Biomedical subjects

M Borkenstein

Publications and source records attributed to M Borkenstein.

At least 19 recordsLinked to original sources

PubMed2004

Low grade inflammation in juvenile obesity and type 1 diabetes associated with early signs of atherosclerosis.

BACKGROUND: Subclinical inflammation has been implicated in the initiation and/or progression of atherosclerosis. Diabetes mellitus and obesity are risk factors for atherosclerosis, and asymptomatic low grade inflammation occurs prior to overt vascular lesions in these patients. In contrast to adults, little information exists concerning low grade inflammation in young type 1 diabetes and juvenile obesity. AIM: To investigate low grade inflammation and immune activation in juvenile diabetes mellitus and obesity. METHODS: hs-CRP, soluble interleukin-2 receptor (sIL-2R), C-peptide, insulin, cortisol, vitamin B12, folic acid, leptin, and homocysteine were determined in 148 patients with juvenile type 1 diabetes, 86 obese children and 142 normal weighted age-matched healthy controls. Intima-media thickness (IMT) and lumen diameter of both common carotid arteries (CCA) was measured by ultrasonography in 52 healthy pediatric controls, 10 diabetics, and 34 obese juveniles. RESULTS: Serum hs-CRP was significantly elevated in patients with type 1 diabetes (p < 0.0001), and obese children (p < 0.0001) as compared to the control group. The obese juveniles (p < 0.0001) and the diabetics (p < 0.0001) showed significantly increased values for IMT of CAAs. Levels of homocysteine, sIL-2R, insulin, cortisol, vitamin B12, and folic acid did not differ from the controls. The elevation of hs-CRP was more pronounced in obesity as compared to type 1 diabetes (p < 0.0001), and the hs-CRP values correlated significantly with body mass index standard deviation score (BMI-SDS) values. Furthermore, the IMT and the luminal diameter of CCAs showed significant correlations with BMI-SDS values. CONCLUSION: A low grade inflammation as determined by serum hs-CRP is significantly increased in children with type 1 diabetes, and even more pronounced in apparently healthy juveniles with obesity. The increased IMT of CCAs strongly argues for an association between this low grade inflammation and early atherosclerotic vessel injury.

Adolescent↗

PubMed2001

Effects of short-term energy restriction and physical training on haemostatic risk factors for coronary heart disease in obese children and adolescents.

OBJECTIVE: To study the changes of haemostatic risk factors for coronary heart disease during a weight reduction programme in obese children and adolescents. DESIGN: A short-term longitudinal study. SUBJECTS: Thirty-seven obese white girls (age, 12+/-1.8 y; body mass index (BMI), 26.9+/-5.25) and 19 obese white boys (age, 11.9+/-1.7 y; BMI, 26.2+/-5.2). MEASUREMENTS: Fibrinogen, factor VII coagulant activity, von Willebrand factor antigen, and soluble P-selectin were determined before and after a 3 week programme including energy restriction and physical activities. RESULTS: All determined haemostatic risk factors decreased significantly during the programme. Changes in risk factors were correlated to changes in body composition. Children and adolescents with the highest initial concentrations showed the greatest decreases. CONCLUSION: Energy restriction combined with physical activity improves the haemostatic risk profile in obese children and adolescents.

Adolescent↗

PubMed2001

Changes in serum interleukin-6 concentrations in obese children and adolescents during a weight reduction program.

OBJECTIVE: To investigate the effect of short term energy restriction combined with physical activity on serum concentrations of Interleukin-6 (IL-6) in obese children and adolescents. DESIGN: Longitudinal intervention study of 3.8-5 MJ daily with exercise. SUBJECTS: Forty-nine white obese children and adolescents (31 girls, age 11.9+/-1.8 y; 18 boys, age 11.6+/-1.7 y). MEASUREMENTS: Indexes of obesity, IL-6, leptin, estradiol, systolic and diastolic blood pressure, heart rate at baseline and after 3 weeks. RESULTS: All determined parameters decreased significantly during the 3 week program (IL-6: 3.9+/-4.7 vs 2.0+/-2.2 pg/ml; P<0.05). Body mass index (BMI) fat mass, percentage fat mass (indexes of obesity), and leptin were not related to IL-6 before the program. In contrast, IL-6 concentrations correlated significantly with indexes of obesity and leptin after weight loss. IL-6 concentrations did not correlate with estradiol, systolic and diastolic blood pressure, and heart rate. Changes in IL-6 concentrations correlated significantly with changes in BMI (r=0.25, P<0.05). CONCLUSION: An improved body composition induced by restriction of energy intake and increase in physical activity is associated with more favorable serum concentrations of IL-6 in obese children and adolescents.

