OBJECTIVE -To validate fasting indices of insulin sensitivity and secretion in a diverse pediatric population against gold standard estimates from euglycemic and hyperglycemic clamps. RESEARCH DESIGN AND METHODS-A total of 31 children (mean BMI 25.1 Ϯ 4.9 kg/m 2 , mean age 8.7 Ϯ 1.4 years, 15 girls and 16 boys, 12 black and 19 white) underwent euglycemic and hyperglycemic clamps 2-6 weeks apart to derive insulin sensitivity indices (SI Eug clamp and SI Hyper clamp ). Fasting samples were used to derive the homeostasis model assessment of insulin resistance index (HOMA-IR), HOMA of percent -cell function (HOMA-B%), quantitative insulin sensitivity check index (QUICKI), insulinogenic index, antilipolytic insulin sensitivity index (ISI-FFA), and C-peptide-to-insulin ratio.RESULTS -The QUICKI correlated best with SI Eug clamp (r ϭ 0.69, P Ͻ 0.05) and had greater correlations to SI Eug clamp than did either SI Hyper clamp (r ϭ 0.45, P Ͻ 0.05) or the HOMA-IR (r ϭ Ϫ0.51, P Ͻ 0.05). Both fasting insulin and the insulinogenic index correlated well with first-and steady-phase insulin secretion (r's from 0.79 to 0.86, P Ͻ 0.05). HOMA-B% was not as highly correlated (r ϭ 0.69 -0.72, P Ͻ 0.05). Fasting C-peptide-to-insulin ratio was not significantly correlated with clamp-derived metabolic clearance rate of insulin. ISI-FFA was not correlated with the degree of free fatty acid suppression obtained from the clamps.CONCLUSIONS -The QUICKI, fasting insulin, and the insulinogenic index all closely correlate with corresponding clamp-derived indices of insulin sensitivity and secretion in this diverse pediatric cohort. These results, if replicated in similarly diverse populations, suggest that estimates based on fasting samples can be used to rank order insulin secretion and sensitivity in pediatric cohorts. Diabetes Care 25:2081-2087, 2002O besity and type 2 diabetes are diseases that have assumed considerable public health importance in the 21st century in both developed and developing countries (1-3). The increased prevalence of both these conditions in children adds an added dimension of seriousness to these modern day epidemics (4). Since insulin resistance appears central to the development of the metabolic syndrome X (1,5), accurate quantification of insulin's in vivo action, secretion, and disposal is necessary. While a combination of hyperglycemic and euglycemic-hyperinsulinemic clamp studies supplies the gold standard for quantifying these parameters (6), clamp studies are expensive and difficult tests to perform and require highly trained personnel. The difficulties with obtaining sequential clamp studies are even more pronounced for young children who may have more difficulty with clamp procedure requirements.For the purpose of epidemiologic studies, several indices based on fasting blood that estimate insulin sensitivity, secretion, and disposal have been developed for adults. The homeostasis model assessment of insulin resistance index (HOMA-IR), the HOMA of percent -cell function (HOMA-B%), the insulinogenic index...
Objective Early presentation and prompt diagnosis of acute appendicitis are necessary to prevent progression of disease leading to complicated appendicitis. We hypothesize that patients had a delayed presentation of acute appendicitis during the COVID-19 pandemic, which affected severity of disease on presentation and outcomes. Patients and methods We conducted a retrospective review of all patients who were treated for acute appendicitis at Morgan Stanley Children's Hospital (MSCH) between March 1, 2020 and May 31, 2020 when the COVID-19 pandemic was at its peak in New York City (NYC). For comparison, we reviewed patients treated from March 1, 2019 to May 31, 2019, prior to the pandemic. Demographics and baseline patient characteristics were analyzed for potential confounding variables. Outcomes were collected and grouped into those quantifying severity of illness on presentation to our ED, type of treatment, and associated post-treatment outcomes. Fisher's Exact Test and Kruskal-Wallis Test were used for univariate analysis while cox regression with calculation of hazard ratios was used for multivariate analysis. Results A total of 89 patients were included in this study, 41 patients were treated for appendicitis from March 1 to May 31 of 2019 (non-pandemic) and 48 were treated during the same time period in 2020 (pandemic). Duration of symptoms prior to presentation to the ED was significantly longer in patients treated in 2020, with a median of 2 days compared to 1 day (p = 0.003). Additionally, these patients were more likely to present with reported fever (52.1% vs 24.4%, p = 0.009) and had a higher heart rate on presentation with a median of 101 beats per minute (bpm) compared to 91 bpm (p = 0.040). Findings of complicated appendicitis on radiographic imaging including suspicion of perforation (41.7% vs 9.8%, p < 0.001) and intra-abdominal abscess (27.1% vs 7.3%, p = 0.025) were higher in patients presenting in 2020. Patients treated during the pandemic had higher rates of non-operative treatment (25.0% vs 7.3%, p = 0.044) requiring increased antibiotic use and image-guided percutaneous drain placement. They also had longer hospital length of stay by a median of 1 day (p = 0.001) and longer duration until symptom resolution by a median of 1 day (p = 0.004). Type of treatment was not a predictor of LOS (HR = 0.565, 95% CI = 0.357–0.894, p = 0.015) or duration until symptom resolution (HR = 0.630, 95% CI = 0.405–0.979, p = 0.040). Conclusion Patients treated for acute appendicitis at our children's hospital during the peak of the COVID-19 pandemic presented with more severe disease and experienced suboptimal outcomes compared to those who presented during the same time period in 2019. Level of Evidence III
According to adolescent and parent reports, overweight is associated with poorer QOL in adolescence, regardless of race; however, compared with overweight white adolescents, blacks report less impairment in QOL. Future research is required to determine whether differences in QOL are predictive of treatment success.
