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam
| | - Duc-Cuong Le
- Department of Epidemiology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Hien Thi Nguyen
- Department of Physiology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Kien Trung Nguyen
- Department of Obstetrics and Gynecology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
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Rodríguez-Rodríguez E, Salas-González MD, Ortega RM, López-Sobaler AM. Leukocytes and Neutrophil–Lymphocyte Ratio as Indicators of Insulin Resistance in Overweight/Obese School-Children. Front Nutr 2022; 8:811081. [PMID: 35601749 PMCID: PMC9121808 DOI: 10.3389/fnut.2021.811081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Aims Inflammation in overweight/obesity may condition the development of insulin resistance (IR). New markers of inflammation and systemic inflammation, such as leukocyte and platelet counts, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), could be used as indicators of IR. The aim of the present study was to investigate the relationship between these markers and IR in overweight/obese children. Materials and Methods A total of 1,035 schoolchildren were studied (398 overweight/obese). Anthropometric, hematological and biochemical measurements were collected. Inflammation was considered to be present when the values of leukocytes, platelets, NLR, PLR and MLR were ≥p75 for each sex. IR was defined as HOMA-IR >3.16. Results In overweight/obese schoolchildren, leukocytes were higher in both boys and girls, and platelets and NLR were higher in boys with IR than in boys with insulin sensitivity. An association between leucocytes and NLR values (≥p75) and IR was found in the entire population [2.911 (1.328–6.381); p = 0.008 and 2.660 (1.185–5.968); p = 0.018, respectively] and in boys [9.255 (1.896–45.168); p = 0.006 and 6.996 (1.377–35.544); p = 0.019, respectively]. Conclusion Elevated white blood cell values and elevated NLR in overweight/obese children, and particularly in boys, could be indicators of the presence of IR in these subjects and should be considered when predicting possible complications, such as type II diabetes mellitus.
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Affiliation(s)
- Elena Rodríguez-Rodríguez
- VALORNUT Research Group, Analytical Chemistry Unit, Department of Chemistry in Pharmaceutical Science, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - M. Dolores Salas-González
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
- *Correspondence: M. Dolores Salas-González
| | - Rosa M. Ortega
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Ana M. López-Sobaler
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
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Severe Quantitative Scale of Acanthosis Nigricans in Neck is Associated with Abdominal Obesity, HOMA-IR, and Hyperlipidemia in Obese Children from Mexico City: A Cross-Sectional Study. Dermatol Res Pract 2022; 2022:2906189. [PMID: 35386232 PMCID: PMC8979734 DOI: 10.1155/2022/2906189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/07/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Acanthosis nigricans (AN) is a clinical sign that commonly occurs in obesity; however, its specificity and sensitivity have been controversial. It is unknown if AN severity degree can be a useful marker for cardiometabolic disorders screening. We suggest that the stratified analysis of AN severity degree in neck by Burke’s scale could be a useful tool in the screening of cardiometabolic alterations in obese children. Objective. The aim of this study was the association of AN severity degree in neck by Burke’s scale with anthropometric, biochemical, and inflammatory parameters in obese school-age children from Mexico City. Methods. A cross-sectional study was conducted, including 95 obese school-age children stratified by AN severity degree in neck by Burke’s scale. Anthropometric and fasting biochemical measurements were determined. Variables were compared by x2 test for frequencies and one-way ANOVA with Bonferroni posttest for continuous variables. Linear regression analysis adjusted by gender, BMI, and age was performed to evaluate the association between AN severity degree and cardiometabolic alterations. Statistical significance was set at
. Results. As AN severity degree in neck by Burke’s scale increased, diastolic blood pressure (
) and triglycerides (
) significantly increased and adiponectin significantly decreased (
). Positive associations between grade 3 AN and waist circumference, HOMA-IR, triglycerides, total cholesterol, and LDL cholesterol were observed. Conclusion. Our findings could be used to identify an easier clinical tool to prevent obesity progression and its complications in pediatrics. There are no similar studies.
