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Introduction. Obesity and its related disorders, clustered into metabolic syndrome (MetS), are increasingly diagnosed in children and adolescents. Clinical features, which define MetS are also encountered in patients with glucocorticoid excess. Since no evident hypercortisolaemia was detected in obesity and MetS, investigations turned to the local modulators of cortisol action. 11b-hydroxysteroid dehydrogenase type 1, encoded by HSD11B1 gene, controls tissue availability of cortisol by its regeneration from inert cortisone. Changes in HSD11B1 expression and enzyme activity may be influenced by its sequence variants and seem implicated in MetS pathogenesis. Our study was designed to evaluate plausible association of the HSD11B1 polymorphisms with early-onset obesity and features of MetS in Polish children and adolescents. Material and methods. The study comprised of 258 obese children (136 females), aged 12.3 ± 3.6 years, with excessive body mass lasting 7.1 ± 3.8 years. Anthropometric and blood pressure measurements, baseline biochemical analyses and oral glucose tolerance test were performed in all participants. Genotyp­ing of the HSD11B1 variants rs12086634, rs846910, rs4844880, and rs3753519 was conducted in obese youth and compared with 568 lean blood donors. Results. Mean relative body mass index in obese cohort was 164.7 ± 27.1%. Hypertension was detected in 12.4%, impaired fasting glucose in 8.9%, impaired glucose tolerance in 10.8%, diabetes in 2.7%, and dyslipidemia in 31.4% children and adolescents. None of the studied HSD11B1 polymorphisms displayed significant difference in frequency between obese and lean individuals. MetS was diagnosed in 27.6% of 203 patients with obesity aged 10–18 years. Further genotype-stratified analyses of relationship between HSD11B1 variants and particular features of MetS did not confirm increased susceptibility to develop early-onset hyperglycaemia, dyslipidaemia and hypertension in carriers of specific genotypes at rs4844880, rs846910, rs3753519, and rs12086634 (p ≥ 0.05 in all tests). Conclusion. Our study does not support the implication of the HSD11B1 polymorphisms in early-onset obesity and other features of MetS.

The growing popularity of health education on social media indicates the need for its appropriate evaluation. This paper aims to present the potential of the Kirkpatrick Model (KM) with New World Kirkpatrick Model (NWKM) additions to evaluate the nutritional education provided by dieticians via Instagram. Instagram profiles of ten dieticians providing nutritional education for their followers were analyzed in March and April 2021. The study sample included profiles of both macro- and micro-influencers. The analyzed quantitative data included Instagram Engagement Rate and the number of likes and comments per post. The qualitative analysis of the comments was performed following the theoretical framework provided by the KM and NWKM. Collected data showed followers’ satisfaction, commitment, and relevance of the presented content, fulfilling the Level 1 of NWKM. Level 2 of NWKM was represented by 4 out of 5 dimensions (knowledge, attitude, confidence, commitment). No comments were found only for skills. Both Levels 3 (Behavior) and 4 (Results) of the KM were met. However, the use of the NWKM for them seems limited. The KM can be used to evaluate nutritional education on social media. The NWKM additions seem applicable mostly for Levels 1 and 2.

Summary Objective Since metabolic syndrome shares several clinical features with hypercortisolism, it was hypothesised that genes altering individual glucocorticoid (GC) sensitivity might be implicated in pathogenesis of obesity and its adverse outcomes. FKBP5 gene encodes a chaperon protein in the GC receptor (GR) complex, which modulates steroid action upon target genes. Its functional variant, rs1360780, may enhance FKBP5 gene transcription, affect GR signalling and thereby influence the hypothalamo–pituitary–adrenal axis. We investigated the association of rs1360780 with obesity and metabolic characteristics in 250 obese children and adolescents (mean age 12.3±3.6years, BMI ≥95th percentile). Methods Anthropometric measurements, body composition, biochemical and hormonal results were analysed. Genotyping of rs1360780 was compared with 568 lean controls. Results Impaired fasting glucose was present in 8.8%, glucose intolerance in 10.4%, diabetes in 2.8% and dyslipidemia in 28.8% obese individuals. Hypertension was diagnosed in 34 out of 143 patients. No difference was found in FKBP5 polymorphism distribution between subjects with obesity and controls ( p >0.05). Stratification by rs1360780 revealed no differences in body mass and composition. However, carriers of the minor allele displayed enhanced insulin resistance ( p =0.009) and elevated serum triglyceride ( p =0.006), whereas cholesterol, HbA1c, and oral glucose challenge results were similar for all genotypes. Morning ACTH and cortisol did not differ but evening cortisol was higher in minor allele carriers ( p =0.039), although this association was lost in logistic regression analysis. Conclusion This study does not support the association of FKBP5 with obesity but demonstrates plausible implication of its variant in susceptibility to obesity-related insulin resistance and hypertriglyceridemia.

Monogenic diabetes results from one or more mutations in a single gene. It is a relatively rare genetic condition, therefore, it was frequently unappreciated among clinicians. Consequently, monogenic diabetes is misdiagnosed as type 1 diabetes or type 2 diabetes. Such misclassification leads to an inappropriate treatment, often inconvenient for the patients, such as insulin injections with their permanent glycemic control. The correct diagnosis may completely change previous methods of treatment. Patients diagnosed with GCK mutations may be completely treated with adequate diet. HNF1A/HNF4A affected patients are extremely sensitive to low dose sulphonylureas. Moreover, the exact diagnosis has an impact on patients’ relatives. Mostly, misdiagnosing of monogenic diabetes is caused by its rare occurrence and insufficient training in this area among physicians. According to different studies it may comprise 1–4% of all cases of diabetes. The aim of this article is to emphasize that despite the fact that monogenic diabetes is an uncommon disease, it should always be considered in cases of diabetes with unusual course.