Sibel Tulgar Kinik

Effect of obesity on inflammatory markers and renal functions

AIM To examine the relationship between inflammation criteria and body mass index in otherwise-healthy obese schoolchildren and to evaluate the effect of obesity on renal functions. METHODS Sixty-five otherwise-healthy obese children (median age 10.8 y, range 7.1-16.5 y; median body mass index 26.8 kg/m(2), range 19.9-38.7 kg/m(2)) and 20 healthy controls (median age 12.4 y, range 10.1-17.1 y; median body mass index 18.8 kg/m(2), range 17.3-23.1 kg/m(2)) were included. Blood and urine samples were taken from every child. RESULTS Children in the obese and control groups had similar age and sex distributions (p>0.05). Inflammatory mediators were higher in obese children (p<0.05). A significant positive correlation was found between glomerular filtration rate and body mass index in the whole study group (r=0.39, p=0.001). A positive correlation was found between body mass index standard deviation and inflammatory mediators and glomerular filtration rate. No significant difference existed regarding protein and microalbumin excretion in the urine. CONCLUSION Inflammatory mediators increased significantly in obese children, and the glomerular filtration rate increased as the body mass index increased. To prevent obesity-related complications in adulthood, it is important to take measures to prevent development of obesity during childhood.

PAI-1 gene 4G/5G polymorphism, cytokine levels and their relations with metabolic parameters in obese children

Obesity is associated with the changes of plasminogen activator inhibitor-1 (PAI-1), tumor necrosis factor-alpha (TNFalpha) and transforming growth factor beta (TGFbeta) levels. However, the precise effect of the 4G allele on obesity is still contradictory. Here, we aimed to elucidate the role of the 4G/5G polymorphism of the PAI-1 gene on the PAI-1 level and determine the associations between cytokines, glucose and lipid metabolism parameters in obese children. Thirty-nine obese children (mean age 11.4 +/- 3.3 years) and 38 age-matched healthy control group (mean age 10.3 +/- 3.5 years) were included in the study. In all cases, serum levels of glucose, lipid and insulin were measured, homeostasis model assessment of insulin resistance (HOMA-IR) was calculated, and 4G/5G polymorphism of PAI-1 gene, plasma PAI-1 level and serum TNFalpha and TGFbeta levels were studied. The mean relative body mass index (BMI) and HOMA-IR score, VLDL, TG, insulin, PAI-1, TNFalpha levels were higher, and HDL and TGFbeta levels were lower in the obese group. The frequency of the 4G/4G genotype was considerably higher in obese children than in controls. Also, a positive correlation was found between PAI-1 and TNFalpha levels, and relative BMI, HOMA-IR score, insulin, TG, HDL levels. TGFbeta was inversely correlated only with relative BMI. There was no correlation among three cytokines. In conclusion, childhood obesity contributes to higher PAI-1 and TNFalpha and lower TGFbeta levels. Especially PAI-1 and TNFalpha accompany insulin resistance and dyslipidemia.

The effect of obesity on echocardiographic and metabolic parameters in childhood.

BACKGROUND Obese children are predisposed to left ventricular (LV) hypertrophy and cardiac dysfunction. We evaluated ventricular function of obese children with conventional echocardiography and tissue Doppler imaging (TDI) and correlated these with fasting serum glucose, lipid and insulin levels. METHODS Thirty obese children were examined by conventional echocardiography and TDI and compared with an age-matched control group. In the obese children, fasting serum glucose, lipid, and insulin levels were obtained. RESULTS Systolic and diastolic function of the LV was normal in obese children. LVM/ht2.7 (LVM normalized for height), relative wall thickness (RWT), and LV end-diastolic diameter were significantly greater in obese children. The early to late relaxation velocity ratio (E/A) determined by TDI for the right ventricle and interventricular septum (IVS) were significantly lower in the obese group, LVM/ht2.7 and RWT correlated with body mass index (BMI). In the obese group, IVS and LV posterior wall thickness correlated with insulin, very low density lipoprotein, and triglyceride levels. However, we failed to show this correlation when these measurements were indexed to height. CONCLUSION Left ventricular hypertrophy, as evidenced by increased LV mass, was present in obese children. Higher BMI, insulin, very low density lipoprotein, and triglyceride levels were associated with LV hypertrophy. TDI revealed subclinical changes in diastolic function of the right ventricle and IVS.

Type I diabetes mellitus, Hashimoto's thyroiditis and celiac disease in an adolescent with Down syndrome.

The prevalence of autoimmune diseases such as autoimmune thyroiditis, type I diabetes mellitus (DM), and celiac disease (CD) is higher in patients with Down syndrome (DS, or trisomy 21) than in the general population. 1,2 However, there are only a few published reports of coexistent autoimmune thyroid disease, type I DM and CD in a DS patient. 3 Here we describe the case of an adolescent boy with DS who was diagnosed with Hashimoto’s thyroiditis, type I DM and CD.

