Patricia Medina-Bravo

Context: Type 2 diabetes (DM2) is an emerging disease in the pediatric population. DM2 is associated with metabolic-associated fatty liver disease (MAFLD). High-density lipoproteins (HDLs) are lipoproteins that are believed to have atheroprotective properties that reduce the risk of cardiovascular disease (CVD). Current evidence suggests that the physicochemical and functional features of HDLs may play a key role in the pathogenesis of atherosclerosis.Objective: We aimed to assess the impact of MAFLD on cholesterol efflux capacity (CEC) in adolescents with DM2.Design: A cross-sectional study.Setting: Attention clinic for Children with Diabetes of the Hospital Infantil de México Federico Gómez.Patients or other participants: This study included a total of 70 adolescents, 47 of which had DM2 and 23 were healthy individuals.Interventions: The presence of MAFLD was determined by MR spectroscopy with proton density fat fraction. We compared the distribution of HDL subtypes (HDL2b, HDL2a, HDL3a, HDL3b, and HDL3c) and the chemical composition of HDLs (total protein, triglycerides, phospholipids, cholesteryl esters, and free cholesterol). HDL functionality was determined by the CEC, measuring the fluorescent cholesterol efflux from J774 macrophage cells.Main outcome measures: We were expecting to observe a decrease in HDL efflux capacity in adolescents with type 2 diabetes and MAFLD.Results: In our study, we observed a prevalence of MAFLD in 66% of adolescents with DM2, similar to that reported in other international studies (60%–80%). In the population with DM2 and MAFLD, we did not observe a decrease in CEC. Initially we found a slight elevation of CEC in adolescents with DM2, however, with the increase in liver fat, a little decrease is observed, which could explain a probable metabolic phenomenon, since the physicochemical composition and distribution of the particles is associated with the percentage of liver fat. A positive correlation between the percentage of liver fat and the concentration of HDL2b (p = 0.011), HDL2a (p = 0.014) and average particle size (p = 0.011) and the proportion of triglycerides inside the particles (p = 0.007). Likewise, negative correlation were found with the percentage of liver fat, cholesterol esters (p = 0.010) and free cholesterol of the particles (p < 0.001). We observed a positive correlation between CEC and the percentage of triglycerides (p = 0.007), and a negative correlation with the percentage of cholesterol esters (p = 0.05) inside the HDL's particles.Conclusions: In this group of adolescents with DM2, the presence of MAFLD was not associated with CEC; however, it is associated with abnormalities in the distribution and lipid composition of HDL particles. The momentum generated by the original proposal for MAFLD in the adult population and following the recommendations for pediatric MAFLD will be a step forward in helping to study the impact of MAFLD on the atheroprotective properties of HDL in the pediatric population.

Overweight and obesity have become a world-health public problem, mainly for developing countries. Both health conditions have a higher prevalence among women of childbearing age. Physiopathology, overweight and obesity are characterized by a chronic oxidative stress status, which has deleterious effects on mothers and children. Hence, we determine whether the qualities of diet during pregnancy and maternal pregestational body mass index (BMI) are associated with increased oxidative stress markers in mothers and newborns. Two hundred forty-two (242) mother-newborn pairs were classified according to their pregestational BMI. Information on food intake was collected using a food frequency questionnaire in the third trimester of pregnancy. Levels of Malondialdehyde (MDA) and Nitric Oxide (NO) were measured in plasma from mothers at the end of the third trimester of pregnancy and from cord blood at birth. MDA and NO levels in mother–newborn pairs with maternal pregestational overweight or obesity were higher than in mother–newborn pairs with pregestational normal weight. For women (and newborns) who had a higher intake of fruit and vegetables, the levels of NO and MDA were lower. Lastly, women with pregestational obesity had lower fruit and vegetable intake during pregnancy and higher levels of oxidative stress and in their newborns.