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Rodríguez-Gutiérrez N, Villareal-Calderón JR, Castillo EC, García-Rivas G. Prediction of Insulin Resistance Based on Anthropometric and Clinical Variables in Children with Overweight or Obesity at a Tertiary Center in Northeast Mexico. Metab Syndr Relat Disord 2022; 20:174-181. [PMID: 35073186 DOI: 10.1089/met.2021.0094] [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: 11/12/2022] Open
Abstract
Background: This study provides a clinical model to identify children with insulin resistance (IR) in health care units where laboratory tests are not readily available. Methods: A retrospective study of Mexican children aged 2-16 years at an obesity (OB) clinic. A receiver operating characteristic (ROC) curve was used to assess the accuracy of the proposed model consisting of clinical parameters and to establish the cutoff value for the variables (439 children). A second cohort of children with similar characteristics served as the cohort for the validation of the model (577 children). Results: To determine the best model for predicting IR, we performed a multivariate logistic regression analysis, which showed that waist circumference, acanthosis nigricans, and pubertal status are independent predictors of IR, and when integrated, their predictive power increases. Based on this model, we constructed a simplified equation. The predictive tool was constructed using an ROC curve, with an area under the curve of 0.849. A cutoff value of 7.68 was selected based on the Youden Index, with sensitivity and specificity of 78.3% and 83.3%, respectively. Incorporating metabolic laboratory determinations with a cutoff value of 20.64 improved the sensitivity to 94.9%. Conclusions: We developed a simple and affordable method of identifying IR in children with overweight or OB based on anthropometric variables and routine blood tests for metabolic indicators, such as glucose and triglycerides, which can be implemented in underserved sites.
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Affiliation(s)
- Nora Rodríguez-Gutiérrez
- Departamento de Endocrinología Pediátrica, Clínica de Obesidad, Hospital Materno Infantil de Alta Especialidad, Secretaría de Salud, Monterrey, México.,Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México
| | - José R Villareal-Calderón
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México
| | - Elena Cristina Castillo
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México
| | - Gerardo García-Rivas
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México.,Tecnologico de Monterrey, Centro de Investigación Biomédica, Hospital Zambrano Hellion, TecSalud, San Pedro Garza García, México.,Tecnologico de Monterrey, The Institute for Obesity Research, San Pedro Garza García, México
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9
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Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Acanthosis Nigricans: An Updated Review. Curr Pediatr Rev 2022; 19:68-82. [PMID: 36698243 DOI: 10.2174/1573396318666220429085231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Early recognition of acanthosis nigricans is important because acanthosis nigricans can be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. OBJECTIVE The purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of acanthosis nigricans. METHODS A search was conducted in November 2021in PubMed Clinical Queries using the key term "acanthosis nigricans". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS Acanthosis nigricans is characterized by symmetric, hyperpigmented, and velvety plaques with ill-defined borders, typically involving intertriginous areas. Obesity is the most common cause of acanthosis nigricans which is increasingly observed in obese children and adolescents and can serve as a cutaneous marker of insulin resistance. Early recognition of acanthosis nigricans is important because acanthosis nigricans can also be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. This may consist of weight reduction, discontinuation of causative drugs, treatment of underlying endocrinopathy, or treatment of an underlying malignancy. For patients with isolated acanthosis nigricans and for those whose underlying cause is not amenable to treatment, treatment of the lesion may be considered for cosmetic reasons. Topical retinoids, vitamin D analogs, chemical peels, and other keratolytics are often used for the treatment of localized lesions. Seldom, systemic therapy such as oral retinoids may be considered for extensive or generalized acanthosis nigricans and acanthosis nigricans unresponsive to topical therapy. Other uncommon treatment modalities include dermabrasion, laser therapy, and surgical removal. CONCLUSION Although acanthosis nigricans is treatable, a complete cure is difficult to achieve. The underlying cause should be treated, if possible, to resolve and prevent the recurrence of acanthosis nigricans. The diagnosis is mainly clinical, based on the characteristic appearance (symmetrically distributed, hyperpigmented, velvety, papillomatous, hyperkeratotic plaques with ill-defined borders) and the typical sites (intertriginous areas, flexural area, and skin folds) of the lesions. The diagnosis might be difficult for lesions that have atypical morphology or are in an unusual location. Clinicians should be familiar with the clinical signs, evaluation, diagnosis, and therapy of acanthosis nigricans because of the link between it and underlying diseases.