Animals ; Biomarkers ; blood ; Fatty Liver ; blood ; etiology ; Humans ; Leptin ; blood ; Obesity ; blood ; complications

Type 2 diabetes mellitus is a progressive process. With the course of the disease progress, microvascular and macrovascular complications always happen. Thrombotic events caused by macrovascular complications, including coronary heart diseases and cerebrovascular diseases, are the main fatal factor for the patients with type 2 diabetes. Endothelial dysfunction, coagulative activation, impaired fibrinolysis, together with hyper-reactive platelets contribute to the diabetic prothrombotic state, which is strongly related to the macrovascular complications. In particular, the hyper-reactive platelets play a fundamental role among them. Type 2 diabetes is characterized by several metabolic dysfunctions such as hyperglycemia, insulin resistance and shortage, oxidative stress, systemic inflammation, obesity, and dyslipidemia. These metabolic dysfunctions work together to promote the formation of hyper-reactive platelets, which are distinctive in type 2 diabetes. The regular antiplatelet drugs, like aspirin, show limited inhibitory effect on them. Hence, studying the mechanism behind the hyper-reactive platelets could provide a brand-new view on the prevention of macrovascular complications and cardiovascular events in type 2 diabetes.
Blood Platelets ; Diabetes Mellitus, Type 2/drug therapy* ; Humans ; Hyperglycemia/complications* ; Insulin Resistance ; Obesity/complications*

OBJECTIVETo investigate the role of non-high density lipoprotein cholesterol (non-HDL-C) in the assessment of cardiovascular disease (CVD) risk factors such as hypertension, pre-diabetes and diabetes in obese children.

METHODSAccording to the presence of complications (hypertension, pre-diabetes and diabetes), 810 children with central obesity were divided into two groups: one group with complications (n=499) and one group without complications (n=311). One hundred and sixty-four age- and sex-matched children served as the control group. Logistic regression analysis and receiver operating characteristic (ROC) curves were used to analyze the detection of non-lipid CVD risk factors by seven lipid markers.

RESULTSThe prevalence rates of hypertension and pre-diabetes were significantly higher in obese children with high non-HDL-C concentrations (≥3.76 mmol/L). After adjusting for waist circumference Z-scores, the area under the ROC curve for non-HDL-C was 0.680 to detect non-lipid CVD risk factors, while the areas for low-density lipoprotein cholesterol, total cholesterol and apoprotein B were 0.659, 0.669 and 0.647 respectively.

CONCLUSIONSCompared with the other lipid markers, non-HDL-C is a better predictor for non-lipid CVD risk factors in obese children. Measurement of non-HDL-C concentations is recommended for obese children.

Adolescent ; Cardiovascular Diseases ; etiology ; Child ; Cholesterol ; blood ; Cholesterol, HDL ; blood ; Female ; Humans ; Logistic Models ; Male ; Obesity ; blood ; complications ; Risk Factors

INTRODUCTIONNon-alcoholic fatty liver disease (NAFLD) is garnering increasing interest and acceptance as one of the most important causes of chronic liver disease. The aim of this study was to investigate the risk factors for NAFLD among selected adolescent students in Hualien City, Taiwan.

MATERIALS AND METHODSA stratified random sampling scheme was carried out among 1724 adolescent students aged 12 or 13 years old in Hualien City. In total, 220 students (normal: overweight: obese = 97:48:75) agreed to join the study. They underwent physical examination, laboratory tests and ultrasonography examination of the liver. Diagnosis of NAFLD in this study was based on sonographic evidence of a fatty liver and testing negative for serum HBsAg and anti- HCV antibody.

RESULTSOf the 220 participants, 4 were excluded because they tested positive for HBsAg or anti-HCV antibody. NAFLD was detected in 86 (39.8%) out of the 216 subjects. The rate of NAFLD in the adolescents increased progressively from 16.0% in the normal group to 50.5% in the overweight group, and 63.5% among the obese subjects. Compared to their normal counterparts, adolescents with NAFLD had a significantly higher weight, body mass index (BMI), waist circumference, levels of alanine aminotransferase (ALT), triglyceride and nonhigh- density-lipoprotein (non-HDL) cholesterol. However, among the participants with NAFLD, only 20 (23.3%) showed ALT abnormality but there was an increasing trend of ALT abnormality as the severity of fatty liver increased. In addition, the higher ALT, Homeostasis model assessment- insulin resistance (HOMA-IR), cholesterol, triglyceride, and non-HDL levels and lower HDL-C as the severity of fatty liver increased. In a stepwise logistic regression analysis, the most significant factor associated with the presence of NAFLD was weight category. When compared with their normal counterparts, overweight and obese adolescents had a 4.14 and 5.98 times the risk of having NAFLD, respectively. Elevated ALT was the second most important factor as adolescents with elevated ALT were more likely to have NAFLD (odds ratio = 3.32, 95% CI: 1.16 to 9.50). Non-HDL cholesterol level was the third most important factor associated with NAFLD with a 3.81-fold increase in risk incurred for every l n (1 mg/dL) increment.

