Israel Rousso

Metabolic syndrome in children and adolescents with acute lymphoblastic leukemia after the completion of chemotherapy.

The metabolic syndrome is a cluster of potent risk factors for cardiovascular diseases. To provide information on the late complications of chemotherapy for acute lymphoblastic leukemia (ALL), the authors prospectively studied the frequency of overweight, obesity, and metabolic syndrome in survivors of ALL in the initial years after the completion of therapy. Children and adolescents were classified as having the metabolic syndrome if they met three or more of the following criteria: hypertriglyceridemia, low levels of high-density lipoprotein (HDL), high fasting glucose, obesity, and hypertension. Obesity was defined on the basis of Body Mass Index (BMI) (kg/m2) standard deviation scores or z-scores. Cutoff points for triglycerides and HDL were taken from equivalent pediatric percentiles with the cutoff points proposed by the Adult Treatment Panel III (ATPIII). Hyperglycemia was defined using the ATPIII cutoff points. Elevated systolic or diastolic blood pressure was defined as a value greater than the 95th percentile for age, gender, and height. Fifty-two subjects (29 male and 23 female) with a median age of 15.2 years (range 6.1-22.6 years) were evaluated. Median interval since completion of therapy was 37 months (range 13-121 months). All of them had been treated according to the ALL-BFM 90 chemotherapy protocol and none had received cranial radiotherapy. Of the 52 subjects, 25 (48%) were overweight (BMI z-score >1.5) and 3 (5.76%) were obese (BMI z-score >2); among them, 1 was severely obese (BMI z-score >2.5). Three criteria for the metabolic syndrome (high triglyceride levels, glucose intolerance, and obesity) were fulfilled by three subjects (5.76%). Twenty-nine subjects (55.7%) had at least one risk factor for metabolic syndrome. Hyperglycemia and hypertension were infrequent. Prompt recognition of the risk factors for metabolic syndrome and intervention seem mandatory to ensure early prevention of cardiovascular disease in survivors of ALL.

Investigation of anthropometric, biochemical and dietary parameters of obese children with and without non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) in children has been recognized as a major health burden. The high prevalence of NAFLD is probably due to the contemporary epidemics of obesity, unhealthy dietary pattern, and sedentary lifestyle. The purpose of this study was to investigate anthropometric, biochemical and dietary intake parameters of obese Greek children with and without NAFLD. Eighty two obese children aged 8-15 (45 boys/37 girls) participated in the study. Ultrasonography (US) was used to diagnose NAFLD in all participated subjects. Liver indexes were measured in all children. A 3-day dietary was recorded for all subjects. Data for continuous variables is expressed as mean values±standard deviation. Thirty-five out of eighty two subjects (42.6%) had NAFLD. Body Mass Index levels (P<0.001) and Waist Circumference (P<0.046) levels were statistically higher in the children with severe NAFLD (37.2kg/m(2)±6.2 and 102.9cm±14) compared to children with mild NAFLD (26.6kg/m(2)±3.3 and 86.1cm±9.9) and absent of fatty liver (25.3kg/m(2)±3.6 and 85.2cm±11.2), respectively. Total carbohydrates intakes were significantly higher in subjects with NAFLD (288.8g±70.6) compared to children without NAFLD (244.5g±67.5), (P<0.001). Saturated fatty acids (SFAs) intake was proportionally increased to the degree of hepatic steatosis, while n-3 fatty acids (n-3 FA) consumption was inversely related with NAFLD. In multiple regression analysis of factors associated with NAFLD, HOMA-IR (OR: 1.260, 95%CI: 1.110-1.470, P<0.001) and n-3FA (OR:1.921, 95%CI:1.132-2.187, P<0.001) were the most significant ones. Our results showed that IR, high dietary intakes of CHO and SFA and a low dietary consumption of fiber and n-3 FA were positively associated with the pathogenesis of NAFLD.

