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Hanusch B, Falkenstein M, Volkenstein S, Dazert S, Lücke T, Sinningen K. No Impairment in Bone Turnover or Executive Functions in Well-Treated Preschoolers with Phenylketonuria-A Pilot Study. Nutrients 2024; 16:2072. [PMID: 38999818 PMCID: PMC11243048 DOI: 10.3390/nu16132072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Patients with phenylketonuria (PKU) present signs of impaired executive functioning and bone health in adolescence and adulthood, depending in part on the success of therapy in childhood. Therefore, nine children with well-treated PKU (4-7 years old, 22.2% ♀, seven with a full set of data, two included into partial analysis) and 18 age-, gender- and season-matched controls were analyzed for differences in executive functioning and bone parameters in plasma. Plasma was analyzed with commercially available kits. Cognitive performance in tonic alertness, visuo-spatial working memory, inhibitory control and task switching was assessed by a task battery presented on a touch screen. Regarding cognition, only the performance in incongruent conditions in inhibitory control was significantly better in children with PKU than in controls. No further differences in cognitive tests were detected. Furthermore, no significant difference in the bone turnover markers osteocalcin, undercarboxylated osteocalcin and CTX were detected between children with PKU and controls, while children with PKU had a significantly higher vitamin D concentration (69.44 ± 12.83 nmol/L vs. 41.87 ± 15.99 nmol/L, p < 0.001) and trended towards lower parathyroid hormone concentrations than controls (48.27 ± 15.16 pg/mL vs. 70.61 ± 30.53 pg/mL, p = 0.066). In this small group of well-treated preschoolers with PKU, no impairments in cognitive performance and bone turnover were observed, while vitamin D supplementation of amino acid supplements seems to be sufficient to achieve good vitamin D status.
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Affiliation(s)
- Beatrice Hanusch
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | | | - Stefan Volkenstein
- Department of Otorhinolaryngology, Head and Neck Surgery, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, 32429 Minden, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital Bochum, Ruhr-University Bochum, 44787 Bochum, Germany
| | - Thomas Lücke
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Kathrin Sinningen
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
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Galler A, Thönnes A, Joas J, Joisten C, Körner A, Reinehr T, Röbl M, Schauerte G, Siegfried W, Weghuber D, Weihrauch-Blüher S, Wiegand S, Holl RW, Prinz N. Clinical characteristics and outcomes of children, adolescents and young adults with overweight or obesity and mental health disorders. Int J Obes (Lond) 2024; 48:423-432. [PMID: 38195831 PMCID: PMC10896720 DOI: 10.1038/s41366-023-01449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/25/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Mental disorders are important comorbidities in youth with obesity. Aim was to describe the clinical characteristics and outcome of youth with overweight or obesity having comorbid mental disorders. METHODS Data from children, adolescents, and young adults (age 6-30 years) with overweight or obesity and mental disorders (depression, anxiety disorder, eating disorder, attention deficit disorder (ADHD)) from 226 centers in Germany and Austria participating in the Adiposity Patient Registry (APV) were analyzed and compared with those without reported mental disorders using regression modeling. RESULTS Mental health comorbidity was reported in a total of 3969 out of 114,248 individuals with overweight or obesity: 42.5% had ADHD, 31.3% anxiety disorders, 24.3% depression, and 12.9% eating disorders. Being male (OR 1.39 (95%CI 1.27;1.52)), of older age (1.42 (1.25;1.62)), or with extreme obesity (1.45 (1.30;1.63)) were most strongly associated with mental health comorbidity. Regression analysis showed that mean BMI-SDS was significantly higher in the group of individuals with depression and eating disorders (BMI-SDS 2.13 (lower; upper mean:2.09;2.16) and 2.22 (2.17;2.26)) compared to those without reported mental health comorbidity (BMI-SDS 2.008 (2.005;2.011); p < 0.001). In youth with ADHD, BMI-SDS was lower compared to those without reported mental disorders (BMI-SDS 1.91 (1.89;1.93) vs 2.008 (2.005;2.011); p < 0.001). Proportion of severe obesity was higher in individuals with depression (23.7%), anxiety disorders (17.8%), and eating disorders (33.3%), but lower in ADHD (10.3%), compared to those without reported mental disorders (13.5%, p < 0.002). Proportions of dyslipidaemia and abnormal carbohydrate metabolism were not different in youth with and without reported mental health comorbidity. BMI-SDS change after one year of lifestyle intervention program ranged between -0.22 and -0.16 and was similar in youth without and with different mental disorders. CONCLUSION Health care professionals caring for youth with overweight or obesity should be aware of comorbid mental disorders and regular mental health screening should be considered.
