[Show abstract][Hide abstract] ABSTRACT: Aim
To investigate metabolic syndrome (MetS) and MetS criteria, and to establish whether metabolic syndrome criteria were associated with non-alcoholic fatty liver disease (NAFLD) in obese children.
A total of 451 pubertal obese children (8–18 years old) were enrolled in the study. Patients were divided into three groups according to the degree of steatosis. Antropometric and laboratory measurements of the participants were recorded.
Of 451 obese children, 217 (48.1%) were diagnosed as having NAFLD and 96 (21.3%) as having MetS. The frequency of abdominal obesity, hypertension, impaired fasting glucose, hyperinsulinemia, dyslipidemia and type 2 diabetes mellitus (T2DM) were 61.8% (279), 25.7% (116), 4.4% (20), 54.3% (245), 41% (185) and 2.2% (10), respectively. The prevalence of NAFLD among patients with MetS [73% (70/96)], was significantly higher than the frequency of hypertension [55% (53/96)] and abnormalities of glucose metabolism [23% (22/96)], but almost equal to the frequency of dyslipidemia [78% (75/96)]. The prevalence of MetS criteria were higher in patients with NAFLD than those without NAFLD. Except impaired fasting glucose, blood pressure and T2DM significant difference was found between groups for all. It was observed that the number of MetS criteria increased in parallel with the severity of steatosis.
NAFLD in obese children is strongly associated with multiple MetS criteria. In addition to NAFLD is not only a liver disease, but also early mediator that reflects metabolic disorder, and liver ultrasound can be a useful tool for MetS screening.
Obesity Research & Clinical Practice 08/2014; 8(4):e356–e363. · 0.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate metabolic syndrome (MetS) and MetS criteria, and to establish whether metabolic syndrome criteria were associated with non-alcoholic fatty liver disease (NAFLD) in obese children.
Obesity Research & Clinical Practice 07/2014; 8(4):e356-63. · 0.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Micropenis is a medical diagnosis based on correct measurement of length. If stretched penile length is below the value corresponding to - 2.5 standard deviation of the mean in a patient with normal internal and external male genitalia, a diagnosis of micropenis is considered. Micropenis can be caused by a variety of factors including structural or hormonal defects of the hypothalamic-pituitary-gonadal axis. It can also be a component of a number of congenital syndromes. For the etiological evaluation, endocrinologic tests are important. This article reviews the etiology, diagnosis, treatment and management of micropenis.
Journal of Clinical Research in Pediatric Endocrinology 12/2013; 5(4):217-23.
[Show abstract][Hide abstract] ABSTRACT: Although head trauma is common in childhood, there is no enough prospective study investigating both acute phase and 12 months after injury. Therefore, a prospective clinical trial was planned to evaluate the pituitary function in childhood in the acute and chronic phase after traumatic brain injury (TBI).
Forty-one children (27 boys and 14 girls, mean age 7 ± 4.3), who were admitted to neurosurgery intensive care unit due to head trauma, were included. Twenty-one (51.2 %) patients had mild, 10 (24.4 %) had moderate, and 10 (24.4 %) had severe TBI. Twenty-two of them were reevaluated 12 months after TBI. Basal pituitary hormone levels were measured during acute (first 24 h) and chronic phase of TBI. Additionally, in the chronic phase, GHRH-arginine test was used for the diagnosis of growth hormone (GH) deficiency.
In the acute phase, 10 patients (24.4 %) had ACTH deficiency, and the overall 44.3 % of patients had at least one pituitary hormone dysfunction. All the pituitary hormone deficiencies during the acute phase were recovered after 12 months. Two patients (9.1 %) had new-onset GH deficiency in the chronic phase, and in one of them, ACTH deficiency was also present.
Present prospective data clearly demonstrated that most of the hormonal changes in the early acute phase were transient, suggesting an adaptive response, and these changes did not predict the hormone deficiencies after 1 year. In the chronic phase, although GH deficiency was present, the frequency of TBI-induced hypopituitarism was clearly lower than the adult patients.
