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Bravo C, Mericq V, Pereira A, Corvalán C, Tobar HE, Miranda JP, Santos JL. Association between plasma leptin/adiponectin ratio and insulin resistance indexes in prepubertal children. Arch Endocrinol Metab 2024; 68:e220353. [PMID: 38289144 PMCID: PMC10948042 DOI: 10.20945/2359-4292-2022-0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/06/2023] [Indexed: 02/01/2024]
Abstract
Objective To assess the association between leptin/adiponectin ratio (LAR) and insulin resistance surrogates in prepubertal children. Materials and methods Study based on data from the Growth and Obesity Chilean Cohort Study (GOCS) involving 968 Chilean prepubertal children. Plasma insulin, leptin, and adiponectin were determined by immunoassays. Several common insulin resistance surrogates were calculated, including the homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride/HDL cholesterol index, triglyceride-glucose (TyG) index, and the TyG index corrected for body mass index (BMI; TyG-BMI) and waist circumference (WC; TyG-WC). Associations among variables were assessed using multiple linear and logistic regression analysis. Results There was a significant direct association between plasma leptin and LAR with BMI z-score but no association between plasma adiponectin and adiposity. After adjustments for sex and age, LAR was significantly associated with all insulin resistance surrogates (which were categorized using the 75th percentile as the cutoff point), with the TyG-WC index emerging as the surrogate with the highest magnitude of association (odds ratio [OR] 2.44, 95% confidence interval [CI] 2.05-2.9). After additional adjustment for BMI z-score, only the association between LAR and TyG-WC remained significant (OR 1.64, 95% CI 1.27-2.12). Conclusion Plasma leptin and LAR were strongly associated with several common insulin resistance surrogates in prepubertal children, most notably with the TyG-WC index. Associations between LAR and insulin resistance indexes were mainly driven by the effect of plasma leptin, which is also directly associated with increased adiposity.
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Affiliation(s)
- Carolina Bravo
- Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Instituto de Nutrición y Tecnología de Alimentos, Universidad de Chile, Santiago, Chile
| | - Verónica Mericq
- Instituto de Investigaciones MaternoInfantil, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Ana Pereira
- Instituto de Nutrición y Tecnología de Alimentos, Universidad de Chile, Santiago, Chile
| | - Camila Corvalán
- Instituto de Nutrición y Tecnología de Alimentos, Universidad de Chile, Santiago, Chile
| | - Hugo E Tobar
- Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Patricio Miranda
- Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Luis Santos
- Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile,
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Ponce D, Rodríguez F, Miranda JP, Binder AM, Santos JL, Michels KB, Cutler GB, Pereira A, Iñiguez G, Mericq V. Differential methylation pattern in pubertal girls associated with biochemical premature adrenarche. Epigenetics 2023; 18:2200366. [PMID: 37053179 PMCID: PMC10114989 DOI: 10.1080/15592294.2023.2200366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Biochemical premature adrenarche is defined by elevated serum DHEAS [≥40 μg/dL] before age 8 y in girls. This condition is receiving more attention due to its association with obesity, hyperinsulinemia, dyslipidemia, and polycystic ovary syndrome. Nevertheless, the link between early androgen excess and these risk factors remains unknown. Epigenetic modifications, and specifically DNA methylation, have been associated with the initiation and progression of numerous disorders, including obesity and insulin resistance. The aim of this study was to determine if prepubertal androgen exposure is associated with a different methylation profile in pubertal girls. Eighty-six healthy girls were studied. At age 7 y, anthropometric measurements were begun and DHEAS levels were determined. Girls were classified into Low DHEAS (LD) [<42 μg/dL] and High DHEAS (HD) [≥42 μg/dL] groups. At Tanner stages 2 and 4 a DNA methylation microarray was performed to identify differentially methylated CpG positions (DMPs) between HD and LD groups. We observed a differential methylation pattern between pubertal girls with and without biochemical PA. Moreover, a set of DNA methylation markers, selected by the LASSO method, successfully distinguished between HD and LD girls regardless of Tanner stage. Additionally, a subset of these markers were significantly associated with glucose-related measures such as insulin level, HOMA-IR, and glycaemia. This pilot study provides evidence consistent with the hypothesis that high DHEAS concentration, or its hormonally active metabolites, may induce a unique blood methylation signature in pubertal girls, and that this methylation pattern is associated with altered glucose metabolism.
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Affiliation(s)
- Diana Ponce
- Institute of Maternal and Child Research, School of Medicine, Universidad de Chile, Santiago, Chile
| | - Fernando Rodríguez
- Institute of Maternal and Child Research, School of Medicine, Universidad de Chile, Santiago, Chile
| | - José P Miranda
- Department of Nutrition, Diabetes, and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Advanced Center for Chronic Diseases (ACCDiS), Pontificia Universidad Católica de Chile & Universidad de Chile, Santiago, Chile
| | - Alexandra M Binder
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, USA
| | - José L Santos
- Department of Nutrition, Diabetes, and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Karin B Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Ana Pereira
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Germán Iñiguez
- Institute of Maternal and Child Research, School of Medicine, Universidad de Chile, Santiago, Chile
| | - Verónica Mericq
- Institute of Maternal and Child Research, School of Medicine, Universidad de Chile, Santiago, Chile
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Duckett K, Williamson A, Kincaid JWR, Rainbow K, Corbin LJ, Martin HC, Eberhardt RY, Huang QQ, Hurles ME, He W, Brauner R, Delaney A, Dunkel L, Grinspon RP, Hall JE, Hirschhorn JN, Howard SR, Latronico AC, Jorge AAL, McElreavey K, Mericq V, Merino PM, Palmert MR, Plummer L, Rey RA, Rezende RC, Seminara SB, Salnikov K, Banerjee I, Lam BYH, Perry JRB, Timpson NJ, Clayton P, Chan YM, Ong KK, O’Rahilly S. Prevalence of Deleterious Variants in MC3R in Patients With Constitutional Delay of Growth and Puberty. J Clin Endocrinol Metab 2023; 108:e1580-e1587. [PMID: 37339320 PMCID: PMC10655545 DOI: 10.1210/clinem/dgad373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/30/2023] [Accepted: 06/16/2023] [Indexed: 06/22/2023]
Abstract
CONTEXT The melanocortin 3 receptor (MC3R) has recently emerged as a critical regulator of pubertal timing, linear growth, and the acquisition of lean mass in humans and mice. In population-based studies, heterozygous carriers of deleterious variants in MC3R report a later onset of puberty than noncarriers. However, the frequency of such variants in patients who present with clinical disorders of pubertal development is currently unknown. OBJECTIVE This work aimed to determine whether deleterious MC3R variants are more frequently found in patients clinically presenting with constitutional delay of growth and puberty (CDGP) or normosmic idiopathic hypogonadotropic hypogonadism (nIHH). METHODS We examined the sequence of MC3R in 362 adolescents with a clinical diagnosis of CDGP and 657 patients with nIHH, experimentally characterized the signaling properties of all nonsynonymous variants found and compared their frequency to that in 5774 controls from a population-based cohort. Additionally, we established the relative frequency of predicted deleterious variants in individuals with self-reported delayed vs normally timed menarche/voice-breaking in the UK Biobank cohort. RESULTS MC3R loss-of-function variants were infrequent but overrepresented in patients with CDGP (8/362 [2.2%]; OR = 4.17; P = .001). There was no strong evidence of overrepresentation in patients with nIHH (4/657 [0.6%]; OR = 1.15; P = .779). In 246 328 women from the UK Biobank, predicted deleterious variants were more frequently found in those self-reporting delayed (aged ≥16 years) vs normal age at menarche (OR = 1.66; P = 3.90E-07). CONCLUSION We have found evidence that functionally damaging variants in MC3R are overrepresented in individuals with CDGP but are not a common cause of this phenotype.
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Affiliation(s)
- Katie Duckett
- Wellcome-MRC Institute of Metabolic Science, Box 289, Level 4, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Alice Williamson
- Wellcome-MRC Institute of Metabolic Science, Box 289, Level 4, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - John W R Kincaid
- Wellcome-MRC Institute of Metabolic Science, Box 289, Level 4, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Kara Rainbow
- Wellcome-MRC Institute of Metabolic Science, Box 289, Level 4, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Laura J Corbin
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Hilary C Martin
- Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Ruth Y Eberhardt
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Qin Qin Huang
- Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Matthew E Hurles
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Wen He
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Raja Brauner
- Pediatric Endocrinology Unit, Hôpital Fondation Adolphe de Rothschild and Université Paris Cité, 25 rue Manin, 75019 Paris, France
| | - Angela Delaney
- Division of Endocrinology, Department of Pediatric Medicine, St. Jude Children’s Research Hospital, 262 Danny Thomas Place MS 737, Memphis, TN 38105, USA
| | - Leo Dunkel
- Centre for Endocrinology, William Harvey Research Institute, Barts & the London Medical School, Charterhouse Square, London EC1M 6BQ, UK
| | - Romina P Grinspon
- Centro de Investigaciones Endocrinolègicas “Dr. César Bergadá” (CEDIE), CONICET–FEI–Divisièn de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, C1425EFD Buenos Aires, Argentina
| | - Janet E Hall
- Clinical Research Branch, Division of Intramural Research, National Institute of Environmental Science, National Institute of Health, 111 TW Alexander Dr, Bldg 101 – A222, Research Triangle Park, NC 27709, USA
| | - Joel N Hirschhorn
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Sasha R Howard
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Ana C Latronico
- Departamento de Clínica Médica, Av. Dr. Arnaldo, 455 - Cerqueira César, 01246903 São Paulo - SP, Brazil
| | - Alexander A L Jorge
- Departamento de Clínica Médica, Av. Dr. Arnaldo, 455 - Cerqueira César, 01246903 São Paulo - SP, Brazil
| | - Ken McElreavey
- Institut Pasteur, Université de Paris, CNRS UMR3738, Human Developmental Genetics, F-75015 Paris, France
| | - Verónica Mericq
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santa Rosa 1234, 2° piso, Santiago 8320000, Chile
| | - Paulina M Merino
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santa Rosa 1234, 2° piso, Santiago 8320000, Chile
| | - Mark R Palmert
- Division of Endocrinology, The Hospital for Sick Children and Departments of Pediatrics and Physiology, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Lacey Plummer
- Massachusetts General Hospital Harvard Center for Reproductive Medicine and Reproductive Endocrine Unit, Massachusetts General Hospital, Bartlett Hall Extension, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Rodolfo A Rey
- Centro de Investigaciones Endocrinolègicas “Dr. César Bergadá” (CEDIE), CONICET–FEI–Divisièn de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, C1425EFD Buenos Aires, Argentina
| | - Raíssa C Rezende
- Departamento de Clínica Médica, Av. Dr. Arnaldo, 455 - Cerqueira César, 01246903 São Paulo - SP, Brazil
| | - Stephanie B Seminara
- Massachusetts General Hospital Harvard Center for Reproductive Medicine and Reproductive Endocrine Unit, Massachusetts General Hospital, Bartlett Hall Extension, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Kathryn Salnikov
- Massachusetts General Hospital Harvard Center for Reproductive Medicine and Reproductive Endocrine Unit, Massachusetts General Hospital, Bartlett Hall Extension, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester M13 9WL, UK
| | - Brian Y H Lam
- Wellcome-MRC Institute of Metabolic Science, Box 289, Level 4, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - John R B Perry
- Wellcome-MRC Institute of Metabolic Science, Box 289, Level 4, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Peter Clayton
- Paediatric Endocrinology, Royal Manchester Children’s Hospital, Oxford Road, Manchester M13 9WL, UK
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Ken K Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus Box 285, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Stephen O’Rahilly
- Wellcome-MRC Institute of Metabolic Science, Box 289, Level 4, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
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Pereira A, Ferrer P, Binder A, Rojas J, Michels KB, Corvalán C, Mericq V. Association Between Markers of Adiposity During Childhood and Puberty Onset in Latino Girls. J Clin Endocrinol Metab 2023; 108:e1272-e1281. [PMID: 37226986 DOI: 10.1210/clinem/dgad294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 05/26/2023]
Abstract
CONTEXT Prepubertal adiposity is associated with earlier puberty. It is unclear when this association starts, if all adiposity markers are similarly associated, and whether all pubertal milestones are similarly affected. OBJECTIVE To evaluate the association between different adiposity markers during childhood and the timing of different pubertal milestones in Latino girls. DESIGN, SETTING, AND PARTICIPANTS Longitudinal follow-up of 539 female participants of the Chilean Growth and Obesity Cohort recruited from childcare centers (mean age 3.5 years) from the southeast area of Santiago, Chile. Participants were singletons born between 2002 and 2003 within the normal birthweight range. Since 2006, a trained dietitian measured weight, height, waist circumference (WC) and skinfolds to estimate body mass index (BMI) Centers for Disease Control and Prevention percentiles, central obesity, percentage of fat mass (%FM), and fat mass index (FMI, fat mass/height2). MAIN OUTCOME Since 2009, sexual maturation was assessed every 6 months to assess age at (1) thelarche, (2) pubarche, (3) menarche, and (4) peak height velocity (PHV). RESULTS At thelarche, 12.5% were obese and 2% had central obesity. The median age of pubarche, menarche, and PHV were all associated with markers of adiposity at different time points during childhood whereas thelarche only with %FM and FMI. Adiposity clusters models showed that children with trajectories of high WC, %FM, and FMI during childhood were related with earlier thelarche, pubarche, menarche, and PHV but BMI trajectories only with menarche and PHV. CONCLUSIONS Higher WC, %FM, and FMI were associated with earlier age at thelarche, pubarche, menarche, and PHV. The effect of BMI was less consistent.
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Affiliation(s)
- Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, 7830490 Santiago, Chile
| | - Pedro Ferrer
- Institute of Nutrition and Food Technology, University of Chile, 7830490 Santiago, Chile
| | - Alexandra Binder
- Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawai'i Cancer Center, Honolulu, HI 96822, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA 90095-1772, USA
| | - Joanna Rojas
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Atacama, 1530000 Copiapó, Chile
| | - Karin B Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA 90095-1772, USA
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, 79110 Freiburg, Germany
| | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, 7830490 Santiago, Chile
| | - Verónica Mericq
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, 8360160 Santiago, Chile
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Baier I, Pereira A, Ferrer P, Iñiguez G, Mericq V. Higher Prepubertal IGF-1 Concentrations Associate to Earlier Pubertal Tempo in Both Sexes. Horm Res Paediatr 2022; 96:404-411. [PMID: 36513037 DOI: 10.1159/000528662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Pubertal onset is triggered by multiple neuroendocrine interactions. The role of prepubertal IGF-1 in this process has not been explored in both sexes. Our objective was to analyze the association of prepubertal IGF-1 concentration with age at thelarche (B2) and menarche (M) in girls and age at gonadarche (G2) in boys. METHODS This is a longitudinal study (n = 1,196 boys and girls) within the Growth and Obesity Chilean Cohort Study (GOCS). At age ≈ 6.7 years, blood sample was taken for IGF-1. Subjects were divided into 4 groups according to the onset age of the pubertal event. RESULTS Higher prepubertal IGF-1 levels were observed at earlier ages of B2 (p = 0.003) and M onset (p = 0.041). A taller prepubertal height was observed at younger ages of B2 and M (p=<0.001 and 0.002, respectively). The hazard proportional regression models (HR) showed that with an increase of 1 SD in IGF-1, the HR of presenting B2 at younger ages was 1.25, and this association was maintained when adjusted for confounding variables. Similarly, the HR of presenting M at earlier ages was 1.21. This association was maintained only when adjusting for body mass index but not using further confounders. In boys, prepubertal IGF-1 showed a tendency to be significantly higher in children with earlier G2 and taller height (both p < 0.001). The HR of presenting G2 at younger ages was 1.22, and this association was maintained after adjusting for confounders. CONCLUSIONS Higher IGF-1 levels in mid-childhood are associated with earlier puberty onset. The role of IGF-1 in the onset of puberty requires further investigation.
