Preterm human milk composition and dietary intake of breastfeeding mothers in the Indonesian population

Background Human milk consumption is a protective factor against infection. However, the high variability of human milk composition makes it difficult for clinicians and researchers to assess the adequacy of nutritional intake. Objective To identify the nutritional profiles and composition of premature human milk and dietary intake of breastfeeding mother. Methods Human milk specimens were collected from mothers who gave birth to very premature and/or very low birth weight infants. Infants had been admitted to the Neonatology Unit of Dr. Cipto Mangunkusumo Hospital, Jakarta. The milk specimens were analyzed with a mid-infrared milk analyzerTM (MIRIS) for four weeks, and  maternal dietary macronutrient intake was determined with food record questionnaires on food consumption frequency and food recall. Results Significant changes in nutritional composition of human milk were observed, with the fat concentration and calories increasing with time, and protein concentration decreasing with time. There were no significant differences observed in carbohydrate concentration of milk over the four weeks (P=0.447). Maternal intake of protein, carbohydrates, fat and calories was lower than the recommended values for breastfeeding women. Conclusion The macronutrient (protein and fat) and energy contents of human milk change weekly. Dietary intake of breastfeeding women are lower than recommended values.

Consensus guidelines for the diagnosis and management of pyridoxine-dependent epilepsy due to α-aminoadipic semialdehyde dehydrogenase deficiency

Pyridoxine-dependent epilepsy (PDE-ALDH7A1) is an autosomal recessive condition due to a deficiency of α-aminoadipic semialdehyde dehydrogenase, which is a key enzyme in lysine oxidation. PDE-ALDH7A1 is a developmental and epileptic encephalopathy that was historically and empirically treated with pharmacologic doses of pyridoxine. Despite adequate seizure control, most patients with PDE-ALDH7A1 were reported to have developmental delay and intellectual disability. To improve outcome, a lysine-restricted diet and competitive inhibition of lysine transport through the use of pharmacologic doses of arginine have been recommended as an adjunct therapy. These lysine-reduction therapies have resulted in improved biochemical parameters and cognitive development in many but not all patients. The goal of these consensus guidelines is to re-evaluate and update the two previously published recommendations for diagnosis, treatment, and follow-up of patients with PDE-ALDH7A1. Members of the International PDE Consortium initiated evidence and consensus-based process to review previous recommendations, new research findings, and relevant clinical aspects of PDE-ALDH7A1. The guideline development group included pediatric neurologists, biochemical geneticists, clinical geneticists, laboratory scientists, and metabolic dieticians representing 29 institutions from 16 countries. Consensus guidelines for the diagnosis and management of patients with PDE-ALDH7A1 are provided.

Determinants of Circulating Soluble Leptin Receptor and Free Leptin Index in Indonesian Pre-Pubertal Obese Male Children: A Preliminary Cross-Sectional Study

PURPOSE

This study aimed to investigate the clinical and metabolic determinants of circulating soluble leptin receptor (CSLR) and free leptin index (FLI) in pre-pubertal obese male children.

METHODS

We conducted a preliminary cross-sectional study at three tertiary hospitals and one public primary school. Eighty obese male children without growth and developmental abnormalities aged 5-9 years were recruited. In these children, obesity was solely caused by excessive food intake, and not by acute illness, medications, endocrine abnormalities, or any syndrome. Body mass index (BMI), body fat mass, carbohydrate intake, fat intake, high density lipoprotein cholesterol level, low density lipoprotein cholesterol level, triglyceride level, and Homeostatic Model Assessment for Insulin Resistance are the potential determinants for leptin regulation, which is represented by CSLR level and FLI.

RESULTS

Carbohydrate was the main source of energy. BMI and body fat mass had negative weak correlation with CSLR and positive weak correlation with FLI. Furthermore, carbohydrate intake was found to be independently associated with CSLR based on the results of the multiple linear regression analysis. Following an increase in carbohydrate intake, CSLR level decreased progressively without any negative peak.

