Reda Bassali

A 16-week randomized clinical trial of 2000 international units daily vitamin D3 supplementation in black youth: 25-hydroxyvitamin D, adiposity, and arterial stiffness.

CONTEXT Vitamin D insufficiency/deficiency is commonly observed in black youth. OBJECTIVE The aim was to determine 25-hydroxyvitamin D [25(OH)D] in response to 2000 IU vitamin D supplementation over time; to evaluate the relation between 25(OH)D concentrations and total body fat mass by dual-energy x-ray absorptiometry; and to determine whether vitamin D supplementation improves arterial stiffness measured by pulse wave velocity (PWV). DESIGN We conducted a randomized, blinded, controlled clinical trial. SETTING AND PARTICIPANTS Forty-nine normotensive black boys and girls, aged 16.3 ± 1.4 yr, were randomly assigned to either the control group (400 IU/d; n = 24) or the experimental group (2000 IU/d; n = 25). RESULTS Plasma 25(OH)D values at baseline and at 4, 8, and 16 wk were 34.0 ± 10.6, 44.9 ± 9.4, 51.2 ± 11.1, and 59.8 ± 18.2 nmol/liter, respectively, for the control group; and 33.1 ± 8.7, 55.0 ± 11.8, 70.9 ± 22.0, and 85.7 ± 30.1 nmol/liter, respectively, for the experimental group. The experimental group vs. the control group reached significantly higher 25(OH)D concentrations at 8 and 16 wk, respectively. Partial correlation analyses indicated that total body fat mass at baseline was significantly and inversely associated with 25(OH)D concentrations in response to the 2000-IU supplement across time. Furthermore, carotid-femoral PWV increased from baseline (5.38 ± 0.53 m/sec) to posttest (5.71 ± 0.75 m/sec) in the control group (P = 0.016), whereas in the experimental group carotid-femoral PWV decreased from baseline (5.41 ± 0.73 m/sec) to posttest (5.33 ± 0.79 m/sec) (P = 0.031). CONCLUSION Daily 2000 IU vitamin D supplementation may be effective in optimizing vitamin D status and counteracting the progression of aortic stiffness in black youth. Plasma 25(OH)D concentrations in response to the 2000 IU/d supplementation are negatively modulated by adiposity.

Prevalence of Cardiovascular Risk Factors in Schoolchildren in a Rural Georgia Community

Background:In the context of a national childhood obesity epidemic, this study sought to document the cardiovascular risk status of children in a rural Georgia community. Methods:Anthropometrics and blood pressure were measured in 211 children, and fasting glucose and lipid profile in 160, recruited from schools in 2002 (grades 2 to 11, ages 7 to 18 years). Results:Nearly half the schoolchildren (48%) were overweight or at risk of overweight; 15% had metabolic syndrome. Overweight children were at higher risk for metabolic syndrome and had more risk factors. Blood pressure: 19% had elevated systolic blood pressure; 4% had elevated diastolic blood pressure. Glycemia: 14% had impaired fasting glucose levels; no diabetes cases were detected. Lipid profile: 26% had high total cholesterol (>170 mg/dL), 20% had high low-density lipoprotein (>110 mg/dL), 13% had high triglycerides (>150 mg/dL), 43% had low high-density lipoprotein (females, <50 mg/dL; males, <40 mg/dL). Ethnicity, gender, and grade level were not predictive of risk except that fewer black children had low high-density lipoprotein, and blood pressure and body mass index increased with grade, as expected. Conclusions:Results from this study indicate a significant problem with overweight and cardiovascular risk in rural schoolchildren. Notably, younger children were just as likely to have risk factors as adolescents, suggesting that screening and intervention ought to begin by school age. Ethnic and gender differences in prevalence were not found, suggesting that contextual factors in a rural setting may outweigh demographic influences on risk.

Lower Uncarboxylated Osteocalcin Concentrations in Children with Prediabetes Is Associated with β-Cell Function

CONTEXT Although animal studies suggest that it is the uncarboxylated rather than carboxylated form of osteocalcin that affects glucose homeostasis, the human data are scant and equivocal. OBJECTIVE This study investigated associations of uncarboxylated and carboxylated forms of osteocalcin with insulin sensitivity and β-cell function in 140 overweight prepubertal children (43% female, 46% black, 84% obese) with normal glucose levels (n = 99) and prediabetes (n = 41). METHODS An oral glucose tolerance test was used to identify prediabetes and for measurement of insulin sensitivity (Matsuda index), β-cell function [oral glucose tolerance test derived insulinogenic index and disposition index (DI(OGTT))] and uncarboxylated and carboxylated forms of osteocalcin. Visceral adipose tissue (VAT) was assessed using magnetic resonance imaging. RESULTS After controlling for age, sex and race, lower uncarboxylated osteocalcin concentrations, Matsuda index, insulinogenic index, and DI(OGTT) and higher VAT levels were found in the prediabetes vs. normal-glucose group (all P < 0.03). Carboxylated osteocalcin levels were not different between groups. Multiple linear regression adjusting for age, sex, race, and VAT revealed that uncarboxylated osteocalcin was associated with insulinogenic index and DI(OGTT) (β = 0.34, 0.36, respectively, both P < 0.04) in the prediabetes group but not the normal-glucose group. In both the normal-glucose and prediabetes groups, carboxylated osteocalcin was associated with insulin sensitivity (β = 0.26, 0.47, respectively, both P < 0.02). CONCLUSIONS These data suggest that the lower uncarboxylated osteocalcin concentrations found in children with prediabetes may be associated with β-cell dysfunction. In addition, our findings between carboxylated osteocalcin and insulin sensitivity suggest that carboxylated osteocalcin plays a role in human glucose homeostasis.