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Affiliation(s)
- Ingrid Baier
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Pedro Ferrer
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - German Iñiguez
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Verónica Mericq
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
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Lesser C, Mericq V, Reyes M, Garmendia ML, Shepherd JA, Michels KB, Corvalán C, Pereira A. Habitual Phytoestrogen Intake Is Associated with Breast Composition in Girls at 2 Years after Menarche Onset. Cancer Epidemiol Biomarkers Prev 2022; 31:1334-1340. [PMID: 35477112 PMCID: PMC9250624 DOI: 10.1158/1055-9965.epi-22-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/23/2022] [Accepted: 04/15/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND High phytoestrogen intake during adolescence is associated with a reduced risk of breast cancer. Breast density (BD) is a strong predictor of breast cancer and can be considered an early marker. We aim to assess the association between the mean habitual intake of isoflavones, lignans, and total phytoestrogens intake during puberty until 2 years after menarche onset and absolute fibroglandular volume (AFGV) and percentage of fibroglandular volume (%FGV) in Hispanic girls at the end of puberty. METHODS Longitudinal study set up in the Growth and Obesity Chilean Cohort Study (GOCS). We included 329 girls with dietary data (multiple 24-hours recalls) from puberty until 2 years after menarche onset (81% had 2-4 recalls). Two international datasets were used to estimate isoflavones, lignans, and total phytoestrogens in the diet. Breast composition was measured by dual energy X-ray absorptiometry at 2 years after menarche. Multiple linear regression models were used to assess the association between isoflavones, lignans, and total phytoestrogens intake and AFGV and %FGV. RESULTS The average total phytoestrogen intake was 1 mg/day and %FGV was 50.7% (SD = 15.2) and AFGV 218.8 cm3 (SD = 79.3). An inverse association was found between consumption of isoflavones and AFGV, as well as, with total phytoestrogens [Q4 vs. Q1 adjusted model ß = -49.2 cm3; 95% CI (-85.5 to -13.0)]. CONCLUSIONS Girls with a higher intake of total phytoestrogens and isoflavones during puberty until 2 years after menarche onset had significantly lower AFGV. IMPACT Although the intake of phytoestrogens is low in Western populations, higher consumption of them during a critical period of life like puberty could be beneficial to reduce breast cancer during adulthood.
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Affiliation(s)
- Constanza Lesser
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Verónica Mericq
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Marcela Reyes
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | | | - John A Shepherd
- Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaiʻi Cancer Center, University of Hawaiʻi, Honolulu, HI, USA
| | - Karin B Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA.,Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Germany
| | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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Griffero M, Benedetti AFF, Pérez M, Carvalho L, Jorge A, Latronico AC, Mendonca B, Arnhold I, Mericq V. Novel OTX2 loss of function variant associated with congenital hypopituitarism without eye abnormalities. J Pediatr Endocrinol Metab 2022; 35:831-835. [PMID: 35320640 DOI: 10.1515/jpem-2021-0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The normal development of the pituitary gland requires multiple induction signals and transcription factors encoded by more than 30 genes, including OTX2. OTX2 mutations have been described with eye abnormalities and variable congenital hypopituitarism, but rarely with hypopituitarism without ocular manifestations. CASE PRESENTATION We report a girl with hypopituitarism associated with pituitary hypoplasia and pituitary stalk atrophy, without ocular manifestations. NGS revealed a novel heterozygous mutation in OTX2 c.426dupC:p.(Ser143Leufs*2). CONCLUSIONS Mutations in the transcription factor OTX2 have been associated with ocular, craniofacial, and pituitary development anomalies. Here we describe a novel mutation in OTX2 associated with hypopituitarism without an ocular phenotype.
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Affiliation(s)
- Mariana Griffero
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Anna Flavia Figueredo Benedetti
- Laboratório de Sequenciamento em Larga Escala (SELA), Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcela Pérez
- Department of Ophthalmology, Clínica Las Condes and Hospital Salvador, Santiago, Chile
| | - Luciani Carvalho
- Disciplina de Endocrinologia e Metabologia, Departamento de Clinica Medica, LIM/42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexander Jorge
- Laboratório de Sequenciamento em Larga Escala (SELA), Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.,Disciplina de Endocrinologia e Metabologia, Departamento de Clinica Medica, LIM/42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Claudia Latronico
- Disciplina de Endocrinologia e Metabologia, Departamento de Clinica Medica, LIM/42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Berenice Mendonca
- Laboratório de Sequenciamento em Larga Escala (SELA), Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.,Disciplina de Endocrinologia e Metabologia, Departamento de Clinica Medica, LIM/42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ivo Arnhold
- Disciplina de Endocrinologia e Metabologia, Departamento de Clinica Medica, LIM/42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Verónica Mericq
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santiago, Chile
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Miranda JP, Lardone MC, Rodríguez F, Cutler GB, Santos JL, Corvalán C, Pereira A, Mericq V. Genome-Wide Association Study and Polygenic Risk Scores of Serum DHEAS Levels in a Chilean Children Cohort. J Clin Endocrinol Metab 2022; 107:e1727-e1738. [PMID: 34748635 DOI: 10.1210/clinem/dgab814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Adrenarche reflects the developmental growth of the adrenal zona reticularis, which produces increasing adrenal androgen secretion (eg, dehydroepiandrosterone [DHEA]/dehydroepiandrosterone sulfate [DHEAS]) from approximately age 5 to 15 years. OBJECTIVE We hypothesized that the study of the genetic determinants associated with variations in serum DHEAS during adrenarche might detect genetic variants influencing the rate or timing of this process. METHODS Genome-wide genotyping was performed in participants of the Chilean pediatric Growth and Obesity Chilean Cohort Study (GOCS) cohort (n = 788). We evaluated the genetic determinants of DHEAS levels at the genome-wide level and in targeted genes associated with steroidogenesis. To corroborate our findings, we evaluated a polygenic risk score (PRS) for age at pubarche, based on the discovered variants, in children from the same cohort. RESULTS We identified one significant variant at the genome-wide level in the full cohort, close to the GALR1 gene (P = 3.81 × 10-8). In addition, variants suggestive of association (P < 1 × 10-5) were observed in PRLR, PITX1, PTPRD, NR1H4, and BCL11B. Stratifying by sex, we found variants suggestive of association in SERBP1 and CAMTA1/VAMP3 for boys and near ZNF98, TRPC6, and SULT2A1 for girls. We also found significant reductions in age at pubarche in those children with higher PRS for greater DHEAS based on these newly identified variants. CONCLUSION Our results disclose one variant associated with DHEAS concentrations at the level of genome-wide association study significance, and several variants with a suggestive association that may be involved in the genetic regulation of adrenarche.
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Affiliation(s)
- José Patricio Miranda
- Department of Nutrition, Diabetes, and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Advanced Center for Chronic Diseases (ACCDiS), Pontificia Universidad Católica de Chile & Universidad de Chile, Santiago, Chile
| | - María Cecilia Lardone
- Institute of Maternal and Child Research, School of Medicine, Universidad de Chile, Santiago, Chile
| | - Fernando Rodríguez
- Institute of Maternal and Child Research, School of Medicine, Universidad de Chile, Santiago, Chile
| | | | - José Luis Santos
- Department of Nutrition, Diabetes, and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Corvalán
- Institute of Nutrition and Food Technology (INTA), Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology (INTA), Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Verónica Mericq
- Institute of Maternal and Child Research, School of Medicine, Universidad de Chile, Santiago, Chile
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Merino PM, Pereira A, Iñiguez G, Corvalan C, Mericq V. High DHEAS Level in Girls Is Associated with Earlier Pubertal Maturation and Mild Increase in Androgens throughout Puberty without Affecting Postmenarche Ovarian Morphology. Horm Res Paediatr 2020; 92:357-364. [PMID: 32259819 DOI: 10.1159/000506632] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/17/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess whether the presence of high DHEAS (HD) at 7 years determines different timing, sequence, and rate of pubertal events, and whether it is associated with adrenal and/or ovarian hyperandrogenism and changes in ovarian morphology throughout puberty. METHODS In a longitudinal study of 504 girls, clinical evaluation was performed every 6 months after 7 years of age to detect Tanner stages; hormonal and anthropometric measurements were conducted at thelarche (B2), breast Tanner 4 (B4), and 1 year after menarche; ultrasonographic evaluation was also performed after menarche. The girls were classified as HD if their DHEAS level was >42.1 µg/dL (>75th percentile) around 7 years. RESULTS HD around 7 years is associated with a younger age at thelarche, pubarche, and menarche. Girls with HD had higher androstenedione and total testosterone levels, and a higher free androgen index (FAI), and lower levels of antimüllerian hormone (AMH) at B2, and higher levels of androstenedione and FAI at B4 and after menarche. All these results were significant even after adjusting for body mass index, age at first DHEAS determination, and birth weight. One year after menarche, polycystic ovarian morphology was detected in 7.6 and 7.3% of the HD and the normal DHEAS group, respectively. Ovarian volume was correlated with AMH, testosterone, androstenedione, and LH but not with DHEAS around 7 years. CONCLUSION Prepubertal HD in normal girls was associated with earlier thelarche, pubarche, and menarche, and a mild androgen increase throughout puberty. We believe continuous follow-up of this cohort is important to prospectively address the interrelationships between biochemical adrenarche and early growth as determinants of ovarian function.
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Affiliation(s)
- Paulina M Merino
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology (INTA), Faculty of Medicine, University of Chile, Santiago, Chile
| | - German Iñiguez
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Camila Corvalan
- Institute of Nutrition and Food Technology (INTA), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Verónica Mericq
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santiago, Chile,
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Bangalore Krishna K, Fuqua JS, Rogol AD, Klein KO, Popovic J, Houk CP, Charmandari E, Lee PA, Freire AV, Ropelato MG, Yazid Jalaludin M, Mbogo J, Kanaka-Gantenbein C, Luo X, Eugster EA, Klein KO, Vogiatzi MG, Reifschneider K, Bamba V, Garcia Rudaz C, Kaplowitz P, Backeljauw P, Allen DB, Palmert MR, Harrington J, Guerra-Junior G, Stanley T, Torres Tamayo M, Miranda Lora AL, Bajpai A, Silverman LA, Miller BS, Dayal A, Horikawa R, Oberfield S, Rogol AD, Tajima T, Popovic J, Witchel SF, Rosenthal SM, Finlayson C, Hannema SE, Castilla-Peon MF, Mericq V, Medina Bravo PG. Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium. Horm Res Paediatr 2020; 91:357-372. [PMID: 31319416 DOI: 10.1159/000501336] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Abstract
This update, written by authors designated by multiple pediatric endocrinology societies (see List of Participating Societies) from around the globe, concisely addresses topics related to changes in GnRHa usage in children and adolescents over the last decade. Topics related to the use of GnRHa in precocious puberty include diagnostic criteria, globally available formulations, considerations of benefit of treatment, monitoring of therapy, adverse events, and long-term outcome data. Additional sections review use in transgender individuals and other pediatric endocrine related conditions. Although there have been many significant changes in GnRHa usage, there is a definite paucity of evidence-based publications to support them. Therefore, this paper is explicitly not intended to evaluate what is recommended in terms of the best use of GnRHa, based on evidence and expert opinion, but rather to describe how these drugs are used, irrespective of any qualitative evaluation. Thus, this paper should be considered a narrative review on GnRHa utilization in precocious puberty and other clinical situations. These changes are reviewed not only to point out deficiencies in the literature but also to stimulate future studies and publications in this area.
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Affiliation(s)
- Kanthi Bangalore Krishna
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA,
| | - John S Fuqua
- Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Alan D Rogol
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - Karen O Klein
- University of California, San Diego and Rady Children's Hospital, San Diego, California, USA
| | - Jadranka Popovic
- Division of Pediatric Endocrinology, Pediatric Alliance, Pittsburgh, Pennsylvania, USA
| | - Christopher P Houk
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Peter A Lee
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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11
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Lardone MC, Busch AS, Santos JL, Miranda P, Eyheramendy S, Pereira A, Juul A, Almstrup K, Mericq V. A Polygenic Risk Score Suggests Shared Genetic Architecture of Voice Break With Early Markers of Pubertal Onset in Boys. J Clin Endocrinol Metab 2020; 105:dgaa003. [PMID: 31915828 DOI: 10.1210/clinem/dgaa003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/07/2020] [Indexed: 02/03/2023]
Abstract
CONTEXT Voice break, as a landmark of advanced male puberty in genome-wide association studies (GWAS), has revealed that pubertal timing is a highly polygenic trait. Although voice break is easily recorded in large cohorts, it holds quite low precision as a marker of puberty. In contrast, gonadarche and pubarche are early and clinically well-defined measures of puberty onset. OBJECTIVE To determine whether a polygenic risk score (PRS) of alleles that confer risk for voice break associates with age at gonadarche (AAG) and age at pubarche (AAP) in Chilean boys. EXPERIMENTAL DESIGN Longitudinal study. SUBJECTS AND METHODS 401 boys from the Growth and Obesity Chilean Cohort Study (n = 1194; 49.2% boys). MAIN OUTCOME MEASURES Biannual clinical pubertal staging including orchidometry. AAG and AAP were estimated by censoring methods. Genotyping was performed using the Multi-Ethnic Global Array (Illumina). Using GWAS summary statistics from the UK-Biobank, 29 significant and independent single nucleotide polymorphisms associated with age at voice break were extracted. Individual PRS were computed as the sum of risk alleles weighted by the effect size. RESULTS The PRS was associated with AAG (β=0.01, P = 0.04) and AAP (β=0.185, P = 0.0004). In addition, boys within the 20% highest PRS experienced gonadarche and pubarche 0.55 and 0.67 years later than those in the lowest 20%, respectively (P = 0.013 and P = 0.007). CONCLUSIONS Genetic variants identified in large GWAS on age at VB significantly associate with age at testicular growth and pubic hair development, suggesting that these events share a genetic architecture across ethnically distinct populations.
