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Maria Puiu

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

EVALUAREA INSULINO-REZISTENTEI LA COPIL: O APRECIERE CRITICA A MODELELOR MINIMALE

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 1, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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EVALUAREA INSULINO-REZISTENTEI LA COPIL: O APRECIERE CRITICA A MODELELOR MINIMALE

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REZUMAT

Obezitatea infantilă a urmat, în ultimele două decenii, un trend ascendent. Rezistenţa la insulină (IR) este esen- ţială pentru fiziopatologia obezităţii. Până în prezent, au fost propuse mai multe metode de evaluare a IR. Ne-am propus evaluarea critică a unora dintre cele mai simple metode folosite pentru determinarea IR la copii şi adolescenţi. Am realizat un studiu retrospectiv al copiilor evaluaţi pentru obezitate în Spitalul Clinic de Urgenţă pentru Copii „Louis Ţurcanu“ Timişoara, pe o perioadă de 10 ani. Populaţia de studiu a fost alcătuită din 342 de copii. Au fost analizate variabilele antropometrice şi metabolice şi au fost evaluaţi următorii indici ai IR: scăderea toleranţei la glucoză (STG), Homeostatic Model of Assessment - IR (HOMA-IR), Homeostatic Model of Assessment- β (HOMA-β), Index cantitativ de verificare a sensibilităţii la insulina (QUICKI), precum şi raportul TG/HDLc. Datele au fost exprimate ca frecvenţă, medie ± deviaţia standard sau media ± intervalul intercuartilic pentru un interval de încredere de 95%. S-a folosit testul t pentru grupuri independente sau testul Mann-Whitney pentru a evalua diferenţele de indici IR, în funcţie de greutate, sex şi dezvoltare pubertară. HOMA-IR a diagnosticat cei mai mulţi copii cu IR, la polul opus am găsit QUICKI. STG a fost rar diagnosticat. Este necesar a se reconsidera modul în care se evaluează metabolismul carbohidraţilor la copii. Dintre posibilităţile existente, HOMA-IR este metoda optimă de evaluare a IR la copii.

Cuvinte cheie: Homeostatic Model of Assessment - IR, test de toleranţă la glucoza orală, Index cantitativ de verificare a sensibilităţii la insulină, rezistenţă la insulină, sensibilitatea la insulină, toleranţă scăzută la glucoză, copii

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EVALUATING INSULIN RESISTANCE IN CHILDREN: A CRITICAL APPRAISAL OF MINIMAL MODELS

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 1, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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ICMJE- Recommendations

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Promoting Global Health

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EVALUATING INSULIN RESISTANCE IN CHILDREN: A CRITICAL APPRAISAL OF MINIMAL MODELS

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ABSTRACT

Childhood obesity has followed, during the last two decades, an ascending trend. Insulin resistance (IR) is central to the pathophysiology of obesity. So far, several methods of assessing IR have been proposed. We aimed to evaluate critically some of the simplest methods used to assess IR in the pediatric population. We studied retrospectively the records of children evaluated for obesity in the “Louis Ţurcanu” Emergency Hospital for Children Timişoara, over a period of 10 years. The study population consisted of 342 children. Anthropometric and metabolic variables were analyzed, and the following indices of IR were assessed: impaired glucose tolerance (IGT), Homeostatic Model of Assesment-IR (HOMA-IR), Homeostatic Model of Assesment- b (HOMA- β), Quantitative Insulin Sensitivity Check Index (QUICKI) as well as the TG/HDLc ratio. Data was expresed as frequencies, means ± standard deviations or median ± interquartile interval for or a 95% confidence interval. The t-test for independent groups or the Mann-Whitney test to assess differences of IR indices across weight, gender and pubertal categories. HOMA-IR diagnosed the most children with IR, at the opposite pole we found QUICKI. IGT was a rare finding. It is necessary to reconsider how we assess the carbohydrate metabolism in children. Of the methods we evaluated, HOMA-IR is the optimal method for assessing IR children.

Keywords: Homeostatic Model, oral glucose tolerance test, Quantitative Insulin Sensitivity Check Index, insulin resistance, insulin sensitivity, impaired glucose tolerance, children.

