The Urinary Concentration of Trefoil Factor 3 (TFF3) in the Term and Preterm Neonates

BACKGROUND

Distinguishing between a pathologic state and renal development is important in neonatology. Because the assessment of serum creatinine in neonates is not reliable, better biomarkers are needed. Trefoil factor 3 (TFF3) is proposed as a biomarker of kidney injury. The study aimed to assess its urinary concentration in healthy term and stable preterm neonates.

MATERIAL AND METHODS

The study included 80 term and 20 preterm neonates born in the Department of Perinatology of the University Clinical Hospital in Bialystok. Urine was obtained from the term neonates on the 1st day of life and from the preterm neonates on the 1st, 8th, 15th and 22nd day of life. The urinary concentration of TFF3 was determined using a commercially available immunoassay and was normalized for the urinary creatinine concentration (cr.).

RESULTS

The values of TFF3/cr. were higher in the preterm than in the term neonates (p < 0.05) (median (Q1-Q3): 1486.85 (614.92-3559.18) and 317.29 (68.07-671.40) ng/mg cr.). They did not differ in the subsequent days of the preterm neonates' lives. The ROC curve for TFF3/cr. in the preterm and term neonates showed AUC = 0.751 (cut-off value = 1684.25 ng/mg cr.).

CONCLUSIONS

Prematurity is associated with higher urinary excretion of TFF3. Male gender is associated with an increased urinary TFF3 excretion in term neonates.

Urinary netrin-1 concentration in healthy full-term newborns

INTRODUCTION

Monitoring of renal function in acute kidney injury in the pediatric population is complicated by the lack of age-related reference values of new biomarkers. Urinary netrin-1 is a new marker to demonstrate early kidney damage. Netrin-1 has a molecular mass of 72 kDa. It is therefore unlikely that it is filtered by the glomerulus under normal conditions. However, netrin-1 is highly induced after acute and chronic kidney injury and excreted in urine in humans. The aim of the study was to determine the normal concentrations of urinary netrin-1 in healthy full-term newborns.

MATERIAL AND METHODS

The study included 88 healthy full-term neonates (51 boys and 37 girls) born from normal, uncomplicated pregnancies. The concentration of netrin-1 was determined in urine obtained on the first or second day of life with a commercially available ELISA kit.

RESULTS

The urinary concentration of netrin-1 in newborns was independent of gender and time of urine collection. We found a negative correlation between both the urinary netrin-1 concentration and urinary netrin-1 concentration after normalization for urinary creatinine and the birth weight.

CONCLUSIONS

This is the first study showing the urinary netrin-1 concentration in healthy full-term newborns. Future investigation is needed to confirm its potential role as a marker of kidney function in this age group.

Health term-born girls had higher levels of urine neutrophil gelatinase-associated lipocalin than boys during the first postnatal days

Neutrophil gelatinase-associated lipocalin (NGAL) is one of the most extensively examined biological markers for early prediction of acute kidney injury, but there is a lack of data on normal NGAL values in healthy term-born infants. This encouraged us to established serum and urine levels using samples collected from 38 girls and 50 boys, born at a median age of 39 weeks, during the first 48 hours after birth.

CONCLUSION

Our findings showed that urine NGAL, but not serum levels, were significantly higher in girls than in boys.

Analysis of serum adiponectin, resistin and leptin levels in children and adolescents with autoimmune thyroid disorders

Leptin, adiponectin and resistin, mainly produced by adipocytes, play a major role in body weight regulation. Disturbances in the maintenance of normal body weight are found to occur also in thyroid diseases. There is a close relationship of the changes in thyroid hormones with the contents of adipose tissue and adipocyte-secreted proteins regulating energetic metabolism in the body. The study objective was to analyze the levels of leptin, adiponectin and resistin in children with untreated Graves' disease, subclinical hypothyroidism in Hashimoto's thyroiditis and in children with simple goiter. The study involved 78 patients with Graves' disease (29 girls and 2 boys, aged 6-21 years, mean 15.2) and with Hashimoto's thyroiditis (30 girls and 2 boys, aged 9-18 years, mean 14.5). The control group consisted of adolescents with simple goiter (13 girls and 2 boys, aged 9-18 years, mean 14.8). The levels of leptin, adiponectin and resistin were determined using the ELISA method (R&D System, USA). Patients with untreated Graves' disease showed higher adiponectin level than the patients with hypothyroidism in Hashimoto's thyroiditis and in simple goiter (14.24 +/- 0.89 vs. 9.18 +/- 2.65, 10.15 +/- 2.5, p < 0.007, p < 0.01), but lower resistin level as compared to simple goiter and Hashimoto's thyroiditis (10.24 +/- 5.2 vs. 13.29 +/- 3.8, 12.2 +/- 2.8, p < 0.01, NS). The analysis of leptin levels revealed no significant differences between children with subclinical hypothyroidism and untreated Graves' disease (4.42 +/- 0.87 vs. 3.1 +/- 0.45 NS). In conclusion, we suggest that disturbances in thyroid hormones in thyroid diseases have an essential effect on the levels of adiponectin and resistin released by adipose tissue.