CONCLUSION

Leptin regulation in prepubertal obese male children is associated with body composition and dietary intake. Carbohydrate intake is useful for predicting CSLR. Lipid profiles and insulin resistance are not related to both CSLR and FLI. Treatment and prevention of leptin resistance in obese children should focus on reducing BMI, fat mass, and carbohydrate intake.

The Effect of Vitamin E Supplementation on Lipid Profiles and Adiponectin Levels in Obese Adolescents: A Randomized Controlled Trial

BACKGROUND

low-grade chronic inflammation in obese individuals contributes to the development of lipid abnormality and insulin resistance. Vitamin E has antioxidant and insulin-sensitizing properties, mediated by adiponectin. In this study, we aimed to evaluate the effect of vitamin E supplementation on lipid profiles and adiponectin levels in obese adolescents.

METHODS

this was a randomized, double-blind, controlled study. Obese adolescents aged 14-18 years, with no history of taking anti-obesity or antioxidant drugs, were recruited and randomized into two groups: vitamin E and placebo. The dose of vitamin E was 400 IU/day. Intervention was administered for two months. Lipid profiles and adiponectin levels were measured at baseline and after intervention. Primary outcomes were analyzed using the per-protocol analysis principle. Statistical analysis was performed using the independent t-test or the Mann-Whitney U test.

RESULTS

a total of 66 subjects completed the intervention study, 34 in the vitamin E group and 32 in the placebo group. Lipid profiles and adiponectin levels at 2 months after intervention did not differ significantly between the two groups. Changes from the baseline level were also not significantly different between the two groups and were inconsistent from one subject to another.

CONCLUSION

in obese adolescents, vitamin E supplementation of 400 IU/day for 2 months does not significantly affect lipid profiles and adiponectin levels.

Genetics and genomic medicine in Indonesia

Genetics and genomic medicine in Indonesia.

Karakteristik Kolestasis Intrahepatik dengan Infeksi Saluran Kemih

Latar belakang. Kolestasis intrahepatik (KI) merupakan salah satu kasus pada bayi yang sering ditemukan.Tata laksana seringkali sulit karena KI sulit menentukan etiologi yang sangat beragam dan memerlukanberbagai pemeriksaan penunjang. Infeksi saluran kemih (ISK) merupakan salah satu infeksi ekstrahepatiktersering yang menyebabkan KI pada bayi.Tujuan. Mengetahui karakteristik pasien KI dengan ISK.Metode. Desain penelitian adalah deskriptif retrospektif dari data pasien KI yang berobat ke RS CiptoMangunkusumo dalam kurun waktu Januari 2001 hingga Desember 2006.Hasil. Proporsi ISK didapatkan pada 56 (77%) diantara 73 pasien KI berusia 0-12 bulan di RSCM yangdilakukan biakan urin. Kolestasis intrahepatik dengan ISK lebih sering pada laki-laki (79%), cukup bulan(80%), dan usia tersering 0-3 bulan (75%). Tinja umumnya berwarna kuning (41%) atau dempul fluktuatif(52%). Hepatomegali ditemukan pada 37% pasien. Gejala klinis tersering adalah ikterik asimptomatik(71%). Rerata kadar bilirubin direk didapatkan 6,6 mg/dL (1,8-15,8), kadar bilirubin indirek 1,5 mg/dL(0,2-6,9), kadar AST 134 U/L (23-660), kadar ALT 114 U/L (14-588), kadar GGT 159 U/L (14-1039) danalbumin 3,7 g/dL (2,3-5,0). Anemia didapatkan pada 11 (20%) pasien dan leukositosis pada 7 (12%) pasien.Nilai PT memanjang terdapat pada 10 (22%) pasien. Urinalisis pada 75% pasien dalam batas normal. E.coli merupakan kuman penyebab ISK tersering (52%).Kesimpulan. Proporsi ISK pada KI cukup tinggi (77%). Kejadian ISK pada KI terutama ditemukan padabayi laki-laki, cukup bulan dan berusia 0-3 bulan. Tidak ditemukan gejala klinis spesifik pada KI denganISK. Proporsi tinja berwarna dempul, hepatomegali, anemia, nilai PT memanjang, serta rerata kadar ALTdan AST, meningkat dengan bertambah lamanya kolestasis. Umumnya urinalisis dalam batas normal,sehingga pemeriksaan biakan urin harus dilakukan pada setiap pasien KI untuk mencari kemungkinanISK.