Child s Nervous System 12/2013; · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Background: Isolated premature thelarche is the breast development in the absence of other secondary sex characteristics in prepubertal girls. Fennel is a plant which contains a phytoestrogen called anethole as an active ingredient. Case: Here, we report a case of a 12-month-old girl who showed breast development that became apparent in the last 3 months. Her medical history revealed that she was given two to three teaspoons of fennel tea by her mother every day for restlessness for the last 6 months. Isolated premature thelarche was diagnosed based on physical and laboratory findings. On follow-up, after cessation of fennel consumption, the breast development of the patient regressed gradually and became normal by the end of 1 year. Conclusion: Reporting this case, we want to emphasize the importance of awareness of fennel tea, a commonly used plant in babies, as a preventable cause of premature thelarche.
[Show abstract][Hide abstract] ABSTRACT: Abstract Aim: To observe change in waist circumference (WC) over 3 years in children and adolescents and to compare these data with local and international references. Subjects and methods: The data of the second study determining the anthropometric measurements of Turkish children and adolescents (DAMTCA-II) were used to calculate WC percentiles. A total of 4234 children and adolescents aged 6-17 years (1890 boys and 2344 girls) were enrolled. The 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th and 97th percentiles and z-scores were computed by the LMS Method. Results: The mean WC was significantly higher in boys than in girls in 12.5, 13 and 15-17 year old children (p < 0.001). The prevalence of central obesity (WC ≥ 90th percentile) was 13.5% (14.3% in boys and 12.9% in girls, respectively). There was no significant difference in prevalence of abdominal obesity, between each gender (p = 0.179) and age group from 6-17 years (p = 0.590). In a comparison with the available contemporary international references, the 50th percentiles of these references were similar to those in Bulgaria, but markedly higher than those of Malaysian children and of Chinese children living in Hong Kong. Conclusions: The prominent finding of this study was the significant increase in WC percentiles in a short time in both genders. In addition, the WC references are similar to other regional references, but significantly higher than those of East Asia.
Annals of Human Biology 05/2013; · 1.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An association between low birth weight, insulin resistance (IR), dyslipidemia, and atherogenesis has been shown in girls with precocious adrenarche (PA).
To evaluate whether girls with PA born appropriate for gestational age (AGA) have increased risk for metabolic complications at initial evaluation.
We conducted a cross-sectional study on 69 AGA born girls with PA (mean (±s.d.) age 7.1±1 years) and 45 body mass index (BMI)- and waist circumference (WC)-matched prepubertal peers born AGA (mean (±s.d.) 7.5±1.9 years). A standard 2-h oral glucose tolerance test with insulin sampling was performed. Fasting plasma lipids and high-sensitivity C-reactive protein were analyzed, and blood pressure was recorded. Insulin sensitivity (IS) index (ISIcomp), homeostasis model assessment of IR, and atherogenic index (AI) (triglycerides/high-density lipoprotein cholesterol) were calculated.
The study was performed at University Hospital.
AI was significantly lower in girls with PA than in controls (P<0.001), and it was correlated with BMI SDS (r=0.44, P=0.001) and WC (r=0.39, P=0.001). The significant correlation of AI with ISIcomp (r=-0.38, P=0.001) disappeared after correcting for BMI (r=-0.185, P=0.16). Multivariate regression analysis revealed that DHEAS was the only significant parameter influencing AI in girls with born AGA (R (2)=0.475 β=-0.018, P=0.0001).
Metabolic screening in prepubertal AGA born girls with PA may yield favorable lipid profiles. AI in girls with PA is increased in relation to decreasing IS and increasing BMI and WC. DHEAS seems to have the most significant effect on AI.