Possible Health Implications and Low Vitamin D Status during Childhood and Adolescence: An Updated Mini Review

Vitamin D deficiency is common in the developing countries and exists in both childhood and adult life. The great importance of Vitamin D is the moderation of calcium (Ca) and phosphorus (P) homeostasis as well as the absorption of Ca. While insufficiency of vitamin D is a significant contributing factor to risk of rickets in childhood, it is possible that a more marginal deficiency of vitamin D during life span contribute to osteoporosis as well as potentially to the development and various other chronic diseases such as cardiovascular disease, cancer and diabetes. This paper reviews the metabolism, epidemiology, and treatment of vitamin D and calcium insufficiency as well as its relation to various diseases during childhood and adolescence.

Association of blood pressure, obesity and serum homocysteine levels in healthy children

Aim: Obesity, hypertension and total serum homocysteine levels are well‐known risk factors for cardiovascular disease in adults. However, there is limited data on the relation of these risk factors in children.

Reference range of total serum homocysteine level and dietary indexes in healthy Greek schoolchildren aged 6–15 years

Elevated total serum homocysteine (tHcy) may be a possible risk factor for CVD. A 5 micromol/l increase in tHcy is associated with an approximately 70 % increase in relative risk of CVD in adults. Data for children and adolescents are, however, limited. The purpose of the present study was to provide a reference range for tHcy and investigate any relationship between tHcy and nutritional indexes in a Greek paediatric population. tHcy, folate, vitamin B12 levels and dietary indexes were measured in 520 healthy schoolchildren (274 boys, 246 girls) aged 6-15 years. As in adults, the tHcy distribution skewed to the right, with a geometric mean for both genders of 7.4 (range 3.4-29 micromol/l). Concentrations were lower in young children and increased with age. No statistically significant difference in tHcy level was observed between gender. The 95th percentiles for the three age groups were as follows: 6-9 years, 9.98 micromol/l; 10-12 years, 10.62 micromol/l; 13-15 years, 14.4 micromol/l. Using Pearsons coefficient analysis, tHcy level was correlated with age, serum folate, BMI and systolic blood pressure. Dietary analysis showed that folate, vitamin B12 and fibre intake were inversely related with tHcy; conversely, sugar and fat were positively associated with tHcy. However, in multiple linear regression analysis, only age (odds ratio 0.246, P < 0.05) and folate (odds ratio -0.346, P < 0.05) were significantly and independently associated with tHcy. This study provides age-specific reference data regarding tHcy concentration in a Greek paediatric population. tHcy levels increased as a function of age. Serum folate levels were significantly and independently associated with tHcy levels.

Are Dietary Cholesterol Intake and Serum Cholesterol Levels Related to Nonalcoholic Fatty Liver Disease in Obese Children

Background. Nonalcoholic fatty liver disease (NAFLD) in children has been recognized as a major health burden. Serum lipids as well as dietary cholesterol (DC) intake may positively relate to development of NAFLD. The purpose of this study was to investigate anthropometric, biochemical, and dietary intake parameters of obese Greek children with and without NAFLD. Materials and Methods. Eighty-five obese children aged 8–15 (45 boys/40 girls) participated in the study. NAFLD was diagnosed by ultrasonography (US) in all subjects. Liver indexes were measured in all children. A 3-day dietary was recorded for all subjects. Results. 38 out of 85 children (44.7%) were found to have fatty liver. Obese children with increased levels of TC (95% CI: 1.721–3.191), low density lipoprotein (LDL) (95% CI: 1.829–3.058), and increased dietary cholesterol intakes (95% CI: 1.511–2.719) were 2.541, 2.612, and 2.041 times more likely to develop NAFLD compared with the children without NAFLD. Conclusion. The present study showed that TC, LDL, and DC were the strongest risk factors of development of NAFLD. Reducing body weight and dietary cholesterol intakes as well as decreasing serum TC and LDL levels are urgently necessary in order to prevent NAFLD and possible other health implications later in life.