CONCLUSIONSObesity, ALT abnormality and elevated non-HDL-cholesterol are risk factors for NAFLD in adolescents. However, only 23.3% of the adolescents with NAFLD showed an abnormality for ALT. Therefore, ALT alone is not a sufficient indicator; and it is recommended that ultrasonography of the liver should be part of the routine health examination of obese adolescents.

Adolescent ; Alanine Transaminase ; blood ; Child ; Cholesterol ; blood ; Fatty Liver ; blood ; diagnostic imaging ; etiology ; Humans ; Obesity ; complications ; Risk Factors ; Taiwan ; Ultrasonography

OBJECTIVETo understand whether hyperhomocysteinemia and early arterial atherosclerosis exist in simply obese children.

METHODSTotally 68 simply obese children (age 6-14 years, mean 10.8 +/- 2.3 years) were enrolled in this study, 50 were male and 18 were female. Body mass index (BMI) of the obese children was equal to or more than 22. The height of the children was (145 +/- 22) cm. Meanwhile, 26 normal children (age 6 - 14 years, mean 10.9 +/- 2.0 years) were selected as control group, 17 of these children were male and 9 were female. Their height was (148.5 +/- 5.8) cm. There were no significant differences in height and age between the obese and the control children. The carotid intimal-medial thickness (IMT), brachial artery flow-mediated vasodilation were examined by Doppler Flow/Dimension System and the liver was examined by B-mode ultrasound imager. Plasma homocysteine was determined by the automated chemiluminescent enzyme immunoassays. Serum lipid concentration was determined by biochemical analytic method. Blood pressure of the right upper limbs was measured. A detailed medical and family history was systematically recorded.

RESULTSBMI was (27.8 +/- 4.5) in the obese children and (16.2 +/- 2.5) in the controls. There was significant difference between two groups (P < 0.01). The obese children had significantly increased values than the controls for the carotid intimal-medial thickness (P < 0.01). Right carotid IMT, right inner-carotid IMT, left carotid IMT and left inner-carotid IMT were respectively (0.54 +/- 0.13) mm, (0.69 +/- 0.14) mm, (0.52 +/- 0.12) mm and (0.67 +/- 0.14) mm in obese children and were respectively (0.45 +/- 0.04) mm, (0.46 +/- 0.04) mm, (0.45 +/- 0.05) mm and (0.46 +/- 0.03) mm in control groups. Conversely, the flow-mediated brachial artery dilation of the obese children was significantly lower than that of the controls [(11.0 +/- 4.3)% vs. (17.5 +/- 4.9)%, P < 0.01]. The obese children had higher level of plasma homocysteine than the controls [(7.9 +/- 2.7) micromol/L vs. (5.6 +/- 2.1) micromol/L, P < 0.01]. Total cholesterol (TC) in the obese children dramatically increased, so did triglyceride concentration (TG), LDL-cholesterol (LDL-ch) and apolipoprotein-B (apo-B). Of the obese children, had fatty liver or the tendency to fatty liver. Six cases of the 68 obese children (8%) had hypertension. Of the 68 obese children, 57 (84%) had the history of consuming excessive food or taking less exercise. Forty-four percent of the obese children (30/68) came from the obese families in which at least one of the parents or grandparents was obese. Twenty-nine percent (20/68) and 22% (15/68) of the obese children respectively came from the families in which at least one of the parents or grandparents suffered from hypertension or coronary heart disease.

CONCLUSIONEarly arterial atherosclerotic changes existed in simply obese children. Hyperhomocysteinemia may be an important factor of the obesity-induced early arterial atherosclerosis during childhood.

Adolescent ; Atherosclerosis ; blood ; etiology ; Carotid Artery Diseases ; etiology ; Child ; Female ; Homocysteine ; blood ; Humans ; Hyperhomocysteinemia ; complications ; Lipids ; blood ; Male ; Obesity ; blood ; complications ; Tunica Intima ; pathology ; Tunica Media ; pathology

OBJECTIVETo determine the clinical value of hepatic fibrosis parameters and serum ferritin (SF) in obese children with nonalcoholic fatty liver disease.

METHODSOne hundred and one obese children aged 6-15 years and 30 healthy children aged 9-14 years were enrolled in the study. Body mass index (BMI), waist circumference (WC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatic fibrosis parameters including hyaluronic acid (HA), laminin (LN), serum type III procollagen (PCIII) and type IV collagen (CIV), serum ferritin and hepatic B-ultrasonography were assessed. All subjects were divided into 4 subgroups: simple obese children (SOC), simple nonalcoholic fatty liver (SNAFL), nonalcoholic steatohepatitis (NASH) and control group. ALT, AST, hepatic fibrosis parameters and serum ferritin were compared in these four groups.

RESULTCompared with control group, the serum levels of HA and PCIII increased significantly in SOC group (P <0.05); Serum levels of HA, PCIII, SF, ALT and AST also elevated markedly in SNAFL group and NASH group compared with those in control group. PCIII, SF, ALT, AST increased stepwise as the disease developed from SOC to SNAFL and NASH (P <0.05). SF was correlated with PCIII, ALT and AST (r=0.33,0.63,0.69,P <0.05) and PCIII was well related to ALT and AST (r=0.55,0.56,P <0.05). There were only 6 cases with SF >301 microg/L among all obese children, they were all NASH. The average levels of HA, CIV, PCIII, ALT, AST of these 6 cases were significantly higher than those of other NASH children.