Adolescent↗

PubMed2001

Determinants of homocysteine during weight reduction in obese children and adolescents.

Plasma homocysteine levels have been shown to be associated with indexes of obesity and insulin resistance in obese children and adolescents. We, therefore, investigated the contribution of changes in body composition, markers of insulin resistance, folate, and vitamin B(12) to changes in homocysteine during a weight reduction program in obese children and adolescents. Thirty-seven obese white girls (mean SD; age, 12 +/- 1.8 years, body mass index [BMI], 26.9 +/- 5.25) and 19 obese white boys (age, 11.9 +/- 1.7 years; BMI, 26.2 +/- 5.2) were investigated for body composition, fasting total plasma homocysteine (tHcy), insulin, C-peptide, folate, and vitamin B(12) before and after a 3-week weight reduction program including physical activities. During weight reduction BMI, fat mass (FM), percentage fat mass, insulin, and C-peptide decreased significantly, whereas homocysteine and vitamin B(12) showed a significant increase. Folate and lean body mass (LBM) remained unchanged. tHcy concentration before weight reduction was a function of age, folate, and C-peptide, whereas tHcy concentration after weight reduction was a function of folate and baseline LBM. Changes in tHcy during weight reduction correlated significantly with baseline LBM and were related inversely to changes in LBM during weight reduction. Children who increased LBM showed lower increases in tHcy compared with children who lost LBM. In multiple linear regression analysis, only baseline LBM contributed independently and significantly to changes in tHcy. Our study suggests that LBM has a significant impact on tHcy metabolism during weight reduction.

Adolescent↗

PubMed2000

Determinants of haemostatic risk factors for coronary heart disease in obese children and adolescents.

OBJECTIVE: To investigate the contribution of serum lipids, parameters of glucose metabolism, body composition and cardiovascular fitness to the variance of several haemostatic risk factors for coronary heart disease (CHD) in obese children and adolescents. SUBJECTS AND MEASUREMENTS: Forty-two healthy, obese children and adolescents (20 male, 22 female, age 12.6 +/- 3.2y; body mass index (BMI), 30.4 +/- 5.3 kg/m2), were screened for haemostatic and metabolic risk factors for CHD. Thirty-five of the participants (18 male, age 13.5 +/- 2.9y; BMI, 29.9 +/-4.5kg/m2; 17 female, age 12.8+/-2.1 y, BMI, 31.1 +/- 5.3 kg/m2) were assessed for cardiovascular fitness by means of incremental cycle ergometer exercise. RESULTS: After adjustment for age, fat mass correlated significantly with plasminogen activator inhibitor-1 antigen (PAI-1-Ag) in boys and girls and factor VIIc only in girls. Children with lower power output (< or = 2.77W/kg) showed significantly higher values for factor VIIc, fibrinogen and tissue-type plasminogen activator antigen (tPA-Ag). Neither body composition nor cardiovascular fitness contributed independently to the variance of the determined haemostatic risk factors, except PAI-1-Ag, which has been shown to be determined by fat mass. In multiple linear regression analysis, triglycerides and PAI-1-Ag explained significant independent proportions of the variance of tPA-Ag. Factor VIIc was explained by C-peptide, insulin and fibrinogen. Von Willebrand factor antigen (vWF-Ag) was significantly related to glucose and insulin. CONCLUSION: The results suggest that in obese children and adolescents the haemostatic risk factors factor VIIc, vWF-Ag and tPA-Ag are mainly determinated by plasma insulin and triglyceride concentrations, but are primarily independent of body composition and cardiovascular fitness.

