Edita Stokic

Body mass index, body fat mass and the occurrence of amenorrhea in ballet dancers

To evaluate the connection between menstrual disorders and body fat mass, we examined a group of 30 ballet dancers and a group of 30 non-athletic girls (controls). Body mass index (BMI) was calculated and percent body fat (FAT%) was measured using the bioelectrical impedance method. A questionnaire was used to obtain age at menarche and duration of menstrual cycles. Ballet dancers had significantly lower values of BMI (18.56 ± 1.53 vs. 19.96 ± 2.12 kg/m2) and FAT% (18.85 ± 4.50 vs. 23.41 ± 4.34%) compared with controls. According to BMI, 50.0% of ballet dancers and 23.3% of the control group were underweight. Of underweight ballet dancers, 66.7% had lower values of body fat, while most underweight girls from the control group had normal body fat. Normal-weight obesity was registered in 40.9% of the control group and in 6.7% of ballet dancers. Amenorrhea was found in 20.0% and oligomenorrhea in 10.0% of ballet dancers. Ballet dancers more frequently had later appearance of menarche and menstrual cycles of longer duration than did non-athletic girls. A significant negative correlation was found between menstrual cycle duration and FAT% among ballet dancers (r =–0.415). To prevent complications caused by changes of body fat mass, we conclude that body composition assessment in ballet dancers is very important.

Expression and subcellular localization of estrogen receptors α and β in human fetal brown adipose tissue.

CONTEXT Brown adipose tissue (BAT) has the unique ability of generating heat due to the expression of mitochondrial uncoupling protein 1 (UCP1). A recent discovery regarding functional BAT in adult humans has increased interest in the molecular pathways of BAT development and functionality. An important role for estrogen in white adipose tissue was shown, but the possible role of estrogen in human fetal BAT (fBAT) is unclear. OBJECTIVE The objective of this study was to determine whether human fBAT expresses estrogen receptor α (ERα) and ERβ. In addition, we examined their localization as well as their correlation with crucial proteins involved in BAT differentiation, proliferation, mitochondriogenesis and thermogenesis including peroxisome proliferator-activated receptor γ (PPARγ), proliferating cell nuclear antigen (PCNA), PPARγ-coactivator-1α (PGC-1α), and UCP1. DESIGN The fBAT was obtained from 4 human male fetuses aged 15, 17, 20, and 23 weeks gestation. ERα and ERβ expression was assessed using Western blotting, immunohistochemistry, and immunocytochemistry. Possible correlations with PPARγ, PCNA, PGC-1α, and UCP1 were examined by double immunofluorescence. RESULTS Both ERα and ERβ were expressed in human fBAT, with ERα being dominant. Unlike ERβ, which was present only in mature brown adipocytes, we detected ERα in mature adipocytes, preadipocytes, mesenchymal and endothelial cells. In addition, double immunofluorescence supported the notion that differentiation in fBAT probably involves ERα. Immunocytochemical analysis revealed mitochondrial localization of both receptors. CONCLUSION The expression of both ERα and ERβ in human fBAT suggests a role for estrogen in its development, primarily via ERα. In addition, our results indicate that fBAT mitochondria could be targeted by estrogens and pointed out the possible role of both ERs in mitochondriogenesis.

Relationship between body mass index and body fat in children—-Age and gender differences

SUMMARY When defining obesity body mass index (BMI) has been used as the main criterion. However it indicates only the nutritional status, whereas body fat demonstrates the real body composition picture. This study aimed at analyzing the relationship between nutritional status and adiposity in the population of 2284 Serbian children (1217 boys and 1067 girls). According to BMI subjects were divided into underweight, normal-weight, overweight and obese, and %BF values (based on skinfold thickness measurements) were analyzed with regard to BMI-category, age and gender. Girls showed stronger correlation between BMI and %BF comparing to boys (r = 0.834 vs. 0.577). Differences in %BF between underweight, normal weight and overweight children from different age groups were more obvious in girls, whereas in boys younger than 8 years overlapping in %BF values between different BMI-categories was registered. In normal weight children we found age-related oscillations in %BF values: 8- and 9-year-old boys had lower %BF comparing to 7-year-old boys, which was followed by %BF increasement in 10- and 11-year-old ones; in girls %BF values gradually increased with aging, with significant jumps in 9-, 10- and 11-year-old ones. Thus, adiposity rebound may appear somehow later in boys. In overweight and obese children of both genders %BF continually increased with aging, whereas in underweight children %BF values remained unchanged. Our results pointed to age- and gender-dependent variations of %BF in normal weight and overweight children. We also indicated inconsistency between %BF and BMI especially in boys, and the need for definition of references for %BF.:

