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Background: Dyslipidemia in children with chronic kidney disease (CKD) is identified based on lipid profile parameters; however, changes in lipoprotein quality precede quantitative changes. Methods: A cross-sectional study was done from January to October 2021; overweight, obese children, known cases of diabetes mellitus, hypothyroidism or on steroid therapy, or lipid lowering drugs were excluded. Clinical details were elicited and examinations done. Besides hemogram, kidney function tests, liver function tests, total cholesterol, low density lipoproteins (LDL), triglycerides, high density lipoproteins (HDL), and apolipoproteins A-1 and B were estimated to identify dyslipidemia. Relevant tests of significance were applied, and ROC curves were drawn for apoA-1, apoB, and apoB/apoA-1 ratios. Results: A total of 76 (61 M:15 F) children with median (IQR) age 7 (3.25–11) years were enrolled; cause of CKD was CAKUT in 82.3% patients. Dyslipidemia (alteration of 1 or more lipid parameters) was seen in 78.9% with a prevalence of 71.7% in early and 95.7% in later stages of CKD (P = 0.02); most had elevated serum triglyceride levels. The median (IQR) values of apoB, apoA-1, and apoB/apoA-1 ratio were 78 (58–110) mg/dl, 80 (63–96.75) mg/dl, and 0.88 (0.68–1.41), respectively; apoB, apoA-1, and apoB/apoA-1 ratio had a sensitivity of 26.67%, 86.67%, and 70%, respectively, and specificity of 87.5%, 62.5%, and 62.5%, respectively, for diagnosis of dyslipidemia. The ROC for apoB, apoA-1, and apoB/apoA-1 ratio showed AUC of 0.66, 0.68, and 0.74 (P = 0.4, 0.02, < 0.01), respectively. Conclusions: The prevalence (78.9%) of dyslipidemia was high in patients with CKD especially in those with later stages. The ratio of apoB/apoA-1 was altered early and appears to be promising for early detection. [ABSTRACT FROM AUTHOR]

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality and morbidity in the United States, accounting for approximately 103 deaths per 100,000 people or 1 in 7 deaths yearly. Risk factors of atherosclerosis in the young include lipoprotein levels, cigarette smoking, body mass index, and systolic as well as diastolic blood pressures. Topics covered in this paper include the physiology of lipid metabolism, pathophysiology of atherosclerosis, classification of hyperlipidemias, secondary causes of hyperlipidemias, and guidelines to evaluation of pediatric patients with hyperlipidemia. Finally, principles of management of hyperlipidemia are presented to aid the primary care clinician in managing this important condition in their pediatric patients. [ABSTRACT FROM AUTHOR]

Background: Pediatric as well as adult patients with chronic kidney disease (CKD) are susceptible to cardiovascular disease (CVD) events, which increase their mortality. Dyslipidemia is thought to be one of the most important contributing risk factors for developing CVD. This study aimed to evaluate the prevalence of dyslipidemia and assess clinical and laboratory risk factors associated with dyslipidemia in East Asian pediatric patients with CKD. Methods: From April 2011 to April 2016, 469 patients with CKD aged < 20 years were enrolled in KNOW-PedCKD (the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease); 356 patients were included in the final analysis. Using the baseline data of the cohort cross-sectionally, a multivariable logistic regression analysis was performed to assess the risk factors for dyslipidemia; a subanalysis for each lipid abnormality was also done. Results: The prevalence of dyslipidemia was 61.5% (n = 219). For dyslipidemia, nephrotic range proteinuria and 25-hydroxyvitamin D deficiency significantly increased the adjusted odds ratio. In the subanalysis, glomerulonephropathy as the origin of CKD and nephrotic range proteinuria significantly increased the risks for high total cholesterol and high low-density lipoprotein cholesterol. Overweight or obese body mass index z-score, elevated proteinuria, hypocalcemia, and 1,25-dihydroxyvitamin D deficiency were significantly associated with low high-density lipoprotein cholesterol. Glomerular filtration rate stage 3b or higher and hyperphosphatemia significantly increased the risk for high triglycerides. Conclusions: Long-term data accumulation and prospective analysis are needed to clarify the relationship between CKD progression and dyslipidemia and to find additional risk factors for dyslipidemia. [ABSTRACT FROM AUTHOR]

Objective: Tri-ponderal mass index (TMI) has been reported to estimate body fat more accurately than body mass index (BMI). This study aimed to compare the efficacy of TMI and BMI in predicting insulin resistance (IR), hyperlipidemia, impaired liver enzymes or thyroid hormone function and vitamin D concentration. Methods: One hundred and forty-three overweight or obese children, based on BMI-standard deviation (SD) scoring (BMI-SDS) were studied retrospectively. TMI thresholds for overweight status were 16.0 kg/m³ for boys and 16.8 kg/m3 for girls and 18.8 kg/m³ for boys and 19.7 kg/m3 for girls for obese status. Results: Twenty-two overweight and eight obese children by BMI-SDS were classified as normal by TMI. Of the overweight children 22 (22.7%) had IR and IR was detected in 2 of 8 obese children with normal TMI. There was no increase in liver enzymes in any of the children with normal TMI. Forty-four obese children were overweight according to TMI and IR was detected in 40.9%. Thyroid stimulating hormone levels were significantly higher in BMI-based obese children. Vitamin D levels were similar in all groups of both classifications. Conclusion: When TMI was used there may be a risk of overlooking IR. However, if it is assumed that liver enzymes are elevated as a result of visceral adiposity, TMI can be used as an auxiliary parameter to show visceral effects of adiposity. Normal TMI may indicate that visceral organ functions have not deteriorated yet. More studies are needed to evaluate TMI as a clinical tool. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia is an important cardiovascular risk factor in steroid-resistant nephrotic syndrome (SRNS). Efficacy of statins for treatment of hyperlipidemia in children with SRNS is unclear.Methods: This prospective, randomized, double-blind, placebo-controlled, parallel-group clinical trial enrolled 30 patients with SRNS, aged 5-18 years, with serum low-density lipoprotein cholesterol (LDL-C) levels between 130 and 300 mg/dl, to receive a fixed dose of atorvastatin (n = 15, 10 mg/d) or placebo (n = 15) by block randomization in a 1:1 ratio. Primary outcome was change in serum LDL-C at 12 months. Change in levels of other lipid fractions, carotid intima-media thickness (cIMT), flow-mediated dilation (FMD) of the brachial artery, and adverse events were also evaluated.Results: At the end of 12 months, atorvastatin was not superior to placebo in reducing plasma LDL-C levels, median percentage reduction 15.8% and 9.5% respectively, in atorvastatin and placebo arms (n = 14 in each; P = 0.40). Apolipoprotein B levels significantly declined with atorvastatin in modified intention-to-treat analysis (P = 0.01) but not in the per-protocol analysis. There was no significant effect on other lipid fractions, cIMT and FMD. Adverse events were similar between groups. Change in serum albumin was negatively associated with change in serum LDL-C, very low-density lipoprotein cholesterol, total cholesterol, triglyceride, and apolipoprotein B (P < 0.001), irrespective of receiving atorvastatin, age, gender, body mass index, and serum creatinine.Conclusions: Atorvastatin, administered at a fixed daily dose of 10 mg, was not beneficial in lowering lipid levels in children with SRNS; rise in serum albumin was associated with improvement in dyslipidemia. [ABSTRACT FROM AUTHOR]