Relationship between metabolic parameters and thyroid hormones and the level of gastric peptides in children with autoimmune thyroid diseases

Overweight and diseases connected with it are increasing problems in children and adults. We often observe change of weight in thyroid disease. It is emphasized that changes in hormones such as peptide levels are in close relationship with regulation of body mass: ghrelin increases appetite and in effect increases body mass, but obestatin decreases appetite and weight. The aim of the study was to analyze the relationship between lipid-carbohydrate metabolism parameters and thyroid hormones and the level of gastric peptides (ghrelin and obestatin) in young patients with Graves' disease, Hashimoto's thyroiditis and in children with simple goiter. The study group formed 78 patients suffering from Graves' disease (29 girls and 2 boys; aged from 6 to 21 - mean 15,2 yrs) and Hashimoto's thyroiditis (29 girls and 3 boys; aged from 9 to 18--mean 14.5 yrs). The control group consisted of children with simple goiter--13 girls and 2 boys; aged from 9 to 18 --mean 14.8 yrs. In all patients, ghrelin and obestatin levels were analyzed by the RIA method (Phoenix Pharmaceuticals, USA). In children and adolescents with untreated Graves' disease we found higher levels of insulin and HOMA-IR index compared to the group of children with simple goiter (34 +/- 8 microIU/mL vs 15 +/- 5; p < 0.03; 7.3 +/- 1.2 vs 3 +/- 0.3, p < 0.03). No significant correlations were observed of gastric hormones with antithyroid antibodies, lipids or h-CRP in patients with untreated hyperthyroidism and subclinical hypothyroidism. Positive correlation was noted of insulin and glucose levels and HOMA-IR index with ghrelin level in children with newly diagnosed Graves' disease (r = 0.109, p < 0.045; r = 0.176, p < 0.036; r = 0.174, p < 0.037). The correlation was also positive between obestatin level and HOMA-IR index in children with subclinical hypothyroidism in the course of Hashimoto's thyroiditis (r = 0.497, p < 0.011). We also examined the relationship between BMI, thyroid hormones and the level of gastric peptides. In untreated GD patients, ghrelin level exhibited a significant negative correlation with fT3 and fT4 (r = -0.38, p < 0.041; r = -0.459, p < 0.012) and positive with TSH (r = 0.38, p < 0.041) and BMI (r = 0.8, p < 0.01). In conclusion, we suggest that the disturbances in carbohydrate parameters in thyroid diseases have an essential effect on change of hormone-controlled appetite: ghrelin (in hyperthyroidism) and obestatin (in Subclinical hypothyroidism).

[Analysis of serum levels of ghrelin and obestatin in children and adolescents with autoimmune thyroid diseases]

INTRODUCTION

Thyroid disease is leading to a change of weight - in hyperthyroidism body mass is reduced, but in hypothyroidism it is increased. Recently researches suggest that many new bioactive substances, like ghrelin and obestatin, play a role in regulation of body mass. These closely related hormones have different effects- ghrelin increases, but obestatin decreases the appetite. The aim of the study was to evaluate ghrelin and obestatin levels in young patients with untreated Graves' disease, subclinical Hashimoto' thyroiditis and in children with nodular goiter in the euthyroid clinical state.

