Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children

Calcaterra, Valeria; Bosoni, Pietro; Dilillo, Dario; Mannarino, Savina; Fiori, Laura M.; Fabiano, Valentina; Carlucci, Paolo; Profio, Elisabetta Di; Verduci, Elvira; Mameli, Chiara; Pelizzo, Glória; Zoia, Elena; Sacchi, Lucia; Larizza, Cristiana; Zuccotti, Gian Vincenzo

doi:10.3390/children8050384

Cited by 8 publications

(7 citation statements)

References 40 publications

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“…In line with previously published results [19,49], clinical and biochemical parameters in the observed subjects support the diagnosis of MIS-C. They have had COVID-19 infection, and present multiorgan system failure, with persistently elevated levels of ferritin, CRP, fibrinogen, IL-6, procalcitonin, and increased ESR, all typical markers of an ongoing inflammatory condition.…”

Section: Discussionsupporting

confidence: 90%

“…The presence of glucose metabolism alterations also observed in this sample of children with MIS-C, such as elevated TyG index, suggests that a bidirectional relationship between COVID-19 and glycemic impairment could not be excluded. Indeed, hyperglycemia and glycemic fluctuations could be caused by the inflammatory cascade triggered by SARS-CoV-2 in the pancreas, and the potentially impaired β-cell function associated with the SARS-CoV-2 entry through the ACE2 receptor [49].…”

Section: Discussionmentioning

confidence: 99%

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Blood Fatty Acids Profile in MIS-C Children

et al. 2021

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MIS-C (multisystem inflammatory syndrome in children) linked to SARS-CoV-2 infection, is a pathological state observed in subjects younger than 21 years old with evidence of either current SARS-CoV-2 infection or exposure within the 4 weeks prior to the onset of symptoms, the presence of documented fever, elevated markers of inflammation, at least two signs of multisystem involvement, and, finally, lack of an alternative diagnosis. They share with adult COVID-19 patients the presence of altered markers of inflammation, but unlike most adults the symptoms are not pulmonary but are affecting several organs. Lipid mediators arising from polyunsaturated fatty acids (PUFA) play an important role in the inflammatory response, with arachidonic acid-derived compounds, such as prostaglandins and leukotrienes, mainly pro-inflammatory and ω3 PUFA metabolites such as resolvins and protectins, showing anti-inflammatory and pro-resolution activities. In order to assess potential alterations of these FA, we evaluated the blood fatty acid profile of MIS-C children at admission to the hospital, together with biochemical, metabolic and clinical assessment. All the patients enrolled showed altered inflammatory parameters with fibrinogen, D-dimer, NT-proBNP, ferritin, aspartate aminotransferase (AST), C-reactive protein (CRP) and TrygIndex levels over the reference values in all the subjects under observation, while albumin and HDL-cholesterol resulted below the normal range. Interestingly, linoleic acid (LA), arachidonic acid (AA) and the ω3 PUFA docosahexaenoic acid (DHA) results were lower in our study when compared to relative amounts reported in the other studies, including from our own laboratory. This significant alteration is pointing out to a potential depletion of these PUFA as a result of the systemic inflammatory condition typical of these patients, suggesting that LA- and AA-derived metabolites may play a critical role in this pathological state, while ω3 PUFA-derived pro-resolution metabolites in these subjects may not be able to provide a timely, physiological counterbalance to the formation of pro-inflammatory lipid mediators. In conclusion, this observational study provides evidence of FA alterations in MIS-C children, suggesting a significant contribution of ω6 FA to the observed inflammatory state, and supporting a potential dietary intervention to restore an appropriate balance among the FAs capable of promoting the resolution of the observed inflammatory condition.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Blood Fatty Acids Profile in MIS-C Children

et al. 2021

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“…Only two of the 30 patients in their report received insulin infusion. 17 In our study, 27 of the 43 patients (62.8%) with normal BMI had developed hyperglycemia. The rate of patients who required insulin infusion ( n = 10/16) was also higher in our study.…”

Section: Resultsmentioning

confidence: 45%

“…Anakinra was used in 48 patients as a biological agent. Twenty-seven of 61 patients received positive inotropes with a median VIS of 14.75 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Thirteen had respiratory support (noninvasive ¼ 7, invasive mechanical ventilation ¼ 6).…”

