Jürgen Doerfer

Influence of food intake, age, gender, HbA1c, and BMI levels on plasma cholesterol in 29,979 children and adolescents with type 1 diabetes--reference data from the German diabetes documentation and quality management system (DPV).

Objective:  We investigated influences of a 12‐h fast, age, gender, body mass index (BMI), hemoglobin A1c (HbA1c) on total cholesterol (TC), low‐density lipoprotein cholesterol (LDL‐C), and high‐density lipoprotein cholesterol (HDL‐C) to provide reference percentiles for TC, LDL‐C, and HDL‐C of patients with good diabetes control (HbA1c < 7.5%) and normal weight (BMI < 90th percentile).

Marked smoking-associated increase of cardiovascular risk in childhood type 1 diabetes.

Type 1 diabetes is a generally accepted atherogenic risk factor, and diabetic patients who smoke markedly accelerate the atherosclerotic process. The main intentions of our investigation were to ascertain differences between juvenile active/passive smokers and non-smokers with type 1 diabetes regarding the number and spectrum of cardiovascular risk factors and their associations with smoking. Ninety-two patients were enrolled comprising 19 active/passive smokers (median age 15.9 years) and 73 non-smokers (median age 12.3 years). To determine age-dependent influences we compared age- and gender-matched groups of 12 smokers with 12 non-smokers. Smokers had significantly higher HbA1c, fructosamine, total cholesterol, LDL cholesterol, apolipoprotein B, serum P-selectin, and lower serum L-selectin than non-smokers. However, L-selectin levels were not different between the age-matched smoker and non-smoker groups. A significant positive relation (Spearman rank correlation) was found between smoking and age, HbAlc, fructosamine, total cholesterol, apolipoprotein B, and P-selectin; a negative relationship between smoking and L-selectin. We conclude that smoking in children and adolescents with type 1 diabetes increases the cardiovascular risk through the deterioration of glucose metabolism, lipid profile, and endothelial function. Therefore, smoking diabetic juveniles may increase their number of cardiovascular risk factors from 1, diabetes, by another four factors, i.e. smoking, hyperglycemia, dyslipidemia, and endothelial perturbation.

Synergistic Effects of Elevated Systolic Blood Pressure and Hypercholesterolemia on Carotid Intima–Media Thickness in Children and Adolescents

This study aimed to investigate the synergistic effects of elevated systolic blood pressure (SBP) and hypercholesterolemia on carotid intima–media thickness (cIMT). For this study, 60 children with hypercholesterolemia and 40 healthy control children were divided into four subgroups: hypercholesterolemic children with normal (<90th percentile) or elevated (≥90th percentile) SBP and control children with normal or elevated SBP. The highest mean and maximal cIMT values were found in the hypercholesterolemic children with elevated SBP and were significantly different from those of all the other groups. The synergistic effects of elevated SBP and hypercholesterolemia lead to a significant increase in cIMT as a subclinical sign of early atherosclerosis.

Adult-like but regressive increase of intima-media thickness and roughness in a child with type 1 diabetes.

Abstract:  A 12‐yr‐old Kosovo‐Albanian boy with insufficiently controlled type 1 diabetes since his second year of life developed severely increased intima‐media thickness (IMT) and roughness (IMR) of the common carotid artery (CCA): max/mean IMT = 0.81/0.68 mm and IMR = 0.048 mm. Intima‐media thickening, comparable with that in a 50‐ to 60‐yr‐old healthy adult, decreased within 41 months (max/mean carotid IMT = 0.72/0.56 mm and IMR = 0.036 mm) by intensive treatment of diabetes. Moyamoya disease (MMD), complicated by cerebral infarction, occurred coincidentally but regressed within 6 months. This case report points out that (i) chronic hyperglycemia in childhood may lead to adult‐like increase of carotid IMT/IMR as early signs of subclinical atherosclerosis, (ii) increased carotid IMT/IMR may be regressive by intensive diabetes control, and (iii) a screening examination for carotid IMT/IMR should be considered in patients at high risk of atherosclerosis.

Decreased levels of homoarginine and asymmetric dimethylarginine in children with type 1 diabetes: associations with cardiovascular risk factors but no effect by atorvastin

Abstract Objectives: To investigate homoarginine and asymmetric dimethylarginine (ADMA) in controls compared to children with type 1 diabetes (T1D) and if homoarginine and ADMA are affected by atorvastatin. Methods: Homoarginine and ADMA levels of 28 T1D patients were compared to levels of 41 controls. In T1D patients, homoarginine and ADMA were determined at baseline, 1 year, and 2 years at daily 10 mg atorvastatin or placebo within a double-blind study. Results: At baseline, both homoarginine and ADMA were lower (p<0.001) in T1D patients compared to controls. In T1D patients, homoarginine and ADMA were not influenced by atorvastatin. Inverse correlations between homoarginine and HbA1c (p<0.001) and between ADMA and systolic blood pressure (p=0.005) and pulse pressure (p=0.003) were shown. Conclusions: Homoarginine and ADMA levels are decreased and associated with cardiovascular risk factors in children with T1D without being affected by atorvastatin.

