I. Rutigliano

Metabolic syndrome, hepatic steatosis, and cardiovascular risk in children

OBJECTIVESnPediatric metabolic syndrome (MetS) is a well-recognized entity; however, there is no consensus on its exact value in predicting long-term cardiovascular (CV) risk. Hepatic steatosis (HS) is another emerging condition associated with pediatric obesity, and data have been reported suggesting a possible role of HS in CV risk linked to MetS. The aim of the present study was to evaluate the usefulness of HS and MetS cluster in predicting CV risk linked to pediatric obesity.nnnMETHODSnWe studied 803 overweight and obese children (395 girls and 408 boys, mean age 9.4xa0±xa02.5xa0y, body mass index z-score 2.2xa0±xa00.53) with complete clinical and biological assessment. MetS was defined using the modified criteria of the American Heart Association. The diagnosis and severity of the HS was based on ultrasound. To assess CV risk, all patients underwent ultrasonography to measure carotid intima-media thickness (cIMT)-a validated marker of subclinical vascular disease.nnnRESULTSnThe overall prevalence of MetS was 13.07%; HS was significantly higher in patients with MetS (40.9 versus 18.5%; Pxa0<xa00.001; odds ratio, 3.059; 95% confidence interval, 1.98-4.7). Spearmans correlation between HS grade and the number of MetS criteria met by each patient was significant (rxa0=xa00.285; Pxa0<xa00.001). No statistical difference was recorded in cIMT and cIMT z-scores between patients with or without MetS, until inclusion of HS as an additional criterion for the diagnosis of MetS. In this case, there was a significant difference in cIMT z-scores between the two groups. In multiple linear regression analysis, the cIMT z-score value was better predicted with HS grade and the MetS cluster (adjusted R2xa0=xa02.6%; Pxa0=xa00.002) than when using the MetS cluster only.nnnCONCLUSIONSnHS could be used as additional criterion in detecting pediatric MetS phenotype at higher risk for long-term CV morbidity.

A multicomponent, school-initiated obesity intervention to promote healthy lifestyles in children

OBJECTIVESnIn the context of a 6-mo obesity program, incorporating school- and family-based components, nutritional education, fun-type skill-learning physical activities, and exercise training, this study examined relationships among changes in nutritional status, physical fitness, and some psychosocial and behavioral treatment-related outcomes, using a before and after comparison.nnnMETHODSnEighteen obese and overweight children ages 10 to 12xa0y were assessed with respect to body weight, height, circumferences, skinfold thickness, and fat mass. Health-related fitness tests, and self-reported physical activity enjoyment and perceived physical ability also were administered. Health-related quality of life (HRQoL) was evaluated using the Pediatric Quality of Life Inventory; dietary habits were collected using a 7-d food diary. The WinFood software was used for the estimation of nutrient and caloric intake.nnnRESULTSnAfter treatment, children showed decreases in body mass index z-score (Pxa0=xa00.001), body fat percentage (Pxa0<xa00.001), arm (Pxa0=xa00.003) and waist circumferences (Pxa0=xa00.004), and skinfold thickness (Pxa0<xa00.008). Actual (Pxa0<xa00.001) and perceived (Pxa0<xa00.03) physical abilities, physical activity enjoyment (Pxa0=xa00.03), and psychosocial HRQoL (Pxa0<xa00.05) also improved from pre- to postintervention. Participants reported reductions in total and commercial food caloric intakes (Pxa0<xa00.001), with higher protein and lower fat consumptions (Pxa0<xa00.001) after the program.nnnCONCLUSIONSnThe findings from the present study highlight the importance of combined dietary-behavioral-physical activity interventions in overweight children, and place emphasis on directing such interventions toward improving perceived physical competence that could lead to increased exercise adherence and promotion of the health benefits associated with it.

Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians

To evaluate physicians adjustments of insulin pump settings based on continuous glucose monitoring (CGM) for patients with type 1 diabetes and to compare these to automated insulin dose adjustments.

Nearly half of the adolescents in an Italian school-based study exceeded the recommended upper limits for daily caffeine consumption

No data are available on caffeine consumption among Italian adolescents. We investigated caffeine intake from coffee, soft drinks and energy drinks in a sample of Italian adolescents and determined if they exceeded the recommended limits.

