Ewa Małecka-Tendera

Prevalence of metabolic syndrome in European obese children.

UNLABELLED The rapid rising prevalence of childhood obesity is related to increased risk of obesity-related diseases during adulthood. The aim of the present study was to review the data concerning the prevalence of metabolic syndrome (MS) in European children and adolescents (Part 1) and to determine and compare the prevalence of MS among overweight and obese children, and adolescents in five European countries using four MS definitions (Part 2). In total, 1 241 European obese children from five different countries (France: n =283, Greece: n =145, Italy: n =274, Poland: n =90, and Hungary: n =449) were studied for MS according to the definition of Ferranti et al., the World Health Organisation, the National Cholesterol Education Program and the International Diabetes Federation. We used age- and sex-specific cut-off values for the diagnosis of high blood pressure and increased waist circumference. The prevalence of MS was 35.7%, 31.4%, 20.3%, and 16.4%, respectively, according to the above-mentioned definitions. Only 6.3-8.8% of obese adolescents were free from any risk factors and the clustering of three risk factors or more was very high: 20.3-35.7% (depending on the type of definition). A total of 12.2% of children had MS and 55.8% were free from MS according to all four definitions. CONCLUSIONS The prevalence of MS is high among European obese children whatever criteria are used. There is an urgent need to achieve consensus concerning the definition of MS in adolescents and children.

Type 2 diabetes mellitus in European children and adolescents

AIM The aim of the study was to review the published and unpublished data on type 2 diabetes in European children in order to determine how common this problem is in the dominantly Caucasian population. METHODS The MEDLINE database was searched and a questionnaire was distributed among European Childhood Obesity Group (ECOG) representatives from 16 countries. RESULTS One hundred and eighty-four children with type 2 diabetes were diagnosed in Europe, 144 of them of Caucasian origin. The majority of them were overweight females and, had positive family history for type 2 diabetes mellitus. CONCLUSION Because of the significant rates of type 2 diabetes in Europe, screening for it in obese children and adolescents is highly recommended.

Childhood Obesity: Knowledge, Attitudes, and Practices of European Pediatric Care Providers

OBJECTIVE: To determine and compare attitudes, skills, and practices in childhood obesity management in 4 European countries with different obesity prevalence, health care systems, and economic situations. METHODS: A cross-sectional survey was distributed to primary health care providers from France, Italy, Poland, and Ukraine. The questionnaire was returned by 1119 participants with a response rate of 32.4%. RESULTS: The study revealed that most of the primary health care providers were convinced of their critical role in obesity management but did not feel sufficiently competent to perform effectively. The adherence to recommended practices such as routine weight and height measurements, BMI calculation, and plotting growth parameters on recommended growth charts was poor. Most primary health care providers recognized the need for continuing professional education in obesity management, stressing the importance of appropriate dietary counseling. CONCLUSIONS: The study underlines insufficient implementation of national guidelines for management of obesity regardless of the country and its health system. It also makes clear that the critical problem is not elaboration of guidelines but rather creating support systems for implementation of the medical standards among the primary care practitioners.

Incidence and Dynamics of Thyroid Dysfunction and Thyroid Autoimmunity in Girls with Turner’s Syndrome: A Long-Term Follow-Up Study

Objective: Clinical studies suggest that the thyroid autoantibodies and/or hypothyroidism are not present in Turner’s syndrome (TS) patients before the age of 8 years and are more frequent in patients with the X isochromosome. The aim of the study was to analyze the dynamics of thyroid dysfunction in girls with TS. Design: 86 TS patients with a median age of 10.6 years were followed for 4.6 ± 3.0 years. Outcomes: The prevalence of thyroid abnormalities increased from 25.5 to 50% during the follow-up. Finally, 31 (36%) patients had positive thyroid autoantibodies and 27 (31.4%) had subclinical hypothyroidism. Hashimoto’s thyroiditis was diagnosed in 15 patients. Median age of developing thyroid antibodies and subclinical hypothyroidism was 14.1 and 14.8 years, respectively. The youngest hypothyroid patient was 1.8 years old and the youngest girl with positive anti-thyroid antibodies was 5.5 years old. Autoantibodies appeared mainly after the age of 13. The risk of developing subclinical hypothyroidism was greatest between 12 and 14 years of age. The prevalence of thyroid abnormalities was not related to the karyotype. Conclusions: Thyroid autoimmunity and dysfunctions in TS may start early, their prevalence increases with age, independently of karyotype and without any clinical symptoms and signs.