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
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10
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Impact of Obesity and Being Overweight on the Immunogenicity to Live Attenuated Hepatitis A Vaccine in Children and Young Adults. Vaccines (Basel) 2021; 9:vaccines9020130. [PMID: 33562009 PMCID: PMC7915133 DOI: 10.3390/vaccines9020130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/16/2022] Open
Abstract
Prior results investigating a correlation between obesity and hepatitis A virus (HAV) vaccine response have been inconclusive, with limited data involving live attenuated HAV vaccines. The aim of this study is to evaluate the effect of overweight and obesity on the response to live attenuated HAV vaccine in children and young adults. This prospective cohort study was conducted in Thailand with subjects ranging in age from seven to twenty-five years. The subjects were administered 0.5 mL of MEVAC™-A and tested for anti-HAV antibodies before and at 8–9 weeks after vaccination. Baseline seronegative subjects (anti-HAV antibodies < 20 mIU/mL) were divided into non-obese (underweight/normal weight) and obese (overweight/obesity/severe obesity) groups. A total of 212 (117 non-obese and 95 obese) subjects completed the study (mean age (SD) = 13.95 (3.90) years). The seroprotection rates were 100%. Postvaccination geometric mean titers (95% CI) were 429.51 (401.97, 458.94) and 467.45 (424.47, 514.79) mIU/mL in the non-obese and obese groups, respectively. Females (p = 0.013) and subjects with truncal obesity (p = 0.002) had significantly higher titers than other participants. Live attenuated HAV vaccine is safe and has comparably high immunogenicity in both underweight/normal weight and overweight/obese persons.
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Daye M, Selver Eklioglu B, Atabek ME. Relationship of acanthosis nigricans with metabolic syndrome in obese children. J Pediatr Endocrinol Metab 2020; 33:1563-1568. [PMID: 33581705 DOI: 10.1515/jpem-2020-0154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/21/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Acanthosis nigricans is a skin symptom in obesity that helps to identify patients at high risk for dyslipidemia, hypertension, insulin resistance, and diabetes. It is the most important complication of obesity in metabolic syndrome. Studies investigating the relationship between acanthosis nigricans and metabolic syndrome in obese children are insufficient. In our study, the relationship of acanthosis nigricans and metabolic syndrome was evaluated in children. METHODS Obese children aged between 6 and 18 years old, who were examined in the pediatric endocrinology outpatient clinic, were included. The patients' anthropometric measurements and laboratory results were recorded. Modified IDF (International Diabetes Federation) criteria for children were used in metabolic syndrome classification. RESULTS A hundred and forty-eight obese children were evaluated. The mean age of the cases was 11.91 ± 2.94 years old. Of the cases, 56.1% were female (n=83) 43.9% (n=65) were male. In 39.9% (n=59) of cases, acanthosis nigricans was determined. Acanthosis nigricans was mostly located in the axillary area (27.1%) and the neck (16.9%). In 55.9% of the cases, it was located in more than one area. The relation of regionally detected acanthosis nigricans and metabolic syndrome was not significant (p=0.291). Metabolic syndrome was detected in 14% of 136 patients according to IDF criteria. Acanthosis nigricans and metabolic syndrome combination was present in 27.7%; however, 6.7% of the metabolic syndrome patients did not have acanthosis nigricans. There was a strong relation between metabolic syndrome and the presence of acanthosis nigricans (p=0.003). CONCLUSIONS In our study, a correlation between acanthosis nigricans and metabolic syndrome was detected. Acanthosis nigricans is a skin sign that can be easily detected by clinician. It is an important and easy-to-detect dermatosis that helps determine patients at risk of metabolic syndrome in obese children.