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Affiliation(s)
- Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany.
| | - Angelika Thönnes
- Universitätsklinikum des Saarlandes, Psychosomatische Medizin und Psychotherapie and Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Homburg, Germany
| | - Jens Joas
- Universitätsklinikum des Saarlandes, Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Homburg, Germany
| | - Christine Joisten
- Deutsche Sporthochschule Köln, Institut für Bewegungs- und Neurowissenschaft, Köln, Germany
| | - Antje Körner
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kinder- und Jugendmedizin, Leipzig, Germany
| | | | - Markus Röbl
- Universitätsmedizin Göttingen, Georg-August-Universität, Klinik für Kinder und Jugendmedizin, Göttingen, Germany
| | | | | | | | | | - Susanna Wiegand
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
| | - Reinhard W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Nicole Prinz
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Boemanns L, Staab J, Meyer T. Associations of attention-deficit/hyperactivity disorder with inflammatory diseases. Results from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS). NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023:10.1007/s40211-023-00479-8. [PMID: 37589869 DOI: 10.1007/s40211-023-00479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/06/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Despite conflicting data, some studies have suggested a pathophysiological relationship between inflammation and attention-deficit/hyperactivity disorder (ADHD). METHODS Using data from the nationwide and representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS; n = 6922 study participants aged 11-17 years), this post hoc analysis assessed the associations between ADHD and three common inflammatory diseases. RESULTS Results showed univariate associations between ADHD and lifetime inflammatory diseases including atopic dermatitis (p = 0.002), otitis media (p = 0.001), and herpes simplex infection (p = 0.032). In logistic regression models adjusted for clinically relevant confounders, we found that ADHD remained a significant predictor of all three inflammatory diseases (atopic dermatitis, Exp(β) = 1.672, 95% confidence interval [CI] 1.239-2.257, p = 0.001; otitis media, Exp(β) = 1.571, 95% CI 1.209-2.040, p = 0.001; herpes simplex, Exp(β) = 1.483, 95% CI 1.137-1.933, p = 0.004). CONCLUSION Our findings demonstrate a positive link between ADHD and peripheral inflammatory diseases, including atopic dermatitis, otitis media, and herpes simplex infection. Further studies are needed to understand the exact pathophysiological mechanisms underlying these associations.
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Affiliation(s)
- Lena Boemanns
- Klinik für Psychosomatische Medizin und Psychotherapie, Universität Göttingen, Göttingen, Germany
| | - Julia Staab
- Klinik für Psychosomatische Medizin und Psychotherapie, Universität Göttingen, Göttingen, Germany
| | - Thomas Meyer
- Klinik für Psychosomatische Medizin und Psychotherapie, Universität Göttingen, Göttingen, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, German Center for Cardiovascular Research, University of Göttingen, Von-Siebold-Str. 5, Göttingen, Germany.