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Affiliation(s)
- María C Lardone
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Alexander S Busch
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - José L Santos
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricio Miranda
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susana Eyheramendy
- Faculty of Engineering and Sciences, Universidad Adolfo Ibañez, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Anders Juul
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Almstrup
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Verónica Mericq
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Abstract
Purpose: Recent reports show that girls with higher body mass index (BMI) have an earlier puberty onset (thelarche). It has been suggested that earlier puberty is a consequence of higher levels of estrogen due to increased aromatization of androgens in adipose tissue. Thus, we aimed to assess the relation between serum levels of estrogen and excess weight (BMI ≥1SD) and central adiposity (>75th percentile for waist circumference) in prepubertal girls at age 7.Materials and Methods: We conducted a cross-sectional study within the Growth and Obesity Cohort Study of 1190 low-middle income children from Santiago, Chile. We selected a random sample of 107 prepubertal girls at age 7. A trained dietitian measured weight, height and waist circumference. Additionally, a fasting blood sample was collected to measure serum levels of estradiol equivalents (via ultrasensitive recombinant cell bioassay), dehydroepiandrosterone sulfate (DHEAS), insulin, insulin-like growth factor 1 (IGF-1), and leptin.Results: Excess weight was observed in 40% of our sample; 11.2% had high central adiposity, and the mean level of estradiol equivalents was 3.6 ± 2.3 pg/ml. In the univariate and multivariate analyzes, we did not observe an association between excess weight, central adiposity and estradiol equivalent levels; however, insulin was inversely associated with the serum level of estradiol equivalents.Conclusions: Our participants had a mean level of estradiol equivalents of 3.6 pg/ml (±2.3 pg/ml) at the pre-pubertal stage. However, with the exception of insulin, we did not observe an association between estradiol equivalents and markers of adiposity and metabolic and hormonal factors.
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Affiliation(s)
| | - Verónica Mericq
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago, Chile
| | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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13
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Delucchi Á, Toro L, Alzamora R, Barrientos V, González M, Andaur R, León P, Villanueva F, Galindo M, Las Heras F, Montecino M, Moena D, Lazcano A, Pinto V, Salas P, Reyes ML, Mericq V, Michea L. Glucocorticoids Decrease Longitudinal Bone Growth in Pediatric Kidney Transplant Recipients by Stimulating the FGF23/FGFR3 Signaling Pathway. J Bone Miner Res 2019; 34:1851-1861. [PMID: 31099911 DOI: 10.1002/jbmr.3761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 05/05/2019] [Accepted: 05/11/2019] [Indexed: 12/11/2022]
Abstract
Renal transplantation (RTx) is an effective therapy to improve clinical outcomes in pediatric patients with terminal chronic kidney disease. However, chronic immunosuppression with glucocorticoids (GCs) reduces bone growth and BMD. The mechanisms causing GC-induced growth impairment have not been fully clarified. Fibroblast growth factor 23 (FGF23) is a peptide hormone that regulates phosphate homeostasis and bone growth. In pathological conditions, FGF23 excess or abnormal FGF receptors (FGFR) activity leads to bone growth impairment. Experimental data indicate that FGF23 expression is induced by chronic GC exposure. Therefore, we hypothesize that GCs impair bone growth by increasing FGF23 expression, which has direct effects on bone growth plate. In a post hoc analysis of a multicentric randomized clinical trial of prepubertal RTx children treated with early GC withdrawal or chronic GC treatment, we observed that GC withdrawal was associated with improvement in longitudinal growth and BMD, and lower plasma FGF23 levels as compared with a chronic GC group. In prepubertal rats, GC-induced bone growth retardation correlated with increased plasma FGF23 and bone FGF23 expression. Additionally, GC treatment decreased FGFR1 expression whereas it increased FGFR3 expression in mouse tibia explants. The GC-induced bone growth impairment in tibiae explants was prevented by blockade of FGF23 receptors using either a pan-FGFR antagonist (PD173074), a C-terminal FGF23 peptide (FGF23180-205) which blocks the binding of FGF23 to the FGFR-Klotho complex or a specific FGFR3 antagonist (P3). Finally, local administration of PD173074 into the tibia growth plate ameliorated cartilage growth impairment in GC-treated rats. These results show that GC treatment partially reduces longitudinal bone growth via upregulation of FGF23 and FGFR3 expression, thus suggesting that the FGF23/Klotho/FGFR3 axis at the growth plate could be a potential therapeutic target for the management of GC-induced growth impairment in children.
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Affiliation(s)
- Ángela Delucchi
- Division of Nephrology, Hospital Luis Calvo Mackenna, Santiago, Chile.,Division of Nephrology, Clínica Alemana de Santiago, Santiago, Chile
| | - Luis Toro
- Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada, Hospital Clínico Universidad de Chile, Santiago, Chile.,Clinica Las Condes, Santiago, Chile
| | - Rodrigo Alzamora
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Millennium Nucleus of Ion Channel-Associated Diseases (MiNICAD), Santiago, Chile
| | - Victor Barrientos
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Magdalena González
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Rodrigo Andaur
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Pablo León
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Francisco Villanueva
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Mario Galindo
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy (MIII), Santiago, Chile
| | - Facundo Las Heras
- Clinica Las Condes, Santiago, Chile.,Department of Anatomic Pathology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Martín Montecino
- Institute of Biomedical Sciences, Faculty of Medicine and Faculty of Life Sciences, Universidad Andrés Bello, Santiago, Chile.,FONDAP Center for Genome Regulation, Universidad Andres Bello, Santiago, Chile
| | - Daniel Moena
- Institute of Biomedical Sciences, Faculty of Medicine and Faculty of Life Sciences, Universidad Andrés Bello, Santiago, Chile.,FONDAP Center for Genome Regulation, Universidad Andres Bello, Santiago, Chile
| | - Andrea Lazcano
- Division of Nephrology, Clínica Alemana de Santiago, Santiago, Chile.,Division of Nephrology, Hospital de Niños Roberto del Río, Santiago, Chile
| | - Viola Pinto
- Clinica Las Condes, Santiago, Chile.,Pediatric Nephrology Unit, Hospital Doctor Exequiel González Cortés, Santiago, Chile
| | - Paulina Salas
- Pediatric Nephrology Unit, Hospital Doctor Exequiel González Cortés, Santiago, Chile
| | - María Loreto Reyes
- Pediatric Endocrinology Unit, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Verónica Mericq
- Clinica Las Condes, Santiago, Chile.,Institute of Maternal and Child Research, Universidad de Chile, Santiago, Chile
| | - Luis Michea
- Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile.,Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy (MIII), Santiago, Chile
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14
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Lardone MC, Castro A, Pereira A, Corvalán C, Ortíz E, Mericq V. Role of the Androgen Receptor Gene CAG Repeat Polymorphism on the Sequence of Pubertal Events and Adiposity in Girls with High Dehydroepiandrosterone Sulfate Level. J Pediatr Adolesc Gynecol 2019; 32:271-277. [PMID: 30550874 DOI: 10.1016/j.jpag.2018.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/09/2018] [Accepted: 11/30/2018] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE The androgen receptor (AR) harbors a variable repeat number of glutamine residues codified by (CAG)n, which seems to inversely affect AR transcriptional activity. We assessed whether (CAG)n affects the sequence of the androgen-sensitive pubertal events and body composition in prepubertal girls. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS Nested case-control study within the Growth and Obesity Cohort Study of 1196 low-middle income children (approximately 50% girls) from a university clinic in Santiago, Chile. Cases were girls with high dehydroepiandrosterone sulfate (DHEAS; >42 μg/dL; HD) at age 7.0 (±0.4) years (n = 58). On follow-up, 32 of them had thelarche (TB2) before the age of pubarche (PH2) and 26 had PH2 before the age of TB2. As controls, 107 age-matched girls with normal DHEAS (≤42 μg/dL; ND) were selected. MAIN OUTCOME MEASURES Methylation-weighted mean (CAG)n (mw[CAG]n) was calculated through X-chromosome methylation-sensitive enzyme restriction and polymerase chain reaction followed by automated capillary electrophoresis in peripheral blood DNA. RESULTS Girls with HD and PH2 before the age of TB2 showed a trend to higher frequency (7/26, 26.9%) of mw(CAG)n <20 compared with ND girls (12/107; 11.2%; P = .087). Accordingly, a direct correlation between age of PH2 and mw(CAG)n was observed in HD (r = 0.352; P = .007) and in ND girls (r = 0.207; P = .033). Moreover, HD girls with mw(CAG)n less than 20 had lower waist circumference and waist/height ratio than HD girls with mw(CAG)n from 20 to less than 25 (P = .027 and P = .012, respectively) at age of DHEAS determination. CONCLUSION Our results suggest that a greater transcriptional activity of the AR, given by short number of CAG repeats, might favor the onset of pubarche and reduce central adiposity in prepubertal girls with HD.
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Affiliation(s)
- María Cecilia Lardone
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Andrea Castro
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Eliana Ortíz
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Verónica Mericq
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.
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Abstract
PURPOSE Puberty onset exhibits remarkable inter-individual and ethnic differences. 5% of Chileans are indigenous but puberty ethnic disparities have not been studied. We aim for evaluating precocious puberty prevalence in children with Mapuche ancestry vs non-indigenous Chilean children (according to their surnames). METHODS Longitudinal cohort study: 1003 children (50.2% girls) participating in the Growth and Obesity Chilean Cohort Study (GOCS) were studied. Annual anthropometry was measured since 4-7 years. Subsequently, Tanner staging and anthropometry were measured every 6 months. In girls, Tanner stage was assessed by breast palpation and in boys by testicular volume measurements. The cohort was stratified in three groups depending on Mapuche surname numbers as follows: (A) no indigenous surnames (n = 811), (B) one to two indigenous surnames (n = 147), and (C) three or more indigenous surnames (n = 45). We evaluated the prevalence of precocious thelarche, pubarche, menarche and gonadarche (testicular volume ≥ 4 ml-G2), using a cutoff age of 8 years in girls and 9 years in boys while controlling for socioeconomic status, body mass index, waist circumference, IGF-1 and DHEAS at 7 years. RESULTS In girls, no significant differences were observed. On the contrary, in boys, precocious gonadarche prevalence was higher in group C (29.2%) vs group A (6.0%) and vs group B (10.5%) (p =0.001, p = 0.004, respectively). Increased precocious gonadarche and pubarche risks in group C were observed even after adjustment [OR 7.31; 95% IC (2.32-23.51); p = 0.001] and [OR 6.17, 95% CI (1.62-23.49); p = 0.008], respectively. CONCLUSION Indigenous origin in Chile is an independent risk factor for precocious gonadarche and pubarche in boys but not in girls.
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Affiliation(s)
- M Fernández
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2a Piso, PO Box 226-3, Santiago, Chile
| | - A Pereira
- Institute of Nutrition and Food Technology (INTA), Faculty of Medicine, University of Chile, Santiago, Chile
| | - C Corvalán
- Institute of Nutrition and Food Technology (INTA), Faculty of Medicine, University of Chile, Santiago, Chile
| | - V Mericq
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2a Piso, PO Box 226-3, Santiago, Chile.
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Colon-Otero G, Torres-Santiago L, Santen R, Mericq V, Ross J, Damaso L, Hossain J, Wang Q, Mesaros C, Blair IA, Mauras N. Abstract P4-10-14: Impact of route of administration of estradiol (oral vs. transdermal) on genotoxic estrogens concentrations in girls with ovarian failure due to Turner syndrome: Potential implications for breast cancer prevention. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-10-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: The established link between estrogen and breast cancer occurs via both estrogen receptor (ER)-mediated and non ER-mediated mechanisms. The term genotoxic estrogens describes mutagenic metabolites, including estrogen catechols and quinones, which have been linked to breast carcinogenesis in post-menopausal women. Recent data showed that childhood obesity is associated with significantly higher levels of genotoxic estrogens in the blood compared with lean children, raising the possibility of a potential pathogenic roles of these metabolites in breast cancer starting even prior to the onset of puberty (Mauras et al: J Clin Endocrinol Metab. 100:2322, 2015). A finding of higher levels of genotoxic estrogens associated with oral estradiol may have breast cancer prevention implications.We hence aimed to assess if the route of administration of 17β estradiol (E2) affects the accumulation of genotoxic estrogen metabolites in a model of ovarian failure in young girls with Turner Syndrome.
Methods: Stored plasma were used from 40 adolescents with Turner's who participated in a previous 12 months randomized controlled trial of the metabolic impact of E2 orally (2mg/d) vs. transdermally (100μg/d). The doses of oral and transdermal E2 were determined to result in similar plasma levels of unconjugated E2. Previously we had reported that despite the similar plasma levels of unconjugated E2, the oral E2 administration route was associated with higher levels of biologically active estrogen activity than the transdermal route (Torres-Santiago L et al:J Clin Endocrinol Metab. 98:2716, 2013). In this study, we measured 12 estrogen metabolites (conjugated and unconjugated) using a highly sensitive LCMSMS assay. Results from 48 normally menstruating adolescents were used for comparison.
Results: After treatment, least square mean (SE) total (conjugated plus unconjugated) E2 and estrone (E1) concentrations were higher in the oral vs. transdermal group (p<0·0001), as were catechol-estrogens 4-OH-E2 (149 vs. 28 (49) pmol/L), 2-OH-E2 (300 vs 76 (52)), 4-OH-E1 (450 vs 105 (113)), 2-OH-E1 (304 vs 740 (684)) and 16α-OH-E1 (3007 vs 157 (534)) (<0·001 between groups). Levels were much closer to controls in the transdermal group.
Conclusions: Common feminizing doses of oral estradiol for 12 months result in greater accumulation of unphysiologic, genotoxic estrogens than transdermal estradiol, expanding concerns about oral estrogens' first hepatic passage contributing to the accumulation of these metabolites. These metabolites have the potential for inducing breast cancer in post-menopausal women. These results suggest the potential benefit of preferential use of transdermal versus oral estrogens as replacement and possibly contraceptive options, in the prevention of breast cancer. Further studies to assess long-term risks of these metabolites in women taking different forms of estrogen replacement are needed.
Citation Format: Colon-Otero G, Torres-Santiago L, Santen R, Mericq V, Ross J, Damaso L, Hossain J, Wang Q, Mesaros C, Blair IA, Mauras N. Impact of route of administration of estradiol (oral vs. transdermal) on genotoxic estrogens concentrations in girls with ovarian failure due to Turner syndrome: Potential implications for breast cancer prevention [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-14.