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Affiliation(s)
- Munise Daye
- Department of Dermatology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Beray Selver Eklioglu
- Necmettin Erbakan University Faculty of Medicine, Division of Pediatric Endocrinology, Konya, Turkey
| | - Mehmet Emre Atabek
- Necmettin Erbakan University Faculty of Medicine, Division of Pediatric Endocrinology, Konya, Turkey
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Rodríguez-Gutiérrez N, Vanoye Tamez M, Vázquez-Garza E, Villarreal-Calderón JR, Castillo EC, Laresgoiti-Servitje E, Elizondo-Montemayor L, García-Rivas G. Association of the Triglyceride/High-Density Lipoprotein Cholesterol Index with Insulin Resistance in a Pediatric Population in Northeast Mexico. Metab Syndr Relat Disord 2020; 18:333-340. [DOI: 10.1089/met.2020.0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nora Rodríguez-Gutiérrez
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México
- Clínica de Obesidad, Departamento de Endocrinología Pediátrica, Hospital Materno Infantil de Alta Especialidad, Secretaría de Salud, Guadalupe, Nuevo León, México
| | - Mariana Vanoye Tamez
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México
| | - Eduardo Vázquez-Garza
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México
| | - José R. Villarreal-Calderón
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México
| | - Elena C. Castillo
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México
| | - Estibalitz Laresgoiti-Servitje
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México
| | - Leticia Elizondo-Montemayor
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Centro de Investigación en Nutrición Clínica y Obesidad, Monterrey, México
| | - Gerardo García-Rivas
- Tecnologico de Monterrey, Escuela Medicina y Ciencias de la Salud, Grupo de Enfoque en Medicina Cardiovascular y Metabolómica, Monterrey, México
- Tecnologico de Monterrey, Hospital Zambrano-Hellion, Centro de Investigación Biomédica, San Pedro Garza-García, México
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Chang-Rueda C, Cañas-Urbina A, Trujillo-Murillo K, Espinoza-Ruiz M, Feliciano-Díaz J, Vázquez-Moreno M, Lugo-Trampe Á. Correlation of HOMA-IR with BMI-for-age percentile in children and adolescents from the Soconusco region of Chiapas, Mexico. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n4.67159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Insulin resistance (IR) is a major risk factor for developing diabetes mellitus type 2 and cardiovascular diseases. In pediatrics, morbidity and mortality associated with these diseases highlights the diagnostic importance of IR for primary care.Objective: To determine Homeostatic Model Assessment Insulin Resistance (HOMA-IR) values and their correlation with BMI-for-age percentile in children and adolescents of the Soconusco region of Chiapas, Mexico.Materials and methods: Cross-sectional study. Overweight and obesity prevalence was determined based on the Body Mass Index (BMI) percentile of 112 children (5-19 years old). Glucose and fasting insulin values were quantified and used for estimation of HOMA-IR.Results: The combined prevalence of obesity and overweight was 66%, with insulin (p=0.010) and HOMA-IR (p=0.015) values higher than those of the normal weight group. The HOMA-IR values correlated positively with age (r=0.636), weight (r=0.569), height (r=0.578) and BMI percentile (r=0.198).Conclusions: In the study population, HOMA-IR has a moderately significant correlation with an increase in BMI percentile.