MATERIAL AND METHODS

The study group formed 78 patients of the Outpatient Endocrinology of the 2nd Department of Children's Disease (Medical University in Bialystok) and Outpatient Endocrinology IHC in Warsaw suffering from Graves' disease (29 girls and 2 boys; aged from 6 to 21 - mean 15,2 yrs) and Hashimoto's thyroiditis (29 girls and 3 boys; aged from 9 to 18 - mean 14,5 yrs). The control group consisted of children with nodular goiter (euthyroid) - 13 girls and 2 boys; aged from 9 to 18 - mean 14,8 yrs. In all patients, ghrelin and obestatin levels were analyzed by RIA's method (Phoenix Pharmaceuticals, USA).

RESULTS

In children and adolescents with hyperthyroidism in Graves' disease we found lower levels of ghrelin compared to the group of children with nodular goiter and with subclinical hypothyroidism in Hashimoto's thyroiditis (123+/-23 vs. 151+/-45; vs. 140+/-36 pg/ml, p<0,02, ns). On the other hand obestatin levels were lower in children with untreated subclinical hypothyroidism in Hashimoto's thyroiditis compared to a group with nodular goiter or Hashimoto's thyroiditis in euthyroidism (203,28+/-59 vs. 222.49+/-49; 267.24+/-70 pg/ml, p<0.03, p<0.02). In a group of untreated hyperthyroidism in Graves' disease we found correlations between ghrelin and fT3 (r=-0.36, p<0,4) and fT4 levels (r=- 0.45, p<0.01).

CONCLUSIONS

In conclusion, we suggested that disturbances in thyroid hormones in thyroid diseases have an essential effect on changes of hormones controlled appetite: ghrelin (in hyperthyroidism) and obestatin (in hypothyroidism).

[Identification of the CD40 (CD154) ligand expression on the surface of conglomerate platelet-monocyte in children with the metabolic syndrome]

INTRODUCTION

The increased expression of the transmembrane protein CD40 on macrophages, endothelium, smooth muscle cells, platelet-monocyte conglomerate is connected with an enlarged risk of the occurrence of diseases of the cardiovascular system in the metabolic syndrome.

THE AIM OF THE STUDY

was to establish whether metabolic syndrome in children can already be a precursor of cardiovascular diseases.

MATERIAL AND METHODS

The study was carried out on 35 children aged 10-18 years with the metabolic syndrome recognized according to the National Cholesterol Educational Program Adult Treatment Panel III (ATP III) criteria. The control group consisted of 26 healthy children without risk factors. In the examined children we evaluated BMI, the blood pressure, lipids, hsCRP, and the HOMA index. The analysis of the expression CD 40L (CD154) was performed with a three-color flow cytometer. The identification surrendered 104 cells. Statistical analysis was performed with use of U-Mann-Whitney test, for correlation analysis we used Spearman and Pearson tests.

RESULTS

We observed an elevated expression of CD40 ligand on the surface on platelet-monocyte conglomerate in patients with the metabolic syndrome compared to healthy children (12.7 vs. 4.95%, p=0.0036). In addition, we found a statistically significant correlation between the expression of the CD40L and HOMA index (r = -0.33, p<0.028).

CONCLUSIONS

Enlarged expression of the transmembrane protein CD40L not only initiates and influences the progression of the atherosclerosis, but modulates the architecture of atherosclerotic plaque as well.

Serum free sialic acid as a marker of alcohol abuse

BACKGROUND

Previous studies have shown that serum total sialic acid (TSA) concentration significantly increases during alcohol abuse. Chronic ethanol consumption impairs glycosylation of many proteins. The increased desialylation rate of serum glycoproteins is one of the effects of alcohol abuse. The aim of this study was to investigate the diagnostic value of free sialic acid (FSA) as a marker of alcohol abuse.

METHODS

We determined serum FSA concentrations in the group of 156 alcoholic subjects and 35 healthy control subjects by means of a modification of the thiobarbituric acid method. The alcoholic group was divided into subgroups according to their history of abuse.

RESULTS

The FSA concentration was significantly higher in alcoholic subjects than in healthy controls. The subjects who consumed alcohol for longer than a week showed significantly higher FSA level than those who consumed alcohol for a shorter period. The serum FSA concentration was significantly higher in alcoholic subjects with elevated markers of liver dysfunction. The diagnostic accuracy of FSA was high, although it did not differ from TSA, and was limited by its low sensitivity.