Adolescent↗

PubMed2000

Correlation between cholesterol, soluble P-selectin, and D-dimer in obese children and adolescents.

Thirty-eight obese children and adolescents were investigated for a possible relation between cholesterol and markers of platelet activation, endothelial cell dysfunction, and activation of the coagulation system. Soluble P-selectin, von Willebrand factor antigen (vWf-Ag), D-dimer, and prothrombin fragment 1 + 2 (F1 + 2) were determined by enzyme-linked immunosorbent assays, and factor VIII coagulant activity (VIIIc) was measured by means of one-stage clotting assay. Cholesterol correlated significantly with log P-selectin (r = 0.43, P = 0.003) and log D-dimer (r = 0.33, P = 0.02). Cholesterol did not correlate with vWf-Ag, factor VIIIc, and F1 + 2. Log P-selectin correlated significantly with log D-dimer (r = 0.42, P = 0.003), which remained significant after adjustment for cholesterol (P = 0.02). Log D-dimer correlated significantly with F1 + 2 (r = 0.38, P = 0.01). Our study demonstrates that, in obese children and adolescents, cholesterol is significantly associated with P-selectin and D-dimer, and suggests an unfavorable intercorrelation between metabolic and hemostatic risk factors for coronary heart disease in childhood obesity.

Adolescent↗

PubMed2000

Insulin is an independent correlate of plasma homocysteine levels in obese children and adolescents.

OBJECTIVE: The aim of the study was to investigate whether anthropometric and metabolic risk factors for coronary heart disease (CHD) contribute to the variation in homocysteine levels in obese children and adolescents. RESEARCH DESIGN AND METHODS: A total of 84 children and adolescents were assessed for fasting total homocysteine, methylenetetrahydrofolate reductase polymorphism (C677T mutation), folate and vitamin B12 status, and anthropometric and metabolic risk factors for CHD. RESULTS: No significant sex differences were found for all available anthropometric and metabolic characteristics except for homocysteine, which was significantly higher in boys than in girls (7.1 vs. 6.3 micromol/l; P<0.05). After adjustment for age and sex, homocysteine correlated significantly with BMI, fat mass, percentage of fat mass, and insulin and showed an inverse correlation with folate levels. Homocysteine did not correlate with vitamin B12; total cholesterol; LDL, HDL, and VLDL; triglycerides; and glucose. BMI and fat mass correlated significantly with insulin and showed a significant inverse correlation with folate. We found no association between homocysteine and the C677T mutation. In multiple regression analyses, insulin was found to be the main correlate of homocysteine. CONCLUSIONS: Our study demonstrates for the first time that insulin is a main correlate of homocysteine in obese children and adolescents and suggests that fat mass-associated hyper-insulinism may contribute to impairment of homocysteine metabolism in childhood obesity

Adolescent↗

PubMed1999

Effect of an individualised training programme during weight reduction on body composition: a randomised trial.

OBJECTIVE: To study the effect of a standardised training programme focusing on maintenance of fat free mass during weight reduction by energy reduction in obese children. DESIGN: Randomised trial of physical training programme and dietary advice (group A) versus dietary advice alone (group B). SUBJECTS: Thirty obese children and adolescents (14 group A, 16 group B) participated in the 12 week long programme; 20 children (10 group A, 10 group B) were also reassessed after one year. MEASUREMENTS: Fat free mass was estimated from the resistance index, obtained by bioelectrical impedance analysis at baseline, after four, eight, and 12 weeks in all subjects, and after one year in 20 subjects. RESULTS: The mean (SD) change in fat free mass was significantly different between the two groups after 12 weeks (group A, 2.68 (3.74) kg; group B, 0.43 (1.65) kg). The change in body weight after one year was inversely correlated with the change in fat free mass after 12 weeks (r = -0. 44), as assessed in the 20 subjects. CONCLUSIONS: A standardised training programme as used in this study can prevent reduction in fat free mass during weight loss in obese children. Reduction in fat free mass during weight reduction might be a risk factor for regain of weight.

Adipose Tissue↗

PubMed1995

Frequency of Hashimoto's thyroiditis in children with type 1 diabetes mellitus.

