Cihan Meral

Vaspin and its correlation with insulin sensitivity indices in obese children

AIM The aim of this study was to assess the vaspin and adiponectin concentrations on markers of insulin sensitivity and obesity in pubertal obese children and adolescents. MATERIAL AND METHODS Plasma vaspin and adiponectin level and its relationships with body mass index standard deviation score (BMI-SDS), insulin sensitivity and lipids were analyzed in 33 pubertal obese children (19 girls and 14 boys) and 36 healthy control children (18 girls and 18 boys) aged 11-16 years. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR) and fasting glucose-to-insulin ratio (FGIR). Plasma vaspin and adiponectin concentrations were determined with radioimmunoassay. RESULTS Mean vaspin levels were found significantly higher and inversely, adiponectin levels were found significantly lower in obese pubertal group than control subjects. Vaspin levels were positively correlated with BMI-SDS, triglycerides, fasting insulin and HOMA-IR and negatively correlated with adiponectin levels and FGIR. Adiponectin levels were positively correlated with high density lipoprotein-chloesterol, FGIR and negatively correlated with vaspin, BMI-SDS, fasting insulin and HOMA-IR. CONCLUSION We found higher vaspin and lower adiponectin levels in obese children and these adipokines were significantly correlated with insulin sensitivity indices in this age.

Enteral glutamine and/or arginine supplementation have favorable effects on oxidative stress parameters in neonatal rat intestine.

Objective: To investigate and compare the effects of enteral glutamine and arginine supply on lipid peroxidation and antioxidant enzyme levels in the small intestine of healthy breast-fed rats. Materials and Methods: The study comprised 40 newborn Sprague-Dawley rats born to 5 mother rats. Newborn rats were randomly divided into 4 groups. Starting from day 1 until day 21, group I received only breast milk; group II received breast milk and 200 mg/kg/day oral glutamine; group III received breast milk and 200 mg/kg/day oral arginine; and group IV received breast milk, 200 mg/kg/day glutamine, and 200 mg/kg/day arginine. Malondialdehyde levels and glutathione peroxidase (GPx) and superoxide dismutase activities were measured. Results: The lowest malondialdehyde levels were found in group II (P = 0.0001). Superoxide dismutase activity was found to be significantly higher in group II than group I (P < 0.001). Of the 4 groups, GPx activity was highest in group IV. GPx activity in group II was significantly higher than in group I (P = 0.001) or group III (P = 0.001). GPx activity was higher in group IV than in group I (P = 0.001) or group III (P = 0.001). Conclusions: Enteral glutamine alone or in the presence of arginine has favorable effects on oxidative stress not only in experimental models of hypoxia-reoxygenation, but also in healthy newborn rats. This suggests that in premature neonates with insufficient oxidative resistance, glutamine and arginine supplementation may help prevent necrotizing enterocolitis.

Elevated Plasma Levels of Apelin in Children with Type 1 Diabetes Mellitus

ABSTRACT Background: Apelin is a novel adipocytokine produced by white adipose tissue that binds the APJ receptor with high affinity. Insulin may have a role in regulation of apelin synthesis and secretion from the adipose tissue. Objective: To investigate blood apelin concentrations in children with type 1 diabetes mellitus (T1DM) and display association of apelin with adiponectin, body mass index (BMI), lipids and insulin sensitivity. Methods: Thirty patients with T1DM and 45 healthy controls were enrolled. Apelin levels were measured along with BMI, lipids, fasting plasma glucose, HbA1c and adiponectin levels. Results: Plasma apelin and adiponectin levels were significantly higher in the diabetic group when compared to controls. No correlation was found between the apelin blood concentrations and adiponectin, BMI, lipids and insulin sensitivity. Conclusions: Children with T1DM have significantly increased circulating apelin levels when compared to healthy controls. However, no significant relation was found between the apelin and BMI, glucose, lipids and adiponectin levels, and also insulin sensitivity.

The relationship between serum visfatin, adiponectin, and insulin sensitivity markers in neonates after birth.