CONCLUSIONS

This study shows that FSA concentration in the sera of alcoholic subjects is increased. The low diagnostic sensitivity is accompanied by high specificity, however the accuracy is high and similar to the accuracy of TSA. Free sialic acid does not seem to be a better marker of alcohol abuse than TSA and current markers.

[hsCRP protein in children and adolescents with diabetes type 1]

INTRODUCTION

HsCRP protein is known as a novel marker of low grade inflammatory state, which characterises an atherosclerotic process in its early stages. Contrary to a large amount of data on inflammatory markers in diabetes type 2 and metabolic syndrome in adults, little is known so far about the inflammatory process in diabetes type 1, especially in children. The aim of the study was to estimate the level of hsCRP protein in children and adolescents with diabetes type 1 depending on coexisting additional risk factors for atherosclerosis and microvascular complications.

MATERIAL AND METHODS

127 children and adolescents with diabetes duration 6.7+/-3.3 years, aged 14.9+/-3.1, were studied. The control group consisted of 52 healthy children aged 14.9+/-2.8 years, matched acc. to gender. HsCRP level was assessed with use of immunoturbidymetric, latex augmented method (Tina-quant CRP (Latex) HS, Roche).

RESULTS

HsCRP in the whole study group was nearly significantly higher compared to control group: 0.17+/-0.2 vs. 0.078+/-0.1 mg/dl, p=0.072. In diabetic hypertensive children (n=38) we found significantly higher levels of hsCRP compared to controls (0.27+/-0.3 vs. 0.07 mg/dl, p=0.008) and compared to diabetic normotensive children (0.13+/-0.22 mg/dl; p=0.024). Diabetic obese patients (n=23) had significantly higer hsCRP compared to controls (0.24+/-0.3 vs. 0.07+/-0.1 mg/dl, p=0.04). In 14 studied diabetic children we found coexisting hypertension and obesity, and we found further increase in hsCRP level - 0.28+/-0.3 mg/dl. In diabetic children with microangiopathy hsCRP level was 0.22+/-0.2 mg/dl, and it was insignificantly higher compared to controls and to diabetic children without complications. Correlation analysis showed interrelations between hsCRP and systolic blood pressure (r=0.2; p=0.04) and HbA1c (r=0.25; p=0.015). In stepwise regression analysis hsCRP was related to systolic blood pressure, HbA1c and the triglycerides level (R=0.37; p=0.003).

CONCLUSIONS

In children and adolescents with diabetes type 1 we proved significantly higher levels of hsCRP in case of a coexistence of hypertension and/or obesity. Elevated hsCRP in children with diabetes type 1 and hypertension and/or obesity reflects low grade inflammatory state in the course of metabolic syndrome.

Carbohydrate-deficient isoforms of transferrin (%CDT) and sialic acid (SA) in iron-deficiency anemia

This study has investigated the serum levels of carbohydrate-deficient isoforms of transferrin (CDT) and sialic acid (SA) in iron-deficiency anemia (IDA). Blood samples were collected from 60 women with IDA and from 20 healthy controls. CDT was estimated by anion-exchange chromatography on minicolumns followed by photometric detection of transferrin and was expressed as a percentage of total transferrin (%CDT). SA was measured by an enzymatic method. There was no difference in the mean level of %CDT between patients with IDA (2.26%) and control patients (2.05%). SA increased significantly from control level 0.61 to 0.69 g/l in anemic patients. We concluded that elevated concentration of total transferrin in IDA did not change the relative value of low sialylated isoforms (%CDT) and the increase of total SA level in the sera of anemic patients is not related to the increase of total transferrin.

Serum and urine leptin concentration in children with nephrotic syndrome

Literature data point to the relationship between leptin concentration and certain markers of the metabolic syndrome, including cholesterol, triglycerides and apolipoproteins. A substantial lipid metabolism disturbance occurs in children with idiopathic nephrotic syndrome (NS). The aim of the study was to find out whether in NS children, serum and urine leptin levels change proportionally to lipid metabolism disturbances. The study was performed on two groups: (I) 30 children with NS (A) before, (B) during, prednisone therapy after proteinuria regression; (II) 25 healthy children. Serum and urine leptin levels were determined by the immunoenzymatic ELISA method. Serum leptin level in NS children before and after treatment was similar to that in the control group (p>0.05). Leptin urinary excretion in group A was approximately 60 times and in group B 24 times higher than in the controls (p<0.01). Before treatment, children with NS had increased concentrations of TC, TG, LDL, beta-lipoprotein, apolipoprotein B (apo B) (p<0.01) and reduced HDL and apolipoprotein A (apo A) (p<0.01). The conclusions were that: (1) in NS children leptin urinary excretion increases but its level is unchanged in serum; (2) serum leptin level is correlated with lipid parameters.