Wnt signaling/LRP6 plays a critical role in metabolic syndrome and atherosclerosis, and variation in this pathway may lead to hyperlipidemia, nonalcoholic fatty liver disease, and coronary artery disease. In the present study, we investigated the effect of LRP6 rs2302685 (V1062I) on hyperlipidemia in Iranian children and adolescents. The population in this study consisted of 200 children (101 boys, 99 girls) aged 9–18 years old. Total cholesterol, high‐density lipoprotein (HDL), low‐density lipoprotein (LDL), non‐HDL cholesterol, and triglyceride levels were measured. Body composition was evaluated by the Hologic DXA system. PCR/restriction fragment length polymorphism was performed for LRP6 rs2302685 (V1062I) genotyping. Logistic regression analysis was done to find the association between LRP6 rs2302685 (V1062I) and categorized lipid parameters in the adjusted model for confounding factors (age, sex, and puberty). Individuals with the CC genotype showed significantly higher levels of cholesterol, triglycerides, LDL, and non‐HDL compared to the CT and TT genotypes. In modeling analysis, for categorized lipid parameters, a significant association was found between CC versus CT, and CC versus TT in terms of cholesterol, LDL, and non‐HDL. It seems that LRP6 rs2302685 (V1062I) variant carriers are associated with an increased risk of hyperlipidemia in Iranian children and adolescents. [ABSTRACT FROM AUTHOR]

Children with primary hyperlipidemia are prone to develop premature atherosclerosis, possibly associated with increased oxidative stress. Nutritional therapy is the primary strategy in the treatment of hyperlipidemia and associated conditions. Dietary interventions with bioactive-rich foods, such as nuts, may contribute to the modulation of both lipid profile and the oxidative/antioxidant status. Our study aimed to assess the impact of a dietary intervention with hazelnuts on selected oxidative stress markers in children and adolescents with primary hyperlipidemia. A single-blind, 8-week, randomized, controlled, three-arm, parallel-group study was performed. Children and adolescents diagnosed with primary hyperlipidemia (n=60) received dietary guidelines and were randomized into three groups: group 1 received hazelnuts with skin (HZN+S), and group 2 hazelnuts without skin (HZN-S), at equivalent doses (15-30 g/day, based on body weight); group 3 (controls) received only dietary recommendations (no nuts). At baseline and after 8 weeks, plasma oxidized low-density lipoprotein (ox-LDL) concentrations, oxidative levels of DNA damage in PBMCs and potential correlation with changes in serum lipids were examined. A reduction of endogenous DNA damage by 18.9%±51.3% (P=.002) and 23.1%±47.9% (P=.007) was observed after HZN+S and HZN-S, respectively. Oxidatively induced DNA strand breaks decreased by 16.0%±38.2% (P=.02) following HZN+S treatment. Ox-LDL levels did not change after HZN+S intervention but positively correlated with total cholesterol and LDL cholesterol. A short-term hazelnut intervention improves cell DNA protection and resistance against oxidative stress but not ox-LDL in hyperlipidemic pediatric patients. The trial was registered at ISRCTN.com, ID no. ISRCTN12261900. [ABSTRACT FROM AUTHOR]

This study aimed at characterizing the fatty acid (FA) composition of red blood cell (RBC) phospholipids in children and adolescents with primary hyperlipidemia, and to ascertain potential association with serum lipid profile and dietary factors. At this purpose, 54 probands aged 6–17 years were recruited. Subjects showed a low omega-3 index (eicosapentaenoic acid, EPA + docosahexaenoic acid, DHA <4%). Compared to males, females had a trend toward lower levels of total monounsaturated fatty acids (MUFA) and MUFA/saturated fatty acids (SFAs) ratio in RBCs. An inverse relationship between MUFA concentration in RBCs and serum cholesterol or HDL-C/triglycerides ratio was found. Omega-6 polyunsaturated fatty acids (n-6 PUFA) were positively associated to serum HDL-C levels, and inversely to dietary cholesterol. Fiber intake was positively associated with MUFA/SFA ratio. In conclusion, we provide the first experimental data on phospholipid FA composition of RBCs in hyperlipidemic children, showing sex differences and an overall low omega 3-index. [ABSTRACT FROM PUBLISHER]

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Purpose: The aim of this study is to evaluate the relationship between abdominal subcutaneous fat thickness measured by ultrasonography (US) and serum lipid profile and liver transaminases in obese children. Methods: One hundred and sixty-six children diagnosed with obesity from May 2001 to December 2013 were included in this study. Data on serum lipid profile and liver transaminases were collected from clinical records. Abdominal subcutaneous fat thickness and grade of hepatic steatosis were evaluated by US. Results: Of the 166 children, 107 were diagnosed with hepatic steatosis by US, 46 with grade I, 56 with grade II, and five children with grade III. According to the grade of hepatic steasosis, the average values of midline abdominal subcutaneous fat thickness and right flank abdominal subcutaneous fat thickness measured 2.9±0.8 cm and 1.9±0.7 cm in the normal group, 3.3±0.8 cm and 2.0±0.7 cm in grade I, 3.8±0.8 cm and 2.3±0.8 cm in grade II, and 4.1±0.8 cm and 2.8±1.4 cm in grade III, respectively. Abdominal subcutaneous fat thickness correlated with grade of hepatic steatosis (p<0.01). In addition, abdominal subcutaneous fat thickness correlated with concentration of serum lipids and liver transaminases in the age group of 12-14 years (p<0.01). Conclusion: Abdominal subcutaneous fat thickness measured by US can be used as a reliable predictor of possible hyperlipidemia and steatohepatitis in children, especially during the adolescent stage. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia is considered as an important modifiable risk factor for cardiovascular disease (CVD). The link between childhood dyslipidemia and occurrence of atherosclerosis and its sequels in adulthood are well-documented. This study aimed to systematically review the prevalence of dyslipidemia among Iranian children and adolescents. Materials and Methods: An electronic search was conducted on studies published from January 1990 to January 2014. The main international electronic data sources were PubMed and the NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS. For Persian databases, we used domestic databases with systematic search capability including IranMedex, Irandoc, and Scientific Information Database (SID). We included all available population-based studies and national surveys conducted in the pediatric age group (aged <21 years). Results: In this review, 1772 articles were identified (PubMed: 1464; Scopus: 11; ISI: 58; SID: 90; IranMedex: 149; Irandoc: 57). During three refine steps and after removing of duplicates, 182 articles related to the study domain were selected. After quality assessment, 46 studies were selected for text appraisal, of which 26 qualified articles were evaluated at the final step. The prevalence range of hypercholesterolemia, hypertriglyceridemia, elevated low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol (HDL-C) were 3-48%, 3-50%, 5-20% and 5-88%, respectively. Low HDL-C and hypertriglyceridemia were the most prevalent lipid disorders in this group of population. Conclusion: Dyslipidemia is a common health problem among Iranian children and adolescents. Few data were available in preschool children. This finding provides useful information for health policy makers to implement action-oriented interventions for prevention and early control of this important CVD risk factor. [ABSTRACT FROM AUTHOR]

A thirteen years old male patient of insulin dependent diabetes mellitus from Medicine Department was referred to our Dermatology Department with multiple eruptive xanthomas over the buttocks, knees and hands. Patient was blind since birth and diagnosis of "retinitis pigmentosa" was made by Ophthalmology Department. He was investigated and found raised levels of blood sugar, triglycerides, VLDL, TSH, SGOT/PT and kidney functions tests. He was diagnosed as a case of eruptive xanthomas with retinitis pigmentosa in secondary hyperlipidemia. We have reported this case because of the rare associations. [ABSTRACT FROM AUTHOR]