Hubungan Ketebalan Tunika Intima Media Arteri Carotis dengan Obesitas pada Remaja

Latar belakang. Obesitas pada anak adalah masalah yang kompleks dengan penyebab multifaktorial, sehingga menyulitkan tata laksananya. Permasalahan yang timbul akibat obesitas berpengaruh terhadap tekanan darah, fungsi metabolisme, diabetes, penyakit kardiovaskular, dan lain-lain.Tujuan. Menilai ketebalan tunika intima-media (intima media thickness / IMT) arteri karotis sebagai petanda awal aterosklerosis pada anak remaja dengan obesitas dini dan faktor-faktor yang mempengaruhinya.Metode. Penelitian observasional dengan rancang bangun cross sectional terhadap 43 remaja obes dan 21 remaja sehat sebagai kontrol. Data meliputi kadar kolesterol total, kolesterol LDL dan HDL, trigliserida dan apolipoprotein B. Penilaian ketebalan tunika intima-media arteri karotis dilakukan dengan alat ultrasonografik. Pengolahan data dengan uji t tidak berpasangan, chi-square atau uji Fisher dan Anova. Untuk hubungan antar variabel digunakan uji regresi linier.Hasil. Terdapat perbedaan yang bermakna ketebalan tunika intima media arteri karotis remaja obes (rerata 0,41 mm; SB 0,05) dibandingkan kontrol 0,33 mm (SB 0,01) (p=0,001). Demikian juga kadar kolesterol total (p=0,001); kolesterol LDL (p=0,001), kolesterol HDL (p=0,004), trigliserida (p=0,017 ) dan apolipoprotein B (p=0,001). Tekanan darah sistolik anak obes rerata 118,2 mmHg (SB10,4), kontrol 109,5 mmHg (SB12,7) dan diastolik anak obes rerata 81,5 mmHg (SB 7,3); kontrol 68,6 mmHg (SB 7,4) berbeda bermakna dengan nilai p berturut-turut 0,004 dan 0,001. Dengan uji regresi linier terdapat hubungan ketebalan tunika intima media arteri karotis dengan indeks masa tubuh (r=0,640;p=0,001); dengan indeks BB/TB (r=0,627;p=0,001). Tetapi tidak terdapat hubungan ketebalan tunika intima media arteri karotis dengan kadar profil lipid. Kadar kolesterol HDL memiliki hubungan yang bermakna dengan ketebalan tunika intima media arteri karotis (r=-0,581; p=0,020).Kesimpulan. Ketebalan tunika intima media arteri karotis, kadar profil lipid, tekanan darah sistolik dan diastolik pada remaja obes berbeda bermakna dibandingkan anak dengan BB normal. Terdapat hubungan peningkatan ketebalan tunika intima media arteri karotis dengan peningkatan indeks masa tubuh, indeks BB/TB, tekanan darah diastolik, dan kadar kolesterol HDL yang rendah. 

Skrining Sistematik terhadap Hiperkolesterolemia Familial pada Anak Berdasarkan Kriteria MedPed, Simon Brome Register Register dan Dutch Lipid Clinic