[Selected new atherosclerosis risk factors and markers of fibrinolysis in children and adolescents with obesity, hypertension and diabetes]

In last years it has been proved that atherosclerosis risk factors are present in children and adolescents, and that already in their young age they are connected with anatomic, atherosclerosis changes in vessels. The aim of the study was to evaluate levels of selected new atherosclerosis risk factors (Lp(a), apo A-I, apo B, homocysteine, fibrinogen) and markers of fibrinolysis (t-PA and PAI-1) in children and adolescents with traditional risk factors (obesity, hypertension, diabetes).

MATERIALS AND METHODS

The study group consisted of 285 children and adolescents aged 14.3 yrs. Children were divided according to their main disease into groups: children with obesity (n = 49), children with obesity and coexisting hypertension (n = 56), children with hypertension (n = 58) and children with diabetes (n = 122). Control group consisted of 79 healthy children and adolescents aged 13.3 yrs. Lp(a), apo A-I and apo B levels were estimated by use of immunoturbidimetric methods, total homocysteine, fibrinogen, t-PA and PAI-1 were estimated by use of immunoenzymatic methods.

RESULTS

Lp(a) level in the total study group was 0.30 g/L and was over twice higher than in the control group -0.14 g/L. Apo A-I level was significantly lower in obese children (1.27 g/L) and in the group with obesity and coexisting hypertension (1.25 g/L) vs 1.35 g/L in controls. Apo B level was significantly higher in the total study group (0.86 g/L) and in groups with obesity, obesity and coexisting hypertension and diabetic children vs 0.73 g/L in controls. Hcy was higher in the group with obesity and coexisting hypertension (8 mumol/L) and in the group with hypertension (9.4 mumol/L) vs 6.2 mumol/L in control group. FB level was higher in the total study group (2.76 g/L) and in groups of obese children (3.18 g/L) and obesity coexisting with hypertension (3.22 g/L) vs 2.52 g/L in controls. Significantly higher t-PA level was found in the obese group (9 micrograms/L) and obesity with hypertension group (9.7 micrograms/L) vs 7.3 mg/L in controls, and PAI-1 level was significantly higher in total study group (62.3 micrograms/L) and groups of obese children (73.8 micrograms/L), obese and hypertensive (78 micrograms/L) and hypertensive (73 micrograms/L) vs 42.4 micrograms/L in control group. 28% of study children had positive family history of cardiovascular diseases.

CONCLUSION

1. Young patients with obesity, hypertension or obesity present significant lipid metabolism disturbances, regarding mainly total cholesterol, LDL, triglycerides, and Lp(a) and apo B levels. Unfavourable lipid profile is characteristic mainly in children with obesity and coexisting hypertension. 2. Elevated homocysteine level is found in children with hypertension. 3. Elevated fibrinogen level and diminished fibrinolytic activity characterises obese children. 4. Children and adolescents with obesity, hypertension or diabetes often come from families with positive family history of cardiovascular diseases and other atherosclerosis risk factors.

[Assessment of transforming growth factor-beta1 in serum of children with idiopathic nephrotic syndrome depending on the way of treatment]

The concentration of transforming growth factor-beta 1 (TGF-beta 1) in serum was performed by immunoenzymatic method in serum of children with nephrotic syndrome in following groups: group I--9 children (5-15 years) with focal segmental glomerulosclerosis (FSG), before Cyclosporine A treatment (CyA) (examination A) and after 3-6 months of Cyclosporine A treatment during remission (examination B), group II--13 children (5-14 years) with minimal change nephrotic syndrome (MCNS) during relapse (examination A) and after 7-20 days of prednisone (Encorton) treatment in dose 60 mg/m2, without the proteinuria (examination B), group III--15 healthy children (5-15 years). The aim of the work was to demonstrate any differences in concentration of TGF-beta 1 in serum of examined children and to show the influence of prednisone and Cyclosporine A on the concentration of TGF-beta 1. The results showed that before treatment increased concentration of TGF-beta 1 was shown only in children with MCSN (p < 0.05) and it was reverse proportional to albuminemia. However in children without proteinuria (B), the concentration of cytokines decreased in children with MCSN and increased in children with FSG treated with Cyclosporine A.