Severe hypertriglyceridemia is the third most common cause of acute pancreatitis and is strongly associated with an increased risk of cardiovascular disease. In infants, the most common cause of severe hypertriglyceridemia is lipoprotein lipase deficiency. We describe a 7-week-old infant with severe hypertriglyceridemia, who presented with frequent gastrointestinal bleeding, respiratory distress, a decreased level of consciousness and lipemia retinalis. Triglycerides were reduced from 734 to 2 mmol/L (64,956–177 mg/dL), by exchange transfusions. The infant made a remarkable recovery with no sequelae. This case highlights atypical, protean presentations and a potential treatment when established therapies are unavailable. [ABSTRACT FROM AUTHOR]

Objective: Antipsychotics, especially atypical ones, are in common use in children and adolescents with psychotic or affective spectrum disorders, as well as in various other psychopathologies. The adverse effects of atypical antipsychotics in children and adolescents are similar to those seen in adults, and include weight gain, elevated blood glucose levels, and hyperlipidemia. In this retrospective chart review, we compared these adverse events in children who were treated with typical, atypical, or no antipsychotic treatment. Methods: The medical charts of 72 children, 65 boys and 7 girls, were reviewed. All children were 6-13 years old (mean age 9.5±1.7 years). In total, 48 children received antipsychotic treatment, and 24 children were in the control group. Data were extracted from the medical charts, including weight, height, body mass index (BMI), blood pressure, aspartate transaminase (AST), alanine transaminase (ALT), triglycerides, total cholesterol, and glucose blood levels. We examined the values in the beginning of the antipsychotic treatment and at release from the hospital in the study group, and at admission and in the end of the drug-free period or at release from the hospital (a duration of at least 4 weeks) in the control group. Results: The average weight gain was 3.9±3.8 kg in the atypical antipsychotic treatment (AAT) group, 1.1±4.4 kg in the typical antipsychotic treatment (TAT) group, and 0.23±2.9 kg in the control group. The average increase in BMI was 15.1±22.0 percentiles in the AAT group, 6.4±14.2 percentiles in the TAT group, and 1.6±12.5 percentiles in the control group. No statistically significant difference was found in the increase in height percentile. There were no significant differences in the rates of elevated values of serum triglycerides, cholesterol, AST, ALT, or fasting blood glucose. Conclusions: We found a significant increase in both absolute weight gain and BMI percentile following atypical antipsychotic treatment. In contrast, typical antipsychotic treatment did not affect weight gain significantly, and the same was true for the control group. In addition, the rates of elevated values of biochemical parameters (AST, ALT, total cholesterol, triglycerides, and fasting blood glucose levels) were very low at the beginning of the study, and were not significantly altered by the various treatments. [ABSTRACT FROM AUTHOR]

The aim of this preliminary study was to explore the effect size of different dietary long chain polyunsaturated supplementations on blood lipid profile in children with primary hyperlipidemia. Thirty-six children (8-13 years) were recruited. After an 8-week stabilization period on the Step I diet, they were randomized to additionally receive for a 16-week period one capsule (500 mg) daily of docosahexaenoic acid (DHA) alone or a DHA plus eicosapentaenoic acid (EPA) mixture (45.6% DHA; 41.6% EPA) or wheat germ oil (control). An effect size (as percentage change from baseline) of +8%, −12% and −16% for high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C ratio and triglycerides was observed in children supplemented with DHA, compared to +2%, −8% and −12%, respectively, in children supplemented with DHA plus EPA. This preliminary study suggests powered trials appear feasible and are warranted to evaluate efficacy of n-3 long-chain polyunsaturated fatty acid dietary supplementations on the blood lipid profile of children with primary hyperlipidemia. [ABSTRACT FROM AUTHOR]

Background. Our goal was to compare the carotid intimal-medial thickness (CIMT) of untreated pediatric patients with metabolic syndrome (MS), heterozygous familial hyperlipidemia (heFH), and MS+heFH against one another and against a control group consisting of healthy, normal body habitus children. Methods. Our population consisted of untreated pediatric patients (ages 5- 20 yrs) who had CIMT measured in a standardized manner. Results. Our population included 57 with MS, 23 with heFH, and 10 with MS+heFH. The control group consisted of 84 children of the same age range. Mean CIMT for the MS group was 469.8 μm (SD = 67), 443.8 μm (SD = 61) for the heFH group, 478.3 μm (SD = 70) for the MS+heFH group, and 423.2 μm (SD = 45) for the normal control group. Significance differences between groups occurred for heFH versus MS (P = 0.022), heFH versus control (P = 0.038), MS versus control (P = 9.0E - 10), and MS+heFH versus control (P = 0.003). Analysis showed significant negative correlation between HDL and CIMT (r = -0.32, P = 0.03) but not for LDL, triglycerides, BP, waist circumference, or BMI.Conclusion. For pediatric patients, the thickest CIMT occurred for patients with MS alone or for those with MS+heFH. This indicates that MS, rather than just elevated LDL, accounts for more rapid thickening of CIMT in this population. [ABSTRACT FROM AUTHOR]

In the last 10 years the incidence of type 2 diabetes (T2DM) in children and adolescents has increased, due to increasing prevalence of obesity in youth. Therefore, the prevalence of diabetes-related complications such as hypertension, hyperlipidemia and microalbuminuria has also increased in pediatric T2DM. The pathogenesis of T2DM in children involves genetic and environmental factors that will determine the increase of insulin resistance and decrease of beta pancreatic insulin secretion. Only metformin and insulin are approved for clinical use in children in the majority of countries. The aim of this paper is to review the benefits of the treatment with metformin in children and adolescents with T2DM. [ABSTRACT FROM AUTHOR]

The objective of this work was to study the prevalence of hyperlipidemia in school children. This is a descriptive study done in 102 school children; 57 girls and 45 males of age range between 9 and 12 years old; to whom a lipid profile was assayed in serum, using enzymatic-colorimetric procedures for total cholesterol, triglycerides and the precipitation method for the LDL-c and HDL-c, previously to the enzymatic assay. The prevalence of dyslipidemia found in the masculine sex was: increased triglycerides 17,8%; increased total cholesterol 4,4%; decreased HDLc, 35,6%; increased LDL-c, 6,7%. In females we found increased triglycerides, 15,7%; increased cholesterol total 3,5%; decreased HDL-c, 45,6%; and increased LDL-c, 5,3%. It is important to point out that both groups have increased cardiovascular risk and particularly the girls with decreased HDL-c levels. It is advisable to periodically evaluate lipid levels in children and adolescents, mainly in those whose parents have cardiovascular diseases. [ABSTRACT FROM AUTHOR]