P295 Optical pathway glioma and neurofibromatosis type 1

Background Neurofibromatosis Type 1 (NF1), a autosomal dominant disorder, which mainly involves Skin and nervous system: 15% of children with NF1 develops optic pathway gliomas (OPG), typically Astrocytomas pilocytic low grade, usually in the first decade of life. In one third of cases OPG occur with proptosis, visual impairment, early puberty or other disorders of hypothalamus-pituitary axis. According to current guidelines, children with NF1 should be screened frequently for visual examination and in case of visual impairment, brain MRI with the orbits analysis should performed. The current SIOP-LGG 2004 recommendations, in all cases of no-symptomatic, no-evolving glioma, provide clinical observation with close monitoring; chemotherapy is indicated only in presence of clinical signs and symptoms, or neuroimaging of progression. In the optic nerve tumours, surgery is reserved for patients with blindness, severe proptosis; chiasmatic tumours need surgery in case of exophytic tumours, with cystic component causing severe hydrocephalus or brain compression. patients and methods This is an observational study of 14 cases of OPG (5 males and 9 females) in patients with NF1, diagnosed from 1999 to 2015 c/o Paediatric Oncology Unit of our Department. We evaluated the clinical and radiological course and response to treatment of OPG. Results OPG were located exclusively to the optic nerves level in 43% of patients; 38% presented hypothalamus-optical-chiasmatic localization and 19% had chiasm or optic tracts involvment. The 57% of patients needed of chemotherapy according to the Protocol for Low Grade Glioma, cause of worsening of visual acuity, exophthalmoses or rapid increase of mass-size. The average age of chemotherapy start was 4.6u2009years (range 1.9 to 7u2009years). In only two cases there was marked reduction in the size of glioma, while in other cases the radiological picture was confirmed stationary at the stop-Therapy. Chemotherapy has allowed to stabilise the visual impairment, improving in 50% of cases the visual field. Conclusions Our data, accordingly with literature, confirmed that chemotherapeutic treatment for OPG is still unsatisfactory in most cases.

PP30 LOW LEVELS OF 6-KETO PGF 1α AND INCREASED CAROTID INTIMA–MEDIA THICKNESS IN OBESE CHILDREN WITH INSULIN RESISTANCE

PP30 – Table 1 Glucose Insulin HOMA Cholesterol Triglyceride TNF-α 6-keto PG (mg/dl) (μUI/ml) (mg/dl) (mg/dl) (pg/ml) (pg/ml) Group A (76 pts) 89.3±6.6 14.6±7.7 3.2±1.7 161±29 105.4±60 10.1±5.4 185.1±24.1 (44 pts) Group B (80 pts) 88.0±8.5 11.0±5.8 2.4±1.3 162±32 85.4±50 14±7.5 492.6±91.8 (26 pts) p NS 0.001 0.002 NS 0.025 NS 0.002 and cirrhosis) usually occur in middle and late age, atherosclerotic process in the vascular wall and liver damage might begin very early in obese children. Aim of the study: was to investigate, in children attending our outpatient clinic for obesity, 1) any early vascular structural change and the presence of fatty liver; 2) any possible metabolic risk factor. Patients and methods: the study population consisted of 156 children (71 girls), whose BMI z-score was 4.5±1.4 and their mean age was 8.2±2.7 years. They all underwent ultrasonography to measure the intima-media thickness (IMT) of carotids and to study the morphology of the liver. Their serum glucose, insulin, HOMA index, lipids, TNF-α were measured as well. For those who gave their consent (70 pts), 6-keto PGF 1α was also evaluated. Results: according to IMT measurement, patients were divided in Group A (0.6-0.7 mm) with a BMI z-score of 4.6±1.4* and Group B (0.4-0.5 mm) with a BMI z-score of 4.1±0.9* (*p= 0.2). Their data are reported in Table 1. Liver steatosis was present in 23/76 pts of Group A (30.2%) and in 11/80 pts of Group B (13.7%) Conclusions: Increased carotid IMT was documented in 76/156 children (48.7%) and fatty liver in 34/156 (21.8%). Fasting insulin levels, HOMA index, triglyceride levels and 6-Keto-PGF1α were significantly different between Group A and Group B. These data might suggest that higher insulin resistance and triglyceride levels, together with low levels of 6-keto PGF 1α could be considered risk factors for early vascular damage and hepatic steatosis in obese children.