CONCLUSION

The concentration of TGF-beta 1 in serum increases in children with nephrotic syndrome during gross proteinuria and hypoalbuminemia and after Cyclosporine A treatment.

[Serum levels of interleukin 6 (IL-6) and soluble IL-6 receptor (sIL-6R) in children and adolescents with Graves-Basedow disease]

The concentration of interleukin 6 (IL-6), soluble IL-6 receptor (sIL-6R) and intercellular adhesion molecule-1 (sICAM-1) was assayed in 24 children with Graves' disease, aged 6.5-17 years, before treatment with methimazole, during clinical and biochemical remission (8 weeks), and following the eighteen-month therapy with the thyrostatic. ELISA method was used to determine the concentration of interleukin 6, sIL-6R and sICAM-1. An increase was observed in serum concentration of IL-6 and its receptor sIL-6R and soluble intercellular adhesion molecule-1 in the course of Graves' disease. A significant reduction in sIL-6R (8 weeks) and IL-6 (18 months) was noted after therapy with methimazole. A positive correlation was found between microsomal antibodies and the concentration of sICAM-1 and sIL-6R, and between antithyroglobulin antibodies and concentration of sIL-6R in children with fresh hyperthyroidism. No correlation was revealed between the level of thyroid hormones and the concentration of cytokines and adhesion molecules.

New atherosclerosis risk factors in obese, hypertensive and diabetic children and adolescents

In the last few years it has been proved that risk factors for atherosclerosis are present in children and adolescents, and that already at this early age they are connected with anatomic, atheromatous changes in vessels. These changes can not be fully explained as occurring in young people exhibiting traditional risk factors for the disease. The aim of the study was to evaluate levels of several new atherosclerosis risk factors (lipoprotein (a) (Lp(a)), apolipoprotein A-I (Apo A-I), apolipoprotein B (Apo B), homocysteine (Hcy), fibrinogen (FB), tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor type 1 (PAI-1)) in children and adolescents with traditional risk factors (obesity, hypertension, diabetes).

MATERIALS AND METHODS

The study group consisted of 285 children and adolescents aged 14.3 years. Children were divided according to their main disease into groups: group A, children with obesity (n=49); group B, children with obesity and coexisting hypertension (n=56); group C, children with hypertension (n=58) and group D, children with diabetes (n=122). Control group consisted of 79 healthy children and adolescents aged 14.1 years. Lp(a), Apo A-I and Apo B levels were estimated by use of immunoturbidimetric methods; total Hcy, FB, t-PA and PAI-1 were estimated by use of immunoenzymatic methods.

RESULTS

Lp(a) level in the total study group was 30 mg/dl and was over twice higher than in control group, 14 mg/dl. Apo A-I level was significantly lower in group A (127.6 mg/dl) and in group B (125.8 mg/dl) versus 135.6 mg/dl in controls. The level of Apo B was significantly higher in total study group (86.2 mg/dl) and in groups A, B and D versus 73.5 mg/dl in controls. Hcy was higher in group B (8 micromol/l) and in group C (9.4 micromol/l) versus 6.2 micromol/l in the control group. The FB level was higher in the total study group (276.7 mg/dl) and in groups A (318.8 mg/dl) and B (322.6 mg/dl) versus 252.8 mg/dl in controls. Significantly higher t-PA level was found in groups A (9 ng/ml) and B (9.7 ng/ml) versus 7.3 ng/ml in controls, and PAI-1 level was significantly higher in the total study group (62.3 ng/ml) and in groups A (73.8 ng/ml), B (78 ng/ml) and C (73 ng/ml) versus 42.4 ng/ml in the control group. Correlation analysis showed significant relationship between body mass index (BMI) and Apo B, Hcy, FB, t-PA and PAI-1. Blood pressure values correlated positively with Hcy. Correlations were verified in multiple regression analysis models: FB and t-PA levels depended on BMI, and Hcy depended on systolic blood pressure.