Latar belakang. Hiperkolesterolemia familial (HF) merupakan kelainan genetik tersering penyebab terjadinya penyakit jantung koroner/aterosklerosis. Penyakit tersebut seringkali terlambat diketahui, padahal jika dapat diketahui sejak usia muda terjadinya penyakit jantung koroner dan kematian dapat dicegah. Terdapat berbagai macam kriteria untuk dapat mendeteksi dini HF pada orang dewasa, yaitu MedPed, Simon Broome RegisterdanDucth Lipid Clinic.Tujuan. Mendeteksi secara dini HF pada anak dengan riwayat orangtua mengalami penyakit jantung koroner dini dan hiperkolesterolemia berdasarkan kriteria MedPed, Simon Broome RegisterdanDucth Lipid Clinic.Metode. Studi potong lintang dari anak dengan riwayat orangtua mengalami PJK dini dan hiperkolesterolemia. Terhadap anak dan orangtua dilakukan pemeriksaan fisis dan laboratorium profil lipid (kolesterol total, LDL, HDL, trigliserida dan Apo B) kemudian digolongkan ke dalam 3 kriteria diagnosis berdasarkan MedPed, Simon Broome Registerdan Dutch Lipid Clinic. Dilakukan juga pemeriksaan untuk menyingkirkan kemungkinan peningkatan kolesterol akibat penyakit lainnya. Hasil. Terdapat 28 subyek dan 20 kasus indeks dari 20 keluarga. Rerata usia anak adalah 11,6±4,75 tahun, dengan rerata usia kasus indeks 47,8±5,50 tahun. Rerata usia saat kasus indeks mengalami serangan jantung pertama kali adalah 45,3±5,65 tahun. Berdasarkan data yang ada dilakukan penggolongan sesuai kriteria MedPed, Simon Broome Registerdan Dutch Lipid Clinic. Didapatkan 15% (3/20) anak yang mungkin menderita HF berdasarkan kriteria MedPed, jika menggunakan kriteria Simon Broome Register didapatkan sekitar 10% (2/20) sedangkan dengan kriteria Dutch Lipid Clinicdidapatkan 50% (10/20) anak yang sangat mungkin(probable)mengalami HF dan 30% (6/20) lainnya mungkin(possible)mengalami HF. Pada penelitian ini memang tidak dilakukan pemeriksaan genetik.Kesimpulan. Kriteria Dutch Lipid Clinicdapat lebih banyak mendeteksi kemungkinan anak yang mengalami HF berdasarkan riwayat orangtua mengalami penyakit jantung koroner dini dan hiperkolesterolemia dibandingkan kriteria lainnya.

Pengaruh Malnutrisi dan Faktor lainnya terhadap Kejadian Wound Dehiscence pada Pembedahan Abdominal Anak pada Periode Perioperratif

Latar belakang.Wound dehiscenceadalah salah satu komplikasi bedah abdominal yang jarang ditemui, namun sering menyebabkan kematian, meningkatkan lama rawat, biaya, dan risiko infeksi berat dengan akibat kematian. Malnutrisi dianggap sebagai salah satu faktor yang berkontribusi terhadap kejadian dehiscencetersebut. Tujuan.Menilai angka kejadiandehiscencebedah mayor pada anak yang berbeda status gizi, risiko relatif serta faktor lain yang mempengaruhi risiko dehiscence.Metode. Penelitian kohort prospektif pada 262 kasus bedah abdominal mayor pada anak. Pasien yang memenuhi kriteria dibagi 2 kelompok yaitu menderita malnutrisi dan tidak. Tata laksana dilakukan sesuai standar Bagian Bedah Anak RSAB Harapan Kita. Pengamatan dilakukan selama periode perioperatif sampai pulang dari rumah sakit. Dihitung angka kejadian, risiko relatif, dan faktor atribusi dehiscence. Pengolahan data dan analisis menggunakan SPSS versi 11.5 dan Open Epi Hasil.Angka kejadian dehiscence2,7% (7/262), satu pasien gizi baik (0,8%), gizi kurang 2/7(1,7%), gizi buruk 4/4(100%). Terjadi pada hari kelima pasca operasi (kisaran 3-7hari). Lama rawat 25 hari (14-73) vs10 hari (1-10) tidak dehiscence. Meninggal dunia 1/7dehiscence. Risiko dehiscencemeningkat secara bermakna pada gizi buruk vsgizi baik (RR136, IK95% 19,3-958,6, p=0,000). Hipoalbumin vsnormal (RR23,6, IK95% 5,8-95,4, p=0,000). Anemia vsnormal (RR18,6, IK95% CI3.7-91.9, p=0,000). Sepsis vsnormal (RR10,7, IK95% 2,5-45,5, p=0,000). Faktor atribusi dehiscence99,3% karena gizi buruk, hipoalbumin 96,6%, sepsis 90,7%, gizi kurang 59%. Kesimpulan.Status gizi buruk, hipoalbumin, dan sepsis berperan hampir seratus persen terhadap kejadian dehiscencepada anak. Saran, perlu dilakukan skoring risiko tinggi dehiscencepada anak yang akan menjalani bedah mayor.