[Show abstract][Hide abstract] ABSTRACT: Waist circumference, a proxy measure of abdominal obesity, is associated with cardio-metabolic risk factors in childhood and adolescence. Although there are numerous studies about waist circumference percentiles in children, only a few studies cover preschool children. The aim of this study was to develop age- and gender-specific waist circumference smoothed reference curves in Turkish preschool children to determine abdominal obesity prevalence and to compare them with reference curves obtained from different countries. The design of the study was cross-sectional. A total of 2,947 children (1,471 boys and 1,476 girls) aged 0-6 years were included in the study. The subjects were divided according to their gender. Waist circumference was measured by using a standardized procedure. The age- and gender-specific waist circumference reference curves were constructed and smoothed with LMS method. The reference values of waist circumference, including 3rd, 10th 25th, 50th, 75th, 90th, and 97th percentiles, and standard deviations were given for preschool children. Waist circumference values increased with age, and there were differences between genders. The prevalence of abdominal obesity was calculated as 10.1 % for boys and 10.7 % for girls. Having compared our data with two other countries' data, we found that our waist circumference data were significantly lower. This is the first cross-sectional study for age- and gender-specific references of 0- to 6-year-old Turkish children. The gender- and age-specific waist circumference percentiles can be used to determine the risk of central obesity.
European Journal of Pediatrics 09/2012; · 1.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Intrauterine growth references are primarily useful indicators in the assessment of the general health status of newborn infants. Although Lubchenco's references are still used in many neonatal care units, we believe that there is a need for up-to-date intrauterine growth references specific for different populations. To develop gestational age-and gender-specific national references for birth weight, birth length and head circumference. Methods: Data were collected from neonatal records of perinatology services of eleven hospitals from January to December 2009. The anthropometry of a total of 4750 singleton live births born between 28 and 41 weeks of gestation were recorded. Means and standard deviations were calculated, and percentiles for each gender and gestational week were produced using the LMS program. The results were compared with US infants and also with local data. Results: Gestational age- and gender-specific 3rd, 5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, 95th and 97th percentile values were produced. Comparison of the 10th, 50th and 90th percentile values showed that the boys were heavier and longer than the girls. Head circumference values were also higher in the boys. Proportions of small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) infants in the sample were 10.1%, 79.1% and 10.8%, respectively. Conclusion: These gender- and gestational age-specific references will be of use in clinical practice and also for research purposes until more comprehensive, reliable and accessible national data pertaining to the intrauterine growth of Turkish infants are produced.
Journal of Clinical Research in Pediatric Endocrinology 05/2012; 4(3):132-9.
[Show abstract][Hide abstract] ABSTRACT: This study explores in a group of obese children and adolescents aged 10 to 16 years, the prevalence of metabolic syndrome (MS) according to the criteria of International Diabetes Federation (IDF). In addition, the prevalence of insulin resistance (IR) was investigated to find correlations between MS and IR. IDF definition was compared to a modified WHO definition. A total of 159 obese patients (74 male and 85 female; median age 12.7 years) were included in the study. Anthropometric measurements, blood pressure, and serum fasting lipids were evaluated. An oral glucose tolerance test (OGTT) was performed, and serum glucose and insulin levels were measured at 0, 30, 60, 90, and 120 min. Homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), fasting glucose/insulin ratio (FGIR), Matsuda index, and total insulin levels during OGTT were calculated. For the IR diagnosis, we used cutoff values described in previous publications (HOMA-IR of >3.16, QUICKI of <0.357, FGIR of <7, and/or the sum of insulin levels during OGTT of >300 mIU/mL). MS prevalence, defined according to IDF criteria, was 34.6 %. Using the IDF definition, there was no statistically significant difference for the surrogate IR indices between patients with or without MS (QUICKI, 94.5 vs. 83.7 %), FGIR (81.1 vs. 78.8 %), HOMA-IR (70.9 vs. 63.5 %), and total insulin levels during OGTT (61.8 vs. 51.9 %). The Matsuda index values, the prevalence of fasting hyperinsulinemia, and impaired glucose tolerance were also similar in these two groups. In conclusion, IR was prominent in obese patients with and without MS. IDF definition of MS fails to discover individuals with IR, unless it is specifically investigated.