We report the case of an 11-year-old female with acute pancreatitis, and review the literature highlighting the presenting symptoms and signs, laboratory tests, and investigational tools that helped in the establishment of a correct diagnosis. First, the patient presented to a regional hospital reporting abdominal pain, vomiting and liquid stool. She was admitted with the diagnosis of acute surgical abdomen and underwent surgery. Upon admission in our department, laboratory findings showed high values for total lipids = 2600 mg/dL and triglycerides 1200 mg/dL. Abdominal ultrasound revealed a pancreas with a small enlargement of the head (19 mm), and with a heterogeneous structure of the parenchyma. Abdominal computed tomography showed small left pleural collection and a high-dimensioned pancreas, particularly at the head, with heterogeneous structure, and peripancreatic collections. The patient was treated by fasting, gastric decompression by nasogastric tube, and intravenous antibiotherapy followed by antialgic and antispasticity treatment. Time of the patient's first feeding was after the 7th day of hospitalization. The patient was discharged in very good condition after 22 days of hospitalization. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The joint effect of obesity and asthma on hyperlipidemia has never been explored. We aim to examine (1) the association of dyslipidemia and asthma, (2) the interaction effect of asthma and obesity on hyperlipidemia, and (3) whether a gender difference existed in the above relationships. Methods: Between 2009 and 2010, 10- to 15-year-old children were recruited from 7 schools and 2 hospitals in Northern Taiwan. The population consisted of 237 asthmatic children and 225 non-asthmatic controls, and was further divided into four groups: non-obese controls, obese controls, non-obese asthmatics, and obese asthmatics. Measurements included anthropometric measures and blood samples for analysis of metabolic factors. The Cook''s criteria were used to define childhood metabolic syndrome. General linear models were used to analyze how lipid profiles were associated with obesity and asthma. Results: Total cholesterol and low density lipoprotein cholesterol levels increased progressively in the group order obese asthmatics>non-obese asthmatics>obese controls>non-obese controls. In boys, low density lipoprotein cholesterol levels were significantly higher in obese asthmatics compared to obese non-asthmatics, with a mean difference of 6.2mmol/L in the general linear model. We also discovered a significant interactive effect of obesity and asthma on hyperlipidemia in boys (p for interaction=0.03). Conclusions: Asthma was associated with higher low density lipoprotein cholesterol levels and this association was amplified in overweight and obese subjects. A gender difference was observed in the joint effect of obesity and asthma on hyperlipidemia. [Copyright &y& Elsevier]

Background Immune deficiency in human might be primary or secondary and could be seen with a wide variety of manifestations. In the following, we presented a Child with various complains that diagnosed to have HIV infection. Case Report A 2/5 y/o child was admitted to the hospital for FUO with prolonged cough, FTT, cervical lymphadenopathy, hepatosplenomegaly and bilateral optic neuritis. . He was hospitalized for fever, cytopenia and hepatosplenomegaly one year ago, and three months later in an outpatient visit, these signs improved, except thrombocytopenia. In evaluation, bicytopenia, elevated ESR, hyperlipidemia, hyperproteinemia, thrombosis of the transverse sinus of brain, antiphospholipid antibodies , decreased levels of protein S and factor V Leiden and increased level of anti thrombin III were detected. Consequently, the result of HIV antibody showed positive. In addition to warfarin and cotrimoxazole therapy, he was referred to special center for possible HARRT therapy. Conclusion In approach to patients with various clinical presentations such as cytopenia, recurrent or persistent lymphadenopathy, unexplained hyperproteinemia or hyperlipidemia, evaluation of HIV infection is highly recommended for consideration and further therapy. [ABSTRACT FROM AUTHOR]

The article discusses about dyslipidemias in childhood and the use of pharmacologic treatments to lower blood lipids in children. It mentions that statins have become the agents of choice for treating dyslipidemia, replacing the poorly tolerated resins and niacin. It states that most effective approach in reducing cardiovascular risk in children is public health oriented and seeks to prevent obesity, tobacco use, encourage a low cholesterol and saturated fat diet and increase exercise.

Background With widespread use of antiretroviral therapy (ART) and prolonged survival of HIV-infected children, toxicities like lipodystrophy are becoming more evident. Little is known about lipodystrophy in children in Uganda yet there is increased use of ART. The aim of this study was to determine the prevalence and factors associated with fat redistribution and metabolic abnormalities among HIV-infected children on highly active antiretroviral therapy (HAART) in Uganda. Methods A cross-sectional study of 364 HIV positive children aged between 2 and 18 years on ART were enrolled after consent and assent as appropriate. Sociodemographic, clinical and immunological data were collected and recorded in a questionnaire. Fat redistribution was assessed clinically for physical findings of lipohypertrophy and lipoatrophy. A fasting blood sample was taken for lipid profile and blood glucose analysis. Lipodystrophy was defined as presence of abnormal fat redistribution or metabolic abnormalities or both. The proportion of children with fat redistribution and metabolic abnormalities was calculated. We conducted multivariate analysis for factors associated with lipodystrophy among children with lipodystrophic features and those without. Results The median age of the participants was eight years (range 2 to 18), with 43% of these aged ≥10 years and a male to female ratio of 1.1:1. Majority (65%) had advanced HIV (WHO Stage III/IV) at ART initiation with a mean duration on ART of 3.8 years (±1.2). The prevalence of fat redistribution and hyperlipidemia was 27.0% and 34.0%, respectively. None of the children had hyperglycaemia. Among the children with hyperlipidemia, 16.8% exhibited hypercholesterolemia and 83% had hypertriglyceridemia. Only 29% of children with fat redistribution had hyperlipidemia. We found significant association between fat redistribution and Tanner stages 2 to 5 OR=2.3 (95%CI 1.3 to 3.8), age≥5 years OR=3.9 (95%CI 1.5 to 9.9) and d4T exposure OR=3.4 (95%CI 2.0 to 5.8). A Tanner stage 2 to 5 was independently associated with hyperlipidemia. No significant association was observed with HIV clinical stage and any of the anthropometric measurements. Conclusion The prevalence of lipodystrophy is high among HIV-infected children on ART with a likelihood of developing fat redistribution and metabolic abnormalities increased during puberty. [ABSTRACT FROM AUTHOR]

Plant sterols lower serum cholesterol concentration. Available data have confirmed the lipid-lowering efficacy in adults, while there is a relative dearth of data in children and almost exclusively restricted to subjects with familial hypercholesterolemia (FH). Aim of the present study was to evaluate the efficacy, tolerability and safety of plant sterol supplementation in children with different forms of primary hyperlipidemias. The effect of plant sterol consumption on plasma lipids was evaluated in 32 children with heterozygous FH, 13 children with Familial Combined Hyperlipidemia (FCH) and 13 children with Undefined Hypercholesterolemia (UH) in a 12-week open-label intervention study using plant sterol-enriched yoghurt. Plasma lipids and apolipoproteins were measured by routine methods. Markers of cholesterol synthesis (lathosterol) and absorption (campesterol and sitosterol) were measured by GC-MS. Tolerability and adherence to recommended regimen was very high. A significant reduction was observed in LDL-cholesterol in the three groups (10.7, 14.2 and 16.0% in FH, FCH and UH, respectively). Lathosterol concentrations were unchanged, reflecting a lack of increased synthesis of cholesterol. Of the two absorption markers, only sitosterol showed a slight but significant increase. Daily consumption of plant sterol dairy products favorably changes lipid profile by reducing LDL-cholesterol. To our knowledge, this is the first report of the use of plant sterols-enriched foods in treating children with primary hyperlipidemia such as FCH and UH, likely to be the most frequent form also in the young age in the western populations. [ABSTRACT FROM AUTHOR]