A total of 1419 children with type 1 diabetes mellitus was investigated in order to assess the true frequency of Hashimoto's thyroiditis (HT), diagnosed by microsomal and/or thyroglobulin autoantibodies, by ultrasound and in many cases also by fine needle biopsy. According to these criteria, 55 cases (3.9%) of HT were identified, a number significantly higher (P < 0.0001) than the distribution reported in the normal paediatric population. No typical antibody pattern was seen prior to the onset of HT, nor was an antibody threshold level found which could have been diagnostic for this disease. Patients with subclinical hypothyroidism were treated with L-thyroxine and were investigated regarding the behaviour of anti-thyroid autoantibodies; however, no significant changes were seen. The data showed a high frequency of HT in diabetic children, and therefore we recommend that children with type 1 diabetes mellitus should be screened for thyroid autoantibodies and those positive should undergo periodic thyroid function testing.

Adolescent↗

PubMed1995

Changes in lean body mass in obese children during a weight reduction program: effect on short term and long term outcome.

OBJECTIVE: To study the changes in body composition during a weight reduction program in obese children and adolescents. DESIGN: A short-term longitudinal study. SUBJECTS: Forty-one obese children and adolescents (19 M, 22F, age 8.5-14.8 [median 11.8] years. MEASUREMENTS: Lean body mass (LBM) was estimated from Resistance Index (RI) obtained by Bioelectrical Impedance Analysis (BIA) before and after the 3 week program. RESULTS: Mean percentage weight for height at baseline was 151 (s.d. 20)% and significantly decreased at the end of the three weeks (139 (s.d. 18)%, P = 0.005). The mean percentage body fat also decreased (from 46.0 s.d. 5.8% to 41.5 s.d. 6.5%, P = 0.0015). All individuals lost body fat during the three weeks, whereas the change in LBM was heterogeneous. The individual change in body fat was inversely correlated with the change in LBM (r = -0.64, P = 0.0001). After 4 months, 18 out of the 41 children could be reevaluated for height and weight. The regain in body weight during these 4 months was inversely correlated with the change in LBM during the weight reduction program (r = -0.55, P = 0.018). CONCLUSIONS: Changes in LBM during a weight reduction program can predict the short term result those children who manage to increase LBM having the greatest reduction in body fat. Changes in LBM during weight reduction seem also to predict the longterm outcome, a reduction in LBM being associated with greater regain of weight. Weight reduction programs for obese children should focus not only on weight loss but also on maintenance or increase of lean body mass to improve longterm results.

Adolescent↗

PubMed1994

Effect of the introduction of dietary sucrose on metabolic control in children and adolescents with type I diabetes.

The effect of sucrose in the diet of children and adolescents with type I diabetes on long-term metabolic control was studied. For a mean observation period of 83 (range 42-127) days, a diet containing 5% of total calories as refined sugar was recommended to 11 children (group A, mean age 15.0, SD 5.4 years), while another 13 children remained on their usual 'sucrose-free' diet (group B, mean age 16.0, SD 5.7 years). The mean observation period in this group was 77 (41-103) days. All children had a dietary assessment at baseline and at follow up using a 7-day food record. At baseline, sucrose intake as a proportion of total daily calories was similar in the two groups (group A 1.4, SD 1.9% vs group B 2.0, SD 2.3%; P = 0.5). At follow-up, sucrose intake increased significantly in group A (5.1, SD 2.5%; P = 0.0008) but not in group B (2.7, SD 3.3%; P = 0.5). Metabolic control assessed by haemoglobin level (HbA1c) was not different between the groups at baseline (group A 8.5, SD 1.2 vs group B 8.8, SD 1.8%; P = 0.7) nor at follow-up (9.1, SD 1.4 vs 9.0, SD 2.5%; P = 0.9). Within group A, the individual change in HbA1c correlated with the individual change in sucrose intake (r = 0.61, P = 0.05), this correlation being strongly influenced by two individuals with an increase in sucrose consumption substantially exceeding 5%. Percentage intake of protein, carbohydrate and fat did not change significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

Effect of actual glycaemia on pupillary function in children with type 1 diabetes.

