Irena Białokoz-Kalinowska

Chemerin as a novel non-invasive serum marker of intrahepatic lipid content in obese children

BackgroundEctopic hepatic lipid accumulation is closely related to the development of insulin resistance, which is regarded as one of the most significant risk factors of non-alcoholic fatty liver disease (NAFLD). The current study has shown that fat tissue constitutes an important endocrine organ with its own production and metabolism of many biologically active substances, among which adipokines play an important role. Classic adipokines (e.g. leptin, adiponectin, resistin) are fat-derived hormones which serum level is altered in patients with NAFLD. The role of novel adipokines in the pathomechanism of this disease is not clear. Therefore, the aim of our study was to evaluate the serum concentrations of chemerin, omentin and vaspin in obese children with NAFLD.MethodsForty-five obese children, aged 7-17 years old, were admitted to our Department with suspected liver disease (hepatomegaly, and/or ultrasonographic liver brightness, and/or increased ALT activity). Viral hepatitides, as well as autoimmune and metabolic liver diseases were excluded. Fasting serum levels of chemerin, omentin and vaspin were determined. The grade of liver steatosis in ultrasound was graded according to Saverymuttu. 1HMR spectroscopy was performed with a 1.5 T scanner and with PRESS sequencing.ResultsFatty liver was confirmed in 39 children by ultrasound and in 33 patients by 1HMRS (19 of them also had increased ALT activity /NAFLD/). Chemerin and vaspin levels were significantly higher in children with NAFLD compared to the control group (n = 30). The concentration of chemerin was significantly higher in children with advanced liver steatosis compared to non-hepatopathic patients (p = 0,02). Significant positive correlations were found between the total liver lipids in 1HMRS and chemerin (r = 0,33; p = 0,02) and vaspin (r = 0,4; p = 0,006). The ability of serum chemerin (cut-off = 190 ng/ml, Se = 75%, Sp = 58%) to differentiate children with fatty liver in 1HMRS from those without steatosis was significant (AUC = 0,7, p = 0,04). Omentin and vaspin did not allow a useful prediction to be made.ConclusionChemerin seems to be the most suitable non-invasive biomarker in predicting both intrahepatic lipid content in obese children and advanced liver steatosis in children with NAFLD.

Serum fetuin A concentration is elevated in children with non-alcoholic fatty liver disease

PURPOSE To assess the serum fetuin A concentration as a potential marker of subclinical atherosclerosis in obese children with NAFLD. MATERIAL/METHODS A prospective analysis of 45 obese children initially diagnosed with liver pathology (elevated serum ALT activity and/or ultrasonographic liver brightness and/or hepatomegaly) was conducted. The diagnosis of NAFLD was established in the children with elevated serum ALT activity and liver steatosis on ultrasound examination. Viral hepatitis, autoimmune, metabolic liver diseases (Wilson disease, alpha-1-antitrypsin deficiency, cystic fibrosis) and drug and toxin-induced liver injury were excluded in all children. The degree of liver steatosis was graded according to Saverymuttu scale and the total liver lipids concentration was assessed using proton magnetic resonance spectroscopy ((1)H MRS). RESULTS Serum fetuin A concentration was significantly higher in examined children compared to the control group (n=30) (p=0.00002). Higher serum fetuin A concentration was also observed in children with NAFLD (n=19) in comparison to the controls (p=0.000026). Additionally, higher BMI values, waist circumferences, ALT and GGT activity, intensity of liver steatosis on ultrasound and total concentration of lipids in the liver in (1)H MRS were found in children with NAFLD compared to the rest of the examined obese patients (n=26). There was not found any correlation of the investigated glycoprotein with any other assessed parameters both in children with NAFLD and obese children without NAFLD. CONCLUSION Higher serum fetuin A concentration found in children with NAFLD compared to the control group support the hypothesis that atherosclerotic processes may develop faster in hepatopatic obese patients.

