Nur Arslan

Intima-media thickness of carotid artery and susceptibility to atherosclerosis in obese children with nonalcoholic fatty liver disease.

Objective: To test, via prospective case-control study, whether measurements of carotid artery intima-media thickness (cIMT) reflect the susceptibility to atherosclerosis in obese children with nonalcoholic fatty liver disease. Patients and Methods: In all, 80 obese asymptomatic normotensive adolescents (body mass index [BMI], 29.12 ± 5.13; 8.5–17.5 years) and 30 age- and sex-matched nonobese healthy children (BMI 18.55 ± 2.24). Children were analysed in 4 groups: Controls formed group 1, 26 children with obesity without hepatosteatosis formed group 2, 32 children with grade 1 hepatosteatosis formed group 3, and 22 children with grade 2 or 3 hepatosteatosis formed group 4. The key parameters were BMI, liver function tests, lipid profiles, glucose, hepatic ultrasonography, and IMT of common carotid artery (CCA), left carotid bulbus (CB), and left internal carotid artery (ICA). Results: Comparisons of IMT measurements of left CCA, left CB, and left ICA between controls and obesity group revealed statistically significant differences (each segment P < 0.0001). There was an increase in the mean of IMT of each segment with the increase in hepatosteatosis grade (each segment P < 0.0001). The relation between the mean of IMT of left CCA, left CB, and left ICA with BMI (P = 0.001, r = 0.318), alanine aminotransferase (P = 0.007, r = 0.256), and hepatosteatosis (P < 0.0001, r = 0.470) was significant. Multiple regression analysis between left CCA, left CB, and left ICA, and age, sex, relative weight, alanine aminotransferase, total cholesterol, obesity, and hepatosteatosis grade was significant for only hepatosteatosis grade. Conclusions: The cIMT is significantly higher, increasing susceptibility to atherosclerosis, in obese children with hepatosteatosis than in healthy children or obese children without hepatosteatosis.

Obesity, fatty liver disease and intestinal microbiota

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disorder that is increasing in prevalence with the worldwide epidemic of obesity. NAFLD is the hepatic manifestation of the metabolic syndrome. The term NAFLD describes a spectrum of liver pathology ranges from simple steatosis to steatosis with inflammation nonalcoholic steatohepatitis and even cirrhosis. Metabolic syndrome and NAFLD also predict hepatocellular carcinoma. Many genetic and environmental factors have been suggested to contribute to the development of obesity and NAFLD, but the exact mechanisms are not known. Intestinal ecosystem contains trillions of microorganisms including bacteria, Archaea, yeasts and viruses. Several studies support the relationship between the intestinal microbial changes and obesity and also its complications, including insulin resistance and NAFLD. Given that the gut and liver are connected by the portal venous system, it makes the liver more vulnerable to translocation of bacteria, bacterial products, endotoxins or secreted cytokines. Altered intestinal microbiota (dysbiosis) may stimulate hepatic fat deposition through several mechanisms: regulation of gut permeability, increasing low-grade inflammation, modulation of dietary choline metabolism, regulation of bile acid metabolism and producing endogenous ethanol. Regulation of intestinal microbial ecosystem by diet modifications or by using probiotics and prebiotics as a treatment for obesity and its complications might be the issue of further investigations.

Effects of Hospital Stay on Nutritional Anthropometric Data in Turkish Children

We evaluated the effects of hospital stay on nutritional anthropometric data in children of various age groups and investigated the effects of admission undernutrition on nutritional anthropometric data in children who were hospitalized in our university hospital in Turkey. The adverse effect of hospitalization on nutritional status was shown to be most obvious on the 2-6-year age group with undernourished children. We also found reduced anthropometric parameters in all patients with mild malnutrition at admission (p < 0.05). A significant number of pediatric patients in Turkey are at nutritional risk at the time of hospital admission (31.8 per cent). The well-nourished children do not carry nutritional risk due to hospitalization for other medical reasons. Since undernutrition has an adverse effect on morbidity and mortality, careful nutritional evaluation of children on admission is essential. Special attention should be given to patients who had mild malnutrition on admission since this population of patients seem to be at higher risk of adverse effect of hospitalization.

Current therapeutic approaches in childhood chronic hepatitis B infection: A multicenter study

Background and Aim:  The aim of the present study was to compare the therapeutic efficacy of three different regimens in childhood chronic hepatitis B (CHB) infection.