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Videira-Silva A, Albuquerque C, Fonseca H. Acanthosis nigricans as a clinical marker of insulin resistance among overweight adolescents. Ann Pediatr Endocrinol Metab 2019; 24:99-103. [PMID: 31261473 PMCID: PMC6603613 DOI: 10.6065/apem.2019.24.2.99] [Citation(s) in RCA: 10] [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] [Received: 08/08/2018] [Accepted: 11/09/2018] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Acanthosis nigricans (AN) is a hyperpigmented dermatosis associated with obesity and insulin resistance (IR). There is no consensus whether AN extension scoring offers added value to the clinical estimation of IR. In this study we aimed to assess and score AN using both a short and an extended version of the scale proposed by Burke et al. and analyze the relationships of both versions with hyperinsulinemia and IR. METHODS We analyzed data from 139 overweight adolescents (body mass index ≥85th percentile) aged 12-18 with (n=67) or without (n=72) AN who were followed at a pediatric obesity clinic. RESULTS Adolescents with AN had higher levels of insulin (d=0.56, P=0.003) and HOMA-IR (d=0.55, P=0.003) compared to those without. Neither the short nor the extended versions of AN scores explained either hyperinsulinemia (β=1.10, P=0.316; β=1.15, P=0.251) or IR (β=1.07, P=0.422; β=1.10, P=0.374). The presence of AN alone predicted hyperinsulinemia and the presence of IR in 7.3% (β=2.68, P=0.008) and 7.1% (β=2.59, P=0.009) of adolescents, respectively. CONCLUSION Screening for AN at the neck and axilla is a noninvasive and cost-effective way to identify asymptomatic overweight adolescents with or at risk of developing IR.
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Affiliation(s)
- Antonio Videira-Silva
- Pediatric University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal,Address for correspondence: António Videira-Silva, MSc Pediatric University Clinic, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal Tel: +351969172368 Fax: +351217985100 E-mail:
| | - Carolina Albuquerque
- Department of Pediatrics, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Helena Fonseca
- Pediatric Obesity Clinic, Department of Pediatrics, Hospital de Santa Maria, Lisbon, Portugal,Rheumatology Research Unit, Molecular Medicine Institute, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Zhu C, Mei F, Gao J, Zhou D, Lu L, Qu S. Changes in inflammatory markers correlated with increased testosterone after laparoscopic sleeve gastrectomy in obese Chinese men with acanthosis nigricans. J Dermatol 2019; 46:338-342. [PMID: 30724385 DOI: 10.1111/1346-8138.14783] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 12/20/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Cuiling Zhu
- Department of Endocrinology and Metabolism School of Medicine Shanghai Tenth People's Hospital of Tongji University Shanghai China
- National Metabolic Management Center Shanghai China
| | - Fangyun Mei
- Department of Endocrinology and Metabolism School of Medicine Shanghai Tenth People's Hospital of Tongji University Shanghai China
- National Metabolic Management Center Shanghai China
| | - Jingyang Gao
- Department of Endocrinology and Metabolism School of Medicine Shanghai Tenth People's Hospital of Tongji University Shanghai China
- National Metabolic Management Center Shanghai China
| | - Donglei Zhou
- Department of Gastrointestinal Surgery School of Medicine Shanghai Tenth People's Hospital of Tongji University Shanghai China
| | - Liesheng Lu
- Department of Gastrointestinal Surgery School of Medicine Shanghai Tenth People's Hospital of Tongji University Shanghai China
| | - Shen Qu
- Department of Endocrinology and Metabolism School of Medicine Shanghai Tenth People's Hospital of Tongji University Shanghai China
- National Metabolic Management Center Shanghai China