The impact of obesity on left ventricular mass and left ventricular systolic function in children

Background Obesity causes cardiovascular disturbances. Theincidence of cardiovascular disease is higher even in mildly obesepatients than in lean subjects.Objectives The purpose of this study was to compare left ven-tricular (LV) mass, LV internal dimensions, and LV systolic func-tion between obese and normal children; and to determine the as-sociation of the degree of obesity with LV mass and LV systolicfunction.Methods This cross-sectional study was conducted on elemen-tary school students in Jakarta from February to April 2003. Wemeasured the subjects’ body weight and height, and performedlipid profile and echocardiography examinations. Measurementsof LV mass, LV internal dimensions with regard to septum thick-ness, LV internal diameter, and LV posterior wall thickness; andLV systolic function as indicated by shortening fraction and ejec-tion fraction, were performed echocardiographically. The differ-ences in measurements between obese and normal children aswell as between obese children with and without lipid abnormalitywere analyzed. The correlation between the degree of obesity withLV size and systolic function was determined.Results Twenty-eight normal children and 62 obese children wereenrolled in the study. Mean LV mass was 35.7 (SD 5.16) g/cm 3 inobese children versus 24.0 (SD 3.80) g/cm 3 in normal children(P<0.0001). Mean septum thickness was 0.8 (SD 0.14) mm inobese children versus 0.6 (SD 7.90) mm in normal children (P<0.0001). Mean posterior wall thickness was 0.9 (SD 0.14) mm inobese children versus 0.6 (SD 9.97) mm in normal children(P<0.0001). Mean LV internal diameter was 4.0 (SD 0.34) mm inobese children versus 3.9 (SD 0.29) mm in normal children(P=0.300). There was strong correlation between the degree ofobesity and LV mass (r=0.838, P<0.0001). LV systolic function(shortening fraction) was 37.1 (SD 4.20) percent in obese childrenversus 35.8 (SD 4.99) percent in normal children (P=0.19). Ejec-tion fraction was 67.4 (SD 5.32) percent in obese children versus65.5 (SD 6.29) percent in normal children (P=0.13). There wasweak correlation between LV systolic function and the degree ofobesity (shortening fraction r=0.219, P=0.038; ejection fractionr=0.239, P=0.023).Conclusions Obese children had significantly greater LV mass,septum thickness, and posterior wall thickness than normal chil-Backgrounddren. Such significant difference was absent for LV internal diam-eter and measures of LV systolic function. There was no signifi-cant difference in LV mass and LV systolic function between obesechildren with or without abnormality of lipid profile. A strong corre-lation exists between the degree of obesity and LV mass, but thecorrelation between degree of obesity and LV systolic function wasweak

The role of apolipoprotein E polymorphism in improving dyslipidemia in obese adolescents following physical exercise and National Cholesterol Education Program Step II intervention

BACKGROUND

Lifestyle changes are important factors for managing dyslipidemia before considering blood lipid-lowering drugs. However, genetic factors can influence the response outcome.

OBJECTIVE

We aimed to determine a dyslipidemia management strategy in obese adolescents.

PATIENTS AND METHODS

A total of 60 dyslipidemic obese adolescents received physical exercise and the NCEP step II diet for 28 days. Apolipoprotein E (apo E) genotypes and blood lipid levels were compared before and after interventions.

RESULTS

The apo E3/E3 genotype was found to be common in all subjects. Mean levels of total cholesterol, triglyceride, and low-density lipoprotein-cholesterol (LDL-C) improved in subjects with the E3 allele after the intervention, but not the E2 allele. Total cholesterol and LDL-C, but not triglyceride levels, improved in subjects with the E4 allele.