European Journal of Pediatrics 03/2012; 171(9):1331-7. · 1.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To establish the association between neck circumference and cardiometabolic risk factors and to determine the utility of the neck circumference as a parameter in predicting children at cardiometabolic risk.
Five - hundred and eighty-one children (461: overweight/obese, 120: normal body mass index) aged between 5 and 18 years were enrolled. Neck circumference, waist circumference, blood pressure and fasting plasma glucose, insulin, total cholesterol, triglyceride and high-density lipoprotein (HDL) cholesterol were recorded, and the homeostasis model assessment for insulin resistance score was calculated.
Neck circumference was negatively correlated with HDL cholesterol and positively correlated with all other parameters, with the exception of fasting plasma glucose in pubertal boys and girls and total cholesterol in pubertal girls. Linear regression analysis by designating neck circumference as a dependent variable revealed that insulin and TG levels in prepubertal boys and blood pressure and TG levels in pubertal boys were positively correlated with neck circumference. We found that diastolic blood pressure and insulin were positively correlated, while HDL levels were negatively correlated with neck circumference in prepubertal girls. Systolic blood pressure and insulin were positively correlated with neck circumference in pubertal girls. The cut-off value for neck circumference, as an indicator for metabolic syndrome (MS), was calculated as 36 cm in boys and 35 cm in girls. Conclusions: Neck circumference measurement was shown to be associated with cardiometabolic risk factors in children. We suggest the use of neck circumference as a novel, simple, practical and reliable anthropometric index in predicting children at risk for cardiometabolic diseases.
European Journal of Clinical Investigation 11/2011; 42(6):623-30. · 3.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Reference body mass index (BMI) percentiles are needed to follow secular changes in Turkish children aged 0-84 months. Obesity prevalence in this age group is also not well documented.
The aim of this study was to determine BMI percentiles and the prevalences of overweight and obesity in Turkish children aged 0-84 months. The authors also tried to compare actual BMI status with World Health Organization (WHO) standards.
This study used data from the Anthropometry of Turkish Children aged 0-6 years (ATCA-06) study. This cross-sectional study, conducted from September 2009 to May 2010 in Kayseri, Turkey, included 2683 children (1359 girls, 1324 boys) aged 0-84 months. Centile curves were constructed using the LMS method.
It was found that BMI percentiles of Turkish children were higher than WHO standards in early childhood. The overweight and obesity prevalences were identical in both genders, 10.0% and 4.9%, respectively.
This study provides both BMI reference values and prevalence figures for overweight and obesity in children aged 0-84 months, residing in Kayseri city, in Turkey. It is believed that these data can be of use in following secular changes as well as for comparisons with international standards.
Annals of Human Biology 09/2011; 38(6):676-80. · 1.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to determine the percentiles of interpopliteal distance to diagnose bowleg in 0-6 year-old children. Measurement of interpopliteal distance is a simple but valuable indicator in clinical examination to diagnose bowleg. We analyzed data from the anthropometry of Turkish children aged 0-6 years. The primary sampling unit included 21 family health centers (Aile Sagligi Merkezi) located in the city center and suburbs of Kayseri, Turkey. A total of 2,873 children and adolescents (1,419 boys, 1,454 girls), whose parents gave consent were included in the study. The smoothed percentiles and Z-scores were calculated by age and gender in 0-6 year-old children in quarter year intervals except for the 0-28-day newborn period. We found a significant correlation (r: 0.60, p < 0.001) between body weight and interpopliteal distance (after onset of walking). We consider that percentiles of interpopliteal distance can be used in the follow-up of children who may be at risk of bone and growth disorders. The zone between -2 standard deviation (SD) and +2SD values can be used to decide if the child has a normal growth pattern.