The synthesis of the rough set model for the better applicability of sagittal abdominal diameter in identifying high risk patients

This paper aims to investigate possible application of the rough set approach to table-organized data in the medical domain, which reveals some relationships among sagittal abdominal diameter, anthropometric parameters and cardiovascular risk factors. When applied to table-organized data, the methodology based on the rough set theory is capable of producing decision rules in the form of If-Then rules. Such rules are suitable for inspection, examination and further analysis. By examination of the selected 30 decision rules, sagittal abdominal diameter could point out a group of obese and preobese patients with high content of visceral fat with different combination and composition of cardiovascular risk factors. These results suggest that sagittal abdominal diameter could be a clinically useful marker for identification of risk factors, combination and structure of total cardiovascular risk by applying different rules in obese and preobese persons.

Body composition analysis in female ballet dancers

Introduction The aim of this study was to evaluate and compare the nutritional status and body composition in female ballet dancers and a group of non-athletic female controls. Materials and methods The study group consisted of 30 female ballet dancers, aged 17.4±2.01, whereas the control group included 30 non-athletic female examinees, aged 18.00 years on average. Height and weight were measured and body mass index (BMI) was calculated in all subjects. Body composition was estimated using the bioelectrical impedance method. Results Body composition analysis of ballet dancers revealed significantly lower values of body fat mass compared to the control group (18.85±4.50% vs. 23.41±4.34). Most examinees in both groups were of normal weight. 50% of ballet dancers and 23.33% of examinees in the control group were underweight, while overweight subjects were registered only in the control group. Most underweight ballet dancers had lower body fat mass, whereas majority of underweight examinees in the control group presented with normal body fat mass. Normal-weight obesity was established in 40.91% candidates in the control and 6.67% in the study group. Conclusion Ballet dancers had significantly lower values of body mass and BMI, compared to the study group. In order to prevent very serious complications caused by changes in size and proportion of some body compartments, it is necessary to carry out assessment of body composition more often in high-risk groups, such as the study group of ballet dancers.

Endothelial dysfunction and diabetes

ENDOTHELIAL FUNCTION AND DYSFUNCTION: During the past two decades, there has been an increasing recognition of the importance of normal endothelial function in the maintenance of vascular homeostasis and vascular health. Abnormalities in the function of endothelium have been recognized in a number of conditions. One of the most important abnormalities of endothelial dysfunction appears to be changes in the bioavailability of nitric oxide. It now appears clear that abnormalities in endothelial dysfunction are associated with abnormalities in the production of nitric oxide and/or abnormalities in the rate of its degragation. Either way, loss of the functional availability of nitric oxide appears to be an important characteristic of endothelial dysfunction. ENDOTHELIAL DYSFUNCTION AND DIABETES: Impaired endothelial-dependent vasodilatation has been described in patients with type 1 and type 2 diabetes, and the degree of impairment may correlate with glycemic control. Hyperglycemia itself appears to affect multiple mechanisms that increase atherosclerosis. Hyperglycemia enhances oxidation, thrombosis, inflammation, matrix production, and the formation of advanced glycation end-products and other metabolites that can potentially damage the vasculature. TREATMENT OF ENDOTHELIAL DYSFUNCTION: A number of trials have demonstrated that therapy with lipid lowering agents (statins) as well as angiotensin converting enzyme inhibitors is associated with improvements in endothelial function in diabetes. These agents have also been shown to improve prognosis in patients with a number of underlying cardiac diseases and risk factors for cardiac disease. Therefore, it seems that interventions that lead to improvement in endothelial function can be associated with improvements in cardiovascular outcome. The role of antioxidant therapy is controversial. No data have been published regarding the effects of hormonal replacement therapy on endothelial dysfunction in postmenopausal women with type 2 diabetes.