Non-Invasive Management of Fetal Goiter during Maternal Treatment of Hyperthyroidism in Grave’s Disease

There is an increased risk of fetal goiter in patients who have a history of Grave’s disease and undergo propylthiouracil (PTU) treatment during pregnancy. In this report, we describe a case of a fetal goiter detected by antenatal ultrasound at the 26th week of gestation in a mother treated with PTU for Grave’s disease. A 32 × 38 × 20 mm fetal goiter was detected, each lobe measured 30 × 18 × 18 mm and estimated volume was 10 cm3. Subsequently, fetal thyroid function was assessed by umbilical fetal blood sampling. Cord blood showed elevated serum TSH (40.2 mU/l) and normal concentrations of free T4 (9.5 pmol/l) and free T3 (2.6 pmol/l). There were no other ultrasonographic signs of fetal hypothyroidism. Based on the above findings, the mother’s PTU dosage was reduced to 50 mg daily from a total of 150 mg and weekly ultrasonographic examinations were performed. Six weeks after the initial ultrasound, a complete regression of the fetal goiter was noted. At the 34th week of gestation, the patient was delivered due to intrauterine growth restriction and oligohydramnios and gave birth to a male, weighing 1,920 g. The newborn thyroid was not palpable and thyroid ultrasonography was normal. Cord blood TSH was normal (8.4 mU/l) and free T4 was within lower normal limit (9.03 pmol/l). Ten days later, newborn thyroid function was normal and the baby did well afterwards. In conclusion, after the evaluation of fetal thyroid status, selected cases with fetal goiter can be initially managed without intrauterine treatment.

The effect of corrective surgery on serum IGF-1, IGFBP-3 levels and growth in children with congenital heart disease.

Abstract The aim of this study is to evaluate growth and insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) levels in infants with congenital heart disease (CHD) pre- and postoperatively over a period of a year. Anthropometric values and serum levels of IGF-1 and IGFBP-3 of 40 infants with CHD (20 cyanotic and 20 acyanotic) were compared with 32 healthy controls. Acyanotic infants and infants with pulmonary hypertension (PH) presented significantly more growth failure. Preoperatively, serum IGF-1 and IGFBP-3 levels were lower in the acyanotic group than the cyanotic and the control groups (p=0.22; p<0.01). The upward trend in IGF-1 and IGFBP-3 levels in this year-long study demonstrated that the values in the third month and the first year were higher than the preoperative values (p<0.05). The parallel increase of weight gain and IGF-1, IGFBP-3 levels were the best evidence that these parameters are good nutritional indicators. Timing the corrective surgery before chronic malnutrition or PH develops is an important issue to maintain a normal growth for children with CHD.

The effects of metabolic control on oxidized low-density lipoprotein antibodies in children and adolescents with type 1 diabetes mellitus.

Objective:  To assess the oxidized low‐density lipoprotein (oxLDL) antibody status in childhood type 1 diabetes mellitus (T1DM) and to investigate the effect of metabolic control on the oxLDL antibodies.

Correlations among serum leptin levels, complete blood count parameters and peripheral CD34(+) cell count in prepubertal obese children

Leptin is a hormone produced by adipocytes that helps reduce body weight by depressing appetite and increasing metabolic activity. Leptin also promotes early hematopoiesis. The main aim of this study was to compare complete blood count (CBC) parameters and peripheral blood CD34(+) cell counts in prepubertal obese and nonobese children. Relationships between leptin levels and CBC parameters and peripheral CD34(+) progenitor cell counts in the obese group were also investigated. Thirty one healthy, prepubertal, obese children and 30 nonobese, age-matched prepubertal controls were included in the study. A fasting blood sample was collected from each subject, and CBC findings, serum leptin level, and peripheral blood CD34(+) progenitor cell count were recorded. In the obese group, the mean results for body mass index (BMI), BMI standard deviation score (BMI SDS), and serum leptin level were significantly higher than the corresponding control findings. There were no significant differences between the groups with respect to CBC parameters and CD34(+) cell percentage. In both the obese and control groups, the girls’ serum leptin levels were significantly higher than the boys’. In the obese group, serum leptin level was strongly correlated with BMI and with BMI SDS (Pearson correlation coefficients r=0.70, p<0.001, and r=0.59, p<0.001, respectively) in both girls and boys. None of the CBC parameters nor CD34(+) progenitor cell percentage was correlated with leptin, BMI, or BMI SDS. The results indicate that serum leptin levels in obese children are positively correlated with BMI. However, in contrast to adults, high leptin level in childhood obesity does not seem to be associated with altered CBC parameters or increased peripheral CD34(+) progenitor cell count.

The effect of plasminogen activator inhibitor-1 gene 4G/5G polymorphism on glucose and lipid metabolisms in Turkish obese children

Objective Obesity is a metabolic disorder that is associated with increased plasminogen activator inhibitor‐1 (PAI‐1) concentration in the circulation. This increase is related to insulin resistance, dyslipidaemia and cardiovascular disease. Some studies have demonstrated a relationship between plasma PAI‐1 concentrations and the 4G/5G gene polymorphism in the PAI‐1 gene, while other studies have not. It is well known that plasma PAI‐1 levels are increased in obesity; however, the relationship between the polymorphism and obesity remains unclear. In this study, we aimed to elucidate the effect of the PAI‐1 4G/5G polymorphism on glucose and lipid metabolism parameters in Turkish obese children.

AMH levels at central precocious puberty and premature thelarche: is it a parameter?

Abstract Background: The possible difference of antimüllerian hormone (AMH) levels at central precocious puberty (CPP) and premature thelarche (PT) has not been properly evaluated. Objective/hypothesis: By evaluating AMH levels in girls with diagnosed CPP and PT, we aim to show the change of AMH levels at the pubertal onset. Subjects: Sixty-five girls who have breast development before the age of 8 years and 25 healthy girls were enrolled in the study. Methods: The subjects were divided into two groups as CPP and PT, according to results of GnRH test. AMH levels were determined in the two groups. Results: The mean AMH levels of the CPP group were significantly lower than those in the PT group (13.57±9.85 pmol/L and 58.42±12.78 pmol/L, respectively, p=0.022). Conclusion: These results suggest that the AMH levels decrease in the duration of the hypothalamus-pituitary-ovarian axis activation. We thought that AMH might/may be a marker for distinguishing between CPP and PT.