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Tam C.S.,Institute of Endocrinology and Diabetes | Tam C.S.,University of Sydney | Tam C.S.,University Pierre and Marie Curie | Clement K.,University Pierre and Marie Curie | And 2 more authors.
Obesity Reviews | Year: 2010

Childhood obesity is a major public health problem. Low-grade inflammation, a hallmark characterizing adult obesity, may be a pivotal mechanism linking obesity to its numerous systemic complications, with adipose tissue depots secreting and producing inflammatory mediators and visceral fat displaying an increased inflammatory profile. While knowledge is relatively scarce regarding the importance of the adipose tissue inflammation process in children, identifying its contribution in childhood obesity and the associated influences of age, sex, weight status, growth, and adipose depot phenotypes are crucial for understanding physiopathology and implementing early intervention strategies. We review the latest research linking obesity and inflammation in childhood focusing on serum inflammatory markers and the effectiveness of lifestyle interventions in improving systemic inflammation. Generally, there are significant correlations between body mass index and increased c-reactive protein and decreased adiponectin levels in children; these levels tend to be improved in interventions resulting in ∼5% weight loss, regardless of the type or length of intervention. There is a need for further research measuring other inflammatory mediators (e.g. tumour necrosis factor (TNF)-α, IL-6, IL-8) and histological studies examining immune cell infiltration in adipose tissue depots in obese children. © 2009 International Association for the Study of Obesity. Source


Cho Y.H.,Institute of Endocrinology and Diabetes
Pediatric endocrinology reviews : PER | Year: 2010

Technology for detecting vascular complications of childhood diabetes has already helped many children and youth by allowing for the early detection and intervention of impending or present problems as the result of the diabetes state. Prior to the advent of screening, young people developed clinical disease, in particular visual loss and renal impairment that often rapidly progressed to end-stage disease. With the advent of laser photocoagulation, which dramatically reduced visual loss from diabetic retinopathy, the importance of early detection and treatment of micro and macrovascular complications prior to clinical symptoms became apparent. Many technological advances are now being applied to the pediatric diabetes population, in either clinical care or the research setting. For example, retinal photography makes screening more accessible and more meaningful to adolescents with diabetes and can be used in large screening programs, for teleophthalmology, clinical trials and in geographically remote areas. Quantitative measures used to assess microvascular structure may be useful in monitoring interventions in the future. Quantitative sensory tests can monitor nerve dysfunction, but evaluations such as intraepidermal nerve fibre pathology and cornea confocal microscopy may be more sensitive to diagnose neuropathic complications in youth. B-mode ultrasonography can assess vascular function by measuring endothelium-dependent flow mediated dilatation and changes in the intima-media thickness of the carotid and aorta. It is the purpose of this manuscript to explore the role of present and future technological advances (Table 1) in young people with diabetes. Source


Cho Y.H.,Institute of Endocrinology and Diabetes
Pediatric diabetes | Year: 2012

The 37th Annual Meeting for the International Society of Pediatric and Adolescent Diabetes was held in Miami Beach, Florida, USA. The meeting, titled 'Possibilities for Prevention and Diabetes and its Complications', attracted over 1000 delegates from 52 countries. Fifty-six oral abstracts were presented, along with 294 posters, representing the diversity of research and clinical innovations in the field of pediatric and adolescent diabetes around the world. Abstracts to the Oral and Poster Sessions can be found in a recent supplement of Pediatric Diabetes. Here are some highlights from the plenary sessions, symposia, and oral presentations. © 2011 John Wiley & Sons A/S. Source


Shalitin S.,Institute of Endocrinology and Diabetes
International journal of clinical practice. Supplement | Year: 2011

Type 1 diabetes (T1D) is one of the most common chronic childhood diseases and its incidence has doubled during the last decade. The goals of intensive management of diabetes were established in 1993 by the Diabetes Control and Complications Trial (DCCT) (1). Children with T1D and their caregivers continue to face the challenge to maintain blood glucose levels in the near-normal range. It is important to prevent sustained hyperglycaemia which is associated with long-term microvascular and macrovascular complications and to avoid recurrent episodes of hypoglycaemia or hyperglycaemia, especially in young children, which may have adverse effects on cognitive function and impede efforts to achieve the recommended glycaemic targets. Advances in the use of technology that may help maintain the metabolic control goals for young people with T1D were centred on continuous subcutaneous insulin infusion (CSII) (2-4), continuous glucose monitoring (CGM) (5-7), and combining both technologies into a closed-loop system (8-10). The dilemma in paediatrics of patient selection for insulin pump therapy was found to be most successful in those with more frequent self-monitoring of blood glucose (SMBG) and younger age prior to pump initiation (2). Similarly, those who used a dual-wave bolus probably paid closer attention to their management and had lower HbA1c levels (3). The advantage of using a pre-meal bolus to improve postprandial glucose levels was shown to offer another potential method to improve glycaemic control (4). SMBG is an important component of therapy in patients with diabetes, especially in the paediatric age group. Standard use of glucose meters for SMBG provides only intermittent single blood glucose levels, without giving the 'whole picture' of glucose variability during the 24 h, and especially during the night, when blood glucose levels are seldom measured. Therefore, the use of a device such as real-time continuous glucose monitoring (RT-CGM) that provides continuous glucose measurements can help patients optimise glycaemic control. These devices may have the potential to increase the proportion of patients who are able to maintain target HbA1c values, to decrease glucose excursions and to decrease the risk of severe hypoglycaemia. Previous studies in paediatric T1D patients (11,12) have demonstrated that the frequency of CGM use was significantly associated with the effect of lowering HbA1c levels. Source


Temajo N.O.,Institute of Endocrinology and Diabetes | Howard N.,Institute of Endocrinology and Diabetes
Autoimmunity Reviews | Year: 2012

An autoimmune disease (AD) occurs in a situation where an individual's protective immune system attacks and destroys the individual's own tissues and organ(s), causing a recognizable syndrome(s). The viruses feature in the triggering of autoimmune diseases in genetically primed individuals through generating a viral group of regulatory immediate early proteins (IE). The IE indulges in promiscuous regulations of the viral replications as well as of host intracellular proteins. But there are consequences in the IE controlling host cell protein regulations, which we suggest as: the IE titration of the transactivator protein, autoimmune regulator (AIRE), which causes abolition of central tolerance; and the IE titration of the repressor protein, FOXP3, which results in the breach of peripheral tolerance. Titrations of AIRE and FOXP3 allow the escape of autoreactive T cells into the (peripheral) circulation where they can reach and zero in on self-tissues. The AD-predisposing MHC-II-DR-DQ haplotypes probably play a crucial role in the shaping of the T cell repertoire intrathymically for the survival of budding autoreactive T cell receptors (TCRs). Finally, we suggest there is IE titration of the repressors, the histone deacetylases (HDACs), in target organ cells which then consequentially express de novo MHC-II molecules and become de novo non-professional antigen-presenting cells (APCs), able to present viral peptides to cognate TCRs, thereby enrolling themselves for apoptotic death: a destiny of all APCs in immune responses, in general. Extensive apoptotic destruction of organ cells leads to an autoimmune syndrome(s). © 2011 Elsevier B.V.. Source

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