Mean Platelet Volume in Obese Adolescents with Nonalcoholic Fatty Liver Disease

ABSTRACT Background: Nonalcoholic fatty liver disease (NAFLD) is the accumulation of excess fat in the liver in the absence of alcohol consumption, which commonly coexists with obesity. NAFLD is associated with increased risk of atherosclerosis and insulin resistance Mean platelet volume (MPV) is a marker of platelet activation, which is a determinant of atherosclerosis. Aims: The first aim of the present study was to investigate the MPV levels in obese adolescents and compare the MPV levels in patients with and without NAFLD and also with healthy controls. The second aim of this study was to evaluate the relationship between IR and MPV. Patients and Methods: Case records of 128 exogenous obese adolescents were retrospectively evaluated. Laboratory parameters were collected by using a computerized patient database. Insulin resistance was calculated by a homeostasis model assessment (HOMA-IR) index. Patients were divided into two groups: patients with NAFLD (Group 1) and patients without NAFLD (Group 2). Forty-seven healthy children constituted the control group. Results: MPV was significantly higher in obese adolescents than their healthy peers. Group 1 had significantly higher MPV than group 2. HOMA-IR was significantly higher in group 1 than group 2. MPV was significantly higher in patients with IR than patients without IR. There was a positive correlation between MPV and HOMA-IR. MPV was inversely correlated with HDL cholesterol and platelet count. Conclusion: MPV may be used as a follow-up marker in patients with NAFLD at the point of atherosclerosis.

Hepatic glycogenosis: a rare cause of hepatomegaly in Type 1 diabetes mellitus

Hepatomegaly, with or without abnormal liver function tests, was a common feature of both pediatric and adult patients with diabetes mellitus. We are reporting a case of a 16-year-old diabetic boy in whom we found hepatomegaly, mildly elevated transaminases and elevated serum lipids never noticed before. Abdominal ultrasound confirmed hepatomegaly; liver biopsy pointed out a picture compatible with glycogenosis. The patients abnormal liver function tests, elevated serum lipids and hepatomegaly decreased over a period of 4 weeks with tight metabolic control. This situation was due to overinsulinization because the patient assumed an excessive quantity of food and therefore took an excessive quantity of insulin. In conclusion, hepatomegaly may be seen in diabetic patients due to hepatic glycogen accumulation as a result of excessive food and insulin consumption. In hepatic glycogenosis, the pathological findings improve in 4 weeks when good metabolic control is provided. Therefore, the other reasons must be investigated when hepatomegaly persists for a longer period.

Investigation of adropin and leptin levels in pediatric obesity-related nonalcoholic fatty liver disease.

Abstract Aim: Nonalcoholic fatty liver disease (NAFLD) is the accumulation of excess fat in the liver in the absence of alcohol consumption, which is commonly associated with obesity and increased risk of atherosclerosis as well as insulin resistance. Adropin is a recently identified protein encoded by the gene related with energy homeostasis, which is expressed in the liver and the brain and has a role in preventing insulin resistance and obesity. The aim of this study was to investigate the serum adropin and leptin levels in obese adolescents and compare the patients with, and without, NAFLD and with healthy controls. Methods: Sixty-four obese adolescents (30 with NAFLD, 34 without NAFLD) and 36 healthy controls were enrolled in the study. Serum adropin and leptin levels were evaluated by sandwich enzyme-linked immunosorbent assay. Results: Serum adropin levels were significantly lower in obese children than healthy controls (3.2±1.0 and 9.2±1.2 ng/mL, respectively, p=0.001). Serum leptin levels were significantly higher in patients than in controls (12.4±1.1 and 4.1±3.1 pg/mL, respectively; p=0.000). Serum adropin levels of patients with NAFLD were significantly lower than in patients without NAFLD (2.9±0.5 and 3.5±1.2 ng/mL, respectively; p=0.023) and healthy controls (p=0.000). Logistic regression analysis showed that a decrease in adropin levels was the only independent factor for fatty liver disease in obese adolescents (odds ratio: 3.07, 95% confidence interval 1.14–8.2, p=0.026). Leptin, relative weight and HOMA-IR of the patients were not independent risk factors for NAFLD. Conclusions: In this study, serum adropin levels were significantly lower in obese adolescents with fatty liver disease compared to patients without fatty liver disease and healthy controls. Lower adropin level was an independent risk factor for NAFLD in obese adolescents in logistic regression analysis. Assessment of serum adropin concentrations may provide a reliable indicator of fatty liver disease in obese adolescents.

Serum leptin concentrations in children with mild protein-energy malnutrition and catch-up growth.

Abstract Background : The aim of the present study was to clarify the relationship between changing nutritional anthropometric data and serum leptin concentrations during the catch‐up growth process in children.

Serum leptin concentrations in children with mild-to-moderate protein-energy malnutrition

Background : The aim of the present study was to clarify the relationship between nutritional anthropometric parameters and serum leptin concentrations in otherwise healthy children with mild‐to‐moderate protein‐energy malnutrition (PEM) secondary to inadequate energy intake.