Background: Pediatric hypertriglyceridemia is an emerging comorbidity of childhood obesity. Methods: This study reviewed medical records retrospectively to describe the characteristics and clinical course of 300 at-risk children followed in a pediatric preventive cardiology clinic. Results: Average baseline triglyceride (TG) level was 269 mg/dL (SD 342 mg/dL); 91% had TG levels between 150 and 399 mg/dL. A total of 77% were overweight/obese, 23% had elevated blood pressure, 23% had a family history of high triglycerides, and 11% reported a psychiatric diagnosis (33.3% of those with severe TG elevations). Diet and activity change were the first-line therapies; few were taking lipid-lowering medications (baseline, 5.1%; follow-up, 11.4%). TG levels declined by 23% (average, 88 mg/dL; SD 231), often with a decline or plateau in TG risk category. Children with a lower body mass index (<85% gender- and age-matched percentile) were more likely to improve in TG category than heavier children (70% vs 40%; P ≤ .05). [ABSTRACT FROM PUBLISHER]

Abstract: Assessment of hyperlipidaemia in children is important to prevent cardiovascular disease later in life. Secondary causes of hyperlipidaemia should always be considered during clinical assessment. There are several primary causes of primary hyperlipidaemia, of which familial hypercholesterolaemia (FH) is the most important. Diagnosis of FH is by use of the Simon Broome criteria and genetic diagnosis can be helpful, particularly in children. DNA diagnostics also facilitate cascade testing, which is now recognized as an important means of identifying individuals with FH. Several classes of drugs are used to treat hyperlipidaemia in children, but the statins are most commonly used. They are effective and safe to use in older children. [Copyright &y& Elsevier]

There are no adequate data that evaluate the safety and effectiveness of lowering triglyceride levels in very young children. The authors report a family with two male siblings, 7 and 4 years old, affected by familial hyperchylomicronemia. The oldest was diagnosed at birth during evaluation of jaundice, and the youngest showed asymptomatic hypertriglyceridemia by 6 months of age. Due to high triglyceride levels, Gemfibrozil (a fibric acid derivative) was started at diagnosis. Close clinical followup and laboratory monitoring of these children showed no side effects from the drug, and the risk of acute pancreatitis was significantly reduced. [ABSTRACT FROM AUTHOR]

In children, exercise modulates systemic anabolism, muscle growth, and overall physiological development through the growth hormone (GH)-insulin-like growth factor I (IGF-I) axis. OH secretion, at rest and during exercise, changes with age and maturational status and can be blunted by hyperlipidemia and obesity, with possible negative effects on physiological growth. However, little is known about the effect of progressively more severe pediatric obesity on the OH response to exercise and its relationship to pubertal status. We therefore studied 48 earlyor late-pubertal obese children [body mass index (BMI) >95th percentile, separated in tertiles with progressively greater BMI] and 42 matched controls (BMI <85th percentile), who performed ten 2-min cycling bouts at ∼80% of maximal O2 consumption, separated by I-mm rest intervals. Plasma GH and IGF-I were measured at baseline and end exercise. OH responses were systematically blunted in obese children, with more pronounced blunting paralleling increasing BMI. Although overall the OH response to exercise was greater in latepubertal than in younger children, this blunting pattern was observed in earlyand late-pubertal children. Our results reveal insight into the interaction between pediatric obesity and key modulators of physiological growth and development and underscore the necessity of optimizing physical activity strategies for specific pediatric dysmetabolic conditions. [ABSTRACT FROM AUTHOR]

Children with hyperlipidemia secondary to renal disease develop premature atherosclerosis and glomerulosclerosis. The aims of this pilot study were to find the dosage and short-term efficacy of simvastatin and potential adverse events in children with chronic kidney diseases. This was a random, double-blind, placebo-controlled, cross-over clinical trial performed on children with hyperlipidemia secondary to kidney disorders. After being placed on a diet for 3 months, patients were randomly placed in one of two balanced group blocks and treated with diet plus placebo or simvastatin at doses of 5 mg for children weighing 30 kg or less and 10 mg for children weighing over 30 kg, for 1 month, and then doubled for two more months. After this treatment, patients were placed on a diet for a 3-month washout period. During the last trial phase, patients previously treated with simvastatin were administered a placebo, and vice versa. A total of 25 patients with ages ranging from 4 years to 17 years were included in the study. A significant decrease in the levels of serum cholesterol (26.4%), low-density lipoprotein (LDL) (35.4%) and triglycerides (23.1%) was noted during the study, primarily during the simvastatin treatments, in which case cholesterol, LDL and triglycerides decreased by 23.3%, 33.7% and 21%, respectively. High-density lipoprotein (HDL) levels increased moderately (10.7%) during the study but without differences during simvastatin treatment. No differences were found across groups with respect to adverse events. In the short-term the combination of diet and simvastatin was effective in lowering hyperlipidemia in children with renal disorders. [ABSTRACT FROM AUTHOR]

Heterozygous familial hypercholesterolemia (heFH) affects 1 in 500 individuals. Evidence supports the low-density lipoprotein (LDL)-lowering effect of statins for adults with heFH. However, there are concerns regarding the treatment children with heFH. By performing a systematic review and metaanalysis of the published literature, this study aimed to evaluate the efficacy and safety of statins used for children with heFH. A systematic review was performed by searching multiple medical databases and citations to identify reports of randomized controlled trials of statins used to treat children with heFH. The trials were retrieved, reviewed, and subjected to metaanalysis. The search yielded 2,174 titles. Of the 63 studies retrieved and reviewed, 56 were excluded, 7 were included in the systematic review, and 4 were included in the metaanalysis. Significant heterogeneity was detected. The metaanalysis showed significant LDL lowering, high-density lipoprotein (HDL) cholesterol elevation, and increases in height and weight with statins. The metaanalysis could not be performed for many side effects of statins, but individual trials showed no significant side effects. Quality assessment showed methodologic concerns, with potential for bias. For example, six trials analyzed statin effects without intention to treat despite such a stated intention. Metaanalysis shows significant LDL lowering with statin treatment. Further studies, including epidemiologic and multicenter studies, are required. [ABSTRACT FROM AUTHOR]

Objective. To study the epidemiological, clinical and histopathological features of children with nephrotic syndrome (NS) and its response to the treatment. Material and methods. 58 patients treated in the hospital in five years were study. Results. 31 patients were male (53%), the gender ratio was 1: 1 and the age from 1 and 14 years. The higher frequency (38%) was observed in the group of 2-6 years. All showed edema, hypoalbuminemia, hyperlipidemia, hypercholesterolemia and massive proteinuria. 25 children (43%) had hematuria, and its permanence was related to resistance to the treatment. Initially, 19 patients (33%) had hypertension. Thirty six (63%) maintained normal values of urea and creatinine and in 28 of them (48%), the C3 fraction also was normal. Nine patients (16%), renal biopsy was made to them, being observed minimal injuries, such as more frequent histopathological finding. The majority (61%) hod good response to steroids. Conclusions. The NS is the disease with the higher morbidity among the renal diseases in children in our hospital and it is the fourth reason for consultation. In children it usually has good prognosis, but in some cases with resistant to steroids, it is necessary to assess renal function periodically and to do renal biopsy at the same time, following various therapeutic strategies. [ABSTRACT FROM AUTHOR]