Hepatokines and non-alcoholic fatty liver disease

Nowadays non-alcoholic fatty liver disease (NAFLD) is becoming the most common chronic liver pathology both in adults and children. NAFLD manifestation ranges from a simple liver steatosis to steatohepatitis (nonalcoholic steatohepatitis - NASH), which may progress to advanced fibrosis, cirrhosis and end-stage liver disease. Due to the coexistence of visceral obesity, insulin resistance and dyslipidemia, NAFLD is considered to be the hepatic manifestation of metabolic syndrome. In recent years, in the pathogenesis of metabolic syndrome, type 2 diabetes mellitus, cardiovascular disease and also NAFLD, more and more attention has been paid to the so-called organokines, proteins with both paracrine or/and endocrine activities. These include most known adipokines (mainly produced by adipose tissue), myokines (mainly produced by skeletal muscles) and hepatokines exclusively or predominantly produced by the liver. It was shown that the liver may affect the lipids and glucose metabolism by hepatokines released into the blood and NAFLD seems to be associated with altered hepatokines production. Fetuin-A, fibroblast growth factor-21 (FGF-21), selenoprotein P, sex hormone-binding globulin (SHBG), angiopoietin-related growth factor (also known as angiopoietin-related protein 6) and leukocyte derived chemotaxin 2 (LECT2) are considered as the most important hepatokines. In this review, we provide an overview of the main hepatokines and we summarize the association of liver-derived proteins with the development and progression of NAFLD.

Thigh Circumference as a Useful Predictor of Body Fat in Adolescent Girls with Anorexia Nervosa

Background/Aim: Girls with anorexia nervosa (AN) demonstrate severe depletion of body fat. The aim of this study was to determine an accurate anthropometric measurement for clinical assessment of fat depletion in girls with AN in connection with body composition measured by dual-energy X-ray absorptiometry (DXA). Methods: In 64 female AN patients aged 12.8–23.1 years (mean 16.0 ± 1.8), body mass index (BMI), skinfold thickness (subscapular, abdominal and triceps), mid-upper arm and thigh circumference, fat mass (FM) and lean mass were determined and compared with the data of 71 controls. Results: Girls with AN had lower anthropometric traits and were fat depleted compared to controls (14.9 ± 7.3 vs. 27.4 ± 6.4% of FM using DXA; all p < 0.001). BMI, thigh circumference and subscapular skinfold thickness demonstrated a very similar predictive value for DXA assessment of body fat. Based on the receiver-operating characteristic curve analysis and the determination of the positive predictive value, thigh circumference appeared the most specific and sensitive anthropometric predictor of fatness discriminating between AN and healthy girls, with the AUC value reaching 0.95 (95% CI = 0.92–0.97). Using a cutoff value of 49.6 cm, accuracy was 90.6%, sensitivity 93% and specificity 88.7%. Conclusions: Thigh circumference strongly correlates with DXA-FM and demonstrates a slight clinical advantage over BMI. This simple measurement might also serve as a useful predictor of body fatness in adolescent girls with AN and should therefore be further evaluated in independent cohort studies.

Występowanie nadwagi i otyłości u dzieci w wieku 7–9 lat w zależności od różnych wartości referencyjnych wskaźnika masy ciała (BMI) ☆

Cel W ciągu minionych 30 lat wzrosla czestośc wystepowania otylości u dzieci. Celem pracy byla ocena czestości wystepowania nadwagi i otylości u dzieci w okresie wczesnoszkolnym, w zalezności od stosowanych metod. Metody W losowo wybranych szkolach podstawowych Bialegostoku przeprowadzono przekrojowe badanie 1304 dzieci (604 dziewcząt, 700 chlopcow) w wieku 7–9 lat. Na podstawie zmierzonych cech antropometrycznych wyliczono BMI. Czestośc wystepowania nadwagi i otylości określono za pomocą dwoch niezaleznych metod interpretacji BMI: wg norm Instytutu Matki i Dziecka w Warszawie oraz kryteriow International Obesity Task Force (IOTF) opracowanymi przez Cole’a i wsp. Wyniki Stwierdzono istotne roznice w czestości wystepowania nadwagi i otylości w zalezności od przyjetych definicji. Przyjmując kryteria IOTF czestośc wystepowania nadwagi i otylości byla wieksza w porownaniu z polskimi wartościami referencyjnymi (odpowiednio 21,9% i 16,8%). Stwierdzono nieznacznie czestsze ich wystepowanie u chlopcow niz u dziewcząt: odpowiednio 22,9% (w tym otylośc 6,0%) vs 20,7% (w tym otylośc 4,5%) wg kryteriow IOTF. Wnioski Nadwaga i otylośc w okresie wczesnoszkolnym wśrod dzieci bialostockich wystepują cześciej niz w podobnych badaniach przeprowadzonych w innych miastach Polski. Ocena skali zjawiska zalezy w znacznym stopniu od zastosowanych kryteriow oceny BMI. Obowiązujące w Polsce normy diagnostyczne otylości u dzieci, opartych na siatkach BMI, niedoszacowują jej wystepowania w porownaniu z kryteriami IOTF. Moze to skutkowac istotnymi rozbieznościami w ocenie ryzyka populacyjnego otylości.

