Gustavo Maccallini

Relationship between obesity and metabolic syndrome among Argentinean elementary school children.

BACKGROUND Argentina has experienced marked increases in the prevalence of childhood overweight (OW)/obesity over the last few decades. OBJECTIVES We examined (1) the distribution of the mean values of lipids, glucose, and HOMA-IR according to the presence of OW/obesity, age, and sex and (2) the association between metabolic syndrome and OW/obesity, Tanner stage, gender, and HOMA-IR. METHODS Data were collected from 1009 children (508 males) in 10 elementary schools between April and September 2007. BMI, waist circumference, blood pressure, Tanner, lipids, insulin, and glucose were determined. Criteria analogous to ATPIII were used for metabolic syndrome in children. RESULTS Over 1009 children (508 males) aged 9.4 + or - 2.0 years were evaluated. One hundred and sixty-five (16.4%) were obese (>95th percentile), and 166 (16.5%) were OW (85-95th). Twenty-five (2.5%) were severely obese (BMI>99th). Most of the children (62%; 613/979) were at Tanner 1. Triglycerides, insulin, and HOMA-IR were higher (p<0.001) and HDL-C lower (p<0.001) in OW/obesity in both age groups and genders. The prevalence of metabolic syndrome was 5.8% overall, 32% in severely obese, 16.4% in OW/obese and 0.4% in normal weight children. Multiple logistic regression showed that BMI (OR 24.48; 95% CI 9.14-65.57), and HOMA-IR (OR 2.09; 95% CI 1.04-4.18) were associated with metabolic syndrome adjusted by gender and Tanner stage. Multiple linear regression also showed that BMI and HOMA-IR were independently associated with the number of metabolic syndrome components (R(2)=0.46). CONCLUSIONS A substantial number of OW/obese children have the metabolic syndrome. HOMA-IR and BMI were strong predictors of metabolic syndrome in children suggesting that OW/obese school children are at a higher risk for future cardiovascular disease.

Inverse Association between Insulin Resistance and Frequency of Milk Consumption in Low-Income Argentinean School Children

OBJECTIVE To determine the association between milk consumption, lifestyle, components of the metabolic syndrome, and insulin resistance in school children. STUDY DESIGN Students (n = 365 [175M]) age 10 +/- 2.3 years from 2 poor suburbs of Buenos Aires were examined for body mass index, waist circumference, blood pressure, and Tanner stage in April 2007. Fasting concentrations of lipids, insulin, and glucose were determined. Mothers completed questionnaires about their childrens lifestyle. RESULTS Approximately 14.0% of the children were obese, and 12.1% were overweight by use of norms from the Centers for Disease Control and Prevention. Half were at Tanner I. Mean values of waist circumference, systolic blood pressure, insulin resistance, and insulin were higher as subjects consumed more glasses of milk. Multiple regression analysis with insulin resistance as the dependent variable showed that there was a significant and positive association with triglyceridemia (beta = 0.007) and waist circumference (beta = 0.024), and a negative association with milk consumption (beta = -0.135) adjusted for blocks walked daily, TV viewing, soft drink consumption, parental educational level, sex, age, high-density lipoprotein (HDL) cholesterol, and systolic blood pressure (R(2) = 0.27). CONCLUSIONS Increased milk consumption was associated with greater insulin sensitivity, suggesting that it might reduce the risk of type 2 diabetes.

Are girls more insulin-resistant than boys?

OBJECTIVE The objective was to determine whether girls were more insulin-resistant than boys. DESIGN AND METHODS Data from 1009 children (508 males) in 10 elementary schools, between April and September, 2007 were collected. BMI, waist circumference (WC), blood pressure, Tanner stage, lipids, insulin, and glucose were obtained. RESULTS One hundred and sixty five (16.4%) of the children were obese (>95%ile), and 166 (16.5%) were overweight (85-95%ile). Mean HOMA-IR and insulin were higher among 10.0-13.9-year-old girls than boys. Multiple logistic regression using the 3rd quartile of HOMA-IR as the dependent variable showed that only BMI OR=1.18 (95% CI 1.12-1.24; p<0.001), Tanner OR=1.39 (95% CI 1.12-1.73; p=0.003) and triglycerides 1.005 (95% CI 1.00-1.01; p=0.04) were significantly associated with insulin resistance while sex and HDL-C were not. CONCLUSIONS This study showed that no significant sex-related differences were found, and HOMA-IR was associated with adiposity and pubertal stage suggesting that the higher values of HOMA-IR in girls than in boys could be due to their earlier pubertal development.

Comparison of different anthropometric indices for identifying dyslipidemia in school children

BACKGROUND Anthropometric indices have been associated with dyslipidemia. OBJECTIVE To compare the abilities of BMI, waist circumference (WC) and WC/height to identify childrens dyslipidemia. METHODS Students 1261 (639 male) age 9.5±2.1 years. were examined for anthropometry and lipid levels. Triglycerides ≥1.69 mmol/L and high-density lipoprotein cholesterol (HDL-C) <0.91 mmol/L were considered abnormal per American Heart Association. RESULTS The prevalence of abnormal triglycerides was 4.1% and HDL-C 8.1%. The areas under the receiver operator curves (ROC) were: BMI=0.87, WC=0.83, and WC/height=0.84 in predicting both low HDL-C and high triglycerides. Multiple regression analyses showed that the odds ratios (OR) were highest for WC [6.5], followed by WC/height [5.4], and BMI [4.9], for dyslipidemia. CONCLUSIONS The results suggest that WC, WC/height, and BMI similarly predicted dyslipidemia, using ROC analyses. However, regression analyses showed that WC followed by WC/height was most predictive of dyslipidemia.