Aim: Since the mortality rate due to cardiovascular disease continues to increase, research into dyslipidemia has been emphasized in not only adults but also paediatric populations. We aimed to study the risk factors of dyslipidemia in Chinese children. Methods: Nine hundred and sixty-two children, aged 6–18 years, in Beijing were enrolled. For each child, data were collected on body height (cm), body weight (kg), sitting height (cm), waist circumference, upper arm circumference, serum lipid levels, as well as familial history of dyslipidemia and early onset cardiovascular disease. Subgroups were determined on the basis of age and sex. Results: The prevalence rate of dyslipidemia was 11.1% (107/962). Children with dyslipidemia differed significantly from those without, in sitting height, upper arm circumference, body mass index (BMI), waist-to-height ratio (WHR) and diastolic and systolic blood pressure (p < 0.05). Logistic regression analysis suggested that WHR, diastolic blood pressure and positive familial history were risk factors for dyslipidemia in children. Conclusion: Sitting height, upper arm circumference, BMI, WHR, diastolic pressure and systolic pressure were significantly higher in dyslipidemic children than in normal subjects in China. BMI, WHR, diastolic pressure and familial history of dyslipidemia and early-onset cardiovascular disease were risk factors for dyslipidemia in Chinese children. [ABSTRACT FROM AUTHOR]

Despite lifestyle management, children with high-risk hyperlipidemias may become overweight, and this may further adversely impact their lipid profile. Regression analysis was used to determine changes over time in adiposity and their association with lipid profiles and other risk factors for hyperlipidemic children followed in a lipid disorder clinic. 184 patients were included. Median age at presentation was 7 years (2-17 years), and median duration of follow-up was 9 years (5-20 years). Mean initial total cholesterol was 6.9 ± 1.6 mmol/L, low-density lipoproteins were 5.2 ± 1.7 mmol/L, high-density lipoproteins were 1.2 ± 0.4 mmol/L, triglycerides were 1.1 ± 0.8 mmol/L, and body mass index z score was +0.4 ± 1 .0. A significant increase in body mass index z score (+0.032/year, P < .001) was observed. There was an associated significant increase in total cholesterol and triglyceride levels and decrease in high-density lipoprotein levels over time. Worsening adiposity is prevalent in hyperlipidemic children and adversely affects their lipid profiles and cardiovascular risk. [ABSTRACT FROM AUTHOR]

PURPOSE. Pediatric hyperlipidemia increases cardiovascular disease risk. The cornerstone of treatment is a restrictive, lipid-lowering diet. Child disease understandings and perceptions of dietary adherence were explored, a secondary aim of the Endothelial Assessment of Risk from Lipids in Youth trial. DESIGN AND METHODS. Focus groups and individual interviews were conducted with participants, ages 9–20 years (n  = 50). Data were thematically analyzed. FINDINGS. Adherence is influenced by individual characteristics (developmental level, knowledge), in the context of social interactions (family modeling, peer relationships, school). PRACTICAL IMPLICATIONS. Dietary practices are developed within social interactions. Interventions promoting adherence must consider children within their social contexts. [ABSTRACT FROM AUTHOR]

Recently, there have been reports on the efficacy of low-density lipoprotein (LDL) apheresis (LDL-A) for focal and segmental glomerulosclerosis (FSGS) in pediatric patients. However, there have been few reports on the long-term efficacy of LDL-A for FSGS in such patients. We report here a case of long-term efficacy of LDL-A for FSGS. The patient was a 13-year-old boy with FSGS who presented with steroid-resistant and cyclosporine-resistant nephrotic syndrome and hyperlipidemia. LDL-A was performed 24 times on one year. Following LDL-A, serum concentrations of LDL, very low-density lipoprotein (VLDL), apoprotein B, and vascular endothelial growth factor significantly decreased, and urinary excretion of protein also decreased. In addition, 3 years after LDL-A, the pathology findings on a second renal biopsy had improved. The patient has been in remission from FSGS for 12 years since LDL-A. These findings suggest that LDL-A may be useful in maintaining long-term remission from pediatric FSGS. [ABSTRACT FROM AUTHOR]

Background: The incidence of hyperlipidemia in children is increasing in Japan, but drug therapy for such children is limited. The ingestion of 4% phytosterols-containing diacylglycerol (PS/DAG) decreases serum total cholesterol and low density lipoprotein cholesterol (LDL-C) concentrations in adults. In the present study, we examined the effect of PS/DAG as part of a diet therapy in pediatric patients with hyperlipidemia. Methods: Pediatric patients with hyperlipidemia with ≥ 5.18mmol/L (200 mg/dL) serum total cholesterol and/or ≥1.70mmol/L (150 mg/dL) triglycerides (N = 22) ingested bread containing PS/DAG (total daily intake, 10g) for 6 months. Blood chemistry was examined prior to and 2, 4, 6 months after the initiation of ingestion, and 4 months after the ingestion period. Results: No significant differences in energy intake or cholesterol intake during the study period were found. After 4 months of ingestion of PS/DAG, LDL-C, lipoprotein(a) [Lp(a)], free fatty acids and total ketone bodies decreased significantly. In seven patients with familial hypercholesterolemia, total cholesterol and remnant-like lipoprotein particles (RLP)-cholesterol also significantly decreased in addition to LDL-C and Lp(a). Conclusions: PS/DAG improves serum lipid metabolism in pediatric patients with hyperlipidemia for whom drug therapy is limited, suggesting that PS/DAG may reduce the risk of developing various diseases induced by hyperlipidemia. [ABSTRACT FROM AUTHOR]

Aim: To investigate the carnitine status and the effect of carnitine supplementation on serum lipid profiles in children with hyperlipoproteinaemia, a clinical open trial was conducted at Hacettepe University Ihsan Dogramaci Children's Hospital, Section of Nutrition and Metabolism.Methods: Patients were given carnitine at a dose of 100 mg/kg/d for 12 wk. Blood samples for the determination of lipid profile and carnitine levels and urine samples for carnitine levels were obtained on admission, at week 4 and week 12 of the study period.Results: A total of 41 children were enrolled in the study: 20 patients had type II heterozygotes, eight patients had type II homozygotes, three patients had type III, six patients had type V and four patients had secondary hyperlipidaemias. Serum and urine carnitine levels were within normal limits on admission. No significant correlations were found between serum carnitine levels and serum lipid profiles. Serum HDL and apolipoprotein A-I decreased significantly during the 12 wk of intervention in type II heterozygotes. In type II homozygotes, total cholesterol and LDL levels at weeks 4 and 12 increased significantly compared to initial levels. No significant change was noted for lipid parameters in hyperlipoproteinaemia type V.Conclusion: The results of this trial demonstrated that carnitine supplementation was of no benefit for children with hyperlipidaemias, especially in primary hyperlipoproteinaemia type II heterozygotes, homozygotes and type V. [ABSTRACT FROM AUTHOR]

Hyperlipidemia is a common problem in solid organ transplant recipients. In this study we evaluated the role of pre-transplant renal replacement therapy on early and late changes of serum lipid levels in children following renal transplantation. In 46 children with chronic renal failure (median age 10.3 years) and 12 children with heart failure (median age 5.0 years), cholesterol and triglycerides were measured before and during follow-up after transplantation. Children with renal failure had significantly higher serum lipids than controls (n=34, median age 9.2 years) and patients with heart failure. Pre transplantation, cholesterol and triglycerides were significantly lower in the hemodialysis than in the peritoneal dialysis population, whereas conservatively treated children had intermediate levels. After transplantation, serum cholesterol converged towards a mean level of 208 mg/dl and triglyceride levels converged towards a uniform level of 195 mg/dl at 9 months post transplant. The ratio of cholesterol/high-density lipoprotein significantly decreased from 4.7 to 3.8. The pattern of "post-transplant hyperlipidemia" was similar in both renal and cardiac allograft recipients. Hence, the early post-transplant changes of serum lipid pattern are markedly dependent on the mode of pre-transplant renal replacement therapy. Later, serum lipid levels were no longer influenced by prior renal replacement therapy and showed a new pattern of "post-transplant hyperlipidemia" in all children. [ABSTRACT FROM AUTHOR]