Aim. The aim of this study was to assess the adiponectin and visfatin concentrations in small-for-gestational age (SGA), appropriate-for-gestational age (AGA), and large-for-gestational age (LGA) newborns and their mothers. Sixty parturients giving birth to 20 term AGA singleton infants, 20 term singleton SGA infants, and 20 term singleton LGA infants were included into the study. Results. Mean visfatin levels were found significantly higher in the SGA (p < 0.001) and LGA (p < 0.001) groups, and adiponectin levels were found significantly lower in the SGA group (p < 0.001) when compared with the AGA group. The SGA and LGA groups had higher insulin concentrations and HOMA-IR in comparison with the AGA group. The visfatin, glucose levels, and HOMA-IR (p < 0.001, p < 0.001, and p: 0.002, respectively) were higher in the LGA group than SGA group. Conclusion. We found significantly higher insulin and visfatin levels in LGA neonates and lower adiponectin levels in SGA neonates. We concluded that the relationship between adiponectin and visfatin and insulin sensitivity (metabolic disturbances) is very complex with little evidence of correlation in SGA and LGA neonates.

Ghrelin Levels and Postnatal Growth in Healthy Infants 0-3 Months of Age

Objective: The effect of ghrelin on growth of the newborn has long been argued, but not fully clarified. In this study, we aimed to investigate the relationship between ghrelin levels and growth parameters in the first 3 months of life. Methods: The study included 60 babies (27 girls and 33 boys) born at gestational ages between 38-42 weeks. The newborns were divided into three groups according to the Lubchenco curves as: small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA). The relationship between ghrelin levels and growth parameters in the third month was investigated. Results: Ghrelin concentrations were significantly higher in SGA (2.4±2.6 ng/dL) babies than in AGA (1.3±0.9 ng/dL) and LGA (1.0±0.8 ng/dL) babies. The lowest ghrelin levels were in the LGA group. In SGA infants, ghrelin concentrations were inversely correlated with change in weight (r=-0.577; p=0.001), change in length (r=-0.361; p=0.005), and change in head circumference (r=-0.387; p=0.002). Conclusion: The results show that at age 3 months, SGA infants had higher ghrelin levels than AGA and LGA infants. Our findings indicate that ghrelin may be involved in the process of catch-up growth in these infants. Conflict of interest:None declared.

New adipocytokines (vaspin, apelin, visfatin, adiponectin) levels in children treated with valproic acid

AIM To investigate the relationship between the newly discovered adipocytokines and increasing body weight (paralleled by increased insulin resistance), and antiepileptic drug therapy with valproic acid (VPA). DESIGN AND METHODS 44 children with idiopathic, generalized epilepsy treated with valproic acid (VPA), and 40 control group children were included in this study. RESULTS Both the VPA-treated group and the control group showed no significant difference in terms of age, total cholesterol and LDL-cholesterol. Subjects in the VPA group had significantly higher BMI-SDS than control subjects (2.3±0.15 vs -0.04±0.8, p<0.001). HOMA-IR, apelin and visfatin levels were significantly increased (4.95±2.07 vs 1.46 vs 0.6, p<0.001; 2.21±1.14 vs 0.57±0.15, p<0.001; 31±12 vs 18.4±10.4, p<0.001; respectively), and adiponectin levels were significantly lower in the VPA group (2.02±1.03 vs 12.4±6.1, p<0.001). Triglyceride levels were significantly increased (126±70 vs 80±40 mg/dL, p=0.001), and HDL-cholesterol levels were significantly lower in the VPA group. Vaspin levels were higher in the VPA group than the control group, but the difference was not significant. CONCLUSION Based on the findings of this study, apelin, visfatin and adiponectin levels may be considered as potential regulators of glucose and fat metabolism during valproic acid therapy.

Treatment with human chorionic gonadotropin induces left ventricular mass in cryptorchid boys.

AIM To examine the effects of human chorionic gonadotropin therapy on left ventricular mass index in boys with cryptorchidism. Cryptorchidism is the most frequent anomaly of male genitalia. PATIENTS AND METHOD Thirty consecutive cryptorchid boys (mean age 4.8 +/- 3.2 years, range 1-8 years) undergoing human chorionic gonadotropin (hCG) therapy and 30 healthy controls were enrolled in the study. The patient group received hCG by intramuscular injection twice weekly for 5 weeks. At the end of the therapy, echocardiographic measures were reevaluated. The results of left ventricular mass were indexed to body surface area before and after therapy. RESULTS Our results showed that cryptorchid boys undergoing hCG therapy had significantly higher left ventricular mass index than healthy controls at the end of therapy (p < 0.001). Serum total testosterone levels significantly increased in the patient group and positively correlated with left ventricular mass index (r = 0.48, p = 0.021). CONCLUSION We demonstrated that hCG treatment for cryptorchidism caused a significant increase in left ventricular mass due to high testosterone levels. We conclude that hCG therapy may not be safe for the cardiovascular system in boys with cryptorchidism.