Can the metabolic syndrome identify children with insulin resistance

Objective:  The metabolic syndrome is associated with insulin resistance in adults. We defined pediatric metabolic syndrome using criteria analogous to Adult Treatment Panel III. The purpose of this study was to determine whether these criteria are reliable for insulin resistance in children.

Dyslipidemia without Obesity in Indigenous Argentinean Children Living at High Altitude

OBJECTIVES To compare the prevalence of cardiovascular disease risk factors in Indian children from San Antonio de los Cobres (SAC) and children from Buenos Aires (BA), and to examine body mass index (BMI), waist circumference (WC), and WC/height as predictors of dyslipidemia in both groups. STUDY DESIGN Data were collected cross-sectionally from BMI, WC, blood pressure, Tanner scale, glucose, lipids, and insulin. Dyslipidemia was defined by the National Cholesterol Education Program and American Heart Association. RESULTS The mean ages were 10.6 ± 3.0 and 9.5 ± 2.0 years in SAC vs BA children. Of the 330 SAC children, 15 (4.5%) were overweight and 12 (3.6%) obese, and of the 603 BA, 97 (16.1%) were overweight and 82 (13.6%) obese per Centers for Disease Control. There was a significantly higher prevalence of high triglycerides (28.8% vs 3.5%) and low high-density lipoprotein cholesterol (30.0% vs 5.5%) in SAC vs BA children. The areas under the receiver operating characteristic curve in predicting high triglycerides were BMI = 0.55 (95% CI, 0.48-0.62; P = .15) in SAC and BMI = 0.65 (95% CI, 0.52-0.77; P = .02) in BA children. Similar results from the areas under the receiver operating characteristic curve were obtained when low high-density lipoprotein cholesterol was used, indicating that BMI was not a significant predictor for dyslipidemia in SAC children. When BMI was replaced by WC and WC/height, results were similar. CONCLUSIONS Anthropometric markers were not an acceptable predictor for National Cholesterol Education Program cutoffs for dyslipidemia in SAC children. Longitudinal studies should determine if SAC children are at high risk for cardiovascular diseases because of genetic background.

Low vitamin D concentrations among indigenous Argentinean children living at high altitudes.

Hypovitaminosis D is an international problem; however, there is little information about its prevalence in apparently healthy Indian children living at high altitudes.

Is albuminuria associated with obesity in school children

Hirschler V, Molinari C, Maccallini G, Aranda C. Is albuminuria associated with obesity in school children?

Frequency and antibiotic susceptibility patterns of urinary pathogens in male outpatients in Argentina

INTRODUCTION Knowledge of the etiology and antimicrobial susceptibility patterns of uropathogens is important for determining the best treatment option. This study aimed to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from adult male outpatients. METHODOLOGY Between November 2012 and April 2013, 3,105 community urine samples were analyzed from adult male patients who attended the Laboratorio Hidalgo, Buenos Aires, Argentina. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Isolates resistant to third generation cephalosporin were tested for extended-spectrum beta-lactamase (ESBL) production using the double-disk synergy test. RESULTS Of the 3,105 urine samples analyzed, 791 (25.5%) had significant bacteriuria. The frequency of positive urine cultures increased significantly with patient age. Escherichia coli was isolated most frequently (47.3%), followed by Enterococcus faecalis (13.6%), and Klebsiella pneumoniae (11.9%). Gram-negative organisms represented 78.8% of urinary pathogens. The highest activities against Gram-negative bacteria were found with imipenem (99.0%), amikacin (98.1%), ertapenem (94.2%), fosfomycin (90.7%), and piperacillin-tazobactam (90.1%). The frequencies of ESBLs among E. coli, K. pneumoniae, and P. mirabilis were 15.2 %, 22.3%, and 8%, respectively. Fosfomycin, piperacillin-tazobactam, and nitrofurantoin were most effective against Gram-positive organisms. CONCLUSIONS Fosfomycin may be an excellent option for cystitis treatment in patients without risk factors, whereas piperacillin-tazobactam is preferred for the treatment of parenchymatous UTIs, complicated UTIs, and UTIs associated with risk factors. To ensure the optimal selection of antibiotics, physicians should have access to up-to-date information about the local prevalence of antimicrobial resistance.

Association between triglyceride to HDL-C ratio and insulin resistance in indigenous Argentinean children.

Insulin resistance is considered one of the major risk factors for the development of type 2 diabetes mellitus (T2DM). Thus, early identification, preferably by using simple and inexpensive diagnostic tools, is essential for preventing T2DM. Triglyceride (TG) to high‐density lipoprotein cholesterol (HDL‐C) ratio (TG/HDL‐C) has been proposed as an inexpensive tool to identify individuals at high risk of T2DM. The objective of this study was to determine the relationship between insulin resistance and TG/HDL‐C in indigenous Argentinean children.