European Journal of Pediatrics 02/2011; 170(9):1143-50. · 1.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To provide neck circumference (NC) percentiles and mean values for Turkish children and to investigate their significance in clinical and epidemiological use.
Data were obtained from a cross-sectional screening study; DAMTCA II (Determination of Anthropometric Measurements in Turkish Children and Adolescents) in which 5481 subjects from 17 primary, secondary and high schools were included. NC percentiles were produced using the LMS method, and NC was compared with other parameters which define body fat distribution.
The smoothed NC curves of 3rd, 5th, 15th, 25th, 50th, 75th, 85th, 90th, 95th and 97th percentiles were constructed by age and gender. The descriptive characteristics of collected data were presented as mean (SD: standard deviation) and median (Min-Max: minimum-maximum) to provide detailed information other than smoothed values. The most prominent finding of this study was that the NC of boys was greater, but not significantly higher, than that of girls until the age of 12 but later a prominent increase in the NC of boys is observed compared with girls. We compared obese and non-obese children in the 6-10, 11-13, 14-18 age groups, NC was found to be an important parameter to define obesity.
This study provides NC percentiles, means and medians values and analyses their significance in obesity evaluation in clinical practice.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to determine the cut-off values for waist circumference (WC) and mid-upper arm circumference (MUAC) and to assess their use in screening for obesity in children.
Anthropometric measurements of a total of 2621 boys and 2737 girls aged 6-17 years were analyzed. WC and MUAC values were compared with ROC analysis using body mass index (BMI) cut-off values of the International Obesity Task Force (IOTF) and using WC≥ 90th percentile.for MUAC.
In both genders, except for boys and girls in the 6-year age group and post-pubertal boys, the differences between area under curve (AUC) values for WC and MUAC were not significant, indicating that both indices performed equally well in predicting obesity. Sensitivity was suboptimal through age groups 6-9 years in the boys and sensitivity was suboptimal at 6, 7,14 and 17 years both in boys and girls.
We conclude that MUAC can be a useful parameter in screening obesity and body fat distribution in children and, can be applied in epidemiological studies and in clinical practice.
Journal of Clinical Research in Pediatric Endocrinology 12/2010; 2(4):144-50.
[Show abstract][Hide abstract] ABSTRACT: Childhood obesity is a major worldwide health problem. In addition to body mass index (BMI), body fat percentiles may be used to predict future cardiovascular and metabolic health risks. The aim of this study is to define new age- and gender-specific body fat centiles for Turkish children and adolescents. A total of 4,076 (2,276 girls, 1,800 boys) children and adolescents aged 6-18 years were recruited for this study. Total body fat was measured by a bioelectrical impedance noninvasive method. Body fat percentiles were produced by the LMS method. The body fat percentile curves of boys appear to rise from age 6 to 12 years and then slope downwards to age 15 years and then flatten off. The body fat % percentiles of girls increased until 14 years of age through 75th to 97th percentiles and then slope downwards, but through the third to 50th percentiles, they showed a downward slope after 14 years old. Conclusions: Since BMI may not always reflect body fat content, direct assessment of adiposity by a practical method would be significantly useful for clinical decisions. Therefore, this study provides normative data for body fat percentage in healthy Turkish children and adolescents. To this goal we used a practical and clinically applicable method. These references can be useful for evaluation of overweight and obesity.
European Journal of Pediatrics 11/2010; 169(11):1329-35. · 1.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Childhood obesity is associated with an increased risk for insulin resistance. The underlying mechanism for the physiological increase in insulin levels in puberty is not clearly understood. The aim of the present study was to determine the cut-off values for homeostasis model assessment for insulin resistance (HOMA-IR) in obese children and adolescents according to gender and pubertal status.
