Children with obesity and T1DM have a similar degree of vascular dysfunction. BMI and weight adjusted for age and sex relate to endothelial and smooth muscle function in nonobese and obese children. Glucose relates to smooth muscle function in nonobese nondiabetic children. This suggests a continuum effect of BMI and glucose within the normal range on vascular function in childhood.

High-dose folate and vitamin B6 normalized endothelial dysfunction in children with type 1 diabetes. This effect was maintained over 8 weeks, with no additional benefit from combination treatment.

OBJECTIVE -Obese children have severe endothelial dysfunction as measured by flowmediated dilation (FMD). We have shown that folic acid normalizes endothelial function in children with type 1 diabetes who have a similar degree of endothelial dysfunction but lower total plasma homocyst(e)ine (tHcy) and higher folate status. Our aim was to evaluate, for the first time, the effect of folate supplementation on endothelial dysfunction in obese children. RESEARCH DESIGN AND METHODS-A total of 53 obese subjects (26 male, mean Ϯ SD age 13.3 Ϯ 2.2 years, and BMI Z score 2.29 Ϯ 0.25) participated in a randomized, double-blind, placebo-controlled, parallel trial of oral folic acid (5 mg/day) or placebo for 8 weeks. Before and after the intervention, we assessed endothelial function (FMD), smooth muscle function (glyceryl trinitrate-induced dilatation [GTN]), high-sensitivity C-reactive protein (hsCRP), tHcy, serum folate, red cell folate (RCF), and lipids.RESULTS -There were no group differences at baseline. FMD did not change with the intervention (folic acid group pre-and postintervention: 6.42 Ϯ 5.03 and 6.56 Ϯ 4.79%, respectively, vs. placebo group: 5.17 Ϯ 3.54 and 5.79 Ϯ 4.26%, respectively; P ϭ 0.6). Folate supplementation increased serum folate and RCF by 18.4 nmol/l (P Ͻ 0.001) and 240.1 nmol/l (P Ͻ 0.001), respectively, and decreased tHcy by 0.95 mol/l (P ϭ 0.008). The intervention did not change GTN, hsCRP, or lipids.CONCLUSIONS -Folic acid supplementation does not improve endothelial function in obese children without diabetes despite increasing folate status and reducing tHcy. This is in contrast to the response to folate in children with type 1 diabetes. Diabetes Care 30:2122-2127, 2007E ndothelium is a key regulator of vascular function. Endothelial dysfunction is an early and fundamental event in the development of atherosclerosis (1). Abnormal endothelial function can be measured by ultrasound, assessing artery responses to an increase in flowmediated dilatation (FMD) and to glyceryl trinitrate-induced dilatation (GTN).Abnormal FMD correlates with abnormal coronary angiography in adults (2).Childhood obesity is an independent risk factor for adult obesity and is associated with atherosclerosis independent of adult weight (3). Obese children have severe endothelial dysfunction (4,5). We have shown that endothelial dysfunction in obese children is comparable in severity with that in children with type 1 diabetes (5). Interventions that begin early in life to improve endothelial function in obese children, in addition to metabolic and weight control, may potentially prevent atherosclerosis.BMI, waist circumference, dyslipidemia, insulin resistance, and markers of the proinflammatory state such as highsensitivity C-reactive protein (hsCRP) and increased total plasma homocyst(e)ine (tHcy) contribute to endothelial dysfunction in obesity (4,5).Folic acid improves endothelial function in adults and children with upperquartile tHcy (6 -8) and improves endothelial dysfunction in adults independently of lowering homo...

Background:  Atherosclerosis is an inflammatory process, and high‐sensitivity C‐reactive protein (Hs‐CRP), a marker of inflammation, predicts cardiovascular events in adults. Vascular endothelial and smooth muscle dysfunction, measurable precursors of atherosclerosis, begin in childhood. Therefore, we sought to determine if Hs‐CRP is associated with vascular endothelial and smooth muscle dysfunction in children with type 1 diabetes mellitus (T1DM) and healthy control subjects. Methods:  Hs‐CRP and endothelial function assessed by flow‐mediated dilatation (FMD) and smooth muscle function assessed by glyceryl‐trinitrate (GTN)‐induced dilatation were measured in 121 subjects with T1DM aged 14.1 (2.9) yr, of whom 31 were also studied at 4 and 8 wk, and in 33 healthy controls aged 14.2 (3.6) yr. Results:  Hs‐CRP did not differ between subjects with T1DM and healthy, age‐matched controls. In both controls and subjects with T1DM, Hs‐CRP did not relate to FMD or GTN at baseline or at intervals over 8 wk in T1DM. Hs‐CRP did not change over time. In T1DM, but not healthy controls, Hs‐CRP related to body mass index (BMI) z‐score (r = 0.47, p < 0.001), weight z‐score (r = 0.41, p < 0.001), and female sex (p = 0.008). Conclusions:  Hs‐CRP is not associated with early vascular dysfunction in children with T1DM. However, in children and adolescents with T1DM, Hs‐CRP was associated with female sex and children with higher BMI, suggesting that these groups may be at greater cardiovascular risk. Maintenance of a healthy BMI may be important in the prevention of vascular disease of T1DM.

We report a 9-year-old boy who had swallowed a small dressmaker's pin during an art & craft class. Confirmation of ingestion of the pin and its passage through the gut was achieved with abdominal radiography. When the pin had not passed after 8 days, and with increasing concern about the likelihood of perforation, US was used to locate its exact position to allow surgical removal. This case report illustrates the unique use of US to reveal the intraappendiceal location of an ingested foreign body, facilitating its surgical removal.