Non-High-Density Lipoprotein Cholesterol in Children with Diabetes: Proposed Treatment Recommendations Based on Glycemic Control, Body Mass Index, Age, Sex, and Generally Accepted Cut Points

Percentile-based non-high-density lipoprotein cholesterol levels were analyzed by glycemic control, weight, age, and sex of children with type 1 diabetes (n = 26,358). Ten percent of all children and 25% of overweight adolescent girls require both immediate lipid-lowering medication and lifestyle changes to achieve non-high-density lipoprotein cholesterol levels <120 mg/dL and cardiovascular risk reduction.

Marked increase of final height by long-term aromatase inhibition in a boy with idiopathic short stature

Abstract Growth hormone (GH) is the most frequently used treatment in children with idiopathic short stature (ISS). Aromatase inhibitor (AI) therapy is still in an experimental state, and both final height (FH) and long-term efficacy data in ISS have not been published. We present a 14.5-year-old boy with ISS and a height of 142.7 cm [standard deviation score (SDS) –2.79]. Based on the baseline bone age (BA) of 13.5–14 years, his predicted adult height (PAH) by Bayley/Pinneau was 154 cm (SDS –3.77)–158.2 (SDS –3.15). After a 5-year letrozole monotherapy, FH was 169 cm (SDS –1.57) showing a height difference between PAH and FH from 10.8 to 15 cm. No permanent side effects of the medication have been observed. Both a transient occurrence and a spontaneous recovery of decreased bone mineral apparent density were seen, verified by dual-energy X-ray absorptiometry. Spinal magnetic resonance imaging revealed no vertebral abnormalities. AI therapy might be an effective and low-cost alternative to the use of GH. Further controlled trials should prove efficacy and safety of long-term AI therapy in boys with ISS.

Grundlagen jugendmedizinischer Tätigkeit in der Klinik

Die stationare Betreuung und Versorgung Jugendlicher hat wachstums- und pubertatsbedingte Einflusse auf die korperliche, geistige, seelische und soziale Entwicklung zu berucksichtigen. Anderungen des Krankheitsspektrums Jugendlicher mit einem Anstieg psychischer, psychosomatischer und chronischer Krankheiten (Diabetes mellitus Typ 1, Adipositas, Asthma bronchiale, rheumatischer Formenkreis) erfordern eine Anpassung der interdisziplinaren, personellen und raumlichen Betreuungsstrukturen. Unterrichtsangebote der Krankenhausschule, psychologische Beratung, palliativmedizinische Versorgung oder die Begleitung durch kirchliche Seelsorger sollten in Abstimmung mit dem kranken Jugendlichen und seiner Familie erfolgen. Hinsichtlich der rechtlichen Aspekte einer stationaren Versorgung Jugendlicher sind die Patienteneinwilligung bei medizinisch erforderlichen Masnahmen und die Schweigepflicht des Klinikpersonals zu berucksichtigen.

Prävention im Jugendalter

Aufgaben der Pravention von Gesundheitsschaden im Jugendalter sind die Identifizierung, Vermeidung und Behandlung krankheitsrelevanter Risikofaktoren und eine bewusste Gesundheitsforderung. Wir bieten eine praxisnahe Anleitung zur kompletten Durchfuhrung der J1 und J2 von der Anamneseerhebung uber die korperliche Untersuchung bis hin zu moglicher Labordiagnostik. Die Jugendarbeitsschutzuntersuchung (JAS) ist sinnvoll zur Erhebung des Ist-Zustands von Jugendlichen vor Beginn einer Ausbildung. Ausgewogene Ernahrung im Jugendalter ist Voraussetzung fur eine gesunde korperliche und geistige Entwicklung. Aktuelle Empfehlungen integrieren Bewegung in den Alltag. Auch im Jugendalter spielen Impfungen eine wesentliche Rolle. Vitamin D ist essenziell fur die Knochenmineralisation und das Knochenwachstum. Freizeitlarm stellt oft ein unerkanntes Schadigungspotenzial dar, und auch Aktiv- und Passivrauchbelastung, E-Zigaretten und E-Shishas. Aluminium und Triclosan sind alltagliche Belastungen.

Körperliche Entwicklung im Jugendalter

Als Jugendalter (Adoleszenz) wird der Lebensabschnitt zwischen dem 10. und 19. Lebensjahr bezeichnet. Diese Entwicklungsperiode ist vor allem durch Korperwachstum, Hirnreifung und die Entfaltung der Sexualitat charakterisiert. Zur Beurteilung von Korpergrose, Korpergewicht und Body-Mass-Index stehen alters- und geschlechtsbezogene Perzentilenkurven zur Verfugung. Weitere Beurteilungskriterien der korperlichen Entwicklung sind Korperfettanteil, Taille-Hufte-Index und Taille-Grose-Index. In der Pubertat kommt es zur Ausbildung der primaren und sekundaren Geschlechtsmerkmale. Zur Dokumentation der Pubertatsentwicklung werden die Pubertatsstadien nach Tanner verwendet (Pubeshaar, weibliche Brust, Penislange, Hodenvolumen). Als Normvarianten der Pubertatsentwicklung ohne Krankheitswert gelten pramature Thelarche, pramature Adrenarche und pramature Menarche ohne Nachweis weiterer Pubertatszeichen sowie Pubertatsgynakomastie bei Jungen und konstitutionelle Entwicklungsverzogerung.