Background Type 2 diabetes mellitus (T2DM) is an emerging disease in the pediatric population. The association between T2DM and nonalcoholic fatty liver disease (NAFLD) has been described. Recent evidence suggests that sizes and composition of HDL may be more important that HDL‐C levels in predicting coronary heart disease (CHD). There is not data regarding the HDL subclasses distribution and composition in T2DM youths with NAFLD. Methods This cross‐sectional study included 47 adolescents with T2DM and 23 non‐diabetic controls of both sexes aged 10‐18 years. The presence of NAFLD was determined estimated proton density fat fraction (PDFF) by magnetic resonance by spectroscopy. We compared the HDL subclasses distribution (HDL2b, HDL2a, HDL3a, HDL3b y HDL3c) and the HDL chemical composition (total protein, TG, PL, CE and FC) between the groups of adolescents with T2DM and the control group. Results Patients with T2DM and NAFLD had a significantly lower proportion HDL2b (P = 0.040) and a higher proportion of HDL3c (P = 0.035); higher proportion of TG (P = 0.032) and a lower CE (P = 0.002) and FC (P < 0.001). A negative association was observed between PDFF and the percentages of HDL2b (r² = −0.341, P = 0.004) and the average particle size (r² = −0.327, P = 0.05), and a positive association with HDL3c subpopulations (r² = 0.327, P = 0.015); about composition inside HDL particle, a positive association with PDFF and the TG (r² = 0.299, P = 0.013) and negative with CE (r² = −0.265, P = 0.030). Conclusions In adolescents diagnosed with T2DM, the presence of NAFLD is associated with abnormalities in the distribution of HDL subpopulations and the lipid composition of HDL particles.

Objective: To compare the level of oxidative deoxyribonucleic acid (DNA) damage (genotoxicity) between the offspring of mothers with and without diabetes diagnosed during pregnancy and its association with maternal body mass index (BMI). Methods: We measured 8-hydroxy-deoxyguanosine (8-OH-dG), a marker of DNA oxidative damage, in venous umbilical cord plasma from newborns of mothers with (n=34) and without (n=56) diabetes diagnoses obtained during pregnancy. Two markers of oxidative stress – namely, nitric oxide degradation products (NOx) and total glutathione (GSH) – were quantified in both mothers and newborns. The effects of BMI, glycated hemoglobin (HbA_1c), age and delivery mode were also analyzed. Results: Newborns of mothers with diabetes during pregnancy exhibited higher levels of 8-OH-dG than those of mothers without diabetes (P1c display an independent association with 8-OH-dG, particularly in the offspring of mothers not diagnosed with diabetes.

To evaluate the effect of a multimedia education program and nutrition therapy on metabolic control in patients with type 2 diabetes.

Type 4 retinol binding protein (RBP4) is a novel adipocytokine that has been related with insulin resistance (IR). In pediatric population, RBP4 levels are higher in obese subjects compared with lean subjects. In adults with type 2 diabetes (T2D) a positive correlation has been found between RBP4 levels and hepatic steatosis (HS). There is scarce information on RBP4 levels in children and adolescents with T2D. The aim of our study was to evaluate RBP4 levels in T2D adolescents and its association to HS.

Background In addition to obesity, low birth weight (LBW) has been proposed as another independent risk factor associated with cardiovascular disease and type 2 diabetes mellitus. Objective This study aimed to evaluate the influence of birth weight on abdominal fat distribution, adipocytokine levels and associated metabolic alterations in obese children. Methods A cross‐sectional study was conducted in 92 children. Children were divided into three groups according to their body mass index and birth weight. Glucose and insulin (0 and 120 min), lipid profile and adipocytokines were measured. Abdominal fat distribution was assessed by magnetic resonance imaging. Results Obese LBW children had higher fasting glucose (P = 0.054) and insulin (P < 0.001), and 120 min glucose (P < 0.001) and insulin levels (P < 0.001), such as increased HOMA‐IR (homeostasis model assessment of insulin resistance index) (P < 0.001). Obesity and LBW were associated with lower concentrations of high molecular weight (HMW) adiponectin (−2.38 [IC 95% −4.27; −0.42, P = 0.018]) and higher subcutaneous adipose tissue (SAT) (28.05 [IC 95% 0.40; 55.7, P = 0.047]) compared with NBW obese children, independent of age or sex. Conclusions LBW in obese children is associated with lower HMW adiponectin, increased insulin resistance and greater SAT.

The beneficial effects of the Mediterranean diet have been amply proven in adults with cardiovascular risk factors. The effects of this diet have not been extensively assessed in pediatric populations with obesity, insulin resistance (IR) and metabolic syndrome (MetS). The aim of this study was to assess the efficacy of the Mediterranean style diet (MSD) to decrease cardiovascular risk factors in children and adolescents with obesity.