DISCUSSION

Apo E alleles might influence improvement in lipid profiles after diet and exercise interventions. These results could inform personalized dyslipidemia management in obese adolescents, to determine which subjects would benefit from blood lipid-lowering drugs.

Physical activity assessments in obese and non-obese adolescents using the Bouchard diary

Background Obesity is now a global epidemic problem. Increasedprevalence of obesity is associated with increased sedentarybeh avior and low physical activity.Objective To assess the physical activity patterns of adolescentsaged 10-15 years and to compare mean energy output, intensityof physical activity, duration of moderate-vigorously intensity ofphysical activity, and length of screen time in obese and non-obeseadolescents.Methods This cross-sectional study was conducted on 7th and3th grade students aged 12-15 years at 216 junior high schools inWest Jakarta. Physical activity was assessed using th e Boucharddiary for 2 school days and 1 holiday.Results There was no significant differen ce in mean energyoutput between th e obese and non-obese adolescent s. Th emedian intensity of physical activity of obese adolescents waslower than that of non-obese adolescents [1.5 (range 0.8 to 1.8)vs. 2 (range 1.6 to 2.8) METs, respectively; P <0.00 1] . The meanduration of moderate-vigorous intensity of physical activity inobese adolescents was shorter than that of non-obese adolescents[19.3 (SD 6.9) vs. 26.4 (SD3.4) minutes, respectively; P= 0.000].Median length of screen time was longer for obese adolescentsthan for non -obese adolescents [2.8 (range 1 to 6.6) vs. 1.8(range 0.3 to 6.1) hours, respectively; P < 0.001]. There was noadolescent who met the recommended physical activity intensityand duration criteria.Conclusion Physical activity varies among adolescents aged10- 15 years. Obese adolescents have signific antly less physicalactivity duration and intensity than n on-obese adolescents, butsignificantly longer screen time. All adolescents' physical activityis less than the recommended intensity and duration.

Regurgitation and gastroesophageal reflux disease in six to nine months old indonesian infants

PURPOSE

Regurgitation is known to peak at the age of 3-4 months, with a sharp decrease around the age of 6 months. Little is known about the natural evolution of infants who still regurgitate after the age of 6 months.

METHODS

Hundred thirty-one infants older than 6 months regurgitating more than once a day were followed for a period of 3 months.

RESULTS

According to our data, gastroesophageal reflux disease (GERD) is seldom at this age. Most of the infants regurgitated 3 or more times/day and spit up an estimated volume of more than 15 mL. Eighty-five parents were educated regarding frequency of feeding. There were only 6 infants that still had frequent regurgitation (>3 times/day) despite an appropriate feeding schedule. The Infant GER Questionnaire score reached a score of 0 in 50% of the infants after one month of follow-up and in 81.9% at the third month of follow-up. There was an increase of the "weight for age z-score" trends in infants that still regurgitated at the end of follow-up and a declining z-score in infants that no longer regurgitated. An explanation may be that infants that regurgitate drink larger volumes than infants who do not regurgitate. Conservative treatment (reassurance, dietary treatment, behavioral advice) resulted in a significant better outcome than natural evolution.

CONCLUSION

Regurgitation that persisted after the age of 6 months, strongly decreased during a 3-month follow-up with conservative treatment. GERD is rare in this age group; therefore, anti-reflux medication is only seldom needed.

The role of uncoupling protein 2 and 3 genes polymorphism and energy expenditure in obese Indonesian children

AIM

Uncoupling protein (UCP) genes, which may contribute to energy metabolism in mitochondria, may be involved in the pathogenesis of obesity. We analyzed the differences in energy expenditure between single nucleotide polymorphisms (SNPs) UCP3-55C/T, UCP3 Y210Y, and UCP2 A55V among Indonesian children.