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Affiliation(s)
- G Colon-Otero
- Mayo Clinic, Jacksonville, FL; University of Virginia, Charlottesville, VA; University of Chile, Santiago, Chile; Nemours Children's Health System, Wilmington, DE; Nemours Children's Health System, Jacksonville, FL; University of Pennsylvania, Philadelphia, PA
| | - L Torres-Santiago
- Mayo Clinic, Jacksonville, FL; University of Virginia, Charlottesville, VA; University of Chile, Santiago, Chile; Nemours Children's Health System, Wilmington, DE; Nemours Children's Health System, Jacksonville, FL; University of Pennsylvania, Philadelphia, PA
| | - R Santen
- Mayo Clinic, Jacksonville, FL; University of Virginia, Charlottesville, VA; University of Chile, Santiago, Chile; Nemours Children's Health System, Wilmington, DE; Nemours Children's Health System, Jacksonville, FL; University of Pennsylvania, Philadelphia, PA
| | - V Mericq
- Mayo Clinic, Jacksonville, FL; University of Virginia, Charlottesville, VA; University of Chile, Santiago, Chile; Nemours Children's Health System, Wilmington, DE; Nemours Children's Health System, Jacksonville, FL; University of Pennsylvania, Philadelphia, PA
| | - J Ross
- Mayo Clinic, Jacksonville, FL; University of Virginia, Charlottesville, VA; University of Chile, Santiago, Chile; Nemours Children's Health System, Wilmington, DE; Nemours Children's Health System, Jacksonville, FL; University of Pennsylvania, Philadelphia, PA
| | - L Damaso
- Mayo Clinic, Jacksonville, FL; University of Virginia, Charlottesville, VA; University of Chile, Santiago, Chile; Nemours Children's Health System, Wilmington, DE; Nemours Children's Health System, Jacksonville, FL; University of Pennsylvania, Philadelphia, PA
| | - J Hossain
- Mayo Clinic, Jacksonville, FL; University of Virginia, Charlottesville, VA; University of Chile, Santiago, Chile; Nemours Children's Health System, Wilmington, DE; Nemours Children's Health System, Jacksonville, FL; University of Pennsylvania, Philadelphia, PA
| | - Q Wang
- Mayo Clinic, Jacksonville, FL; University of Virginia, Charlottesville, VA; University of Chile, Santiago, Chile; Nemours Children's Health System, Wilmington, DE; Nemours Children's Health System, Jacksonville, FL; University of Pennsylvania, Philadelphia, PA
| | - C Mesaros
- Mayo Clinic, Jacksonville, FL; University of Virginia, Charlottesville, VA; University of Chile, Santiago, Chile; Nemours Children's Health System, Wilmington, DE; Nemours Children's Health System, Jacksonville, FL; University of Pennsylvania, Philadelphia, PA
| | - IA Blair
- Mayo Clinic, Jacksonville, FL; University of Virginia, Charlottesville, VA; University of Chile, Santiago, Chile; Nemours Children's Health System, Wilmington, DE; Nemours Children's Health System, Jacksonville, FL; University of Pennsylvania, Philadelphia, PA
| | - N Mauras
- Mayo Clinic, Jacksonville, FL; University of Virginia, Charlottesville, VA; University of Chile, Santiago, Chile; Nemours Children's Health System, Wilmington, DE; Nemours Children's Health System, Jacksonville, FL; University of Pennsylvania, Philadelphia, PA
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Hernandez MI, Rossel K, Peña V, Garcia M, Cavada G, Avila A, Iñiguez G, Mericq V. Patterns of Infancy Growth and Metabolic Hormonal Profile Are Different in Very-Low-Birth-Weight Preterm Infants Born Small for Gestational Age Compared to Those Born Appropriate for Gestational Age. Horm Res Paediatr 2018; 89:233-245. [PMID: 29763893 DOI: 10.1159/000487994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 02/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS An increased preterm birth survival rate is associated with long-term neurological and metabolic risks; thus, our aim was to evaluate whether early patterns of infancy anthropometry and metabolic hormonal profile differ in preterm infants born small for gestational age (SGA) or appropriate for gestational age (AGA) from birth to 36 months of corrected age (CA). METHODS We recruited 110 very-low-birth-weight (VLBW) preterm infants (AGA = 60 and SGA = 50) with a mean birth weight of -2.39 ± 0.77 versus 0.57 ± 0.54 standard deviation scores (SDS) (p < 0.01) and birth length of -2.1 ± 1.05 versus -0.44 ± 0.82 SDS (p < 0.01), respectively. Anthropometry and blood sampling for insulin, insulin-like growth factor (IGF)-II, IGF-I, and leptin were performed for up to 3 years. RESULTS All neonates increased their weight, length, and head circumference SDS during the early inpatient period. Up to 90% reached a normal length within this period. The IGF-II, insulin, and glycemia concentrations changed in parallel with weight. In the first year of CA, only SGA infants gained weight and height SDS. The homoeostatic model assessment had a trend toward higher values in SGA infants at 24 and 36 months (p = 0.06 and p = 0.07). CONCLUSION Being SGA is the strongest predictor of early recovery of height in VLBW preterm infants. Follow-up will allow us to determine whether the differences in the growth patterns of VLBW preterm infants by birth weight SDS persist.
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Affiliation(s)
- María Isabel Hernandez
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago de Chile, Chile
| | - Katherine Rossel
- Unit of Neonatology, Department of Pediatrics Hospital San Borja Arriaran, Santiago de Chile, Chile
| | - Veronica Peña
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago de Chile, Chile.,Unit of Neonatology, Department of Pediatrics Hospital San Borja Arriaran, Santiago de Chile, Chile
| | - Mirna Garcia
- Unit of Neonatology, Department of Pediatrics Hospital San Borja Arriaran, Santiago de Chile, Chile
| | - Gabriel Cavada
- Department of Public Health, University of Chile and University of Los Andes, Santiago de Chile, Chile
| | - Alejandra Avila
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago de Chile, Chile
| | - German Iñiguez
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago de Chile, Chile
| | - Verónica Mericq
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago de Chile, Chile
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18
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Binder AM, Stiemsma LT, Keller K, van Otterdijk SD, Mericq V, Pereira A, Santos JL, Shepherd J, Michels KB. Inverse association between estrogen receptor-α DNA methylation and breast composition in adolescent Chilean girls. Clin Epigenetics 2018; 10:122. [PMID: 30286806 PMCID: PMC6172836 DOI: 10.1186/s13148-018-0553-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/14/2018] [Indexed: 12/21/2022] Open
Abstract
Background Estrogen receptor-α (ER-α) is a transcriptional regulator, which mediates estrogen-dependent breast development, as well as breast tumorigenesis. The influence of epigenetic regulation of ER-α on adolescent breast composition has not been previously studied and could serve as a marker of pubertal health and susceptibility to breast cancer. We investigated the association between ER-α DNA methylation in leukocytes and breast composition in adolescent Chilean girls enrolled in the Growth and Obesity Cohort Study (GOCS) in Santiago, Chile. Breast composition (total breast volume (BV; cm3), fibroglandular volume (FGV; cm3), and percent fibroglandular volume (%FGV)) was measured at breast Tanner stage 4 (B4). ER-α promoter DNA methylation was assessed by pyrosequencing in blood samples collected at breast Tanner stages 2 (B2; n = 256) and B4 (n = 338). Results After adjusting for fat percentage at breast density measurement, ER-α methylation at B2, and cellular heterogeneity, we observed an inverse association between B4 average ER-α DNA methylation and BV and FGV. Geometric mean BV was 15% lower (95% CI: − 28%, − 1%) among girls in the highest quartile of B4 ER-α methylation (6.96–23.60%) relative to the lowest (0.78–3.37%). Similarly, FGV was 19% lower (95% CI: − 33%, − 2%) among girls in the highest quartile of B4 ER-α methylation relative to the lowest. The association between ER-α methylation and breast composition was not significantly modified by body fat percentage and was not influenced by pubertal timing. Conclusions These findings suggest that the methylation profile of ER-α may modulate adolescent response to estrogen and breast composition, which may influence breast cancer risk in adulthood. Electronic supplementary material The online version of this article (10.1186/s13148-018-0553-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexandra M Binder
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 90095, USA
| | - Leah T Stiemsma
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 90095, USA
| | - Kristen Keller
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, 90095, USA
| | - Sanne D van Otterdijk
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Verónica Mericq
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - José L Santos
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - John Shepherd
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA
| | - Karin B Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 90095, USA.
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Binder AM, Corvalan C, Calafat AM, Ye X, Mericq V, Pereira A, Michels KB. Childhood and adolescent phenol and phthalate exposure and the age of menarche in Latina girls. Environ Health 2018; 17:32. [PMID: 29615064 PMCID: PMC5883544 DOI: 10.1186/s12940-018-0376-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/20/2018] [Indexed: 05/19/2023]
Abstract
BACKGROUND The age of menarche has been associated with metabolic and cardiovascular disease, as well as cancer risk. The decline in menarcheal age over the past century may be partially attributable to increased exposure to endocrine disrupting chemicals (EDCs). METHODS We assessed the influence of 26 phenol and phthalate biomarkers on the timing of menarche in a longitudinal cohort of Chilean girls. These EDCs were quantified in urine collected prior to the onset of breast development (Tanner 1; B1), and during adolescence (Tanner 4; B4). Multivariable accelerated failure time (AFT) models were used to analyze associations between biomarker concentrations and the age of menarche adjusting for body mass index (BMI) Z-score and maternal education, accounting for within-subject correlation. RESULTS Several biomarkers were significantly associated with the age at menarche; however, these associations were dependent on the timing of biomarker assessment. A log(ng/ml) increase in B1 concentrations of di(2-ethylhexyl) phthalate biomarkers was associated with later menarche (hazard ratio (HR): 0.77; 95% CI: 0.60, 0.98), whereas higher B1 concentrations of 2,5-dichlorophenol and benzophenone-3 were associated with earlier menarche (HR: 1.13; 95% CI: 1.01, 1.27; HR: 1.17; 95% CI: 1.06, 1.29, respectively). Elevated B4 concentrations of monomethyl phthalate were similarly associated with earlier menarche (HR: 1.30; 95% CI: 1.10, 1.53). The impact of monoethyl phthalate and triclosan concentrations on pubertal timing were significantly modified by BMI Z-score. Higher monoethyl phthalate and triclosan concentrations were associated with earlier menarche among overweight or obese girls, but not among those that were normal weight. CONCLUSIONS This study identifies modulation of sexual maturation by specific EDC biomarkers in Latina girls.
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Affiliation(s)
- Alexandra M. Binder
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA USA
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Xiaoyun Ye
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Verónica Mericq
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Karin B. Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA USA
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Binder AM, Corvalan C, Mericq V, Pereira A, Santos JL, Horvath S, Shepherd J, Michels KB. Faster ticking rate of the epigenetic clock is associated with faster pubertal development in girls. Epigenetics 2018; 13:85-94. [PMID: 29235933 DOI: 10.1080/15592294.2017.1414127] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Epigenetic age is an indicator of biological aging, capturing the impact of environmental and behavioral influences across time on cellular function. Deviance between epigenetic age and chronological age (AgeAccel) is a predictor of health. Pubertal timing has similarly been associated with cancer risk and mortality rate among females. We examined the association between AgeAccel and pubertal timing and adolescent breast composition in the longitudinal Growth and Obesity Cohort Study. AgeAccel was estimated in whole blood using the Horvath method at breast Tanner 2 (B2) and 4 (B4). Total breast volume, absolute fibro-glandular volume (FGV), and %FGV were evaluated at B4 using dual X-ray absorptiometry. The impact of AgeAccel (mean: 0; SD: 3.78) across puberty on the time to breast development (thelarche), menarche, and pubertal tempo (thelarche to menarche) was estimated using accelerated failure time models; generalized estimating equations were used to evaluate associations with breast density. A five-year increase in average adolescent AgeAccel was associated with a significant decrease in time to menarche [hazard ratio (HR): 1.37; 95% confidence interval (CI): 1.04, 1.80] adjusting for birth weight, maternal pre-pregnancy body mass index, maternal height, maternal education, B2 height, fat percentage, and cell composition. AgeAccel displayed a stronger inverse association with pubertal tempo (HR: 1.48; 95% CI: 1.10, 1.99). A five-year increase in AgeAccel was associated with 5% greater %FGV, adjusting for B4 percent body fat, and maternal traits (95% CI: 1.01, 1.10). Our study provides unique insight into the influence of AgeAccel on pubertal development in girls, which may have implications for adult health.
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Affiliation(s)
- Alexandra M Binder
- a Department of Epidemiology , Fielding School of Public Health, University of California , Los Angeles , 650 Charles E Young Drive South, Los Angeles , CA 90095 , USA
| | - Camila Corvalan
- b Institute of Nutrition and Food Technology , University of Chile , Av el Libano 5524, Santiago , Chile
| | - Verónica Mericq
- c Institute of Maternal and Child Research , University of Chile , Santa Rosa 1234, 2° piso, Santiago , Chile
| | - Ana Pereira
- b Institute of Nutrition and Food Technology , University of Chile , Av el Libano 5524, Santiago , Chile
| | - José Luis Santos
- d Department of Nutrition , Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile , Av Libertador Bernardo O'Higgins 340, Santiago , Chile
| | - Steve Horvath
- e Department of Biostatistics , School of Public Health, and Department of Human Genetics, Gonda Research Center , David Geffen School of Medicine, University of California, Los Angeles , 695 Charles E Young Drive South, Los Angeles , CA 90095 , USA
| | - John Shepherd
- f Department of Radiology and Biomedical Imaging , University of California, San Francisco , 400 Parnassus Avenue, San Francisco , CA 94117 , USA
| | - Karin B Michels
- a Department of Epidemiology , Fielding School of Public Health, University of California , Los Angeles , 650 Charles E Young Drive South, Los Angeles , CA 90095 , USA
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Iñiguez G, Gallardo P, Castro JJ, Gonzalez R, Garcia M, Kakarieka E, San Martin S, Johnson MC, Mericq V, Cassorla F. Klotho Gene and Protein in Human Placentas According to Birth Weight and Gestational Age. Front Endocrinol (Lausanne) 2018; 9:797. [PMID: 30697189 PMCID: PMC6340928 DOI: 10.3389/fendo.2018.00797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/19/2018] [Indexed: 01/02/2023] Open
Abstract
Introduction: Fetal growth restriction may be the consequence of maternal, fetal, or placental factors. The insulin-like growth factors (IGFs) are major determinants of fetal growth, and are expressed in the mother, fetus and placenta in most species. Previously we reported higher placental protein content of IGF-I, IGF-IR, and AKT in small (SGA) compared with those from appropriate for gestational age (AGA) placentas. The protein Klotho, has been reported in placenta and may regulate IGF-I activity. In this study we determined Klotho gene expression and protein immunostaining in term (T-SGA y T-AGA) and preterm (PT-SGA y PT-AGA) human placentas. In addition, we assessed the effect of Klotho on the IGF-IR and AKT activation induced by IGF-I. Methods: Placentas (n = 1 17) from 32 T-SGA (birth weight (BW) = -1.74 ± 0.08 SDS), 37 T-AGA (BW = 0.12 ± 0.12 SDS), 20 PT-SGA (BW = -2.08 ± 0.14 SDS), and 28 PT-AGA (BW = -0.43 ± 0.13 SDS) newborns were collected. mRNA expression by RT-PCR in the chorionic (CP) and basal (BP) plates of the placentas, and the presence of Klotho was evaluated by immunohistochemistry (integral optical density, IOD). In addition, we developed placental explants that were incubated with IGF-I in the presence or absence of Klotho. Results: We found a lower mRNA expression and protein immunoreactivity of Klotho in the CP of SGA (term and preterm) compared with AGA placentas. We also observed a significant reduction in IGF-IR tyrosine activation induced by IGF-I 10 nM when preincubated with 2.0 nM of Klotho (2.4 ± 0.5 arbitrary units vs. 1.3 ± 0.3 AU), and similar results we observed on AKT and ERK42/44 activation. Conclusion: We describe for the first time that Klotho mRNA and protein varies according to fetal growth and gestational age. In addition, Klotho appears to down-regulate the activation induced by IGF-I on IGF-IR and AKT, suggesting that Klotho may be regulating IGF-I activity in human placentas according to intrauterine fetal growth.