Change in Knowledge of Kindergarten Employees Participating in the Course “Diet full of life” in the Field of Children’s Nutrition, as Assessed by Generalized Estimating Equations

Abstract Nutrition is one of the most important environmental factors affecting the physical development and health of children. Education in this area and the development of proper eating habits are priorities. A prerequisite for the proper nutrition of preschool children is knowledge of proper nutrition of people working there. The aim of this study was an evaluation of the knowledge of kindergarten employees participating in the course “Diet full of life – courses in the field of children’s nutrition”. The study included 90 employees of nurseries and kindergartens, participants of the course in the field of children’s nutrition. The research tool was an original questionnaire. Study I (pre-test) was performed before the beginning of the course, while study II (post-test) was performed after its completion. Generalized Linear Models with a Generalized Estimating Equations extension was used to estimate the impact of the number of covariates on knowledge of course participants, taking into consideration the correlation between before- and after-course results. An increase in the knowledge of the participants of the investigated course on children’s nutritional standards was significant and reached 2.053 points on average. No relationship between age, job position, and knowledge level was determined. In the area of principles of proper nutrition for children, older participants had a lower level of knowledge compared to younger ones, and participants with higher education showed a significantly higher knowledge increase as compared to those with vocational education. A significant knowledge increase in the field of dietary behaviors of children was obtained during the course by all examined women, 1.6 points on average (p < 0.001). Younger participants obtained significantly more knowledge from the course than older ones (p < 0.001). Thus, it can be concluded that realization of the course entitled “Diet full of life” specifically relating to young children’s nutrition affected a significant increase in participant knowledge, particularly among the younger age groups and people with higher education. Kindergarten employees need constant supplemental education in the form of training courses, during which they acquire actual knowledge given in an accessible manner for use in practice. The proper assessment of the supplemental education course presented herein, as well as of the course participants, was performed using General Estimating Equations.

Predictive Role of Interleukin-18 in Liver Steatosis in Obese Children

Introduction Interleukin-18 (IL-18) is a proinflammatory cytokine associated with metabolic syndrome (MS). Nonalcoholic fatty liver disease (NAFLD) can be recognized as a feature of MS. Material and Methods Serum IL-18 concentration was evaluated in serum of 108 obese children, determined with ELISA, and referred to degree of liver steatosis in USG or total intrahepatic lipid content assessed by magnetic resonance proton spectroscopy (1HMRS). Results Fatty liver was confirmed in 89 children with USG and in 72 with 1HMRS. IL-18 concentration demonstrated significantly higher values in patients than in controls. Significant correlations between IL-18 and ALT, GGT, triglycerides, hsCRP, and the degree of liver steatosis were demonstrated. NAFLD children had significantly higher level of IL-18, ALT, GGT, HOMA-IR, waist circumference, and total lipids content in 1HMRS than other obese children. IL-18 level was also significantly higher in obese children with advanced liver steatosis. Measurement of serum IL-18 showed ability to differentiate children with fatty liver from those without steatosis. Conclusion Elevated serum IL-18 concentration and its correlation with hepatocyte injury, systemic inflammation, and degree of liver steatosis support role in NAFLD pathomechanism. IL-18 can be considered to play a role in predicting advanced liver steatosis and fatty liver in obese children.