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Sett A, Pradhan S, Sancheti K, Basu D, Datta A, Biswas L, Das S, Pal SK, Gupta N, Sil A, Das NK. Effectiveness and Safety of Metformin versus Canthex™ in Patients with Acanthosis Nigricans: A Randomized, Double-blind Controlled Trial. Indian J Dermatol 2019; 64:115-121. [PMID: 30983607 PMCID: PMC6440186 DOI: 10.4103/ijd.ijd_417_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Acanthosis nigricans has been associated with conditions of insulin resistance such as obesity, polycystic ovary syndrome, and type 2 diabetes. Metformin and alpha-lipoic acid, two types of insulin-sensitizing agents, have been demonstrated to reduce insulin levels and improve insulin sensitivity. Alpha-lipoic acid is available as a fixed-dose combination with biotin, calcium pantothenate, and zinc sulfate as Canthex™. Aims: This study aimed to compare the effectiveness, safety, and improvement of the insulin resistance profile of Canthex™ and metformin in acanthosis nigricans. Materials and Methods: In this double-blind, randomized (1:1), active-controlled trial (CTRI/2017/02/007880), participants received either metformin 500 mg BD or Canthex™ BD for 12 weeks. Effectiveness parameters were improvement of severity of neck lesions and neck texture. Serum fasting insulin level, glucose, lipids, body weight, waist circumference, body mass index (BMI), and homeostatic model assessment-insulin resistance (HOMA-IR) were also assessed at baseline and at the end of the study. Adverse effects and changes in routine laboratory parameters were taken as safety parameters. Results: Thirty-three patients were analyzed by modified-intention-to-treat criteria. Severity of neck lesions and texture were comparable at baseline and it showed significant reduction (P<0.001) in both the treatment arms from the first follow-up onward. No intergroup variation was observed in any of the follow-ups. There was reduction in the values of fasting insulin, blood sugar, total cholesterol, and thyroid-stimulating hormone in both the groups. Weight, BMI, and waist circumference and BMI reduced significantly in both the groups. HOMA-IR decreased significantly in metformin group (P<0.001). Conclusion: Canthex™ is as effective and safe as metformin in the management of acanthosis nigricans and associated features of insulin resistance.
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Affiliation(s)
- Arindam Sett
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Samiksha Pradhan
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Karan Sancheti
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Dibyendu Basu
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Adrija Datta
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Lekha Biswas
- Department of Biochemistry, Medical College and Hospital, Kolkata, West Bengal, India
| | - Sayan Das
- Department of Biochemistry, Medical College and Hospital, Kolkata, West Bengal, India
| | - Subhasis Kumar Pal
- Department of Biochemistry, Medical College and Hospital, Kolkata, West Bengal, India
| | - Nidhi Gupta
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Amrita Sil
- Department of Pharmacology, IPGMER, Kolkata, India
| | - Nilay Kanti Das
- Department of Dermatology, Bankura Sammilani Medical College, Bankura, West Bengal, India
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Hochberg Z. An Evolutionary Perspective on the Obesity Epidemic. Trends Endocrinol Metab 2018; 29:819-826. [PMID: 30243773 DOI: 10.1016/j.tem.2018.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/23/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
An evolutionary approach to obesity involves a genomic/anthropological dimension. For 1.8 Myr the lifestyle of hunter-gatherers (HGs) comprised intense physical activity and a high-protein/low-carbohydrate diet. Genomes of HGs were adapted to low insulin sensitivity. When the agrarian epoch began a new 'farmer diet' high in carbohydrates (CHO) emerged. Owing to periodic famines, the genome may not have adapted; they preserved a HG genome. Ever since the industrial revolution our genome is adapting rapidly to a CHO-rich diet. Individuals with preserved HG genome develop obesity at age 4-8 years and need a low-CHO diet. By contrast, those with a farmer genome become obese in infancy; they need a low-calorie diet. This knowledge prompts exploration of the two genomes and their clinical presentations.
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Affiliation(s)
- Z Hochberg
- Faculty of Medicine, Technion - Israel Institute of Technology, 31096 Haifa, Israel; https://md.technion.ac.il/faculty_member/zeev-hochberg/.