CONCLUSIONS

(1) Young obese, hypertensive and diabetic patients present significant disturbances in lipid metabolism, regarding mainly total cholesterol, LDL, triglycerides, as well as Lp(a), Apo A-I and Apo B levels. Unfavourable lipid profile is characteristic mainly for children with obesity and accompanying hypertension. (2) Elevated Hcy levels are found in children with hypertension. (3) Elevated FB level and diminished fibrinolytic activity are characteristic of obese children.

Cardiovascular risk factors in children with obesity, hypertension and diabetes: lipoprotein(a) levels and body mass index correlate with family history of cardiovascular disease

The aims of the study were to compare atherosclerosis risk factors in obese, hypertensive and diabetic children with positive and negative family history (FH) of cardiovascular disease (CVD) and to find which of the new atherosclerosis risk factors may be of clinical value in predicting future cardiovascular events. A total of 285 children and adolescents were divided into groups: obese, obese and hypertensive, hypertensive, and diabetic. Each group was further segregated into children with positive or negative FH of CVD. Positive FH groups were analysed according to FH of CVD before or after 55 years of age, and in parents and grandparents separately. We assessed lipids, body mass index (BMI) and new risk factors: lipoprotein(a) Lp(a), apolipoprotein A-I (apo A-I) and apolipoprotein B (apo B), homocysteine (Hcy), fibrinogen (FB), tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1). A positive FH of CVD was found in 28% of the children and in 8.7% it was premature CVD. Children with a positive FH had higher BMI (25.4 versus 23.7 kg/m(2), P<0.05) and highest BMIs were found in those with FH of CVD <55 years (26.8 kg/m(2), P<0.05) or in parents (27.4 kg/m(2), P<0.05). Lp(a) levels were higher in children with a positive FH (0.38 versus 0.28 g/l, P<0.05) and highest in children with a FH of premature CVD (0.44 g/l, P<0.05). Differences were also found in apo B levels (0.90 versus 0.84 g/l, P<0.05). In logistic regression analysis only BMI and Lp(a) were significant in predicting future cardiovascular events.

CONCLUSION

obese, hypertensive and diabetic children often originate from families with cardiovascular disease. Children with a family history of cardiovascular disease have a higher body mass index. Levels of lipoprotein(a) and apolipoprotein B may be predictive of future cardiovascular disease in predisposed children.

[Correlation between body mass index, lipoprotein (a) level and positive family history of cardiovascular diseases in children and adolescents with obesity, hypertension and diabetes]

The study was carried out in a group of 285 children and adolescents aged 4-20 yrs. Children were divided according to their main disease: group with obesity, obesity and coexisting hypertension, hypertension and diabetes. Each group was divided into children with positive or negative family history of cardiovascular diseases. We assessed routine lipid parameters, body mass index and new atherosclerosis risk factors: lipoprotein (a), apolipoproteins A-I and B, homocysteine, fibrinogen, t-PA and PAI-1. Positive family history of cardiovascular diseases was found in 28% families, and in 8% families it was premature cardiovascular disease. In 48% children we found hypertension in family. Children with positive family history had significantly higher body mass index (25.4 vs 23.8 kg/m2). In the group with obesity and hypertension we found significantly higher cholesterol (182 vs 160 mg/dl) and LDL-cholesterol level (114 vs 93 mg/dl). Lipoprotein(a) level was significantly higher in children with positive family history (38 vs 28 mg/dl). Significant differencies were also found in apolipoprotein B level (90 vs 84 mg/dl). In logistic regression analysis only BMI and lipoprotein(a) were significant in predicting future cardiovascular events in children. Obese, hypertensive and diabetic children often come from families with cardiovascular diseases. Hypertension is the most often prevalent atherosclerosis risk factor in families. Children with positive family history of cardiovascular diseases have significantly higher body mass index. Out of new atherosclerosis risk factors lipoprotein(a) and apolipoprotein B may have real value in predicting future cardiovascular disease in the child. The aim of the study was to compare obese, hypertensive and diabetic children with positive and negative family history of cardiovascular diseases. In the work we have tried to find which of the new atherosclerosis risk factors may have the real value in predicting future cardiovascular events in children already predisposed to atherosclerosis.