METHODS

The study included 76 schoolchildren (36 obese and 40 healthy; mean age, 12.8 years) in Semarang, Indonesia. Body composition was measured by bioelectrical impedance analysis; resting energy expenditure (REE) by indirect calorimetry; physical activity by uniaxial accelerometer; and total energy expenditure (TEE) by the equations extrapolated from REE and physical activity. UCP3-55C/T, UCP3 Y210Y, and UCP2 A55V were examined by restriction length fragment polymorphism analysis.

RESULTS

The TEE of the subjects with the T/T genotype at UCP3-55C/T after adjusting for fat-free mass (63.2±7.2 kcal/kg/day) and T/T at UCP2 A55V (62.8±5.6 kcal/kg/day) was lower than that of the subjects with the C/C and C/T genotypes (p<0.05). The REE of the subjects with these T/T genotypes tended to be lower than that of the subjects with C/C and C/T (p≥0.05). No significant differences in REE or TEE were found between the UCP3 Y210Y genotypes.

CONCLUSIONS

The subjects with the T/T genotypes of UCP3-55C/T or UCP2 A55V had lower TEE than those with other genotypes.

Metabolic syndrome and visceral fat thickness in obese adolescents

Background Metabolic syndrome (MS) is one of the long-termconsequences of obesity which can be found in adolescents. MS iscaused by excessive visceral fat accumulation. The visceral fatthickness (VFT) itself can be measured by using waist circumference(WC) measurement and abdominal ultrasonography. Until now,there are no WC and VFT cut-off points to predict MS in childrenand adolescents. This study used MS criteria based on NationalCholesterol Education Program – Adult Treatment Panel III(NCEP-ATP III) which specifically modified.Objective The objectives of this study are (a) to determine the MSocurrence based on modified NCEP-ATP III in obese adolescents;(b) to measure the VFT by using abdominal ultrasonography in obeseadolescent with MS and obese adolescent without MS.Methods We conducted a cross-sectional study from March toMay 2006. Fifty obese adolescents were recruited from severaljunior and senior high schools in Jakarta.Results Of those 50 obese adolescents, there were 34 subjects withWC>P 80  and 16 subjects with WC <P 80 . Of those 34 subjectswith WC>P 80 , 17 subjects had MS and the others had no MS. Allthe 16 subjects with WC <P 80 did not have MS. The VFT in 17subjects with WC>P 80  who had MS was 5.19 cm (SD 2.07 cm).The VFT in 17 subjects with WC>P 80 who had no MS was 3.94cm (SD 1.62 cm). The VFT in all 16 subjects with WC <P 80 whodid not have MS was 3.54 cm (SD 0.92 cm). All obese adolescentswith MS had WC>P 80  and they also had visceral fat which wasthicker than obese adolescents without MS.Conclusions All obese adolescents with MS have WC>P 80  andthicker visceral fat than obese adolescents without MS; the VFTof obese adolescents without MS, who had WC>P 80 was 3.94cm (SD 1.62 cm), and the VFT of obese adolescents without MS,who had WC <P 80 was 3.54 cm (SD 0.92 cm).

Glycerol kinase deficiency: residual activity explained by reduced transcription and enzyme conformation

Four unrelated patients with glyceroluria ranging from 7 to 170 mmol/l were studied. The activity of glycerol kinase (GK) in cultured fibroblasts was determined with a specific enzyme assay and with two indirect methods, that is, incorporation into macromolecules of [(14)C] from [(14)C]glycerol and its oxidation to [(14)C]CO(2). Exon amplification and RT-PCR were used to identify mutations. In patient 1, with low activity in all three assays, we identified a c.1194A>C (E398D) missense mutation. In patient 2 with a considerable activity of the GK enzyme (22% of reference), oxidation to [(14)C]CO(2) (37%) and a high incorporation of [(14)C] into macromolecules (92%), we identified a c.182T>C (L61P) mutation that causes the enzyme to have a higher K(m) for glycerol ( approximately 300 microM) than normals (2-8 microM). In patient 3, the GK activity estimated by the three different methods ranged from 16 to 22% of reference. Analysis of mRNA from the GK gene revealed three alternatively spliced transcripts. A mutation in intron 3 (g.16835G>A) resulted in an insertion of a cryptic exon between exon 2 or 3 and exon 4. Patient 4 with minor glyceroluria (7 mmol/l) and normal plasma glycerol concentration had normal activity with all three assay methods, thus excluding GK deficiency (GKD) as a cause of slight glyceroluria. To evaluate fully patients with glyceroluria, one needs to measure the GK activity and relate this and the clinical data to genetic findings. Residual enzyme activities in cultured fibroblasts can be found in GKD patients with severe clinical symptoms.