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4
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Huber F, Schulz J, Schlack R, Hölling H, Ravens-Sieberer U, Meyer T, Rothenberger A, Wang B, Becker A. Long-term changes in serum levels of lipoproteins in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). J Neural Transm (Vienna) 2023; 130:597-609. [PMID: 36826608 PMCID: PMC10050056 DOI: 10.1007/s00702-022-02583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/26/2022] [Indexed: 02/25/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting approximately 5% of children worldwide. The causal mechanisms of ADHD remain unclear as the aetiology of this disorder seems to be multifactorial. One research field addresses the impact on lipid metabolism and particularly serum lipid fractions on the development of ADHD symptoms. This post hoc analysis aimed to investigate long-term changes in serum levels of lipoproteins in children and adolescents with ADHD and controls. Data of German children and adolescents from the nationwide and representative "Kinder- und Jugendgesundheitssurvey (KiGGS)" study were analysed at baseline and at a ten-year follow-up. At the two time points, participants in the control group were compared with those in the ADHD group, both before and after propensity score matching. Differences in total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL) and triglycerides were assessed between matched children with and without ADHD. In addition, subgroups with versus without methylphenidate use were compared at both time points. At baseline before matching, there were no significant differences for lipid parameters between participants in the ADHD group (n = 1,219) and the control group (n = 9,741): total cholesterol (Exp(ß) = 0.999, 95%-CI 0.911-1.094, p = .979), LDL (Exp(ß) = 0.967, 95%-CI 0.872-1.071, p = .525), HDL (Exp(ß) = 1.095, 95%-CI 0.899-1.331, p = .366) and triglycerides (Exp(ß) = 1.038, 95%-CI 0.948-1.133, p = .412). Propensity score matching confirmed the non-significant differences between the ADHD and non-ADHD group at baseline. At the 10-year follow-up, n = 571 participants fulfilled complete inclusion criteria, among them 268 subjects were classified as ADHD. The two groups did not significantly differ in lipid fractions, neither cross-sectionally nor with regard to long-term changes. There was also no significant difference between methylphenidate subgroups. In this sample of children and adolescents we could not reveal any significant associations between serum lipid fractions and the diagnosis of ADHD, neither cross-sectionally nor longitudinally; even when methylphenidate use was considered. Thus, further studies using larger sample sizes are required to investigate putative long-term changes in serum lipid fractions related to ADHD.
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Affiliation(s)
- Franziska Huber
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Jan Schulz
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Robert Schlack
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Unit Mental Health, Berlin, Germany
| | - Heike Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Unit Mental Health, Berlin, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- Partner Site Göttingen, German Centre for Cardiovascular Research, Göttingen, Germany
| | - Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Biyao Wang
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Andreas Becker
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
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Peng X, Peng Y, Zhang C, Zhao M, Yang H, Cao S, Li G, Jiang Y, Guo Z, Chen D, Xu J, Chen H, Xiang Y, Mu R, Zeng J, Shen Y, Wang Y, Li Q, Hu L, Ren N, Cai Y, Zhang W, Ma J, Yan R, Chen W, Song W, Ni X. Reference intervals of 14 biochemical markers for children and adolescence in China: the PRINCE study. Clin Chem Lab Med 2022; 60:1627-1639. [PMID: 35934870 DOI: 10.1515/cclm-2022-0299] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The Pediatric Reference Intervals in China (PRINCE) was initiated to establish the reference intervals (RIs) of Chinese children, as well as to make it possible to compare the variability of biochemical markers among countries internationally. METHODS Healthy participants, aged up to 20 years, from 11 provinces across China, were enrolled in PRINCE and according to a standard screening procedure, that included a questionnaire survey, physical examinations and laboratory tests. Fasting venous blood specimens were collected. All serum specimens were analyzed with Cobas C702 in the center laboratory, i.e. clinical laboratory of Beijing Children's Hospital, with certified qualification (ISO15189). The nonparametric method recommended by Clinical Laboratory Standards Institute guidelines, was used to calculate the age- and sex-specified RIs. RESULTS Among the 15,150 participants enrolled, 12,352 children (6,093 males and 6,259 females) were included to calculate RIs. The RIs for total protein, albumin, globulin, calcium, phosphate, potassium, sodium, chlorine, alkaline phosphatase, γ-glutamyl transpeptadase, alanine aminotransferase, aspartate aminotransferase, creatinine and urea were established by age- or sex-partitions. Most biochemical markers displayed larger variability and higher dispersion during the periods between 28 days and 1 year old, and included 4-6 age partitions commonly during 1 to <20 years old. In addition, differences of RIs between sexes usually occurs around the initiation of puberty at 12-13 years old. CONCLUSIONS The age- and sex-specified RIs of 14 biochemical markers in PRINCE study can provide a solid reference, which will be transferred into relevant RIs for other clinical laboratory's platforms according to the CLSI guidelines.