Section: Resultsmentioning

confidence: 99%

Incidence and Risk Factors of Hyperglycemia in Severe Multisystem Inflammatory Syndrome in Children: A Retrospective Case-Control Study

Nakip

Kesici

Bozkurt

et al. 2022

J Pediatr Infect Dis

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Objective Multisystem inflammatory syndrome in children (MIS-C) patients might be at risk for hyperglycemia and associated complications. Herein, we aimed to determine the incidence of hyperglycemia, understanding the underlying risk factors in MIS-C patients. Methods All MIS-C patients were retrospectively evaluated and compared according to the presence of hyperglycemia and the need of insulin. Inflammatory markers and body mass index Z-scores were also compared. Results The median age of the patients with hyperglycemia was higher than those without (p = 0.001). Disease severity scores of patients with hyperglycemia were higher. Procalcitonin levels of patients with hyperglycemia were higher, while ferritin, CRP, and interleukin-6 levels were not. BMIs of patients with hyperglycemia were higher (p = 0.01) but BMI Z-scores were similar (p = 0.055). There was a positive correlation between BMIs and CRP (r: 0.31, p = 0.015). There was a positive correlation between procalcitonin (r: 0.431, p = 0.001) and CRP (r: 0.279, p = 0.029) and maximum PG. Conclusion Hyperglycemia is a common feature of MIS-C patients and is associated with the severity of the inflammation. As a novel finding, high CRP and procalcitonin should be considered as predictive markers for impaired glucose homeostasis in MIS-C patients.

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“…However, these findings may have important implications for children and adolescents with obesity, as they are more vulnerable to the changes caused by the COVID-19 pandemic. 5 34 …”

Section: Discussionmentioning

confidence: 99%

Sedentary Time and Fast-Food Consumption Associated With Weight Gain During COVID-19 Lockdown in Children and Adolescents With Overweight or Obesity

et al. 2022

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Background The coronavirus disease pandemic is predicted to have adverse health effects on children and adolescents who are overweight or obese due to restricted school activity and stay-at-home orders. The purpose of this observational study was to determine the factors associated with weight gain in children and adolescents with overweight and obesity during coronavirus disease 2019 (COVID-19) lockdown. Methods Ninety-seven participants (sex- and age-specific body mass index (BMI) ≥ 85th percentile) were included. A baseline examination was conducted pre-COVID-19 (August 2019 to January 2020), and re-examination was performed post-lockdown (June to September 2020) and the results were compared. Correlation and regression analyses were conducted to investigate the association among changes in cardiometabolic markers and lifestyle behaviors with changes in BMI z-score. Results During the COVID-19 pandemic, an increase in BMI z-score (2.56 [2.01–2.94] to 2.62 [2.03–3.18]) was noticed in children and adolescents with obesity. Changes in cardiometabolic markers including liver enzymes, triglycerides ( r = 0.398), leptin ( r = 0.578), and adiponectin ( r = −0.326), as well as muscular strength ( r = −0.212), were correlated with the increase in BMI z-score. According to a multivariate regression analysis, changes in sedentary time (B = 0.016; 95% confidence interval [CI], 0.001–0.032) and fast-food consumption (B = 0.067; 95% CI, 0.013–0.122) were the lifestyle variables associated with BMI z-score increase. Conclusion Changes in lifestyle behaviors including fast-food consumption and sedentary time during the COVID-19 pandemic may be associated with weight gain. In order to prevent health-related risks in children and adolescents with obesity during the pandemic, it is important to maintain the level of physical activity and healthy dietary habits.

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Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children

Cited by 8 publications

References 40 publications

Blood Fatty Acids Profile in MIS-C Children

Blood Fatty Acids Profile in MIS-C Children

Incidence and Risk Factors of Hyperglycemia in Severe Multisystem Inflammatory Syndrome in Children: A Retrospective Case-Control Study

Sedentary Time and Fast-Food Consumption Associated With Weight Gain During COVID-19 Lockdown in Children and Adolescents With Overweight or Obesity

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