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Abstract: Objectives: Endothelial dysfunction is a known precursor of atherosclerosis and can be assessed by measuring the brachial artery flow-mediated dilatation (FMD) via ultrasonography. This study investigated endothelial function in young type 1 diabetics without cardiovascular morbidity or diabetes-related pathology. Methods: Young diabetics and healthy controls were recruited, both meeting strict inclusion and exclusion criteria. To prove absence of subclinical atherosclerosis, intima-media thickness (IMT) measurements at the carotid bifurcation were done in all of them. FMD was measured at the brachial artery. The results were compared using the t-test and the influences of different variables on FMD were assessed using multiple linear regression. Results: Twenty-six diabetics (23.4±5.8 years) and 36 healthy volunteers (23.1±2.8 years) were recruited. The duration of diabetes was 9.2±5.3 years; metabolic control was moderate (HbA1c 7.6±1.0%) and IMT was normal in both groups. FMD was significantly impaired in type 1 diabetics (7.13±0.43 vs. 8.77±0.43%; p =0.002). The FMD grade was associated with diabetes and age. Patients with a good metabolic control (HbA1c≤7.0%) had a better FMD. Conclusions: In type 1 diabetics, even without preclinical or clinical atherosclerosis, endothelial function is already disturbed and can be detected using ultrasonography. [Copyright &y& Elsevier]

Objective: To assess whether sleep-disordered breathing (SDB) is a risk factor of the metabolic syndrome (MS) in children and adolescents who are overweight and to examine whether the severity of SDB was independently associated with glucose intolerance, insulin resistance, and/or dyslipidemia. Study design: Consecutive subjects who were overweight or obese underwent polysomnography, fasting blood sample, and oral glucose tolerance test (for calculation of area under the curve [AUC]). SDB was defined as a respiratory disturbance index ≥2. MS was present when ≥3 of these factors were present: waist circumference ≥90th percentile; fasting glucose level ≥110 mg/dL; triglyceride level ≥110 mg/dL; high-density lipoprotein cholesterol level ≤40 mg/dL; blood pressure ≥90th percentile. Results: A total of 104 subjects were included in the study (44% boys; 58% prepubertal; mean age, 11.1 ± 2.6 years; 69% obese). Mean SaO2 (odds ratio, 0.54) and SaO2nadir (odds ratio, 0.89) were independent, significant predictors of the presence of MS. Multiple regression showed significant associations between SaO2nadir and high-density lipoprotein cholesterol level, mean SaO2 and both AUC glucose and triglyceride levels, and between the percentage of total sleep time with SaO2 ≥ 95% and cholesterol level, while controlling for adiposity and sex, puberty, or both. Conclusion: This study supports the hypothesis of an interaction between SDB and metabolic abnormalities, independent of estimates of body fat distribution, in children and adolescents who are overweight and obese. [Copyright &y& Elsevier]

Abstract: Since heterozygous familial hypercholesterolemia (HeFH) is a disease that exposes the individual from birth onwards to severe hypercholesterolemia with the development of early cardiovascular disease, a clear consensus on the management of this disease in young patients is necessary. In Belgium, a panel of paediatricians, specialists in (adult) lipid management, general practitioners and representatives of the FH patient organization agreed on the following common recommendations. [1.] Screening for HeFH should be performed only in children older than 2 years when HeFH has been identified or is suspected (based on a genetic test or clinical criteria) in one parent. [2.] The diagnostic procedure includes, as a first step, the establishment of a clear diagnosis of HeFH in one of the parents. If this precondition is satisfied, a low-density-lipoprotein cholesterol (LDL-C) level above 3.5mmol/L (135mg/dL) in the suspected child is predictive for differentiating affected from non-affected children. [3.] A low saturated fat and low cholesterol diet should be started after 2 years, under the supervision of a dietician or nutritionist. [4.] The pharmacological treatment, using statins as first line drugs, should usually be started after 10 years if LDL-C levels remain above 5mmol/L (190mg/dL), or above 4mmol/L (160mg/dL) in the presence of a causative mutation, a family history of early cardiovascular disease or severe risk factors. The objective is to reduce LDL-C by at least 30% between 10 and 14 years and, thereafter, to reach LDL-C levels of less than 3.4mmol/L (130mg/dL). Conclusion: The aim of this consensus statement is to achieve more consistent management in the identification and treatment of children with HeFH in Belgium. [Copyright &y& Elsevier]