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Affiliation(s)
- Xiaoxia Peng
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Yaguang Peng
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Chuanbao Zhang
- National Center for Clinical Laboratories (NCCL), Beijing, P.R. China
| | - Min Zhao
- The First Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Hongling Yang
- Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Sancheng Cao
- Xi'an Children's Hospital, Xi'An, Shaanxi, P.R. China
| | - Guixia Li
- Children's Hospital of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Yongmei Jiang
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhenxin Guo
- Henan Children's Hospital Zhengzhou Children's Hospital, Zhengzhou, Henan, P.R. China
| | - Dapeng Chen
- Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Jin Xu
- Children's Hospital of Fudan University, Shanghai, P.R. China
| | - Hongbing Chen
- Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Yun Xiang
- Wuhan Women and Children Medical Care Center, Wuhan, Hubei, P.R. China
| | - Runqing Mu
- The First Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Jie Zeng
- National Center for Clinical Laboratories (NCCL), Beijing, P.R. China
| | - Ying Shen
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Yan Wang
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Qiliang Li
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Lixin Hu
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Na Ren
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Yanying Cai
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Wei Zhang
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Jie Ma
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Ruohua Yan
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Wenxiang Chen
- National Center for Clinical Laboratories (NCCL), Beijing, P.R. China
| | - Wenqi Song
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
| | - Xin Ni
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, P.R. China
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Neuhauser HK, Büschges J, Schaffrath Rosario A, Schienkiewitz A, Sarganas G, Königstein K, Schweizer D, Schmidt-Trucksäss A. Carotid Intima-Media Thickness Percentiles in Adolescence and Young Adulthood and Their Association With Obesity and Hypertensive Blood Pressure in a Population Cohort. Hypertension 2022; 79:1167-1176. [PMID: 35255707 DOI: 10.1161/hypertensionaha.121.18521] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aimed to derive carotid intima media thickness (CIMT) percentiles from a population-based sample of adolescents and young adults using improved technology, standardization and quality control, and to investigate the association of CIMT with hypertensive blood pressure (BP) and obesity. METHODS Four thousand seven hundred nine 14- to 28-year-old participants of the German KiGGS cohort 11-year follow-up, which was based on a nationwide population sample, had B-mode ultrasound CIMT measurement with semi-automated edge-detection and automatic ECG-gated real-time quality control. CIMT percentiles were estimated from far wall CIMT during 2 to 6 heart cycles using the GAMLSS statistical model. Hypertensive BP, overweight, obesity, and a risk score from added Z scores of triglycerides, total/HDL (high-density lipoprotein)-cholesterol ratio, and glycated hemoglobin were based on standardized measurements at baseline and follow-up. RESULTS CIMT differed by sex at all ages, furthermore by age and height in a nonlinear fashion. Percentiles were estimated simultaneously by age and height. Hypertensive BP and obesity were associated cross-sectionally and longitudinally with a higher risk of CIMT ≥75th percentile in log-binomial regression models adjusted for age, sex, height, current smoking, and cardiovascular risk score. For CIMT ≥90th percentile, the relative risk effect estimates were consistently >1 but often had large confidence intervals including 1, largest adjusted relative risk 3.37 (95% CI, 1.41-8.04) for the combination of hypertensive BP and obesity at follow-up. CONCLUSIONS Based on state-of-the-art measurements and statistical techniques, these population-based CIMT percentiles by sex, age and height add unbiased evidence for the association of subclinical atherosclerosis with hypertensive BP and obesity in the young.
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Affiliation(s)
- Hannelore K Neuhauser
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany (H.K.N., J.B., A.S.R., A.S., G.S.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany (H.K.N., J.B., A.S., G.S., K.K.)
| | - Julia Büschges
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany (H.K.N., J.B., A.S.R., A.S., G.S.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany (H.K.N., J.B., A.S., G.S., K.K.)
| | - Angelika Schaffrath Rosario
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany (H.K.N., J.B., A.S.R., A.S., G.S.)
| | - Anja Schienkiewitz
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany (H.K.N., J.B., A.S.R., A.S., G.S.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany (H.K.N., J.B., A.S., G.S., K.K.)
| | - Giselle Sarganas
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany (H.K.N., J.B., A.S.R., A.S., G.S.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany (H.K.N., J.B., A.S., G.S., K.K.)
| | - Karsten Königstein
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany (H.K.N., J.B., A.S., G.S., K.K.).,Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Switzerland (K.K., A.S.-T.)
| | | | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Switzerland (K.K., A.S.-T.)
