The accuracy of acanthosis nigrcans (AN) as a dermatological clinical marker to predict insulin resistance (IR) has not been well established in children. A cohort of obese Caucasian children was prospectively recruited. Demographic data, body mass index values, and laboratory data were compared for the presence or absence of AN. A total of 76 children participated. In all, 46 (60.5%) children had AN, and 34 (44.7%) children were positive for IR (>3.16); 25 (32.9%) children were positive for both AN and IR. Sensitivity, specificity, positive and negative predictive values, and accuracy level for AN to detect IR in the obese children who participated in this study were 73.5%, 50%, 54.3%, 70%, and 49%, respectively. The correlation between insulin and fasting glucose levels in AN-negative or AN-positive patients was low (R (2) = 13% to 17%). Acanthosis nigricans was only a surrogate marker for IR. It is concluded that IR should be examined in every obese West Virginian child irrespective of his or her AN status.

No abstract

In an attempt to throw light on the question of age-related variations in the normal blood content of cobalamin and on the frequency of deficiencies of antimegaloblastic nutriments in the elderly, 273 geriatric patients have been investigated. Low serum vitamin B,, values were found in one third of these patients, due to latent pernicious anaemia in five and malabsorption in seven cases, and probably caused by nutritional deficiency of folate or cobalamin in 78 cases. In that part of the series with apparently normal vitamin B,, levels, the mean value (379f14 pg/ml) was lower than the mean (465f20 pg/ml) for a younger control group. However, this cannot be taken as a sign of a physiological lowering of the cobalamin values with age, as nutritional deficiencies could not be ruled out in this part of the series. It is concluded that serum vitamin B,, assays should be performed rather liberally in the aged. Patients with nutritional deficiency of cobalamin or folate should be treated, even if frank megaloblastic anaemia is not present.Measurements of serum vitamin B,, concentration in the general population have shown that the level remains relatively constant throughout life (9,10,18,21,24,26). Some investigators (5, 6,12,16,17,19,25,27,28,31) have, however, reported a tendency to decreasing values with advancing age.As pernicious anaemia is predominantly a disease of old age, and as nutritional deficiencies are found more frequently at this stage of life, it is of importance to evaluate the clinical significance of serum vitamin B,, assays in the aged.This study was performed in an attempt to throw light on the question of age-related variations in the normal blood content of cobalamin and on the fre-quency of deficiencies of antimegaloblastic nutriments in a group of elderly people who were in need of geriatric care. MATERIAL AND METHODSDuring a period extending over 12 months a total of 349 patients, 236 women and 113 men, who had been admitted to the Geriatric Centre, Arhus, for various social and medical reasons, were studied. Some of these patients died shortly after admission; others were transferred to another home for the aged, and a few failed to attend the investigation for various technical reasons. Patients treated with vitamin BIZ for previously diagnosed pernicious anaemia, gastrectomy or other gastrointestinal disorders were primarily excluded, as were patients treated with antibiotics at the time of admission. In the remaining 273 patients, a venipuncture was performed immediately on admission for an assay of vitamin BIZ by the Lactobacillus leichmannii method (performed by the Research Laboratories of Dumex Ltd., Copenhagen) (15).Patients with normal serum vitamin B12 levels, i.e. above 200 pglml, were not subjected to any further study.In patients with low concentrations of vitamin BIZ an investigation programme was instituted, comprising peripheral blood studies (WBC, MCV, platelets), serum iron, total iron-binding capacity, marrow examination, hydrochloric acid in gastric juice after histamine ...