Are saturated fatty acids and insulin resistance associated with fatty liver in obese children

BACKGROUND Fatty liver (FL) is a common cause of liver disease in children. Obesity and insulin resistance (IR) play an important role in pathogenesis of FL. Diet has been reported to affect IR and possibly FL. The purpose of this study was to investigate certain parameters (anthropometric, biochemical, dietary intake) of obese Greek children with and without FL. METHODS Forty-three obese children aged 9-14 (25 boys/18 girls) participated in the study. FL was diagnosed by ultrasonography (US). Liver indexes (ALT, AST, gamma-GT) were measured in all children. A 3-day dietary was recorded for all subjects. None of the subjects were positive for viral hepatitis or had a history of consuming alcohol. RESULTS Eighteen out of 43 subjects (41.8%) had FL based on US. Intakes of carbohydrates and simple refined carbohydrates were significantly higher in subjects with FL compared to children without FL, while saturated fatty acids (SFA) were proportionally increased to the degree of hepatic steatosis. In multiple regression analysis of factors associated with FL, only HOMA-IR [Beta: 0.160, 95%CI (0.122-1.340), P<0.001] and SFA [Beta: 0.455, 95%CI (0.129-2.129), P<0.001] were the most significant one. CONCLUSIONS Our results suggest that high intake of carbohydrates and simple refined carbohydrates as well as low intake of fiber may be correlated with the pathogenesis of FL. Moreover, IR and high intake of SFA are independently associated with FL in obese children.

EVALUATION OF BONE METABOLISM IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA AFTER INDUCTION CHEMOTHERAPY TREATMENT

Osteopenia and osteoporosis are currently receiving particular attention as late effects of therapy in survivors of childhood acute lymphoblastic leukemia (ALL). The aim of this study was to evaluate abnormalities in bone mass and mineral homeostasis in children with ALL after induction therapy (during consolidation treatment). Lumbar spine (L2–L4) bone mineral density (BMD, g/cm2) was measured by dual energy X-ray absorptiometry in 20 children with ALL, a median of 25.9 months postdiagnosis and results were expressed as z-scores relative to healthy Caucasian children (controls). Serum levels of intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), calcium, phosphate, and magnesium were also analyzed. In addition, the body mass indexes (kg/cm2) of patients and controls were calculated. Results were compared with those of 40 healthy controls. Among the 20 children with ALL (12 boys and 8 girls), 12 presented z-scores < 1 SD (normal) and 8 were osteopenic (z-score between 1 and 2.5 SD). In addition, children with ALL had reduced lumbar BMDs (z-score −0.817) in comparison to healthy controls (z-score −0.353) (p =. 04). Moreover, alkaline phosphatase and intact parathyroid hormone values were significantly increased compared to controls values. The data demonstrate that bone metabolism in children with ALL during consolidation therapy is disturbed, resulting in a reduced BMD and z-score with respect to healthy controls. Since a reduced BMD predisposes to osteopenia and osteoporosis, specific attention and therapeutic interventions should be considered.

Homocysteine lowering with folic acid supplements in children: effects on blood pressure.

Abstract Hyperhomocysteinemia is emerging as an independent predictor of cardiovascular disease and hypertension among children. The aim of the study was to examine the effects of oral folic acid on homocysteine and blood pressure. Folic acid supplementation has been found to reduce homocysteine levels and in some cases blood pressure. Five hundred and twenty children participated in the study, and 26 of them were found to be hyperhomocysteinemic; 20 of these children randomly received 5 mg oral folic acid supplement while the other six children were the controls. Serum homocysteine (P < 0.001) levels as well as systolic (P < 0.001) and diastolic (P = 0.045) blood pressure were statistically significantly decreased in the intervention group compared with the controls, while folic acid levels were statistically significantly increased (P < 0.001). Total serum homocysteine levels were correlated with age, serum folate, body mass index, and blood pressure. It appears that folic acid may be a safe and effective supplement to reduce homocysteine and possibly blood pressure, which consequently may prevent cardiovascular disease in children in early life.

Central precocious puberty due to hypothalamic hamartoma in a 7-month-old infant girl

Hypothalamic hamartomas (HH) are rare congenital lesions of the tuber cinereum presenting with the classic triad of gelastic epilepsy, central precocious puberty (CPP) and developmental delay. In light of the important and diverse consequences of precocious puberty for affected children and their families, a correct diagnosis without delay is imperative. We present here a rare case of a 7-month-old infant girl with CPP and HH who was successfully treated with depot gonadotropin-releasing hormone (GnRH) analogue.