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INDICELE INTIMA MEDIE CAROTIDIAN LA COPIII OBEZI NASCUTI CU GREUTATE MICA PENTRU VARSTA GESTATIONALA VERSUS CEI NASCUTI CU GREUTATE NORMALA PENTRU VARSTA GESTATIONALA

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 3, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Promoting Global Health

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INDICELE INTIMA MEDIE CAROTIDIAN LA COPIII OBEZI NASCUTI CU GREUTATE MICA PENTRU VARSTA GESTATIONALA VERSUS CEI NASCUTI CU GREUTATE NORMALA PENTRU VARSTA GESTATIONALA

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REZUMAT

Indicele intimă medie carotidian (IMc) este un cunoscut marker subclinic pentru ateroscleroză. Fenomenul de recuperare nutriţională la copiii născuţi mici pentru vârsta gestaţională (SGA) a fost asociat cu obezitate precoce şi cu riscul dezvoltării sindromului metabolic.

Scop. De a determina dacă există o asociere între SGA şi IMc; de a stabili valori prag ale IMc la copiii obezi.

Material şi metodă. Studiul prospectiv a fost derulat pe o perioadă de un an (iulie 2012 – iunie 2013). Au fost analizaţi 122 de pacienţi cu obezitate, 96 de pacienţi născuţi cu greutate normală pentru naştere (AGA) şi 26 de pacienţi născuţi cu greutate mică pentru naştere (SGA). Ambele loturi au fost omogene din punct de vedere al vârstei, sexului şi indicelui de masă corporală (IMC). Folosind curba ROC au fost stabilite valori prag pentru ambele grupe. IMc a fost semnificativ mai crescut la lotul SGA (p = 0,0035). Valoarea prag de 0,049 cm pentru IMc a fost obţinută la ambele loturi, cumulat, cu o specificitate şi sensibilitate crescută.

Concluzii. Copiii născuţi SGA se asociază cu risc aterosclerotic. IMc este un cunoscut marker subclinic pentru ateroscleroză, fiind o metodă ieftină şi noninvazivă. Studii populaţionale extinse sunt necesare în vederea stabilirii unor valori prag în ceea ce priveşte IMc.

Cuvinte cheie: obezitate, mic pentru vârsta gestaţională, indicele intimă medie carotidian

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COMMON CAROTID INTIMA MEDIA THICKNESS IN OBESE CHILDREN BORN SMALL FOR GESTATIONAL AGE VERSUS APPROPRIATE FOR GESTATIONAL AGE

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 3, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

Indexed

DOI - Crossref
Similarity Check by iThenticate, worldwide No 1 professional plagiarism checking system
DOAJ
NLM Catalog
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Google Academic
Semantic Scholar

HIGHLIGHTS

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

COMMON CAROTID INTIMA MEDIA THICKNESS IN OBESE CHILDREN BORN SMALL FOR GESTATIONAL AGE VERSUS APPROPRIATE FOR GESTATIONAL AGE

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ABSTRACT

The intima media thickness of the common carotid artery (CIMT) is a well-known marker of subclinical atherosclerosis. The “catch-up growth” phenomenon in children born small for gestational age (SGA) has been linked to early onset obesity with the subsequent emergence of metabolic syndrome (MetS). Aim: to determine the association between being born SGA and CIMT, a measure of atherogenesis and to establish cut off values for CIMT in obese children.

Material and methods. A prospective study was carried out over a 1 year period (Jul 2012-June 2013). We analyzed 122 obese patients, 96 patients appropriate for gestational age (AGA) and 26 patients SGA. Both groups were matched for age, sex and BMI. CIMT was measured in all the patients. Using ROC curve, cut off values have been obtained for both groups.

Results. CIMT in obese children born SGA was significantly increased as compared with obese children born AGA similar age, sex and BMI (p = 0.0035). A CIMT cut off value of 0.049 cm has been obtained with a high sensitivity and specificity.

Conclusion. Being born SGA increases the atherogenic risk. CIMT is a well-known marker of subclinical atherosclerosis and is a noninvasive and inexpensive method for detecting development of subclinical atherosclerosis. Further population studies regarding reference values for CIMT in obese children born SGA and AGA are necessary

Keywords: small for gestational age, obesity, intima media thickness of the common carotid artery

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