CONCLUSIONAmong all hepatic fibrosis parameters, serum PCIII level is an early and sensitive indicator of NAFLD and is correlated with the disease progress. SF may be also involved in early injury of fatty liver and the process of NAFLD.

Adolescent ; Biomarkers ; blood ; Child ; Collagen Type III ; blood ; Fatty Liver ; blood ; etiology ; Female ; Ferritins ; blood ; Humans ; Liver Cirrhosis ; blood ; etiology ; Male ; Obesity ; blood ; complications

Alanine Transaminase ; blood ; Aspartate Aminotransferases ; blood ; Fatty Liver ; blood ; etiology ; Glucose Tolerance Test ; Humans ; Insulin Resistance ; Leptin ; blood ; Liver Diseases ; blood ; etiology ; Obesity ; blood ; complications ; Risk Factors

Child ; Diabetes Mellitus ; etiology ; Diet ; Humans ; Hypertension ; etiology ; Lipids ; blood ; Obesity ; complications ; prevention & control ; psychology

Surveys of noncommunicable diseases were performed in six communities in Papua New Guinea during 1985-1986. Results are reported here with respect to blood pressure and associated factors in adults. Mean systolic and diastolic blood pressures were lowest, and hypertension was rarest (less than 2%), in three rural/semirural villages on Karkar Island, Madang Province. Intermediate values for blood pressure and moderate prevalence of hypertension (3-6%) were observed in rural and urban Tolai communities in East New Britain Province. A periurban village in the Eastern Highlands Province displayed the highest mean blood pressures and prevalence of hypertension (12% in men and 5% in women). There was a modest rise in mean systolic blood pressure with age in most groups, but the age-related rise in diastolic pressure was much less pronounced. Other cardiovascular risk factors--body mass index (BMI), and plasma cholesterol, glucose and insulin concentrations--were lowest in the least developed rural villages on Karkar Island and highest in the urban Tolai and periurban highland communities. Both systolic and diastolic blood pressures were significantly (and positively) related to age, male sex, BMI and speaking a non-Austronesian language. It is concluded that there is now a considerable variation in the prevalence of hypertension, and the levels of blood pressure and other cardiovascular risk factors, in different communities in Papua New Guinea.
Adult ; Blood Pressure ; Cardiovascular Diseases - etiology ; Diabetes Mellitus - epidemiology ; Hypertension - complications ; Obesity - epidemiology ; Papua New Guinea

Background: Obstructive sleep apnea syndrome (OSAS) is prevalent in obesity and is associated with many metabolic abnormalities. The relationship between OSAS and bone metabolism is still unclear. The aim of this study was to investigate the relationship between the severity of OSAS and bone metabolic markers. Methods: A total of 119 obese males were enrolled in this study in spring months from 2015 to 2017. All candidates underwent polysomnography, and their bone mineral density (BMD) and the serum levels of total procollagen type 1 N-terminal propeptide (t-P1NP), N-terminal midfragment of osteocalcin (N-MID), β-C-terminal telopeptide of type 1 collagen (β-CTX), vitamin D (VD), and parathyroid hormone (PTH) were measured. The analysis of variance and Pearson correlation analysis were performed for data analyses. Results: No significant differences in the mean values of BMD were observed among the obesity, mild-to-moderate OSAS, and severe OSAS groups; and the serum levels of t-P1NP and β-CTX in the severe OSAS group were significantly higher than those in the obesity group (48.42 ± 23.78 ng/ml vs. 31.98 ± 9.85 ng/ml, P < 0.001; 0.53 ± 0.24 ng/ml vs. 0.41 ± 0.13 ng/ml, P = 0.011, respectively). The serum level of VD in the obesity group was significantly higher than those in the mild-to-moderate and severe OSAS groups (both P < 0.001), and decreased as the severity of OSAS increased (P < 0.001). The serum level of PTH in the severe OSAS group was significantly higher than those in the obesity and mild-to-moderate OSAS groups (both P < 0.001). The results of correlation analysis indicated that the level of apnea-hypopnea index (AHI) was correlated with the levels of t-P1NP (r = 0.396, P < 0.001), VD (r = -0.404, P < 0.001), and PTH (r = 0.400, P < 0.001), whereas the level of minimum Osaturation (SaOmin) was correlated with the levels of VD (r = 0.258, P = 0.016) and PTH (r = -0.376, P < 0.001). Conclusions The levels of bone resorption and formation markers in patients with severe OSAS were significantly increased compared to obese men, and the severity of OSAS was correlated with the serum levels of t-P1NP, VD, and PTH.
Biomarkers ; blood ; Bone Density ; Bone and Bones ; metabolism ; Humans ; Male ; Middle Aged ; Obesity ; complications ; Parathyroid Hormone ; Polysomnography ; Sleep Apnea, Obstructive ; complications