MCDUFFIE, JENNIFER R., KARIM A. CALIS, GABRIEL I. UWAIFO, NANCY G. SEBRING, ERICA M. FALLON, VAN S. HUBBARD, AND JACK A. YANOVSKI. Three-month tolerability of orlistat in adolescents with obesity-related comorbid conditions. Obes Res. 2002;10:642-650. Objective: To study the safety, tolerability, and potential efficacy of orlistat in adolescents with obesity and its comorbid conditions. Research Methods and Procedures: We studied 20 adolescents (age, 14.6 Ϯ 2.0 years; body mass index, 44.1 Ϯ 12.6 kg/m 2 ). Subjects were evaluated before and after taking orlistat (120 mg three times daily) and a multivitamin for 3 months. Subjects were simultaneously enrolled in a 12-week program emphasizing diet, exercise, and strategies for behavior change. Results: Participants who completed treatment (85%) reported taking 80% of prescribed medication. Adverse effects were generally mild, limited to gastrointestinal effects observed in adults, and decreased with time. Three subjects required additional vitamin D supplementation despite the prescription of a daily multivitamin containing vitamin D. Weight decreased significantly (Ϫ4.4 Ϯ 4.6 kg, p Ͻ 0.001; Ϫ3.8 Ϯ 4.1% of initial weight), as did body mass index (Ϫ1.9 Ϯ 2.5 kg/m 2 ; p Ͻ 0.0002). Total cholesterol (Ϫ21.3 Ϯ 24.7 mg/dL; p Ͻ 0.001), low-density lipoproteincholesterol (Ϫ17.3 Ϯ 15.8 mg/dL; p Ͻ 0.0001), fasting insulin (Ϫ13.7 Ϯ 19.0 U/mL; p Ͻ 0.02), and fasting glucose (Ϫ15.4 Ϯ 7.4 mg/dL; p Ͻ 0.003) were also significantly lower after orlistat. Insulin sensitivity, assessed by a frequently sampled intravenous glucose-tolerance test, improved significantly (p Ͻ 0.02). Discussion: We conclude that, in adolescents, short-term treatment with orlistat, in the context of a behavioral program, is well-tolerated and has a side-effect profile similar to that observed in adults, but its true benefit versus conventional therapy remains to be determined in placebocontrolled trials.
FIELD, ALISON E., NAN LAIRD, EMILY STEINBERG, ERICA FALLON, MARIAMA SEMEGA-JANNEH, AND JACK A. YANOVSKI. Which metric of relative weight best captures body fatness in children? Obes Res. 2003;11: 1345-1352. Objective: To evaluate the relative merits of BMI (kilograms per meter squared) and age-and gender-adjusted BMI, age-and gender-specific z score of BMI, and age-and gender-specific percentiles of BMI as surrogate measures of body fatness among a sample of youth. Research Methods and Procedures:The sample comprised 596 children and adolescents 5 to 18.7 years old and was 40% male and 55% white. Height and weight were measured by trained research staff. DXA was used to determine body fat mass. BMI, age-and gender-specific percentile of BMI, and age-and gender-specific z scores of BMI were computed, and these metrics were compared with measured body fatness. Results:The BMI values in the sample ranged from 12.9 to 55.0 kg/m 2 , with a mean of 24.9 kg/m 2 . The Spearman correlations with percentage body fat were similar for all of the BMI metrics (r ϭ 0.82 to 0.88). Linear regression models with age-and gender-specific percentiles of BMI explained significantly less of the variance (65%) than models with log-transformed BMI (81%) or age-and gender-specific z scores of BMI (75% to 79%). z scores were the most accurate at classifying children who were overfat (sensitivity ϭ 0.84, specificity ϭ 0.96 for z score Ն1). However, using a BMI Ն85th percentile or a BMI Ն20 kg/m 2 was also accurate at classifying youth. Discussion: The BMI metrics had similar correlations with body fatness, but age-and gender-specific percentiles of BMI were the least accurate proxy measure of body fatness. However, a BMI z score Ն1, BMI percentile Ն85, and BMI Ն20 kg/m 2 are all useful for identifying children who may be overfat.
PNALD remains the most severe complication of long-term parenteral nutrition with an unclear pathophysiology. However, the use of a fish oil-based emulsion appears efficacious and hepatoprotective.
The switch from a SOLE to a FOLE in PN-dependent children with cholestasis and dyslipidemia was associated with a dramatic improvement in serum triglyceride and VLDL concentrations, a significant increase in serum omega-3 (n-3) fatty acids (EPA and DHA), and a decrease in serum omega-6 fatty acids (arachidonic acid). A FOLE may be the preferred lipid emulsion in patients with PN-cholestasis, dyslipidemia, or both. This trial is registered at clinicaltrials.gov as NCT00910104.
Summary Women approaching advanced maternal age have extremely poor outcomes with both natural and assisted fertility. Moreover, the incidence of chromosomal abnormalities and birth defects increases with age. As of yet, there is no effective and practical strategy for delaying ovarian aging or improving oocyte quality. We demonstrate that the lifelong consumption of a diet rich in omega-3 fatty acids prolongs murine reproductive function into advanced maternal age, while a diet rich in omega-6 fatty acids is associated with very poor reproductive success at advanced maternal age. Furthermore, even short-term dietary treatment with a diet rich in omega-3 fatty acids initiated at the time of the normal age-related rapid decline in murine reproductive function is associated with improved oocyte quality, while short-term dietary treatment with omega-6 fatty acids results in very poor oocyte quality. Thus, omega-3 fatty acids may provide an effective and practical avenue for delaying ovarian aging and improving oocyte quality at advanced maternal age.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.