Isolated and contiguous glycerol kinase gene disorders: a review

Glycerol kinase deficiency (GKD) is an X-linked recessive disorder. There are two types. an isolated form and a complex form. We review the clinical, biochemical and molecular genetic features of GKD. The clinical and biochemical phenotype of isolated GKD may vary from a life-threatening childhood metabolic crisis to asymptomatic adult 'pseudohypertriglyceridaemia', resulting from hyperglycerolaemia. To date 38 patients from 24 families with isolated GKD have been reported. At least 7 of these patients had a metabolic crisis during a catabolic condition. The complex GKD is an Xp21 contiguous gene syndrome involving the glycerol kinase locus together with the adrenal hypoplasia congenita (AHC) or Duchenne muscular dystrophy (DMD) loci or both. Clinical features of a patient with complex GKD depend on the loci that are involved. Approximately 100 patients from 78 families with a complex GKD have been reported. Seventeen patients with complex GKD (AHC-GKD-DMD or AHC-GKD) died in the neonatal period or early childhood because of unrecognized or inappropriate management of adrenal dysfunction. Since the outcome of the crisis in GKD is highly dependent on the physicians' knowledge of the disease, we devised an algorithmic approach to the diagnosis. From molecular genetic investigations of isolated GKD, 7 missense mutations, 2 splice site mutations, I nonsense mutation, 1 Alu Sx insertion and 2 small deletions were reported for isolated GKD in 13 unrelated families. In 4 families consisting of more than one patient with the same biochemical and genetic defect, the phenotypic variability of the isolated GKD was remarkable. The clinical variability in isolated GKD cannot be explained by biochemical or by molecular heterogeneity. Isolated GKD patients showed a tendency towards hypoglycaemia with hyperketonaemia; whether the clinical symptoms of GKD are caused by dysfunction of gluconeogenesis and/or ketolysis needs to be investigated further.

Clinical heterogeneity and novel mutations in the glycerol kinase gene in three families with isolated glycerol kinase deficiency

Isolated glycerol kinase deficiency (GKD) is an X linked recessive disorder. The clinical and biochemical picture may vary from a childhood metabolic crisis to asymptomatic adult "pseudohypertriglyceridaemia", the result of hyperglycerolaemia. We performed glycerol kinase (GK) gene analysis to study the molecular heterogeneity and genotype-phenotype correlation in eight males from three families with isolated GKD. All patients had hyperglycerolaemia and glyceroluria. Four patients from two families were essentially free of symptoms. Three patients had gastrointestinal symptoms with ketoacidosis or hypoglycaemia or both. One patient had recurrent convulsions as the only acute sign, without evidence that it was correlated with a catabolic state. Fasting tests in two symptomatic patients of family 1 showed hyperketotic states, together with a tendency to hypoglycaemia. The diagnosis was confirmed by a defective 14C-glycerol incorporation into trichloroacetic acid precipitable macromolecules in intact skin fibroblasts. Mutation screening of the GK gene was performed by amplification and direct sequencing of exons using PCR. Three novel mutations were identified: (1) a deletion starting downstream of exon 9, extending to the 3' end of the gene; (2) a nonsense mutation R413X caused by a C1351T transition; and (3) a missense mutation W503R caused by a T1651C transition. In addition, we found differences from the reported sequence: (1) exon 9 actually consists of two exons, which consequently will change the number of GK gene exons from 19 to 20 exons, and (2) nucleotide differences in exon 19. So far, no genotype-phenotype correlation can be established in these GKD families.