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Gudala M, Ahmed M, Conroy R, Tonyushkina K. Insulinoma masquerading as a loss of consciousness in a teenage girl: case report and literature review. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2017; 2017:13. [PMID: 29075301 PMCID: PMC5645892 DOI: 10.1186/s13633-017-0049-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hypoglycemia due to a pancreatic beta cell neoplasm - insulinoma, is uncommon with only a few cases described. We report on a previously healthy 15-year-old Hispanic female with insulinoma who presented with a loss of consciousness due to hypoglycemia unawareness. CASE PRESENTATION EM was first brought to the emergency department (ED) after she was found unresponsive at home with point of care (POC) glucose of 29 mg/dL(1.6 mmol/L) documented by emergency medical services (EMS) upon arrival. After treatment with dextrose and normal laboratory evaluation, including complete blood count, basal metabolic profile and urine drug screen, she was sent home with recommendations to follow-up the next day with an endocrinologist. Due to insurance issues, the family did not keep the appointment. Two days later, she returned to the ED with POC of 19 mg/dL (1.05 mmol/L). Detailed history review identified vague fatigue, excessive sleepiness, poor oral intake and weight gain for a 2-3 month period and no suspicion for drug, alcohol or prescription medication abuse. Family history of multiple endocrine neoplasia was negative. Physical examination revealed mild acanthosis nigricans and a body mass index of 32.8 kg/m2 (98th percentile). Laboratory evaluation showed elevated insulin with low cortisol and growth hormone levels at the time of hypoglycemia. Abdominal magnetic resonance imaging revealed a pancreatic mass, also supported by ultrasound, computed tomography and positron emission tomography scans. The patient underwent a partial pancreatectomy with removal of a well-circumscribed insulinoma from the anterior-superior aspect of the pancreatic neck confirmed by histology. Hypoglycemia resolved post-operatively and she remained euglycemic during a 48-h cure fast. At her 3-month follow-up visit, she had no symptoms of hypoglycemia. CONCLUSION Documented hypoglycemia in an otherwise healthy adolescent should be fully investigated before discharging a patient. Even a short duration of symptoms should prompt, in-depth diagnostic evaluations to rule out a potentially life threatening diagnosis of insulinoma.
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Affiliation(s)
- Meghana Gudala
- Division of Pediatric Endocrinology, Baystate Children's Hospital, 50 Wason Ave, Springfield, MA 01199 USA
| | - Mahmuda Ahmed
- Division of Pediatric Endocrinology, Baystate Children's Hospital, 50 Wason Ave, Springfield, MA 01199 USA
| | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital, 50 Wason Ave, Springfield, MA 01199 USA
| | - Ksenia Tonyushkina
- Division of Pediatric Endocrinology, Baystate Children's Hospital, 50 Wason Ave, Springfield, MA 01199 USA
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Karadag AS, Ozlu E, Lavery MJ. Cutaneous manifestations of diabetes mellitus and the metabolic syndrome. Clin Dermatol 2017; 36:89-93. [PMID: 29241758 DOI: 10.1016/j.clindermatol.2017.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Metabolic diseases are commonly encountered in the Western world. Cutaneous manifestations are common in metabolic disorders, such as diabetes mellitus (DM) and the metabolic syndrome (MetS), and metabolic diseases may manifest with specific skin findings. MetS and DM share a common mechanism in their etiopathogenesis. As a result, the skin findings associated with these two diseases partially overlap. Several skin findings in DM and MetS may be the first clinical features of the disease, and early diagnosis facilitates treatment, thereby helping in preventing long-term complications. In this review, MetS and skin manifestations associated with DM are discussed.
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Affiliation(s)
- Ayse Serap Karadag
- Department of Dermatology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey.
| | - Emin Ozlu
- Department of Dermatology, Duzce University, School of Medicine, Duzce, Turkey
| | - Michael Joseph Lavery
- Department of Dermatology, St James' Hospital, Trinity College Dublin, Dublin, Ireland
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Melvin A, Stears A. Severe insulin resistance: pathologies. PRACTICAL DIABETES 2017. [DOI: 10.1002/pdi.2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Audrey Melvin
- National Severe Insulin Resistance Service, Wolfson Diabetes and Endocrinology Department; Addenbrooke's Hospital; Cambridge UK
- Metabolic Research Laboratories, Wellcome Trust MRC Institute of Metabolic Science; University of Cambridge; Cambridge UK
| | - Anna Stears
- National Severe Insulin Resistance Service, Wolfson Diabetes and Endocrinology Department; Addenbrooke's Hospital; Cambridge UK
- Metabolic Research Laboratories, Wellcome Trust MRC Institute of Metabolic Science; University of Cambridge; Cambridge UK
- Institute of Metabolic Science; Addenbrooke's Hospital; Cambridge UK
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