The objective was to study the effect of actual glycaemia on autonomic function. Autonomic function was assessed by computerised infrared video-pupillometry in 10 children with type 1 diabetes (age 10.5-15.8, median 13.7 years, diabetes duration 1.1-10.0, median 3.8 years) on 6 occasions (07:30, 12:00, 17:30 h on days 1 and 10, respectively). Blood glucose was measured by a reflectance meter immediately prior to each pupillometry study. To allow for inter-individual differences in pupillary variables (resting pupil diameter (RPD), reflex amplitude (RA), maximum constriction velocity (MCV)) the variation of each variable from the mean for the individual (difference between the actual value and the mean value from the 6 measurements (delta RPD, delta RA, delta MCV)) was used in calculations. None of the three pupillary variables showed a significant correlation with the blood glucose value (delta RPD: r = 0.072, P = 0.59; delta RA: r = -0.008, P = 0.96; delta MCV: r = -0.080, P = 0.55). It is concluded, that autonomic function in children with Type 1 diabetes as determined by computerised infrared video-pupillometry is not affected by actual glycaemia.

Adolescent↗

PubMed1994

Melanotic macules following Blaschko's lines in McCune-Albright syndrome.

Hyperpigmented macules are a characteristic feature of neurofibromatosis and the McCune-Albright syndrome. Whereas neurofibromatosis 1 has an autosomal dominant mode of inheritance, it has been suggested that McCune-Albright syndrome is the result of a lethal gene surviving by mosaicism. Recent molecular studies have supported this concept by providing evidence of a somatic mutation of the gene encoding the G protein. We report two patients with McCune-Albright syndrome whose melanotic macules show a clear relation to the lines of Blaschko. The lines of Blaschko are thought to represent the dorso-ventral outgrowth of two different cell populations during embryogenesis, thus reflecting genetic mosaicism. A survey of published photographs of patients with McCune-Albright syndrome in the literature revealed additional cases with macules following Blaschko's lines. In other cases, the configuration of the macules was reminiscent of the flag-like rectangular pattern of pigmentation found in human chimaeras. A very early somatic mutation may have similar effects on the pigmentation pattern as a chimaeric state, which is the result of the double fertilization of an ovum. Café-au-lait spots in 10 of our own patients with neurofibromatosis 1 could not be associated with either Blaschko's lines or the rectangular pattern of pigmentation in chimaeras. We conclude that, in contrast with the café-au-lait spots in autosomal dominant neurofibromatosis 1, the configuration pattern of melanotic macules in McCune-Albright syndrome in many cases characteristically reflects the mosaic state of the organism.

Child, Preschool↗

PubMed1993

[A rapid method of HbA1c determination in a pediatric diabetic patient sample].

A new Method for HbA1c measurements (Abbott vision) was evaluated. 107 patients (45 F, 62 M) of a paediatric diabetes clinic participated. The mean age was 14.9 (5.8-26.3) years, the mean duration of diabetes was 7.6 (0.1-21.1) years. Measurements were performed immediately after capillary blood sampling, the result was available within 15 min. The automated HPLC-system Diamat was used as a reference method, blood samples were stored at 4 degrees C and analysed within 24 h after blood sampling. There was a close correlation between both methods (r = 0.96, P < 0.0001). In the lower range the results measured by Abbott Vision were slightly lower, whereas in the higher range the results were slightly higher (HbA1c (Abbott) = 1.53 + HbA1c (Diamat).0.84). The accuracy seems to be satisfactory for estimating metabolic control. The HbA1c-result is available within 15 min which means a major advantage for the management of children and adolescents with type I diabetes.

Adolescent↗

PubMed1993

[Accuracy of blood glucose self-monitoring in children with type-I diabetes].