Two hundred and eight obese children and adolescents (141 girls, 127 boys) aged between 5 and 18 years were included in the study. The children were divided into prepubertal and pubertal groups. A standard oral glucose tolerance test (OGTT) was carried out in all children. A total insulin level exceeding 300 μU/mL in the blood samples, collected during the test period, was taken as the insulin resistance criterion. Cut-off values for HOMA-IR were calculated by receiver operating characteristic (ROC) analysis.
In the prepubertal period, the rate of insulin resistance was found to be 37% in boys and 27.8% in girls,while in the pubertal period, this rate was 61.7% in boys and 66.7% in girls. HOMA-IR cut-off values for insulin resistance in the prepubertal period were calculated to be 2.67 (sensitivity 88.2%, specificity 65.5%) in boys and 2.22 (sensitivity 100%, specificity 42.3%) in girls, and in the pubertal period, they were 5.22 (sensitivity 56%, specificity 93.3%) in boys and 3.82 (sensitivity 77.1%, specificity 71.4%) in girls.
Since gender, obesity and pubertal status are factors affecting insulin resistance, cut-off values which depend on gender and pubertal status, should be used in evaluation of insulin resistance.
Journal of Clinical Research in Pediatric Endocrinology 09/2010; 2(3):100-6.
[Show abstract][Hide abstract] ABSTRACT: Growth hormone (GH), insulinlike growth factor-1 (IGF-1), and IGF-binding protein-3 (IGFBP-3) are used in the neonatal period for evaluation of diseases such as GH deficiency, intrauterine growth restriction, and hypoglycemia. However, GH level has been reported as a single value during the neonatal period. In this study, we attempted to determine the changes of GH, IGF-1, and IGFBP-3 in the neonatal period for each week.
One hundred and two appropriate-for-gestational age (AGA) term neonates who did not have any diseases that would interfere with GH-IGF axis were included in this cross-sectional study. Blood samples were collected and serum GH, IGF-1 and IGFBP-3 levels were measured by immunoradiometric analysis (IRMA) and weekly values were obtained for the first postnatal four weeks.
We showed that GH level [median (1st-3rd quartile)] decreases from the first to the fourth postnatal week [25.1 (18.5-37.4); 17.2 (13.2-22.8); 17.6 (12.2-20.2); 14.4 (6.60-19.8) ng/mL, respectively)], IGF-1 and IGFBP-3 levels [median (lst-3rd quartile)] increase [41.7 (18.0-70.0); 55.9 (39.0-103); 53.0 (40.0-97.7); 71.7 (44.3-137) and 1852 (1597-2451); 2430 (1645-2838); 2841 (2280-3675); 3018 (2151-4189) ng/mL, respectively)]. Conclusions: GH, IGF-1 and IGFBP-3 values can be evaluated for each week separately instead of for the entire neonatal period.
[Show abstract][Hide abstract] ABSTRACT: To produce age and gender specific exophthalmos references for Turkish children aged 7-18 years old.
This was a preliminary cross-sectional study. Data were obtained from the second study of the Determination of Anthropometric Measurements of Turkish Children and Adolescents (DAMTCA II). A Hertel exophthalmometer was used and age and gender specific standard deviations (SD) and percentiles were calculated.
The 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th 97th percentiles of right and left eye protrusion, and the mean and SD for each age and gender were calculated. In comparison of eyes and genders: Protrusion in the right eye was 14.81 (1.68), and 14.65 (1.67) in the left eye for boys. Protrusion in the right eye was 14.95 (1.68) and 14.75 (1.67) in the left eye of girls. In both genders the difference in protrusion of the two eyes was statistically significant (p <0.001). Exophthalmometric measurements were compared for pubertal periods by one-way analysis of variance and a significant difference was found in exophthalmos between pubertal periods for both eyes and gender (p <0.001).
Age and gender specific references for exophthalmia provide information for both clinical decision process and screening in describing abnormal or pathological conditions resulting in exophthalmos.