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Affiliation(s)
- Germán Iñiguez
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
- *Correspondence: Germán Iñiguez
| | - Pedro Gallardo
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
| | - Juan Jose Castro
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
| | - Rene Gonzalez
- Biomedical Research Centre, School of Medicine, University of Valparaíso, Valparaíso, Chile
| | - Mirna Garcia
- Neonatology Unit, San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - Elena Kakarieka
- Pathology Unit, San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - Sebastian San Martin
- Biomedical Research Centre, School of Medicine, University of Valparaíso, Valparaíso, Chile
| | - Maria Cecilia Johnson
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
| | - Verónica Mericq
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
| | - Fernando Cassorla
- School of Medicine, Maternal and Child Research Institute (IDIMI), University of Chile, Santiago, Chile
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Pereira A, Iñiguez G, Corvalan C, Mericq V. High DHEAS Is Associated With Earlier Pubertal Events in Girls But Not in Boys. J Endocr Soc 2017; 1:800-808. [PMID: 29264531 PMCID: PMC5686671 DOI: 10.1210/js.2017-00120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/16/2017] [Indexed: 11/25/2022] Open
Abstract
Context: Premature adrenarche (PA) has been associated with increased metabolic risk. Objective: To describe the risk of precocious thelarche (PT; <8 years), pubarche (PP; girls <8 years, boys <9 years), and gonadarche (PG; <9 years) in children with high dehydroepiandrosterone sulphate (DHEAS [HD]) vs those with normal DHEAS (ND). Setting and Intervention: Longitudinal Chilean cohort (n = 1052, 49.9% girls). Annual clinical examination including secondary sex characteristics by Tanner staging. Logistic regression models were adjusted by age and BMI. Main Outcome: Assess the relationship between DHEAS and premature thelarche, gonadarche, and pubarche in both sexes. Results: At age of DHEAS determination, overweight/obesity was present in 44.3% of boys and 42.9% of girls. Incidences of any precocious event were observed in 17.2% of boys and in 25.4% of girls, presented as 8.7% of PG and 8.5% of PP in boys and as 21.3% of PT and 4.1% of PP in girls. In crude and adjusted models in boys, HD did not increase the risk of earlier pubertal events. Conversely, girls with HD had a 2.6 times greater risk of early thelarche and a three times greater risk of early pubarche compared with girls with ND concentrations. Conclusion: In Chilean adolescents, precocious events of pubertal development were in line with the worldwide secular trend of earlier sexual maturation. HD was only associated with PT and PP in girls. Continuous follow-up of this cohort is a unique opportunity to prospectively address and analyze the interrelationships among HD, early growth, and adiposity as determinants of gonadarche, pubertal rate/sequence progression, and ovarian function.
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Affiliation(s)
- Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile 8360168
| | - German Iñiguez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile 7830490
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile 8360168
| | - Verónica Mericq
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile 7830490
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Mericq V, Pereira A, Uauy R, Corvalán C. Early BMI Gain and Later Height Growth Predicts Higher DHEAS Concentrations in 7-Year-Old Chilean Children. Horm Res Paediatr 2017; 87:15-22. [PMID: 27974716 DOI: 10.1159/000452885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 10/27/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Accelerated weight and height gain in infancy have been associated with premature adrenarche. However, the exact tempo of these events remains undefined. Thus, our goal was to assess the relationship between early BMI and height growth in different periods before 7 years of age and plasma DHEAS levels at 7 years of age. METHODS This is a longitudinal follow-up of participants of the Growth and Obesity Chilean Cohort Study (GOCS) that represents Chilean children from low- to middle-income families. The subjects were 972 children (48% girls) with birth weights of 2,500-4,500 g for whom serial weight and height measurements from birth until 7 years were available. At 7 years of age, we also measured DHEAS, IGF-I, leptin, insulin, and other metabolic markers in serum. The main outcome of interest was plasma DHEAS concentrations at 7 years of age. RESULTS At 7 years of age, children with DHEAS >75th percentile of the sample were taller and fatter and presented higher HOMA-IR and IGF-I than their counterparts (p < 0.05). Children with higher DHEAS were heavier at 4 years of age and beyond compared to their counterparts (higher BMI [BMI SDS at 4 years: 1.16, 95% CI 1.02-1.29 vs. 0.83, 95% CI 0.76-0.91, p < 0.001]) and taller at 7 years of age (height SDS at 7 years: 0.19, 95% CI -0.08 to 0.31 vs. -0.001, 95% CI -0.06 to 0.06, p < 0.005). CONCLUSIONS We observed weight and BMI from 2 to 4 years, and height gains from 4 to 7 years were associated with higher DHEAS levels at 7 years.
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Affiliation(s)
- Verónica Mericq
- Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile
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Castro A, Rodríguez F, Flórez M, López P, Curotto B, Martínez D, Maturana A, Lardone MC, Palma C, Mericq V, Ebensperger M, Cassorla F. Pseudoautosomal abnormalities in terminal AZFb+c deletions are associated with isochromosomes Yp and may lead to abnormal growth and neuropsychiatric function. Hum Reprod 2017; 32:465-475. [PMID: 28057878 DOI: 10.1093/humrep/dew333] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/23/2016] [Accepted: 12/07/2016] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Are copy number variations (CNVs) in the pseudoautosomal regions (PARs) frequent in subjects with Y-chromosome microdeletions and can they lead to abnormal stature and/or neuropsychiatric disorders? SUMMARY ANSWER Only subjects diagnosed with azoospermia factor (AZF)b+c deletions spanning to the end of the Y chromosome (i.e. terminal deletions) harbor Y isochromosomes and/or cells 45,X that lead to pseudoautosomal gene CNVs, which were associated with abnormal stature and/or neuropsychiatric disorders. WHAT IS KNOWN ALREADY The microdeletions in the long arm of the Y chromosome (Yq) that include the loss of one to three AZF regions, referred to as Yq microdeletions, constitute the most important known etiological factor for primary spermatogenic failure. Recently, controversy has arisen about whether Yq microdeletions are associated with gain or loss of PAR genes, which are implicated in skeletal development and neuropsychiatric function. STUDY DESIGN, SIZE, DURATION We studied a cohort of 42 Chilean patients with complete AZF deletions (4 AZFa, 4 AZFb, 23 AZFc, 11 AZFb+c) from a university medical center, diagnosed over a period of 15 years. The subjects underwent complete medical examinations with special attention to their stature and neuropsychiatric function. PARTICIPANTS/MATERIALS, SETTING, METHODS All subjects were characterized for Yq breakpoints by PCR, and for CNVs in PARs by multiplex ligation-dependent probe amplification (MLPA), followed by qPCR analysis for genes in PAR1 (SHOX and ZBED1), PAR2 (IL9R) and two single copy genes (SRY and DDX3Y, respectively located in Yp11.3 and AZFa). In addition, karyotypes revision and fluorescence in situ hybridization (FISH) for SRY and centromeric probes for X (DXZ1) and Y (DYZ3) chromosomes were performed in males affected with CNVs. MAIN RESULTS AND THE ROLE OF CHANCE We did not detect CNVs in any of the 35 AZF-deleted men with interstitial deletions (AZFa, AZFb, AZFc or AZFb+c). However, six of the seven patients with terminal AZFb+c deletions showed CNVs: two patients showed a loss and four patients showed a gain of PAR1 genes, with the expected loss of VAMP-7 in PAR2. In these patients, the Yq breakpoints localized to the palindromes P8, P5 or P4. In the four cases with gain of PAR1, qPCR analysis showed duplicated signals for SRY and DDX3Y and one copy of IL9R, indicating isodicentric Yp chromosomes [idic(Y)] with breakpoint in Yq11.22. The two patients who had loss of PAR1, as shown by MLPA, had an additional reduction for SRY and DDX3Y, as shown by qPCR, associated with a high proportion of 45,X cells, as determined by FISH and karyotype. In agreement with the karyotype analysis, we detected DYZ3++ and DYZ3+ cells by FISH in the six patients, confirming idic(Y) and revealing additional monocentric Y chromosome [i(Y)]. Five patients had a history of major depressive disorders or bipolar disorder, and three had language impairment, whereas two patients showed severe short stature (Z score: -2.75 and -2.62), while a man with bipolar disorder was very tall (Z score: +2.56). LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION The number of males studied with Y-chromosome microdeletions and normozoospermic controls with normal karyotypes may not be enough to rule out an association between AZF deletions and PAR abnormalities. The prevalence of Y isochromosomes and/or 45,X cells detected in peripheral blood does not necessarily reflect the variations of PAR genes in target tissues. WIDER IMPLICATIONS OF THE FINDINGS This study shows that CNVs in PARs were present exclusively in patients with terminal AZFb+c deletions associated with the presence of Y isochromosomes and 45,X cells, and may lead to neuropsychiatric and growth disorders. In contrast, we show that men with interstitial Yq microdeletions with normal karyotypes do not have an increased risk of PAR abnormalities and of phenotypical consequences. Moreover, our results highlight the importance of performing molecular studies, which are not considered in the usual screening for patients with Yq microdeletions. STUDY FUNDING/COMPETING INTERESTS This work was supported by the National Fund for Scientific and Technological Development of Chile (FONDECYT), grant no. 1120176 (A.C.). The authors declare that no conflicting interests exist.
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Affiliation(s)
- A Castro
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - F Rodríguez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - M Flórez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - P López
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - B Curotto
- Laboratorio de Genética y Enfermedades Metabólicas, Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago 7830490, Chile
| | - D Martínez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - A Maturana
- Psychiatric Unit, Clínica Las Condes, Santiago 7591046, Chile
| | - M C Lardone
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - C Palma
- Department of Urology, José Joaquín Aguirre Clinical Hospital, School of Medicine, University of Chile, Santiago 8380453, Chile
- Department of Urology, Clínica Las Condes, Santiago 7591046, Chile
| | - V Mericq
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - M Ebensperger
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
| | - F Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Hospital San Borja Arriarán, Santiago 8360160, Chile
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Gaete X, López P, Unanue N, Codner E, Cavada G, Mericq V. Factors associated with post-menarcheal growth: results of a longitudinal study in Chilean girls from different socioeconomic statuses. J Pediatr Endocrinol Metab 2016; 29:1063-7. [PMID: 27544720 DOI: 10.1515/jpem-2016-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/18/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Menarche is the last stage of pubertal development, which coincides, with the completion of longitudinal growth. Our aim was to evaluate, post-menarcheal growth and clinical variables proposed to be associated with this growth. METHODS In a prospective fashion, 106 healthy girls attending five different socioeconomic status (SES) schools of Santiago were randomly recruited. A pediatric endocrinologist obtained anthropometrics and registration of date at menarche every 6 months. The evolution of the girls' heights was assessed through mixed models adjusted to the SESes, parental height and body mass index (BMI). RESULTS Sixty-three girls from a high socioeconomic status (HSS) and 50 from a low socioeconomic status (LSS) were followed. Four years post menarche, the girls reached a growth plateau and the average height gain was 5.2±2.5 cm. This gain was not associated with SES, BMI, nor with parental height (p=0.744). The only variable that modulated this gain was age at menarche (r=-0.1997, p=0.0332). There was an inverse correlation between height at the moment of menarche and the height reached after 4 years of follow-up adjusted to parental height (r=-0302, p=0.0011). CONCLUSIONS Post-menarcheal growth ends 4 years post-event and is inversely correlated with the age at menarche and with the height at the moment of menarche independent of BMI, parental height and SES.
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Cediel G, Corvalán C, López de Romaña D, Mericq V, Uauy R. Prepubertal Adiposity, Vitamin D Status, and Insulin Resistance. Pediatrics 2016; 138:peds.2016-0076. [PMID: 27335379 DOI: 10.1542/peds.2016-0076] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the following from prepuberty to the puberty-onset: (1) changes in serum 25-hydroxyvitamin-D (25[OH]D), adiposity, and insulin resistance (IR); (2) the effect of prepubertal adiposity on serum 25(OH)D changes; and (3) the combined effect of prepubertal obesity and suboptimal-25(OH)D on IR at puberty-onset. METHODS A total of 426 prepubertal children (∼54% girls) were followed during pubertal-onset assessing before and after puberty-onset serum 25(OH)D, adiposity (BMI and waist circumference) and IR indicators (homeostasis-model-assessment of IR [HOMA-IR]). Associations were tested using multiple and logistic regression models adjusted by age, gender, and seasonality. RESULTS At puberty-onset, mean serum 25(OH)D decreased (32.2 ± 8.9 Tanner I vs 25.2 ± 8.3 ng/mL Tanner II) and total and central obesity increased (BMI-for-age-z-score ≥2 SD [%]: 16.4 vs 22.1; waist-circumference ≥75th percentile [%]: 27.2 vs 37.1, all P < .05). Children with higher adiposity before puberty onset had higher risk of suboptimal-25(OH)D (<30 ng/mL) in Tanner II (ie, odds ratio = 2.7 [1.1-6.7] for obesity and 2.7 [1.4-5.5] for central-obesity) after adjusting for relevant covariates. Children with higher adiposity and suboptimal-25(OH)D before puberty-onset had higher HOMA-IR compared with their counterparts in Tanner II (HOMA-IR: 2.8 [2.5-3.1] if central-obese and suboptimal-25[OH]D vs 2.1 [1.9-2.3] no central-obesity and optimal-25[OH]D). CONCLUSIONS We found that serum 25(OH)D declined with puberty-onset, likely because of adiposity increase. Moreover, children with the combined condition of central-obesity and suboptimal-25(OH)D before puberty-onset had higher pubertal IR. These results highlight the need of ensuring adequate-25(OH)D status before pubertal-onset, particularly in obese children.