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Yan R, Peng Y, Hu L, Zhang W, Li Q, Wang Y, Peng X, Song W, Ni X. Continuous reference intervals for 21 biochemical and hematological analytes in healthy Chinese children and adolescents: the PRINCE study. Clin Biochem 2022; 102:9-18. [PMID: 35108586 DOI: 10.1016/j.clinbiochem.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Critical gaps have existed in pediatric reference intervals in China. In this study, we presented the sex and age distributions of 21 laboratory analytes from childhood to adolescence, and established the corresponding continuous reference intervals based on direct samples. METHODS We used the data from the Pediatric Reference Intervals in China (PRINCE), which is a nation-wide cross-sectional study enrolling 15,150 healthy children and adolescents aged 0 - <20 years from 11 centers across China. Blood samples were collected and analyzed by trained staff following standard operating procedures. Biochemical tests were performed with Cobas C702 at the central laboratory, and hematological tests were performed with Sysmex XE, XN, or XS that satisfy the national standards at each participating center. Children younger than 3 months were excluded due to high neonatal variability and insufficient samples. Continuous reference intervals were calculated using the generalized additive models for location, shape, and scale, and were validated among another 387 healthy volunteers. RESULTS We provided pediatric continuous reference intervals for 21 commonly used biochemical and hematological analytes in China, and depicted the changes in analyte concentrations from 3 months to 20 years. The out-of-range values for all analytes were less than 10%, indicating a well applicability of the continuous reference intervals to the general pediatric population. CONCLUSIONS This is the first comprehensive report of continuous reference intervals based on healthy Chinese children, reflecting the complex dynamic trends of analytes from infancy to adulthood. Applying continuous reference intervals to clinical practice would not only improve the laboratory test result interpretation, but also help better clinical decision making.
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Affiliation(s)
- Ruohua Yan
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing 100045, China
| | - Yaguang Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing 100045, China
| | - Lixin Hu
- Department of Clinical Laboratory Center, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing 100045, China
| | - Wei Zhang
- Department of Clinical Laboratory Center, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing 100045, China
| | - Qiliang Li
- Department of Clinical Laboratory Center, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing 100045, China
| | - Yan Wang
- Department of Clinical Laboratory Center, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing 100045, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing 100045, China.
| | - Wenqi Song
- Department of Clinical Laboratory Center, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing 100045, China.
| | - Xin Ni
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing 100045, China; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck, Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing 100045, China.
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8
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Schündeln MM, Fritzemeier S, Goretzki SC, Hauffa PK, Munteanu M, Kiewert C, Hauffa BP, Fleischhack G, Tippelt S, Grasemann C. Prevalence of osteopathologies in a single center cohort of survivors of childhood primary brain tumor. Front Pediatr 2022; 10:913343. [PMID: 35923779 PMCID: PMC9339690 DOI: 10.3389/fped.2022.913343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood primary brain tumors (CPBT) are the second largest group of childhood malignancies and associated with a high risk for endocrine late effects. OBJECTIVE To assess endocrine late effects and their relevance for the development of osteopathologies in survivors. METHODS This single center cross sectional study investigated data from 102 CPBT survivors with a mean age of 13.0 years and a mean age at diagnosis of 8.7 years. Clinical, biochemical, radiographic, and anamnestic data regarding endocrine and bone health were obtained at study visits. In addition, data regarding tumor stage and therapy was obtained by chart review. An expert opinion was applied to define presence of osteopathologies. RESULTS Impaired bone health, defined by at least one pathological screening parameter, was present in 65% of patients. 27.5% were found to have overt osteopathologies per expert opinion. 37.8% displayed a severe vitamin D deficiency (25-OH vitamin D < 10 ng/ml) and 11% a secondary hyperparathyroidism. Patients with osteopathologies had lower 25-OH vitamin D levels compared to patients without osteopathologies. Multiple endocrine late effects were present: diabetes insipidus in 10.8%, aberrant pubertal development in 13.7%, central hypocortisolism in 14.9%, thyroid dysfunction in 23.8% and growth hormone deficiency in 21.8%. A total of 31.3% of survivors displayed any endocrinopathy. Tumors located near hypothalamic structures and patients who received irradiation had a higher likelihood of endocrine morbidity. CONCLUSION This study indicates that endocrine deficiencies are common in pediatric survivors of CPBTs. Osteopathologies are present in this cohort. A prominent effect of hormonal deficiencies on bone health was not detected, possibly because patients were sufficiently treate for their endocrine conditions or indicating resilience of the childhood bone remodeling process. Vitamin D deficiency is frequent and should be treated as recommended.