A case of del(13)(q14.2)(q31.3) associated with hypothyroidism, hypertriglyceridemia, hypercholesterolemia and total ophthalmoplegia

13q deletion syndrome is caused by the absence of a portion of the long arm of chromosome 13. This syndrome is a rare condition characterized by a wide range of clinical findings. Phenotype varies with the location and size of the deletion. We report a female dizygotic twin with a proximal deletion of 13q and failure to thrive, hypotonia, and multiple anomalies included pytosis and total ophthalmology at right side, strabismus at left, bilateral iris heterochromia and telecantus. She had a broad nasal bridge with flat philtrum, micrognathia and antevert ear lobes. Her umbilicus had vanished. Her left coxa was dislocated and left toes were overlapped. She was also found to have hypertriglyceridemia, hypercholesterolemia, and hypothyroidism. Chromosome analysis showed a proximal deletion of chromosome 13 [karyotype 46,XX,del(13) (q14.2q31.3)] which was confirmed by high-resolution microarray based comparative genomic hybridization. The described patient is unique among similar rare cases with different deletion breakpoints. It is the first case of 13q14.2q31.3 deletion where the breakpoints are clearly defined, indicating the importance of detailed clinical description and high-resolution genomic analysis for characterization of rare genetic syndromes.

Long-term effects of antiepileptic therapy on cardiovascular risk factors in children

1. Higuchi M, Shimogawara M, Haruta Y, Uehara G, Kawai J, Ogata H, et al. System integration and trade-offs of SQUID system for biomagnetic applications. Appl Superconduct 1998;5:441-9. 2. Sekihara K, Nagarajan SS, Poeppel D, Marantz A, Miyashita Y. Reconstructing spatio-temporal activities of neural sources using an MEG vector beamformer technique. IEEE Trans Biomed Eng 2001;48:760-71. 3. Kamada K, Saguer M, Möller M, Wicklow K, Katenhäuser M, Kober H, et al. Functional and metabolic analysis of cerebral ischemia using magnetoencephalography and proton magnetic resonance spectroscopy. Ann Neurol 1997;42:554-63. 4. Seki S, Nakasato N, Ohtomo S, Kanno A, Shimizu H, Tominaga T. Neuromagnetic measurement of unilateral temporo-parietal theta rhythm in patients with internal carotid artery occlusive disease. Neuroimage 2005;25:502-10. 5. Astrup J, Siesjö BK, Symon L. Thresholds in cerebral ischemia The ischemic penumbra. Stroke 1981;12:723-5.

Visfatin and gallstone disease.

Visfatin is a recently described adipose tissue–derived protein, which has insulin-mimetic actions. Adipocyte visfatin expression and plasma concentrations increase in some, but not all, forms of obesity, both in animals and humans. Visfatin exerts its insulin-mimetic action by binding to the insulin receptor, and there is evidence that it may contribute to the development of the metabolic syndrome. We read with great interest the article by Wang et al reporting the blood levels of visfatin, a newly described adipokine in patients with gallstone disease. This study is important because there are very limited data regarding the role of adipokines in the pathogenesis of this clinically relevant condition. However, we think that some points should be discussed. First, though not stated clearly in the text, it can be seen in the Table 1 that some of the patients with gallstone disease were diabetic and obese at the time of enrollment. In addition, some of the healthy subjects also had high blood glucose levels. However, there is no information regarding the glucose tolerance status of these subjects. We think that some of the study participants may still have overt glucose dysregulation or type 2 diabetes mellitus without implementation of the glucose tolerance test. This issue is important because obesity is strongly associated with prediabetes (namely, impaired fasting glucose and/or impaired glucose tolerance) and blood adipokine and insulin levels are altered in subjects with disordered glucose metabolism. At this point, matching the groups for body mass index may not be enough to make clear comparisons because diabetes mellitus and even glucose intolerance is itself associated with the altered circulating visfatin concentrations. Secondly, there is a significant difference regarding the blood lipid parameters in 2 groups. It has been reported that blood visfatin levels are affected from blood lipid parameters. Finally, there is no information about the medications in the present study. It is well known that circulating adipokines and measures of insulin sensitivity are easily affected by drugs for the abovementioned problems. Therefore, we would like to ask the authors whether they can present some new results by categorizing the study participants according to metabolic confounders such as