Utility of waist circumference percentile for risk evaluation in obese children

OBJECTIVE Increased waist circumference has been shown to contribute to cardiovascular risk in obese adults. This study was designed to examine whether routinely assessing waist circumference in obese children adds predictive value for the development of diabetes and other cardiovascular risk factors. METHODS This is a cross-sectional study on a community sample of 188 apparently healthy obese children 7-11 years, 60% black, 39% male. Anthropometry, fasting lipid profile, oral glucose tolerance test, and magnetic resonance imaging of abdominal fat were done. High waist circumference was defined as > or = 90(th) percentile for age and sex. Statistical analyses were done to examine the relationship between waist circumference and the different cardiovascular risk factors. RESULTS Those with a high waist circumference had significantly lower high-density lipoprotein, higher triglycerides, fasting insulin, insulin response to glucose, subcutaneous and visceral abdominal fat than those with a normal waist circumference. Children with a high waist circumference were 3.6 times more likely than those with a normal waist status to have a low high-density lipoprotein level, 3.0 times more likely to have high triglycerides, and 3.7 times more likely to have a high fasting insulin level. CONCLUSIONS Obese children with waist circumference at or above the 90th percentile are at higher risk for dyslipidemia and insulin resistance than obese children with normal waist circumference. These results indicate that routine waist circumference evaluation in obese children may help clinicians identify which obese children are at greater risk of diabetes and other cardiovascular disease.

Relations of body fatness and cardiovascular fitness to lipid profile in black and white adolescents.

High body fatness is associated with unfavorable cardiovascular disease risk profiles in juveniles. However, the degree to which the deleterious effects attributed to fatness may actually be due to the low cardiovascular fitness (CVF) that is usually confounded with fatness is not known. This study determined in 14- to 18-y-old (n = 398) youths the degree to which percentage body fat (%BF) and CVF explained variability in lipids and lipoproteins. Blood samples were taken after a 12-h fast. %BF was measured with dual-energy x-ray absorptiometry. CVF was determined with a multistage treadmill test. The degree to which %BF and CVF explained variance in outcome variables was determined by regression analyses, controlling for demographic variables before entering %BF or CVF and their interactions with race and sex. Because %BF and CVF were highly correlated (r = –0.69, p < 0.001), they were first entered separately in the regression models before being considered together. Both higher %BF and lower CVF were associated with unfavorable concentrations of total cholesterol to HDLC ratio and triglycerides. However, the effects of %BF and CVF were not additive; once %BF was in the regression model, CVF did not explain additional variance. For Lp(a), only %BF explained a significant portion of the variance. For triglycerides, there was a %BF by race interaction, such that the deleterious effects of high %BF were greater in whites than in blacks. These results suggest that interventions to improve lipid profile in youths should be designed primarily to minimize fatness.

Interstitial pulmonary edema in children and adolescents with diabetic ketoacidosis

The acute complications of diabetic ketoacidosis in children and adolescents are well recognized but not completely understood. Clinical studies have focused primarily on brain edema. We have investigated the prevalence and course of interstitial pulmonary edema in patients with severe diabetic ketoacidosis all of whom had uneventful clinical courses. High resolution computed tomography scans of the lungs were analyzed by determining the Hounsfield attenuation level and then converting to physical density values. All seven patients had evidence of interstitial pulmonary edema on the first scan, which was performed within 1 h of hydration and prior to receiving insulin; six of the seven patients had increased pulmonary density 6-8 h into treatment, and all had complete resolution of the interstitial changes at discharge. Our study suggests that subclinical interstitial pulmonary edema may be a frequent occurrence in children and adolescents with severe diabetic ketoacidosis and may very well be present prior to treatment. The study also supports the philosophy of cautious rehydration and the close monitoring of children and adolescents with diabetic ketoacidosis until a more complete understanding of this pathophysiologic event is achieved.

Hyperlipidemia, insulin-dependent diabetes mellitus, and rapidly progressive diabetic retinopathy and nephropathy in Prader-Willi syndrome with del(15)(q11.2q13)

We report on a white man with Prader-Willi syndrome (PWS) and del(15)(q11.2q13), confirmed by fluorescence in situ hybridization (FISH), who had hyperlipidemia, insulin-dependent diabetes, and the early onset and rapid progression of diabetic retinopathy and nephropathy within 4 years after diagnosis of diabetes. The spectrum of glucose intolerance in patients with PWS is discussed, as well as those references which suggest that the prevalence of hyperlipoproteinemia in this condition may be greater than previously recognized. We suggest the need for clarification of both the prevalence and types of hyperlipoproteinemia, as well as the pathophysiology of glucose intolerance and correlation with molecular cytogenetic findings. We also encourage careful monitoring for diabetic complications to further clarify the prevalence and possible accelerated course of microvascular lesions.

Exercise dose and diabetes risk in overweight and obese children: A randomized control trial

Exercise has been prescribed for diabetes treatment since at least 600 B.C. The early East Indian text, the Shushruta, described a reduction in the sweetness of urine from diabetic patients after exercise. One might think that very little could be left to discover in the field of exercise and diabetes, yet surprisingly this is far from the truth. Ongoing research is refining the exercise prescription for patients of all ages, with the main types of diabetes (gestational, type 1, and type 2) and discovering new ways in which exercise has benefits. Alterations in metabolism caused by diabetes and new types of exercise modalities are also actively being researched. A search of several hundred articles on exercise published between July 1, 2012, to June 30, 2013, uncovered the following 9 articles we felt had the most relevance to patients with diabetes or prediabetes.