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Affiliation(s)
- Michael M Schündeln
- Pediatric Hematology and Oncology, Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Fritzemeier
- Pediatric Hematology and Oncology, Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sarah C Goretzki
- Pediatric Hematology and Oncology, Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Pia K Hauffa
- Pediatric Hematology and Oncology, Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Munteanu
- Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Pediatric Endocrinology and Diabetology, Caritas Hospital, Bad Mergentheim, Germany
| | - Cordula Kiewert
- Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Berthold P Hauffa
- Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Gudrun Fleischhack
- Pediatric Hematology and Oncology, Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stephan Tippelt
- Pediatric Hematology and Oncology, Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Corinna Grasemann
- Department of Pediatrics, Division of Rare Diseases, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
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9
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Föcker M, Timmesfeld N, Bühlmeier J, Zwanziger D, Führer D, Grasemann C, Ehrlich S, Egberts K, Fleischhaker C, Wewetzer C, Wessing I, Seitz J, Herpertz-Dahlmann B, Hebebrand J, Libuda L. Vitamin D Level Trajectories of Adolescent Patients with Anorexia Nervosa at Inpatient Admission, during Treatment, and at One Year Follow Up: Association with Depressive Symptoms. Nutrients 2021; 13:nu13072356. [PMID: 34371865 PMCID: PMC8308738 DOI: 10.3390/nu13072356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
(1) Background: Evidence has accumulated that patients with anorexia nervosa (AN) are at higher risk for vitamin D deficiency than healthy controls. In epidemiologic studies, low 25(OH) vitamin D (25(OH)D) levels were associated with depression. This study analyzed the relationship between 25(OH)D serum levels in adolescent patients and AN and depressive symptoms over the course of treatment. (2) Methods: 25(OH)D levels and depressive symptoms were analyzed in 93 adolescent (in-)patients with AN from the Anorexia Nervosa Day patient versus Inpatient (ANDI) multicenter trial at clinic admission, discharge, and 1 year follow up. Mixed regression models were used to analyze the relationship between 25(OH)D levels and depressive symptoms assessed by the Beck Depression Inventory (BDI-II). (3) Results: Although mean 25(OH)D levels constantly remained in recommended ranges (≥50 nmol/L) during AN treatment, levels decreased from (in)patient admission to 1 year follow up. Levels of 25(OH)D were neither cross-sectionally, prospectively, nor longitudinally associated with the BDI-II score. (4) Conclusions: This study did not confirm that 25(OH)D levels are associated with depressive symptoms in patients with AN. However, increasing risks of vitamin D deficiency over the course of AN treatment indicate that clinicians should monitor 25(OH)D levels.
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Affiliation(s)
- Manuel Föcker
- Department of Child and Adolescent Psychiatry, University Hospital Münster, 48149 Münster, Germany;
- Correspondence: ; Tel.: +49-25-1835-3636
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, 44780 Bochum, Germany;
| | - Judith Bühlmeier
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.B.); (J.H.); (L.L.)
| | - Denise Zwanziger
- Department of Endocrinology, Diabetes and Metabolism, Division of Laboratory Research, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (D.Z.); (D.F.)
