Comparison of osteoprotegerin and vascular endothelial growth factor in normoalbuminuric Type 1 diabetic and control subjects

Comparison of osteoprotegerin and vascular endothelial growth factor in normoalbuminuric Type 1 diabetic and control subjects
Alireza Esteghamati, M.D. 1,*, Alireza Arefzadeh, M.D. 1, Ali Zandieh, M.D., M.P.H. 1,
Mohammad Salehi Sadaghiani, M.D., M.P.H. 1, Sina Noshad, M.D., M.P.H. 1, Manouchehr
Nakhjavani, M.D. 1
1 Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of
Medicine, Tehran University of Medical Sciences, Tehran, Iran.
* Address correspondence to Alireza Esteghamati, Endocrinology and Metabolism
Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical
Sciences, Tehran, Iran.

Abstract:
Background: The aim of the current study was to evaluate the association of osteoprotegerin
and vascular endothelial growth factor (VEGF) with glycaemic indices and diabetes status.
Methods: A total of 44 normoalbuminuric type-1 diabetic patients and 44 healthy control
subjects, matched for age, body mass index, sex ratio and lipid measures were enrolled.
Univariate and multivariate logistic regression analyses were used to determine the association of
osteoprotegerin and VEGF with diabetes status. Further, linear regression analysis was
performed to investigate the roles of osteoprotegerin and VEGF as determinants of hemoglobin
A1c (HbA1c).
Results: Osteoprotegerin and VEGF were significantly elevated in diabetic subjects
(2.76±0.85 vs. 2.26±0.75 pmol/l and 187.1±92.7 vs. 125.9±52.3 pg/ml, respectively, P <0.01)
and were positively correlated with glycaemic indices (i.e. fasting plasma glucose and HbA1c, P
<0.001). After controlling for possible confounding factors odds ratios (confidence interval) of
osteoprotegerin and VEGF for diabetes were 2.113 (1.043-4.280) and 1.014 (1.002-1.026),
respectively (P <0.05). Further, linear regression analysis revealed that the association of
osteoprotegerin with HbA1c is independent of VEGF and vice versa (P <0.001).
Conclusion: Osteoprotegerin and VEGF are elevated in normoalbuminuric type 1 diabetic
subjects and are independently associated with glycaemic indices and diabetes status.

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  Short Stature is one of the most important problems in children. 

Etiology:

The European Society for Pediatric Endocrinology (ESPE) classifies the main causes of

• Primary growth disorders, where the condition is intrinsic to the growth plate.
• Secondary growth disorders, where the growth plates change as a consequence of the condition.
• Idiopathic, where there is no identifiable cause of short stature.

Primary growth disorders

• Clinically defined genetic syndromes, such as:
• Down's syndrome
• Prader-Willi syndrome
• Silver- Russell syndrome
• Noonan's syndrome
• Turner syndrome
• Intrauterine growth restriction with failure to catch up:
• Fetomaternal factors
• Prematurity
• Placental dysfunction
• Congenital bone disorders such as:
• Achondroplasia
• Hypochondroplasia
• Osteogenesis imperfecta

Secondary growth disorders

• Endocrine:
• Hypothyroidism.
• Panhypopituitarism.
• Hypothalamic or pituitary lesions (eg, trauma or tumour).
• Laron's syndrome (growth hormone insensitivity).
• Cushing syndrome.
• Growth hormone deficiency or insufficiency.
• Precocious puberty.
• Disorders of the growth hormone insulin-like growth factor I axis.
• Metabolic:
• Mucopolysaccharidoses.
• Glycogen storage diseases.
• Diabetes mellitus (poor control).
• Chronic disease:
• Cardiovascular disease.
• Respiratory disease (eg, cystic fibrosis).
• Haemoglobinopathies.
• Renal disorders disease.
• Malignancy.
• Neurological (eg, hydrocephalus).
• Juvenile arthritis.
• Malnutrition:
• Poverty or neglect.
• Inflammatory bowel disease.
• Coeliac disease.
• Bowel obstruction.
• Enzyme deficiencies.
• Chronic bowel infection.
• Short bowel syndrome.
• Anorexia nervosa.
• Rickets.
• Psychosocial deprivation, including hyperphagic short stature syndrome.
• Medication: steroid therapy.

Although many etiologies have roles in short stature, however, malnutrition is  important factor in short stature.

Malnutrition is the most common cause of growth failure and is usually related to poverty or anarchy. Nutritional deficiencies in developed countries are more often the result of self-restricted diets. Poor weight gain is often more noticeable than short stature.

Nutrition is most important factor specially before puberty.

Parents should check their children and refer to doctor continuously to assess children's stature.

Notice:

After puberty and fusion of the growth plates, doctor can not help to increase height, therefore patients should refer before this time.

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Diabetes mellitus is very common in Iran.

It is a complex disease and patients need to control four important factors :

1) Reduce stress and sudden emotional behaviour

2)Control of Diet 

3) Excersie 

4) Self monitoring blood glucose 

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