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Affiliation(s)
| | | | - Daniel López de Romaña
- Institutes of Nutrition and Food Technology, and Nutrition Research Institute, Lima, Peru; and
| | - Verónica Mericq
- Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ricardo Uauy
- Institutes of Nutrition and Food Technology, and Department of Nutrition and Public Health Intervention Research, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Linares J, Corvalán C, Galleguillos B, Kain J, González L, Uauy R, Garmendia ML, Mericq V. The effects of pre-pregnancy BMI and maternal factors on the timing of adiposity rebound in offspring. Obesity (Silver Spring) 2016; 24:1313-9. [PMID: 27086475 DOI: 10.1002/oby.21490] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 01/06/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the effect of pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and other maternal factors on the timing of adiposity rebound (AR). METHODS In this study, 594 mothers (mothers who do not have diabetes and not underweight) from the longitudinal Growth and Obesity Chilean Cohort Study self-reported their weights at the beginning and end of their pregnancies, and their heights were measured. Pre-pregnancy BMI was categorized as normal weight, overweight, or obesity, and GWG was assessed according to Institute of Medicine guidelines. For children, weight and height measurements from 0 to 3 years were retrieved from records, and they were measured from age 4 to 7 years. BMI curves from 0 to 7 years were used to estimate the age at AR, which was categorized as early (<5 years), intermediate (5-7 years), or late (>7 years). The associations between pre-pregnancy BMI and GWG and early AR were tested using logistic regression models. RESULTS In total, 33% of the mothers had excess pre-pregnancy weight, 31.2% exceeded Institute of Medicine recommendations, and 45% of children had early AR. The pre-pregnancy BMI and parity were associated with earlier AR (OR = 1.07, 95% CI = 1.02-1.11; OR = 0.86; 95% CI = 0.74-0.99, respectively), but GWG was unrelated. CONCLUSIONS These results suggest that preventive strategies for promoting normal pre-pregnancy BMI, especially in women's first pregnancies, could delay the timing of AR, with protective metabolic effects on offspring.
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Affiliation(s)
- Jeannette Linares
- IDIMI, Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Camila Corvalán
- INTA, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Bárbara Galleguillos
- INTA, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Juliana Kain
- INTA, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Laura González
- INTA, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Ricardo Uauy
- INTA, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - María Luisa Garmendia
- INTA, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Verónica Mericq
- IDIMI, Institute of Maternal and Child Research, University of Chile, Santiago, Chile
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Pereira A, Corvalán C, Uauy R, Klein KO, Mericq V. Ultrasensitive estrogen levels at 7 years of age predict earlier thelarche: evidence from girls of the growth and obesity Chilean cohort. Eur J Endocrinol 2015; 173:835-42. [PMID: 26369578 DOI: 10.1530/eje-15-0327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/08/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Prepubertal estradiol equivalents have been inconsistently linked to age at thelarche; elucidating this relationship becomes relevant given the worldwide decline in the age of puberty onset. Thus, our aim is to assess whether prepubertal girls with higher serum levels of estradiol equivalents at age 7 have a greater risk of presenting early thelarche (ET). DESIGN Nested case-control study within the Growth and Obesity Cohort Study of 1196 low-middle income children (∼50% girls) from Santiago, Chile. Girls were defined as cases (ET; n=61) if breast bud appeared prior to 8 years of age; controls (n=91) had thelarche >8 years. METHODS At 6.7 years, weight, height and waist circumference were measured and a fasting blood sample was obtained for measuring estrogen equivalent (ultrasensitive recombinant cell bioassay), DHEAS, leptin, insulin and IGF1. Beginning at 7 years old, Tanner staging was assessed prospectively twice a year and the appearance of breast bud was assessed by palpation. RESULTS Mean serum estradiol-equivalent at 6.7 years was 3.9±3.6 pg/ml for cases and 3.6±2.3 pg/ml for controls. Girls with ET had a higher risk of presenting elevated estradiol-equivalent (≥5 pg/ml) at 7 years (OR=2.05, 95% CI: 0.96-4.36) than controls that was borderline significant. However, after adjusting by BMI, insulin and IGF1 at age 7, the association between estradiol-equivalent and ET was significant (OR=2.29 (95% CI: 1.05-5.01)). CONCLUSIONS Chilean girls from low to middle socioeconomic status with ET exhibited double the risk of having high levels of estradiol-equivalent at 7 years than girls with a later age of thelarche. Whole-body adiposity and increased adrenal activity did not explain the observed prepubertal estrogen increase.
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Affiliation(s)
- Ana Pereira
- Institute of Nutrition and Food TechnologyUniversity of Chile, Avenida El Líbano 5524, Macul, Santiago, ChileDepartment of NeonatologyFaculty of Medicine, Catholic University of Chile, Santiago, ChileDepartment of PediatricsUniversity of California, San Diego, California, USAInstitute of Maternal and Child ResearchFaculty of Medicine, University of Chile, Santiago, Chile
| | - Camila Corvalán
- Institute of Nutrition and Food TechnologyUniversity of Chile, Avenida El Líbano 5524, Macul, Santiago, ChileDepartment of NeonatologyFaculty of Medicine, Catholic University of Chile, Santiago, ChileDepartment of PediatricsUniversity of California, San Diego, California, USAInstitute of Maternal and Child ResearchFaculty of Medicine, University of Chile, Santiago, Chile
| | - Ricardo Uauy
- Institute of Nutrition and Food TechnologyUniversity of Chile, Avenida El Líbano 5524, Macul, Santiago, ChileDepartment of NeonatologyFaculty of Medicine, Catholic University of Chile, Santiago, ChileDepartment of PediatricsUniversity of California, San Diego, California, USAInstitute of Maternal and Child ResearchFaculty of Medicine, University of Chile, Santiago, Chile Institute of Nutrition and Food TechnologyUniversity of Chile, Avenida El Líbano 5524, Macul, Santiago, ChileDepartment of NeonatologyFaculty of Medicine, Catholic University of Chile, Santiago, ChileDepartment of PediatricsUniversity of California, San Diego, California, USAInstitute of Maternal and Child ResearchFaculty of Medicine, University of Chile, Santiago, Chile
| | - Karen O Klein
- Institute of Nutrition and Food TechnologyUniversity of Chile, Avenida El Líbano 5524, Macul, Santiago, ChileDepartment of NeonatologyFaculty of Medicine, Catholic University of Chile, Santiago, ChileDepartment of PediatricsUniversity of California, San Diego, California, USAInstitute of Maternal and Child ResearchFaculty of Medicine, University of Chile, Santiago, Chile
| | - Verónica Mericq
- Institute of Nutrition and Food TechnologyUniversity of Chile, Avenida El Líbano 5524, Macul, Santiago, ChileDepartment of NeonatologyFaculty of Medicine, Catholic University of Chile, Santiago, ChileDepartment of PediatricsUniversity of California, San Diego, California, USAInstitute of Maternal and Child ResearchFaculty of Medicine, University of Chile, Santiago, Chile
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Mericq V, De Luca F, Hernandez MI, Peña V, Rossel K, Garcia M, Avila A, Cavada G, Iñiguez G. Serum fibroblast growth factor 21 levels are inversely associated with growth rates in infancy. Horm Res Paediatr 2015; 82:324-31. [PMID: 25300595 DOI: 10.1159/000367922] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fibroblast growth factor 21 (FGF21) is a metabolic and growth regulator. AIM To investigate the role of FGF21 during growth in infancy. METHODS Blood samples for FGF21, leptin, insulin and glucose were collected from cord blood obtained from 95 preterm and term newborns (cross-sectional group), and at 6 and 12 months of life in 80 preterm and term infants (longitudinal group). Length and weight were measured at birth, 6 months, and 12 months. RESULTS From birth through 12 months of age, preterm infants' linear growth and weight gain were larger than those of term infants, irrespective of birth weight SDS. At birth and at 12 months, there was no difference in FGF21 levels between preterm and term infants; in contrast, at 6 months, serum FGF21 in term infants was significantly higher than that of preterm ones. In the 0-6-month period, in the whole longitudinal group, serum FGF21 was inversely correlated to the length change SDS, and such a significant inverse correlation persisted in the preterm-AGA group in the 6-12-month period. In addition, term infants who experienced length catch-up in the first 6 months of life exhibited lower serum FGF21 levels at 6 months, and those with length catch-up growth between 6 and 12 months had a greater decrease of serum FGF21 level in the same time period. CONCLUSIONS Our results indicate that FGF21 in infancy is inversely correlated with linear growth rate, thus suggesting that FGF21 is a negative regulator of human growth.
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Affiliation(s)
- Verónica Mericq
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
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de Bruin C, Mericq V, Andrew SF, van Duyvenvoorde HA, Verkaik NS, Losekoot M, Porollo A, Garcia H, Kuang Y, Hanson D, Clayton P, van Gent DC, Wit JM, Hwa V, Dauber A. An XRCC4 splice mutation associated with severe short stature, gonadal failure, and early-onset metabolic syndrome. J Clin Endocrinol Metab 2015; 100:E789-98. [PMID: 25742519 PMCID: PMC4422886 DOI: 10.1210/jc.2015-1098] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Severe short stature can be caused by defects in numerous biological processes including defects in IGF-1 signaling, centromere function, cell cycle control, and DNA damage repair. Many syndromic causes of short stature are associated with medical comorbidities including hypogonadism and microcephaly. OBJECTIVE To identify an underlying genetic etiology in two siblings with severe short stature and gonadal failure. DESIGN Clinical phenotyping, genetic analysis, complemented by in vitro functional studies of the candidate gene. SETTING An academic pediatric endocrinology clinic. PATIENTS OR OTHER PARTICIPANTS Two adult siblings (male patient [P1] and female patient 2 [P2]) presented with a history of severe postnatal growth failure (adult heights: P1, -6.8 SD score; P2, -4 SD score), microcephaly, primary gonadal failure, and early-onset metabolic syndrome in late adolescence. In addition, P2 developed a malignant gastrointestinal stromal tumor at age 28. INTERVENTION(S) Single nucleotide polymorphism microarray and exome sequencing. RESULTS Combined microarray analysis and whole exome sequencing of the two affected siblings and one unaffected sister identified a homozygous variant in XRCC4 as the probable candidate variant. Sanger sequencing and mRNA studies revealed a splice variant resulting in an in-frame deletion of 23 amino acids. Primary fibroblasts (P1) showed a DNA damage repair defect. CONCLUSIONS In this study we have identified a novel pathogenic variant in XRCC4, a gene that plays a critical role in non-homologous end-joining DNA repair. This finding expands the spectrum of DNA damage repair syndromes to include XRCC4 deficiency causing severe postnatal growth failure, microcephaly, gonadal failure, metabolic syndrome, and possibly tumor predisposition.
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Affiliation(s)
- Christiaan de Bruin
- Cincinnati Center for Growth Disorders (C.d.B., S.F.A., V.H., A.D.), Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229; Institute of Maternal and Child Research (V.M.), Faculty of Medicine, University of Chile, 226-3 Santiago, Chile; Laboratory for Diagnostic Genome Analysis (H.A.v.D., M.L.), Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Department of Genetics (N.S.V., D.C.v.G.), Erasmus MC, 3015 CE Rotterdam, The Netherlands; Center for Autoimmune Genomics and Etiology (A.P.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229; Pediatrics Division (H.G.), Faculty of Medicine, Pontificia Universidad Catolica de Chile Santiago, 340 Santiago, Chile; Division of Developmental Biology (Y.K.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229; Institute of Human Development (D.H., P.C.), University of Manchester and Manchester Academic Health Sciences Centre, Manchester M13 9PL, United Kingdom; and Department of Pediatrics (J.M.W.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Pereira A, Garmendia ML, González D, Kain J, Mericq V, Uauy R, Corvalán C. Breast bud detection: a validation study in the Chilean growth obesity cohort study. BMC Womens Health 2014; 14:96. [PMID: 25115568 PMCID: PMC4137044 DOI: 10.1186/1472-6874-14-96] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 07/25/2014] [Indexed: 11/11/2022]
Abstract
Background Early puberty onset has been related to future chronic disease; however breast bud assessment in large scale population studies is difficult because it requires trained personnel. Thus our aim is to assess the validity of self and maternal breast bud detection, considering girl’s body mass index (BMI) and maternal education. Methods In 2010, 481 girls (mean age = 7.8) from the Growth and Obesity Chilean Cohort Study were evaluated by a nutritionist trained in breast bud detection. In addition, the girl(n = 481) and her mother(n = 341) classified the girl’s breast development after viewing photographs of Tanner stages. Concordance between diagnostics was estimated (kappa, Spearman correlation) considering girls’ BMI and mother’s educational level. Results 14% of the girls presented breast buds and 43% had excess weight (BMI z-score > 1, World Health Organization 2007). Self-assessment showed low concordance with the evaluator (K < 0.1) and girls with excess weight over-diagnosed more than girls of normal weight (44% vs. 24%, p-value < 0.05). Instead, mothers showed good concordance with the evaluator (K = 0.7, 95% confidence interval (CI) = 0.6-0.9), even in overweight girls and/or in mothers with low education (K = 0.7, 95% CI = 0.6-0.8). Conclusions Mothers were able to adequately evaluate the appearance of breast bud despite low educational level and girls’ excess weight. Mother could be a useful resource for defining puberty onset in epidemiological studies, particularly developing countries.
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Affiliation(s)
| | | | | | | | | | | | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Avda, El Líbano 5524, Macul, Santiago, Chile.
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Iñiguez G, Castro JJ, Garcia M, Kakarieka E, Johnson MC, Cassorla F, Mericq V. IGF-IR signal transduction protein content and its activation by IGF-I in human placentas: relationship with gestational age and birth weight. PLoS One 2014; 9:e102252. [PMID: 25050889 PMCID: PMC4106823 DOI: 10.1371/journal.pone.0102252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/16/2014] [Indexed: 02/05/2023] Open
Abstract
Introduction The human placenta expresses the IGF-I and IGF-IR proteins and their intracellular signal components (IRS-1, AKT and mTOR). The aim of this study was to assess the IGF-IR content and activation of downstream signaling molecules in placentas from newborns who were classified by gestational age and birth weight. We studied placentas from 25 term appropriate (T-AGA), 26 term small (T-SGA), 22 preterm AGA (PT-AGA), and 20 preterm SGA (PT-SGA) newborns. The total and phosphorylated IGF-IR, IRS-1, AKT, and mTOR contents were determined by Western Blot and normalized by actin or with their respective total content. The effect of IGF-I was determined by stimulating placental explants with recombinant IGF-I 10-8 mol/L for 15, 30, and 60 minutes. Results The IGF-IR content was higher in T-SGA compared to T-AGA placentas, and the IRS-1 content was higher in PT-placentas compared with their respective T-placentas. The effect of IGF-I on the phosphorylated forms of IGF-IR was increased in T-SGA (150%) and PT-SGA (300%) compared with their respective AGA placentas. In addition, AKT serine phosphorylation was higher in PT-SGA compared to PT-AGA and T-SGA placentas (90% and 390% respectively). Conclusion The higher protein content and response to IGF-I of IGF-IR, IRS-1, and AKT observed in SGA placentas may represent a compensatory mechanism in response to fetal growth restriction.