The changing face of celiac disease: a girl with obesity and celiac disease.

The widespread use of serological tests has changed the clinical spectrum of recently diagnosed celiac patients. In this paper, we present an obese patient with Hashimoto’s thyroiditis who was investigated for hypochromic microcytic anaemia that is unresponsive to iron replacement therapy and finally had the diagnosis of celiac disease. A 7-year-old girl was admitted to our hospital with the complaint of being overweight for 3 years. Her medical history was unremarkable except for consuming high energy-containing foods and sedentary life-style. Her mother was taking treatment for Hashimoto’s disease. On physical examination, her weight was 42.5 kg (>95 percentile), height 126.8 cm (75–90 percentile), weight for height 167%. She had an obese appearance but no signs of stria, hepatomegaly or acanthosis nigricans. Laboratory results showed: haemoglobin: 11.2 g/dL, hematocrit: 34.8%, MCV: Mean corpuscular volume 69 fL, RDW: Red cell distribution width 18, leukocyte: 9800/mm, thrombocyte: 361 000/ mm, fasting blood glucose: 85 mg/dL, aspartate aminotransferase: 18 U/L, alanine aminotransferase: 30 U/L, triglyceride: 150 mg/ dL, total cholesterol: 233 mg/dL, LDL-cholesterol: Low density lipoprotein 158 mg/dL, free T3: 4.11 (2–4.1 pg/mL), free T4: 0.91 (0.8–2.2 ng/dL), thyroid stimulating hormone: 56.3 (0.6– 5.5 U/mL), anti-T: 621 IU/mL, anti-G: 92.9 IU/mL, in abdominal ultrasonography there was no sign of fatty liver. Thyroid ultrasonography revealed fibrous septa in both thyroid glands consistent with autoimmune thyroiditis. She was started thyroid replacement therapy for Hashimoto’s disease and also diet and exercise for obesity. At the first year of follow-up, her weight for height was 152%. She was found to have a persistent iron-deficiency anaemia that is not responsive to iron supplements (Table 1). She did not have bleeding history and stool examination was negative for occult blood. Haemoglobin electrophoresis was normal. An antibody screening test resulted positive for anti-endomysium IgA and anti-gliadin IgG and IgA antibodies. Serum IgA level was within the normal ranges (212 mg/dL (N: 33–226)). Her parent’s screening tests for celiac disease were negative. Endoscopic duodenal biopsy showed villous atrophy, crypt hyperplasia and lymphocyte proliferation consistent with the celiac disease. She was started a gluten-free diet and encouraged to consume iron-rich foods. After 4 months of treatment with gluten-free diet, all her haematological parameters returned to normal values. There are few published data in the literature about the co-existence of obesity and celiac disease. Classically in a disease where there is a disorder of absorption, the expected clinical condition is malnutrition rather than obesity. Co-existence of obesity and celiac disease is explained with a compensation theory. According to this theory, nutrients that cannot be absorbed because of villous atrophy in proximal small bowel is taken into body with increased absorption in distal small bowel and as a result, these patients do not lose weight. The patients reported with obesity and celiac disease presented with different clinical signs in the literature. Franzese et al. determined hepatosteatosis in an obese patient. This patient was evaluated for persistent liver disease despite the hypocaloric-diet and celiac disease was diagnosed. Oso and Fraser detected celiac disease in an obese adolescent patient who had recurrent diarrhoea attacks especially after eating spaghetti. Another published obese celiac case is a 5-year-old girl with short stature and recurrent abdominal pain. Our patient was presented with obesity and refractory irondeficiency anaemia. Anaemia can be seen in obese patients. Bekri et al. reported that 24% of morbid obese patients presented with anaemia. Similarly, in childhood series, anaemia frequency was found to be higher in obese children than normal children. The possible causes of this situation are early menarche in girls and on the contrary of assumed; the fact that obese patients consume inadequate iron in their diet. Our patient was taking adequate iron through her diet and supplementation. In celiac disease patients who have obesity, anaemia is a frequent finding. Four adult morbid obese patients who had the diagnosis of celiac disease were reported. Two of these patients had diarrhoea and one of them had gastroesophageal reflux complaints. At admission, iron deficiency was determined in two patients while vitamin B12 deficiency was determined in one. The prevalence of celiac disease in adults with Hashimoto’s disease was 5%. Similarly, the frequency of autoimmune thyroiditis is increased in celiac patients compared with normal population. But in childhood period, this togetherness of two diseases was reported very rarely. Our patient was admitted to our clinic for obesity and found to have autoimmune thyroiditis after investigations. She was screened for celiac disease in the follow-up period because of iron-deficiency anaemia. In conclusion, patients who have symptoms and signs suggesting celiac disease should be screened for celiac disease without considering their body weight.