Is epicardial fat tissue a marker of metabolic syndrome in obese children

OBJECTIVE The goal of the study was to assess the association between epicardial fat (EF) thickness and waist circumference, insulin resistance and other metabolic syndrome components in obese children. METHODS 52 obese children (23 males and 29 females) in the mean age 11.6 + or - 2.87 years were studied. Their mean BMI was 26.17 + or - 2.13. Control group included 54 normal weight children (22 males and 32 females) in the mean age 12.85 + or - 2.15 years (BMI -18.55 + or - 2.71). Obesity was defined according to IOTF criteria. EF thickness on the right ventricle was obtained in all children by two-dimensional M-mode echocardiogram. In obese children systolic (SBP) and diastolic (DBP) blood pressure was measured and fasting serum triglycerides, low- and high-density lipoproteins, cholesterol, and glucose and insulin levels were measured. Metabolic syndrome was determined according to IDF 2007 criteria. RESULTS We documented a statistically significant correlation between epicardial fat BMI z-score and waist circumference in both groups. No statistically significant correlation between EF thickness and HOMA Index was found. There was also no statistically significant difference in EF thickness between obese children with or without metabolic syndrome. CONCLUSION Although EF in overweight children is a good indicator of visceral fat it does not seem to be the independent predictor of metabolic syndrome in this age group. The lack of relationship of EF thickness with insulin resistance and metabolic syndrome suggests that in children the prognostic value of this fat tissue may differ from that in adults.

Predegenerated Peripheral Nerve Grafts Rescue Retinal Ganglion Cells from Axotomy-Induced Death

The inability of axons to grow across damaged central nervous system tissue is a well-known consequence of injury to the brain and spinal cord of adult mammals. Our previous studies showed that predegenerated peripheral nerve grafts facilitate neurite outgrowth from the injured hippocampus and that this effect was particularly distinct when 7-, 28-, and 35-day-predegenerated nerve grafts were used. The purpose of the present study was to use the above method to induce and support the regrowth of injured nerve fibers as well as the survival of retinal ganglion cells (RGCs). Adult Sprague-Dawley rats were assigned to three groups. In the experimental groups transected optic nerve was grafted with peripheral nerve (predegenerated for 7 days (PD) or nonpredegenerated). In the control group, the optic nerve was totally transected. RGCs and growing fibers labeled with fluorescent tracers were examined. They were counted and the results were subjected to statistical analysis. Retinal ganglion cells survived in the groups treated with predegenerated as well as nonpredegenerated grafts; however, the number of surviving retinal ganglion cells was significantly higher in the first one. In both groups the regrowth of the transected optic nerve was observed but the distance covered by regenerating fibers was longer in the PD group. No fibers inside grafts and no labeled cells in retinas were present in the control animals. On the basis of the obtained results we can state that the predegeneration of grafts enhance their neurotrophic influence upon the injured retinal ganglion cells.

Management of familial hypercholesterolemia in children and adolescents. Position paper of the Polish Lipid Expert Forum

Familial hypercholesterolemia (FH) affects on average 1 in 500 individuals in European countries, and it is estimated that FH in Poland may affect more than 80,000 people. However, in Poland, only about 20% of the population is estimated to have been diagnosed with FH, of which only a small number receive adequate treatment. FH results in more rapid development of atherosclerosis and is associated with a high risk of cardiovascular events. Atherosclerosis develops beginning in childhood in patients with FH and reaches advanced stages before clinical manifestations develop. Inadequate diagnostics and treatment of FH in Polish children suggests a need for raising the level of awareness and understanding of the condition in both society and among health professionals. These recommendations present the current epidemiological status, guidelines for diagnosing FH in Polish children and adolescents, and effective treatment options.

Overweight prevention strategies in preschool children

During the last several decades, the prevalence of childhood overweight and obesity achieved an alarming rate. Unfortunately, it also affects children in the preschool age. In this review, special emphases are made on determinants and risk factors for obesity development in early age, effectiveness of preventive strategies in preschool children and outcome measurements of intervention programme in preschool children. It is concluded that prevention of overweight and obesity in younger children is not an easy task but it could be even more rewarding than in the older age group. All the efforts should be made to stop this adverse public health problem from expanding.

Prevalence of glucose intolerance in school age children. Population based cross‐sectional study

Aim: The aim of the study was to determine the prevalence of glucose intolerance among school children in south‐eastern Poland.

Quality of Medical Follow-Up of Young Women with Turner Syndrome Treated in One Clinical Center

For Turner syndrome (TS) patients, smooth transition from pediatric to adult health care is a critical point. The study objective was to evaluate the medical follow-up of young women with TS in one clinical center 3 years after the latest guidelines had been introduced by the TS Study Group. A questionnaire study was performed in 59 TS adults selected from a database of 117 patients. Twenty-two of them, aged 23.0 ± 2.8 years, consented to participate. Nineteen responders (86.4%) were followed up by general practitioners who were not aware of the TS diagnosis in 14 (63.6%) cases. Eight (36.4%) were seen regularly by the relevant specialists. Adequate medical assessment varied from 5% (celiac serology) to 74% (gynecology assessment) and 82% (ear-nose-throat) of participants. None of the patients had undergone all of the recommended investigations according to recommendation. Height deficiency, body mass index, age at TS diagnosis and level of education did not correlate with the number of assessments performed (p = 0.687, p = 0.810, p = 0.641, and p = 0.568, respectively). Three years after the introduction of the current guidelines, medical follow-up in the transition phase is still inadequate. Improvement in transitional health care is warranted through better patient education, referring to physicians caring for adults with TS and better cooperation with general practitioners with wider popularization of the TS recommendations among them.