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Affiliation(s)
- Germán Iñiguez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
- * E-mail:
| | - Juan José Castro
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Mirna Garcia
- Hospital Clínico San Borja-Arriarán, University of Chile, Santiago, Chile
| | - Elena Kakarieka
- Hospital Clínico San Borja-Arriarán, University of Chile, Santiago, Chile
| | - M. Cecilia Johnson
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Verónica Mericq
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
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Sepúlveda C, Urquidi C, Pittaluga E, Iñiguez G, Avila A, Carrasco F, Mericq V. Differences in body composition and resting energy expenditure in childhood in preterm children born with very low birth weight. Horm Res Paediatr 2014; 79:347-55. [PMID: 23774886 DOI: 10.1159/000351466] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 04/18/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Rapid early ponderal growth is associated with adverse metabolic risks in young adults born at term. AIM To determine whether there are differences in body composition, resting energy expenditure (REE) and metabolic variables between preterm children born with very low birth weight (VLBW) either appropriate (AGA) or small (SGA) for gestational age and whether these differences are related to an early period of weight gain. METHODS 67 VLBW preterm (40 AGA, 27 SGA). Body composition by DEXA, REE by indirect calorimetry and blood sampling at age 6.7 ± 0.5 years. RESULTS VLBW SGA children were lighter, shorter, had a lower waist and hip circumference, HDL cholesterol and lipid oxidation rates than their AGA counterparts (adjusted for age, sex and BMI). Birth weight correlated negatively with total body and trunk fat mass. In a multivariate linear regression analysis, we found a positive association between weight gain in the first 3 months of life and total and trunk fat at age 6 years and a reciprocal association with REE at age 6 years. In contrast, the weight gain rate at 6-9 months of life was associated with higher REE and lipid oxidation rates at 6 years. A higher weight gain rate at 9-12 months was associated with a higher lean mass at 6 years. CONCLUSION An early fast-pace weight gain in VLBW infants may have detrimental consequences for metabolic health later on.
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Affiliation(s)
- Carolina Sepúlveda
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
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Okuma C, Hernández MI, Rodríguez P, Flores R, Avila A, Cavada G, Kopplin E, Rossel K, Iñiguez G, Mericq V. Microstructural brain and multivoxel spectroscopy in very low birth weight infants related to insulin-like growth factor concentration and early growth. Horm Res Paediatr 2013; 79:197-207. [PMID: 23594793 DOI: 10.1159/000348517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/25/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Very low birth weight (VLBW) children have higher risk of neurologic disabilities and growth factors are essential for brain maturation. AIM To assess whether there are differences in neurologic findings, psychometric parameters and microstructural brain morphology in 1-year-old VLBW infants versus term healthy controls and whether these differences are related to hormonal/growth changes. METHODS Prospective anthropometry, prefeed venous blood sample [insulin, insulin-like growth factor-I (IGF-I), insulin-like growth factor-II (IGF-II), leptin, glucose], neurologic and imaging assessment, at age 1 year in 34 VLBW infants (12 SGA; 10 M) and 10 healthy term controls (5 M). RESULTS IGF-I concentrations at 1 month of corrected age were 20% lower in SGA versus appropriate for gestational age VLBW (p < 0.02). Gray and white matter volume and fractional anisotropy in 15/27 regions were decreased (p < 0.001). Abnormal spectroscopy was observed in 4 zones in VLBW versus term controls (p < 0.001). Some of these changes were associated with different periods of first-year growth and IGF-I/IGF-II, leptin and HOMA-IR. CONCLUSIONS VLBW infants show differences in brain volumes and microstructural brain morphology as compared to term controls, changes related to circulating growth factor and anthropometry changes in the first year. This apparent reorganization of the developing brain offers a unique opportunity to investigate the relationship between changes in cortical anatomy, cognitive and social impairments and periods of early growth.
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Affiliation(s)
- Cecilia Okuma
- Pediatric Endocrinology Unit, Institute of Maternal and Child Research, University of Chile, Santiago, Chile
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Valdés C, Unanue N, Hernández M, García R, Castro M, Vásquez L, Torres JP, Mericq V. Is there a link between influenza and type I diabetes? Increased incidence of TID during the pandemic H1N1 influenza of 2009 in Chile. Pediatr Endocrinol Rev 2013; 11:161-166. [PMID: 24575551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Pandemic H1N1 2009 had the highest incidence in the middle-high income area of Santiago and affected mostly school age patients. Influenza A virus (IAVs) causes systemic and most commonly non-systemic infection. Interestingly, it is able to replicate only in the presence of trypsin-like enzymes, as lung and pancreas. HYPOTHESIS IAVs infection may trigger beta cell destruction and increase the incidence of T1DM. METHODS A retrospective observational study of new T1DM pediatric patients from database of Clinica Las Condes between 1995 and 2012. RESULTS From 58 patients, 44.7% were diagnosed between 2009 and 2010, coincident with the H1N1 virus outbreak. There were no differences in clinical neither metabolic parameters between those patients from the 2009-2010 period and the rest. From those patients with available antibody panel, it was negative in 30% of the 2009-2010 group vs. 12.5% of the rest of the cohort (p < 0.05). Only one 5.8 year old boy had history of H1N1 virus infection three months prior to the DM1 onset with negative antibodies. CONCLUSIONS The temporal coincidence suggests a possible link between T1DM and H1N1 virus, might be thought to be through direct cytopathic damage. Unfortunately we could only confirm H1N1 previous infection in only one case. Prospective studies in new T1DM cases are necessary to test this hypothesis.
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Affiliation(s)
- C Valdés
- Pediatric Endocrinology Department, San Borja Arriarán Hospital, IDIMI, University of Chile
| | - N Unanue
- Pediatric Endocrinology Department, San Borja Arriarán Hospital, IDIMI, University of Chile
| | - M Hernández
- Pediatric Endocrinology Department, San Borja Arriarán Hospital, IDIMI, University of Chile
| | - R García
- Pediatric Endocrinology Department, San Borja Arriarán Hospital, IDIMI, University of Chile
| | - M Castro
- Research Department, Clínica Las Condes
| | - L Vásquez
- Pediatric Department, Clínica Las Condes
| | - J P Torres
- Pediatric Infectious Diseases Department, Clínica Las Condes
| | - V Mericq
- Pediatric Endocrinology Department, San Borja Arriarán Hospital, IDIMI, University of Chile
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Gaete X, Iñiguez G, Linares J, Avila A, Mericq V. Cortisol hyporesponsiveness to the low dose ACTH test is a frequent finding in a pediatric population with type 1 diabetes mellitus. Pediatr Diabetes 2013; 14:429-34. [PMID: 23490274 DOI: 10.1111/pedi.12021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/06/2012] [Accepted: 01/04/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In adults with type 1 diabetes mellitus (DM1), a 25% of risk of hypocortisolism has been found through a low dose ACTH test with negative antibodies suggesting other causes of hypothalamic-pituitary-adrenal axis dysfunction. AIM To evaluate adrenal function in pediatric patients with DM1 and correlate the results with the frequency of hypoglycemia and metabolic control. METHODS Sixty-nine patients were enrolled, age 12.3 (5.7-18.1); 50 boys and 19 girls. A 20% had additional autoimmune diseases. Mean hemoglobin A1c (HbA1c) was 8.1% and insulin dose was 1.14 U/kg/d. After an overnight fast, a low dose ACTH test (1 µg) was performed. Basal and stimulated cortisol concentrations, DHEAS, and plasma renin activity (PRA) were measured. A cortisol response post-ACTH below 18 µg/dL was considered abnormal. RESULTS 58% of the tested patients had an abnormal response to ACTH test. These patients also had lower DHEAS concentrations, but were not different in diabetes duration, HbA1C, severe hypoglycemia, ACTH, or PRA concentrations compared to those who had a normal cortisol post-ACTH. One patient out of 59, had a positive anti-21-hydroxylase antibody (21OHA) and presented a poor response to ACTH. CONCLUSIONS We found a significant proportion of our patients having a subnormal cortisol response independent of the presence of anti-adrenal cell antibodies. We did not find a correlation with metabolic control, probably due to the good metabolic control of this group. The absence of 21OHA does not rule out subclinical hypocortisolism in this population. Our results suggest testing adrenal function in children with DM1.
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Affiliation(s)
- X Gaete
- Institute of Maternal and Child Research, Pediatric Endocrinology unit, Faculty of Medicine, University of Chile, Santiago, Chile
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Toso A, Ayala MJ, Brunner V, Rodríguez J, Hernández MI, Urquidi C, Mericq V. [Interests and perspectives of first and last year medical students]. Rev Med Chil 2013; 140:609-15. [PMID: 23096666 DOI: 10.4067/s0034-98872012000500008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 01/05/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND The interests that motivate medical students to study this career are diverse and they may change during the seven years of study. In Chile, 22 universities offer medicine and the number of graduated students has increased by more than 50% over the last 10 years. AIM To determine the motivational profile of medical students at admission, and at the end of their career. SUBJECTS AND METHODS A voluntary anonymous survey was applied to 275 first and 140 seventh year medical students from one traditional public and two private schools. RESULTS The main reason for applying to medical school was social interest (68.7%), followed by interest in science and academia. Thirty six percent of students from seventh year would not study medicine again. In the seventh year, the interest in medical care persists in 88% of students, followed by academic interests in 64%. Only 24% had research interests. Fifty nine and 57% of students projected their medical work in private and public hospital settings, respectively. Only 11% projected themselves as doing research. Sixty nine percent of students would like to receive more information about post graduate education. CONCLUSIONS There is a low interest in research and a high percentage of seventh year students that would not apply to medicine again. Medical schools should perform a systematic analysis of students' interests to improve faulty areas.
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Affiliation(s)
- Alberto Toso
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Torres-Santiago L, Mericq V, Taboada M, Unanue N, Klein KO, Singh R, Hossain J, Santen RJ, Ross JL, Mauras N. Metabolic effects of oral versus transdermal 17β-estradiol (E₂): a randomized clinical trial in girls with Turner syndrome. J Clin Endocrinol Metab 2013; 98:2716-24. [PMID: 23678038 PMCID: PMC5393461 DOI: 10.1210/jc.2012-4243] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT The long-term effects of pure 17β-estradiol (E₂) depending on route of administration have not been well characterized. OBJECTIVE Our objective was to assess metabolic effects of oral vs transdermal (TD) 17β-E₂ replacement using estrogen concentration-based dosing in girls with Turner syndrome (TS). PATIENTS Forty girls with TS, mean age 16.7 ± 1.7 years, were recruited. DESIGN Subjects were randomized to 17β-E₂ orally or TD. Doses were titrated using mean E₂ concentrations of normally menstruating girls as therapeutic target. E₂, estrone (E₁), and E₁ sulfate (E₁S) were measured by liquid chromatography tandem mass spectrometry and a recombinant cell bioassay; metabolites were measured, and dual-energy x-ray absorptiometry scan and indirect calorimetry were performed. MAIN OUTCOME Changes in body composition and lipid oxidation were evaluated. RESULTS E₂ concentrations were titrated to normal range in both groups; mean oral dose was 2 mg, and TD dose was 0.1 mg. After 6 and 12 months, fat-free mass and percent fat mass, bone mineral density accrual, lipid oxidation, and resting energy expenditure rates were similar between groups. IGF-1 concentrations were lower on oral 17β-E₂, but suppression of gonadotropins was comparable with no significant changes in lipids, glucose, osteocalcin, or highly sensitive C-reactive protein between groups. However, E₁, E₁S, SHBG, and bioestrogen concentrations were significantly higher in the oral group. CONCLUSIONS When E₂ concentrations are titrated to the normal range, the route of delivery of 17β-E₂ does not affect differentially body composition, lipid oxidation, and lipid concentrations in hypogonadal girls with TS. However, total estrogen exposure (E₁, E₁S, and total bioestrogen) is significantly higher after oral 17β-E₂. TD 17β-E₂ results in a more physiological estrogen milieu than oral 17β-E₂ administration in girls with TS.
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Alvarez-Nava F, Lanes R, Quintero JM, Miras M, Fideleff H, Mericq V, Marcano H, Zabala W, Soto M, Pardo T, Borjas L, Villalobos J, Gunczler P, Unanue N, Tkalenko N, Boyanofsky A, Silvano L, Franchioni L, Llano M, Fideleff G, Azaretzky M, Suarez M. Effect of the parental origin of the X-chromosome on the clinical features, associated complications, the two-year-response to growth hormone (rhGH) and the biochemical profile in patients with turner syndrome. Int J Pediatr Endocrinol 2013; 2013:10. [PMID: 23731950 PMCID: PMC3679778 DOI: 10.1186/1687-9856-2013-10] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 05/29/2013] [Indexed: 11/17/2022]
Abstract
Background It is possible that genes on the X chromosome are expressed differently depending of its parental origin. The objective of this study was to determine the influence of the parental origin of the X-chromosome on phenotypic variability, response to rhGH and on the biochemical profile of TS patients. Methods This was a cross-sectional multicenter correlational study carried out over three years in six Latin-American university hospitals. Unrelated 45,X TS patients (n = 93; 18.3 ± 8.5 years )) were evaluated. A subgroup (n = 34) of the patients were prospectively treated with rhGH over two years. DNA profiles of patients and their mothers were compared to determine the parental origin of the retained X-chromosome through 10 polymorphic X-chromosome-STRs. The association with clinical features, biochemical profiles and anthropometric data at the beginning and after two years of rhGH treatment was determined. Results Seventy two percent of patients retained the maternal X chromosome (Xm). A trend towards significance between maternal height and patients final height (p ≤ 0.07) in 45,Xm subjects was observed. There was no correlation between paternal height and patient height. No differences were detected between both groups in regard to dysmorphic features, classical malformations or increase in the height-SDS after rhGH. There were higher levels of triglycerides, total and LDL cholesterol in patients >20 years who retained the Xm. Conclusions The parental origin of the retained X chromosome may influence lipid metabolism in TS patients, but its effect on growth seems to be minimal. No parental-origin-effect on the phenotypic features, associated anomalies and on the growth response to rhGH was found in 45,X TS individuals.
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Corvalán C, Uauy R, Mericq V. Obesity is positively associated with dehydroepiandrosterone sulfate concentrations at 7 y in Chilean children of normal birth weight. Am J Clin Nutr 2013; 97:318-25. [PMID: 23283497 PMCID: PMC3545681 DOI: 10.3945/ajcn.112.037325] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In low-birth-weight girls, obesity increases the risk of premature adrenarche and metabolic complications. However, the consistency of this association in normal-birth-weight children and its potential mediators remain unknown. OBJECTIVES The objectives were to assess the associations between obesity indicators and dehydroepiandrosterone sulfate (DHEAS) at 7 y of age and to evaluate the role of hormonal markers on these associations. DESIGN We assessed in 969 participants (6.9 y; 48% girls; all Tanner I) in the Growth and Obesity Chilean Cohort Study the associations between DHEAS and weight, BMI, waist circumference (WC), waist-to-height ratio, skinfold thickness, and percentage total fat (bioimpedance) and determined whether these associations were related to insulin, insulin-like growth factor I (IGF-I), and leptin. We also compared BMI and height growth from 0 to 7 y of age in nonobese and obese children with normal and high DHEAS (≥75th percentile) at 7 y. RESULTS DHEAS concentrations were similar between girls (30.3 ±1.86 μg/dL) and boys (29.4 ±1.73 μg/dL) (P > 0.05); 17.3% of children were obese (BMI-for-age z score ≥2 SD). Adiposity indicators were positively and similarly associated with DHEAS [ie, BMI, β standardized regression coefficient: 0.23 (95% CI: 0.17, 0.29); WC, β standardized regression coefficient: 0.23 (95% CI: 0.16, 0.30)]; these associations were only partially related to IGF-I and leptin. Obese children had twice the risk of high DHEAS (OR: 2.16; 95% CI: 1.51, 3.09); at 7 y, obese children with high DHEAS were fatter and more centrally obese than their counterparts (P < 0.05), although their previous growth was similar (P > 0.05). None of the results differed by sex (P > 0.05). CONCLUSION In children of normal birth weight, obesity is positively associated with DHEAS at 7 y of age.