OBJECTIVE — To determine the relative influence of diet, metabolic control, and familial factors on lipids in children with type 1 diabetes and control subjects. RESEARCH DESIGN AND METHODS — We assessed fasting serum cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, lipoprotein(a), apolipoprotein (apo)-A1, and apoB in 79 children and adolescents with type 1 diabetes and 61 age- and sex-matched control subjects, together with dietary intakes using a quantitative food frequency questionnaire. RESULTS — Total cholesterol, LDL cholesterol, apoB, HDL cholesterol, and apoA1 were significantly higher in children with diabetes. Children with diabetes had higher percentage energy intake from complex carbohydrates (P = 0.001) and fiber intake (P = 0.02), and they had lower intake of refined sugar (P < 0.001) and percentage energy from saturated fat (P = 0.045) than control subjects. Total cholesterol (β = 0.43, P < 0.001), LDL cholesterol (β = 0.4, P < 0.001), and apoB (β = 0.32, P = 0.006) correlated independently with HbA[sub 1c] but not dietary intake. HDL cholesterol (β = 0.24, P = 0.05) and apoA1 (β = 0.32, P = 0.004) correlated independently with HbA[sub 1c], and HDL cholesterol (β = -0.34, P = 0.009) correlated with percentage energy intake from complex carbohydrates. Triglycerides correlated independently with percentage energy intake from complex carbohydrates (β = 0.33, P = 0.01) and insulin dose (β = 0.26, P = 0.04). Subjects with diabetes and elevated LDL (>3.35 mmol/l, >130 mg/dl), for whom dietary therapy would be recommended, had significantly higher HbA[sub 1c] (P = 0.007), but they had higher intake of complex carbohydrates than subjects with LDL cholesterol <3.35 mmolA. CONCLUSIONS — Lipid abnormalities remain common in children and adolescents with type 1 diabetes who adhere to current dietary recommendations, and they relate to metabolic control but not dietary intake. [ABSTRACT FROM AUTHOR]

Hyperlipidemia is now established as a major risk factor for causation of coronary heart disease (CHD) in adults; however, there is much debate on the level of coronary risk at which lipid-lowering drugs should be used. These issues of possible harm or lack of benefit from long-term use of lipid-lowering therapy, and cost effectiveness, are also pertinent in the pediatric setting. Evidence from several countries indicates that children have an increasing prevalence of obesity, hyperlipidemia and type 2 diabetes mellitus. Children who have high serum lipids ‘track’ these increased levels into adulthood. In some countries there is a trend to screen children for hypercholesterolemia. Family history itself is a poor discriminator in determining which children need to be screened and treated. Estimation of apolipoprotein B and/or apolipoprotein E genotype can improve prediction. Measuring high density lipoprotein cholesterol also helps, but obesity appears to be the best marker for screening children at high risk. These considerations should not cloud the need for case finding and treatment of children with genetic disorders. Low fat diets have been shown to be well tolerated and effective in children; however, there are no major long-term studies demonstrating harm or benefit in those on lipid-lowering drugs. Nevertheless, concerns regarding the psychological effect and the theoretical metabolic effects of long-term lipid lowering remain. Lipid-lowering drugs should be generally restricted to children with genetic disorders of lipid metabolism. Children with diabetes mellitus, hypertension or nonlipid-related inherited disorders leading to premature CHD in adults should be treated with diet, and with lipid-lowering drugs when they reach adulthood. Children with secondary hyperlipidemia should be assessed individually. A number of drugs and nutriceuticals are available for use in children, but only a few drugs are licensed for use in children. [ABSTRACT FROM AUTHOR]

Objective: To assess the nutritional adequacy of the diets of children with hyperlipidemia following medically unsupervised low-fat diets compared with children receiving unrestricted diets. Design: Case comparison study. Patients and Other Participants: Forty-six children were referred to the Children's Cardiovascular Health Center, Columbia–Presbyterian Medical Center, New York, NY, for treatment of hyperlipidemia who had achieved the Step I diet recommendations for total fat before formal nutritional counseling (mean age ± SE, 9.7 ± 0.3 years; sex distribution, 24 boys [53%]; ethnicity, 26 Latinos [57%] and 20 whites [43 %]; body mass index ± SE, 22.4 ± 0.7 kg/m[sup 2]), and 34 healthy children participating in well-child visits at a local pediatric practice (mean age ± SE, 10.2 ± 0.4 years; sex distribution, 18 boys [54%]; ethnicity, 19 Latinos [57%] and 15 whites [43%]; body mass index ± SE, 22.5 ± 1.1 kg/m[sup 2]). Main Outcome Measures: Three-day food records were analyzed by a registered dietitian using the Minnesota Nutrient Data System. Outcome measures were intakes of calories, total and saturated fats, carbohydrate, protein, essential fatty acids, fat-soluble vitamins, folate, vitamin C, calcium, iron, and zinc. Results: The percentage of calories from fat and saturated fat was significantly lower in the hyperlipidemic population (mean ± SE, hyperlipidemic vs control subjects: total fat, 22.7% ± 0.7% vs 34.5% ± 0.6%, P<.001; saturated fat, 7.9% ± 0.3% vs 12.9% ± 0.4%, P<.001). The caloric intake in controls was 17% higher than in patients with hyperlipidemia. Ninety percent of the decrease in calories in the hyperlipidemic group could be accounted for by the decrease in total fat intake. After adjusting for calories, no significant difference was noted between the groups for any of the vitamins and minerals mentioned earlier. Conclusion: Our findings suggest that before for... [ABSTRACT FROM AUTHOR]

The present study was performed to determine quantitatively the effect of hypercholesterolemia induced by a lipid-rich diet on glomerulosclerosis in an animal model of nephrotic syndrome (NS) induced by Adriamycin (ADR). Twenty NS Wistar rats administered ADR with a single intravenous dose of 5 mg/kg body weight were divided into standard and lipid-rich chow groups. Another 20 weight-matched non-NS rats that received a vehicle alone were grouped as controls. Quantitative analyses of renal histological changes were performed with determination of blood and urine biochemical parameters. It was found that serum cholesterol was markedly higher in rats with lipid-rich chow in both NS and nonNS rats. Urinary protein was significantly higher in rats on the lipid-rich diet in the NS group. The mesangial matrix and cell indices were significantly increased in rats with the lipid-rich diet and the most obvious changes were found in the NS group. Lipid deposits and foam cells were observed in mesangial areas, and some glomeruli had progressed to form focal and segmental glomerulosclerosis in the NS group. Findings indicated that diet-induced hyperlipidemia can lead to proliferation of mesangial cells and accumulation of mesangial matrices, and further aggravate glomerulosclerosis in Adriamycininduced nephrosis. [ABSTRACT FROM AUTHOR]