UNLABELLED: Children with type I diabetes often believe that they are able do gauge their blood glucose value without measurement. This study investigated how accurate these estimates are and which of the patient characteristics might affect accuracy. Nineteen children with type I diabetes (age 7.3-17.3 years, duration of diabetes 0.1-12.0 years) estimated their blood glucose immediately before a blood glucose measurement by reflectance meter. Ten to 54 estimations and measurements were done by each individual during a summer camp. According to the method of Cox et al. accuracy of estimates was evaluated by error grid analysis. Five zones were defined: accurate estimates (zone A); clinically benign errors (zone B); clinically dangerous errors (zone C, D, E). An overall accuracy index was calculated by subtracting the summed percentage of estimates in zones C, D, E from the percentage in zone A. The mean percentage of estimates in zone A was 41.5 (10.0-75.0)%, the mean overall accuracy index was 9.8 (-47.4-62.5)%. Except for mean blood glucose which was inversely correlated with accuracy index (r = -0.53, P = 0.02) none of the other patient characteristics showed an effect on accuracy index. CONCLUSIONS: Accuracy of blood glucose estimates is lower in children with type I diabetes than in adults and varies substantially between individuals. High mean blood glucose values are associated with a lower accuracy of estimates.

Adolescent↗

PubMed1991

[Delayed evaluation of test strips for blood glucose determination in small reflectometers].

The precision and accuracy of reacted reagent strips (Haemoglucotest 20-800 R, Reflocheck) stored in an envelope and analysed 24 and 48 hours later, by means of glucose reflectance meters (Reflolux II, Reflocheck) was studied. A good correlation of the values estimated after 24 and 48 hours to the value analysed immediately after sampling was found for both systems (Reflolux II 24 hours later, r = 0.9713, y = 24.16 + 0.7369. x, and 48 hours later, r = 0.9388, y = 44.21 + 0.5234. x; Reflocheck 24 hours later, r = 0.977, y = 9.72 + 0.9525. x, and 48 hours later, r = 0.9433, y = 45.97 + 0.4802. x). Our data show, that the initial value can be calculated using the 24 and 48 hour values by means of linear regression. Therefore the analysis of reacted reagent strips for blood glucose determination is beneficial in the management of Typ-I-Diabetics.

Blood Glucose↗

PubMed1991

[Normal values for free thyroxine, free triiodothyronine, reverse triiodothyronine, thyrotropin, thyroglobulin and thyroxine-binding globulin in umbilical cord blood of healthy mature newborn infants].

The venous cord blood levels of free thyroxine (fT4), free triiodothyronine (fT3), reverse triiodothyronine (rT3), thyrotropin (TSH), thyroglobulin (TG) and thyroxine binding globulin (TBG) were studied in 56 mature and healthy newborns. Newborns with a gestational age less than 37 or more than 42 weeks, a delivery by forceps or cesarian section, a birth-weight less than 2500 g, a pH-value of the cord-artery blood less than 7.15, an Apgar-value after 1 minute less than 7 were excluded from the study. All mothers were non-smokers. The values of fT4 were 18.66 +/- 4.18 pmol/L, of fT3 were 1.59 +/- 0.75 pmol/L, of fT3 were 2152 +/- 666 pg/ml, of TSH were 7.83 +/- 4.49 mU/ml, of TG were 44.61 +/- 23.84 ng/ml, and of TBG were 25.61 +/- 5.42 micrograms/ml. A weak negative correlation was found between the TG-value and the pH-value of the cord-artery blood (r = -0.27, y = 191.55 - 22.82.x, p less than 0.05), and between the fT4 values and the gestational age (r = -0.34, y = 67.53-1.22.x, p = 0.01). The rT3-values were positively correlated to the gestational age (r = 0.29, y = -4571 + 167.x, p less than 0.03).

Female↗

PubMed1991

[The responsibility of medicine in adolescence].

Adolescence is a not very well defined time period between childhood and the adult age. The self esteem of an adolescent is neither that one of a child nor that one of an adult. If somatic, psychologic or psychosomatic complications or problems occur within this period, most of the adolescents disagree to be treated by a pediatrician, but they also disagree to be treated by "doctors for the elderly". Most of the complications or problems are specific for that age period; they are not well known to all medical doctors. Because of these reasons, specialists in adolescent medicine are mandatory for proper treatment. The most important problems or complications are dealing with puberty (early or delayed puberty, acne), growth, sexuality and sexual behavior, contraception, chronic disease and drugs.

Adolescent↗