Adipokines, insulin resistance, and adiposity as a predictors of metabolic syndrome in child survivors of lymphoma and acute lymphoblastic leukemia of a developing country

BACKGROUND

There is a growing body of evidence indicating that pediatric survivors of cancer are at a greater risk of developing metabolic syndrome. This study evaluated some probable predictors of metabolic syndrome (MS), such as leptin and adiponectin concentrations, the leptin/adiponectin ratio, insulin resistance, and adiposity, in a sample of child survivors of lymphoma and leukemia in Mexico City.

METHODS

Fifty two children (leukemia n = 26, lymphoma n = 26), who were within the first 5 years after cessation of therapy, were considered as eligible to participate in the study. Testing included fasting insulin, glucose, adipokines and lipids; body fat mass was measured by DXA. The MS components were analyzed according to tertiles of adipokines, insulin resistance, and adiposity. Comparisons between continuous variables were performed according to the data distribution. The MS components were analyzed according to tertiles of adipokines, insulin resistance, and adiposity. With the purpose of assessing the risk of a present MS diagnosis, odds ratios (OR) with a 95% confidence interval (95% IC) were obtained using logistic regression analysis according to the various metabolic markers.

RESULTS

The median children age was 12.1 years, and the interval time from the completion of therapy to study enrollment was 4 years. Among the MS components, the prevalence of HDL-C low was most common (42%), followed by central obesity (29%). The HOMA-IR (OR 9.0, 95% CI 2.0; 41.1), body fat (OR 5.5, 95% CI 1.6; 19.3), leptin level (OR 5.7, 95% CI 1.6; 20.2) and leptin/adiponectin ratio (OR 9.4, 95% CI 2.0; 49.8) in the highest tertile, were predictive factors of developing MS; whereas the lowest tertile of adiponectin was associated with a protective effect but not significant.

CONCLUSIONS

Biomarkers such as HOMA-IR, leptin and leptin/adiponectin are associated with each of the components of the MS and with a heightened risk of suffering MS among children survivors of cancer. Given the close relationship between MS with risk of developing type 2 diabetes and cardiovascular disease, it is imperative to implement prevention measures in this population and especially in developing countries where these pathologies have become the leading cause of death.

A fortifier comprising protein, vitamins, and calcium-glycerophosphate for preterm human milk

BACKGROUND

The infant's own mother's milk, fortified with proteins, minerals, and vitamins, is considered the best food for low-birth-weight infants. This paper describes the process to obtain a liquid human milk fortifier.

METHODS

The fortifier comprises a protein concentrate, calcium, phosphate, and zinc salts, as well as vitamins A and D. A powdered whey protein extracted from bovine milk was concentrated from 31.5-76.8 g/100 g using repetitive dialysis. The protein concentrate was dissolved in a 0.2 M phosphate buffer pH 7.4 and mixed with calcium-glycerophosphate and calcium-gluconate, vitamins A and D, folic acid, and zinc. Each 10 mL of this liquid fortifier has 0.78 g protein, 53 mg calcium, 36 mg phosphate, and 0.93 mg zinc.

RESULTS

Repetitive dialysis did not modify the protein structure as demonstrated by electrophoresis. A total of 95% of lactose content was discarded. Enriching human milk using this human milk fortifier increased the concentration per deciliter of all added nutrients; proteins increased from 1.68-2.35 g, calcium from 26-90 mg, and phosphorus, from 15-51 mg.

CONCLUSIONS

A liquid human milk fortifier was successfully manufactured using a noncomplex procedure. An intake of 180-200 mL/kg/day of the fortified human milk by the premature infant would satisfy the infant's nutritional requirements and achieve expected growth and development.