Background Dyslipidaemia is a well-recognized risk factor for cardiovascular diseases. Inflammation has been linked to alterations of the lipid profile and accelerated atherogenesis. Lipid profile disorders are one of the most studied problems in adult patients with rheumatoid arthritis. However, few studies addressed this problem in juvenile idiopathic arthritis patients. The objective is to describe the prevalence of dyslipidaemia in children and adolescents with Juvenile Idiopathic Arthritis. Methods One hundred patients diagnosed with JIA were included. Exclusion criteria were patients previously treated with lipid lowering drugs, history of familial dyslipidaemia, thyroid disease, and diabetes mellitus. Data obtained from the patients included age, gender, duration of disease and body mass index (BMI). Fasting lipid profiles included triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL) and high-density lipoprotein cholesterol (HDL). Fasting lipid profiles were measured after overnight fasting and consumption of normal diet for previous 2 days (without fat restriction). Normal values were considered according to reference values. Other laboratory tests included ESR, CRP, RF, and ANA. Disease activity was classified according to juvenile disease activity score (JADAS-27). Results The study included 100 JIA patients. Out of them, 78 patients were females, 51 patients had RF negative Polyarticular type, 20 patients had RF positive polyarticular type, 24 patients had systemic onset type and 5 patients had extended oligoarticular type. Mean age was 11.55 ± 4.02 years. Mean age at disease onset was 8.3 ± 1.5 years. Mean disease duration was 4.30 ± 1.7 years. Mean BMI was 22.3 ± 7.32 Kg/m2. Mean ESR was 31.24 ± 10.4 mm/h. Mean CRP level was 7.56 ± 4.61 mg/dl. About 20% of the patients had positive RF and about 8% had positive ANA. Twenty-six patients had active disease. Mean TC was 153.818 ± 29.8 mg/dl, mean HDL was 47.65 ± 16.8 mg/dl, mean LDL was 87.43 ± 28.1 and mean TG was 89.04 ± 26.1 mg/dl. The most common lipid abnormality was disturbed HDL, it was found in 40% patients followed by disturbed TG in 21% of patients. Abnormal TC was found in 15% of the patients and abnormal LDL was found in 12% of the patients. Active disease was significantly associated with abnormal TC, HDL, and TG levels (P  = 0.03*), (P  = 0.03*) and (P  = 0.04*) respectively. No associations were found with ESR or CRP levels. Active disease is a significant risk factor for abnormal TG with increased risk of abnormal TG by 2.9 among cases with active disease than cases with inactive disease. The overall percent predicted was 73.8%. Conclusion Children and adolescents with JIA showed significant lipid profile abnormalities. Abnormal TC, HDL and TG are significantly associated with active disease. Active disease is a significant risk factor for abnormal TG. Therefore, we recommend monitoring lipid profile in JIA patients regularly to reduce the long-term risk of CVD. [ABSTRACT FROM AUTHOR]

To assess the impact of prematurity-associated nephrocalcinosis on kidney function later in life, 20 premature children with neonatal nephrocalcinosis and 20 controls, matched for birth weight and postnatal age but without nephrocalcinosis, were examined (birth weight 905±;209 vs. 957±;226 g; study age 4.7±;1.1 vs. 4.6±;0.9 years). Distal tubular acidification capacity was measured with the oral acetazolamide test, in which the response was abnormal in 1 out of the 20 children with a history of nephrocalcinosis, but in none of the controls. Urinary calcium and β[sub 2]-microglobulin excretion were higher in the children with nephrocalcinosis, but no differences were found in fractional excretion of sodium and potassium or tubular reabsorption of phosphate. Estimated creatinine clearance was not different between the groups. Of the 6 children with nephrocalcinosis lasting beyond 2 years of age, 5 had had chronic lung disease neonatally and exhibited a tendency for compensated respiratory acidosis at the time of the examination. Neonatal nephrocalcinosis seems to lead to some signs of renal tubular dysfunction in early childhood of preterm infants. Glomerular function, however, appears not to be specifically disturbed by nephrocalcinosis. [ABSTRACT FROM AUTHOR]

Abstract. Medical and public health recommendations regarding detection and treatment of hyperlipidemia in children have generally been based on two principal epidemiologic studies: the Lipids Research Clinics Population Study (1972 to 1976) and the Bogalusa Heart Study (1973 to 1974). The present study was initiated to further describe the distribution of plasma cholesterol levels in a multiracial sample of American children. Between 1984 and 1988, the total cholesterol levels of 6585 children from 22 schools were measured as part of the Know Your Body School Health Program. For the entire population, ages 5 to 18 years, the mean total cholesterol concentration was 166.4 mg/dL. Total cholesterol was significantly greater in girls (168 mg/dL) than in boys (165 mg/dL), although sex differences were inconsistent across race/ethnicity. The mean value for blacks, 173 mg/dL, and Hispanics, 168 mg/dL, was higher than for Asians, 165 mg/dL, and whites, 163 mg/dL. Across race/ ethnicity, values tended to peak between ages 8 and 10 years for girls and approximately 10 years of age for boys. These values are slightly higher than those reported in the Lipids Research Clinics and Bogalusa studies. Public health implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Abstract. Coronary heart disease is the leading cause of death in the United States, and there is reason to believe that it begins in childhood. Evidence is accumulating that early diagnosis and treatment of hypercholesterolemia, a major coronary risk factor, can markedly reduce the incidence of artherosclerotic heart disease in later life. A pediatric group practice consisting of six pediatricians and a pediatric nurse practitioner performed a cholesterol surveillance study of 6500 children between 3 and 18 years of age. Parents and patients were counseled regarding other coronary risk factors, and the American Heart Association diet was recommended. According to the results of the study, 1251 children (19%) exceeded the acceptable 90th percentile for cholesterol and that 143 of 299 significantly hypercholesterolemic children (48%) had no family history of premature myocardial infarction or known hypercholesterolemia. The current recommendation is that only those children from high-risk families should be screened for an elevated cholesterol level. The authors conclude, as a result of this study, that all children older than 3 years of age should have a cholesterol test and that advice regarding avoidance of high-risk coronary life-style behaviors should be a routine part of pediatric anticipatory guidance. [ABSTRACT FROM AUTHOR]

Abstract. Eighteen appropriate-for-gestational-age premature infants with birth weights ranging from 0.77 to 1.89 kg received 1 gm/kg of body weight of fat emulsion, intravenously, over a four-hour period. Infants less than 1 week of age developed a significant decrease in Po[sub 2] levels (P < .05) during the fat infusion period. There were no changes in other pulmonary function parameters. Infants less than 1 week of age also developed significantly higher peak levels of plasma triglycerides than infants 2 to 3 weeks old (P < .05). A correlation between increment in triglyceride levels and postnatal age was demonstrated (r = .75), with the younger infants presenting the higher triglyceride levels. This study demonstrates that: (1) small premature infants receiving intravenous fat are more susceptible to hyperlipemia and hypoxemia during the first week of life; (2) hypoxemia associated with intravenous fat infusion does not result from changes in lung dynamics; (3) the capacity to tolerate intravenous fats is enhanced after the first week of life. Pediatrics 66: 26-30, 1980. [ABSTRACT FROM AUTHOR]

Focuses on hyperlipidemia in children. Role of diet in the etiology of atherosclerotic disease; Information on the genetic conditions that lead to hyperlipidemia and premature coronary artery disease; Difference between the treatment of patients with hypertriglyceridemia and hypercholesterolemia.

Assesses growth patterns of hyperlipidemic children enrolled in the Mayo Clinic Cardiovascular Health Clinic for the Young. Measurement of weight and height every three months; Need to detect the infrequent occurrence of excessive weight loss or weight stabilization.