[Treatment of low HDL-cholesterol levels in the reduction of cardiovascular risk].

INTRODUCTION Although reduction of LDL-C levels is a priority in the treatment of dyslipidemia, not all coronary events are prevented despite aggressive LDL-C lowering, and risk reduction can be improved by treating additional lipid abnormalities. The Framingham Study was the first to demonstrate the inverse relationship between HDL-C and risk of coronary heart disease (CHD). This relationship was present at all levels of LDL-C, whereas the highest risk was associated with low HDL-C and high LDL-C. THE ANTIATHEROGENIC ACTIONS OF HDL-CHOLESTEROL: The antiatherogenic actions of HDL-C are complex. HDL-C plays a major role in reverse cholesterol transport, mobilizing cholesterol from the periphery to the liver. In addition, cardioprotective effects of HDL-C include endothelial protection, anti-inflammatory activity, as well as antioxidant and antithrombotic effects. TREATMENT OF LOW HDL CHOLESTEROL In addition to lowering LDL-C, statins increase HDL-C by 5 to 15% by increasing apolipoprotein A-I synthesis. Fibrate therapy results in an increase in HDL-C of 10 to 25 % by activating PPAR- , which stimulates hepatic apolipoprotein A-I gene expression. Niacin is the most effective agent used for increasing HDL-C, causing increase of 15 to 35%. The side effects of niacin therapy, which is largely mediated by prostaglandins, may be minimized by the use of prolonged-release formulation of nicotinic acid. Combination therapy with HDL-raising agents, such as nicotinic acid and statin, markedly increases HDL-C, lowers LDL-C and improves the lipoproteins subclass distribution. CONCLUSION New therapeutic modalities in the treatment of low HDL-C and lowering LDL-C, either in combination or as a monotherapy, may provide additional benefits in reducing CHD risk.

[Fever of unknown origin--a case report of brucellar discitis].

INTRODUCTION Febrile episodes of unknown origin lasting for two weeks require detailed investigation by various medical specialists. Fever of unknown origin is most commonly caused by infections, malignancy, colagenosis and in 5-10% of cases, despite detailed diagnostic assessmnet, the cause remains unknown. In cases of fever of unknown origin, the diagnostic procedures are difficult and complex. CASE REPORT This is a case report of brucellar discitis in a female patient treated at the Clinic of Endocrinology, Diabetes and Metabolic Diseases with a diagnosis of fever of unknown origin. Her laboratory findings revealed high erythrocyte sedimentation rate, anemia and high gamma globulin fractions. The patient underwent radiology examination and a suspicion of infection was defined, which was later confirmed by additional tests. CONCLUSION Despite the fact that the diagnostic investigations of patients with fever of unknown origin are complex and time consuming, detection of the cause is of utmost importance and it is a prerequisite for successful therapy.

The significance of some anthropometric parameters and parameters ensuing from them in assessing cardiovascular risk in type 2 diabetes

INTRODUCTION Current clinical practice requires simple and available tools for cardiovascular risk assessment in diabetic patients. MATERIAL AND METHODS This study included 290 type 2 diabetics of both sexes. The following anthropometric parameters were measured: body mass index, waist circumference, sagittal abdominal diameter, while ensuing parameters included: waist-to-stature ratio(WSH), ratio of abdominal sagital diameter to height (SADH), and conicity index. Metabolic status was evaluated based on lipidograms and HbA1c, and of cardiovascular parameters blood pressure was measured. RESULTS Female patients were obese, with central accumulation of fat, elevated blood pressure and lipid disorders such as hypo-HDL cholesterolemia. The applied anthropometric parameters and indicators ensuing from them (WSH, SADH and conicity index), are reliable indicators of elevated blood pressure in diabetic patients. CONCLUSION The obtained results showed negative correlation with HDL cholesterol in women, which indirectly indicates to development of hypertension, as one of the most common diabetic complications. Central accumulation of fat with dyslipidemic disorder, characteristic of metabolic syndrome, is of highest importance. Sagital abdominal diameter (SAD) and WSH showed the highest correlation with lipidograms in females, whereas BMI was the best indicator in males.