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Affiliation(s)
- Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile.
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Flanagan SE, Mackay DJG, Greeley SAW, McDonald TJ, Mericq V, Hassing J, Richmond EJ, Martin WR, Acerini C, Kaulfers AM, Flynn DP, Popovic J, Sperling MA, Hussain K, Ellard S, Hattersley AT. Hypoglycaemia following diabetes remission in patients with 6q24 methylation defects: expanding the clinical phenotype. Diabetologia 2013; 56:218-21. [PMID: 23111732 PMCID: PMC3982857 DOI: 10.1007/s00125-012-2766-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/12/2012] [Indexed: 12/11/2022]
MESH Headings
- Chromosome Deletion
- Chromosome Duplication
- Chromosomes, Human, Pair 6/genetics
- DNA Methylation
- Diabetes Mellitus/congenital
- Diabetes Mellitus/genetics
- Diabetes Mellitus/metabolism
- Diabetes Mellitus/physiopathology
- Fathers
- Female
- Humans
- Hypoglycemia/etiology
- Hypoglycemia/therapy
- Infant, Newborn
- Infant, Newborn, Diseases/genetics
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/physiopathology
- Male
- Remission, Spontaneous
- Uniparental Disomy
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Hernández MI, Martínez-Aguayo A, Cavada G, Peña V, Trejo L, Avila A, Salazar T, Asenjo S, Iñiguez G, Rey R, Mericq V. Accelerated early pubertal progression, ovarian morphology, and ovarian function in prospectively followed low birth weight (LBW) girls. J Pediatr Endocrinol Metab 2013; 26:223-30. [PMID: 23314525 DOI: 10.1515/jpem-2012-0345] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/30/2012] [Indexed: 11/15/2022]
Abstract
AIM To compare pubertal development in age-matched healthy girls born with low birth weight (LBW) or appropriate birth weight for gestational age (AGA). SUBJECTS AND METHODS Girls with breast in Tanner stage II and normal body mass index were followed for 3 years with a complete physical exam, bone age, pelvic ultrasound, and measurement of gonadal hormones using a leuprolide test. RESULTS Forty-one girls (AGA 25/LBW 16) were followed up for 3 years. By 3 years, they had similar bone age, adjusted height, and body composition. In LBW girls, breast Tanner stage advanced faster during the first 2 years of follow-up, which was associated with higher serum androgens. Hirsutism score, ovarian volume, and number of follicles between AGA and LBW were not different nor was age of menarche. By the third year, basal and poststimulated levels of gonadotropins and androgens anti-Müllerian hormone and inhibin B were similar in both groups and did not show differences related to birth weight or degree of catch-up growth. CONCLUSION LBW recruits showed a slightly faster breast development but no differences in androgen excess signs, internal genitalia, and gonadal hormonal patterns.
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Torres A, Iñiguez G, Ferrario M, Mericq V. Differences in Expression, Content, and Activity of 11β-HSD1 in Adipose Tissue between Obese Men and Women. ISRN Endocrinol 2012; 2012:787201. [PMID: 23304545 PMCID: PMC3523536 DOI: 10.5402/2012/787201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/01/2012] [Indexed: 11/30/2022]
Abstract
Cortisol production in adipose tissue is regulated by 11β-HSD1. Objective. To determine whether there are differences in gene expression, enzyme activity, and protein content of the 11β-HSD1 enzyme in VAT (visceral adipose tissue) and SAT (subcutaneous adipose tissue) from obese compared to nonobese adults. Methods. VAT and SAT samples were obtained from 32 obese subjects (BMI > 30 Kg/m2) who underwent bariatric surgery and 15 samples from controls submitted to elective surgery. Fasting serum glucose, insulin, and lipids were measured. The expression of 11β-HSD1 was determined by RT-PCR, the enzyme activity by thin-layer chromatography, and the protein content by Western blot. Results. Obese patients had higher cholesterol, insulin, and HOMA-IR compared to nonobese. There were no differences in VAT or SAT expression of 11β-HSD1 between obese and nonobese patients. However, we found lower 11β-HSD1 activity and protein content in VAT, in obese women versus nonobese women (P < 0.05). BMI and 11β-HSD1 enzyme activity and protein content in VAT correlated inversely in women. Conclusions. Regulation of 11β-HSD1 activity in VAT from obese subjects appears to be gender specific, suggesting the existence of a possible protective mechanism modulating this enzyme activity leading to a decrease in the production of cortisol in this tissue.
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Affiliation(s)
- A Torres
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Casilla 226-3, 8360160 Santiago, Chile
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García RJ, Martinez-Aguayo A, Mericq V. How to optimally manage growth hormone therapy: survey of Chilean pediatric endocrinologists. Horm Res Paediatr 2012; 77:94-9. [PMID: 22433929 DOI: 10.1159/000336328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 01/06/2012] [Indexed: 11/19/2022] Open
Abstract
Early referral is the key to the optimal management of growth failure. Evidence shows that there is no universal consensus for endocrinologists on the handling, tracking and monitoring of growth hormone (GH) treatment. The monitoring of therapy varies due to national prescription guidelines. The aim of this work was to assess the clinical management of short-stature patients who use GH prescribed by pediatric endocrinologists (n = 30) who belong to the Chilean Endocrinology Society (SOCHED). We conducted a questionnaire through an anonymous survey. We observed a large variability of responses to all of the questions. Once the clinician suggests GH treatment, patients usually begin treatment with a strong motivation, and maintenance of this motivation will improve the treatment outcomes. We propose 3-4 months of medical follow-up during which strict physician-patient communication and education is critical.
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Affiliation(s)
- Roberto J García
- Institute of Mother and Child Research, Faculty of Medicine, Universidad de Chile, Casilla, Santiago, Chile
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Hernandez MI, Rossel K, Peña V, Cavada G, Avila A, Iñiguez G, Mericq V. Leptin and IGF-I/II during the first weeks of life determine body composition at 2 years in infants born with very low birth weight. J Pediatr Endocrinol Metab 2012; 25:951-5. [PMID: 23426825 DOI: 10.1515/jpem-2012-0184] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 06/25/2012] [Indexed: 11/15/2022]
Abstract
Rapid early growth is associated with adverse metabolic outcome. The aim of this study was to determine whether there are differences in body composition (BC) between very-low-birth-weight preterm (VLBWPT) infants born appropriate for gestational age (AGA) and small for gestational age (SGA) and whether these differences relate to first-year growth. Twenty-six VLBWPT (15 AGA and 11 SGA). The BC was analyzed by dual X-ray absorptiometry at 2 years, and insulin-like growth factors (IGFs) I and II and leptin were administered weekly for 8 weeks and at 1, 3, 6, and 12 months. At 24 months, the VLBW SGA infants were lighter and had less peripheral fat and lean mass than VLBW AGA infants. In all patients, the percentage of fat mass correlated inversely with the change in weight [standard deviation scores (SDS)] from newborn to 2 and 4 weeks and the 1-month leptin and lean mass (SDS) correlated inversely with the change in weight (SDS) from newborn to 2, 4, and 8 weeks and with 4-week IGF-I and 8-week IGF-II. Lean mass (SDS) inversely correlated with 6-month IGF-I and directly correlated with 1-week and 3-month IGF-I in SGA VLBW infants only. A longer follow-up period will show whether additional differences will develop later.
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Abstract
CONTEXT Corticosteroid-binding globulin (CBG; SERPIN A6) gene mutations are rare; only four mutations have been described, often in association with fatigue and chronic pain, albeit with incomplete penetrance. PATIENT We report a kindred with a novel SERPINA6 mutation. The proband, a 9-yr-old male, had excessive postexertional fatigue, weakness, and migraine. MAIN OUTCOME MEASURES AND RESULTS Investigations revealed low morning and ACTH-stimulated peak cortisol levels. SERPIN A6 sequencing detected a novel exon 2 single base deletion (c.13delC) leading to a frameshift generating a stop codon within the signal peptide coding region (p.Leu5CysfsX26) and 50% reduced CBG levels in heterozygotes. The patient's father and two sisters share the mutation. Symptom expression within the family may have been modified by a polymorphic CBG allele (c.735G>T). Exogenous hydrocortisone had no effect on the fatigue. CONCLUSION This report documents the fifth CBG gene mutation in humans and the second causing major effects on CBG levels. Individuals with low CBG levels may be misdiagnosed as having secondary hypocortisolism. The association with fatigue and idiopathic pain is again noted and may relate to altered stress system function. Variability of the phenotype may relate to other genetic variations of the CBG gene or environmental factors.
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Affiliation(s)
- D J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia.
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Eyzaguirre F, Bancalari R, Román R, Silva R, Youlton R, Urquidi C, García H, Mericq V. Prevalence of components of the metabolic syndrome according to birthweight among overweight and obese children and adolescents. J Pediatr Endocrinol Metab 2012; 25:51-6. [PMID: 22570950 DOI: 10.1515/jpem.2011.446] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVES Extremes of birthweight (BW) have been associated with increased rates of metabolic risks. The objective was to study the prevalence of metabolic risks markers among obese and overweight (OW) subjects according to BW. SUBJECTS/METHODS A cross-sectional study was performed in a cohort of 1002 patients (2-18 years, 40.6% male) evaluated for OW or obese subjects in two private clinics. Anthropometrics, fasting lipids, glycemia, and insulin were obtained. RESULTS Of the subjects, 76.1% were born appropriate for gestational age (AGA), 10.9% small for gestational age (SGA), and 13% large for gestational age (LGA). Children born LGA presented a more severe degree of obesity compared with those born AGA and SGA (p<0.0001). No differences in glycemia, insulin, and lipid levels were detected among the groups. Abnormal glucose was found in 37 subjects: one with type 2 diabetes mellitus (from the previously glucose-intolerant subjects), 10 with glucose intolerance, and 27 with impaired fasting glucose. According to Boney criteria, 6.6% of the patients (6-18 years old) exhibited metabolic syndrome (MS) (69.4% AGA, 12.9% SGA, and 17.7% LGA). CONCLUSIONS Being born LGA represents a higher risk of severe obesity. At this age, the most frequent component of MS was an abnormal lipid profile with low high-density lipoprotein and high triglycerides. Finally, the most frequent finding associated with abnormalities of glucose tolerance was a family history of diabetes. Thus, BW, lipid profile, and family history are mandatory when these patients are evaluated.
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Affiliation(s)
- Francisca Eyzaguirre
- Pediatric Endocrinology, Pontificia Universidad Católica de Chile, Santiago, Chile
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García RJ, Kant SG, Wit JM, Mericq V. Clinical and genetic characteristics and effects of long-term growth hormone therapy in a girl with Floating-Harbor syndrome. J Pediatr Endocrinol Metab 2012; 25:207-12. [PMID: 22570979 DOI: 10.1515/jpem.2011.406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The established facts to date relating to Floating-Harbor syndrome (FHS) are its characteristic typical triangular facies with bulbous nose and thin lips, short stature, delayed bone age, and mild mental retardation with delay in expressive speech; its sporadic occurrence without Mendelian inheritance; and its unknown cause. Little is known about the growth hormone-insulin-like growth factor 1 (GH-IGF-1) axis and the effect of GH treatment in children with this syndrome. We report on a 9-year-old girl born small for gestational age (SGA, birth length -2.2 standard deviation score) with persistent short stature who has been treated with GH from 3.5 years onward with a modest growth response. Revision of the case led to the diagnosis of FHS. No abnormalities were found in the sequence or copy number of IGF-1 receptor or in the genomic single-nucleotide polymorphism array. GH treatment led to an increase in serum IGF-1 in the upper normal range, but the growth response was modest, suggesting a defect in IGF-1 signaling. Early recognition of this entity is important, as it enables specific diagnostic tests targeted at other abnormalities associated with FHS.
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Affiliation(s)
- Roberto J García
- Institute of Maternal and Chile Research (IDIMI), University of Chile, Santiago, Chile
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Pittaluga E, Vernal P, Llanos A, Vega S, Henrriquez MT, Morgues M, Escobar M, Diaz A, Standen J, Moncada P, Arriagada M, Rodriguez L, Mericq V. Benefits of supplemented preterm formulas on insulin sensitivity and body composition after discharge from the neonatal intensive care unit. J Pediatr 2011; 159:926-32.e2. [PMID: 21784447 DOI: 10.1016/j.jpeds.2011.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 05/13/2011] [Accepted: 06/01/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate body composition and fasting insulin level in preterm infants receiving preterm formulas (higher protein plus docosahexaenoic acid) for longer periods compared with a recent historical cohort receiving these formulas for shorter periods. STUDY DESIGN A total of 95 infants fed preterm formula for 6 months or longer (postdischarge formula group) and 87 infants fed preterm formula only during their hospital stay (hospital formula group) were included in this arm of the study. RESULTS Bone mineral density, content, and lean mass were not different at 1 year and 2 years. However, in the postdischarge formula group, total fat mass (%) was lower by the second year (19.3% ± 5.3% vs 21.7% ± 4.2%; P < .01), trunk fat was lower by the first year (14.7% ± 5.0% vs 16.9% ± 4.9%; P < .005) and at the second year (14.1% ± 5.7% vs 17.2% ± 4.7%; P < .001), and fasting insulin was lower by the first year (13.2% ± 7.1% vs 17.2% ± 13.6% mIU/L; P = .06) and at the second year (13.6% ± 6.1% vs 26.4% ± 14.2%; P < .001). CONCLUSION Preterm infants fed formulas enriched with docosahexaenoic acid may have a better subsequent metabolic profile.
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Abstract
Being born small-for-gestational age and a rapid increase in weight during early childhood and infancy has been strongly linked with chronic diseases, including metabolic syndrome, which has been related to intrauterine life environment and linked to epigenetic fetal programming. Metabolic syndrome includes waist circumference > 90th percentile for age, sex and race, higher levels of blood pressure, triglycerides and fasting glucose, and low levels of HDL-cholesterol. Insulin resistance may be present as early as 1 year of age, and obesity and/or type 2 diabetes are more prevalent in those born SGA than those born AGA. The programming of adaptive responses in children born SGA includes an association with increased blood pressure, changes in endothelial function, arterial properties and coronary disease. Early interventions should be directed to appropriate maternal nutrition, before and during pregnancy, promotion of breast feeding, and prevention of rapid weight gain during infancy, and to promote a healthy lifestyle.
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