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, Division of Laboratory Research, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (D.Z.); (D.F.)
| | - Corinna Grasemann
- Department of Pediatrics, Division of Rare Diseases, St Josef-Hospital, and CeSER, Ruhr-University Bochum, 44791 Bochum, Germany;
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry & Division of Psychological & Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany;
| | - Karin Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, 97080 Wuerzburg, Germany;
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Freiburg, 79104 Freiburg, Germany;
| | - Christoph Wewetzer
- Department of Child and Adolescent Psychiatry and Psychotherapy, Kliniken der Stadt Köln, 51067 Cologne, Germany;
| | - Ida Wessing
- Department of Child and Adolescent Psychiatry, University Hospital Münster, 48149 Münster, Germany;
| | - Jochen Seitz
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.S.); (B.H.-D.)
| | - Beate Herpertz-Dahlmann
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.S.); (B.H.-D.)
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.B.); (J.H.); (L.L.)
| | - Lars Libuda
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.B.); (J.H.); (L.L.)
- Faculty of Natural Sciences, Institute of Nutrition, Paderborn University, Consumption and Health, 33098 Paderborn, Germany
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Headache Is Associated with Low Systolic Blood Pressure and Psychosocial Problems in German Adolescents: Results from the Population-Based German KiGGS Study. J Clin Med 2021; 10:jcm10071492. [PMID: 33916726 PMCID: PMC8038357 DOI: 10.3390/jcm10071492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Studies have reported controversial results on the relationship between headache and blood pressure. The aim of this post hoc study was twofold: first, to further investigate this relationship and, second, to assess the impact of psychosocial factors on this association in a population-based study of German children and adolescents. The analysis was conducted on study participants aged between 11 and 17 years (n = 5221, weighted from the total study cohort) from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Health-related quality of life was assessed by self- and parent-rated German-language KINDL-R questionnaires (Children’s Quality of Life Questionnaire), while mental problems were analyzed using the Strengths and Difficulties Questionnaire (SDQ). Our findings confirmed that blood pressure was significantly lower in adolescents reporting episodes of headache than in those without headache (114.0 ± 10.2 mmHg vs. 115.5 ± 11.0 mmHg, p < 0.001). Logistic regression models adjusted to sex, age, body mass index, contraceptive use, and serum magnesium concentration demonstrated that headache was significantly associated with self-rated KINDL-R (Exp(B) = 0.96, 95% confidence interval (95% Cl) = 0.96–0.97, p < 0.001), parent-rated KINDL-R (Exp(B) = 0.97, 95% CI = 0.96–0.98, p < 0.001), as well as self-rated SDQ (Exp(B) = 1.08, 95% CI = 1.07–1.10, p < 0.001), and parent-rated SDQ (Exp(B) = 1.05, 95% CI = 1.04–1.06, p < 0.001). There was evidence that quality of life and mental problems mediated the effect of blood pressure on headache, as revealed by mediation models. Our results from the nationwide, representative KiGGS survey showed that low blood pressure is a significant predictor of headache, independent of quality of life and mental problems. However, these psychosocial factors may mediate the effect of blood pressure on headache in a still unknown manner.
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11
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Hype um die Vitamin-D-Substitution: Was bleibt? Internist (Berl) 2020; 61:1196-1203. [PMID: 32970191 PMCID: PMC7581590 DOI: 10.1007/s00108-020-00869-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Der „Hype um Vitamin D“ ist neben der Bedeutung für die Knochengesundheit auch auf die ubiquitäre Präsenz des Vitamin-D-Rezeptors in vielen Organsystemen zurückzuführen. Große Beobachtungsstudien lieferten Hinweise, dass ein Vitamin-D-Mangel Risiken altersassoziierte chronische Erkrankungen, wie Krebs- und kardiovaskuläre Erkrankungen, begünstigt. In der vorliegenden Übersicht werden neueste Informationen, einerseits zur Knochengesundheit bei erwachsenen Menschen sowie andererseits zu Krebs- und kardiovaskulären Erkrankungen, anhand der aktuellen Resultate des großen Vitamin D and Omega‑3 Trial (VITAL) eingeordnet.
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12
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Albrecht D, Ittermann T, Thamm M, Grabe HJ, Bahls M, Völzke H. The association between thyroid function biomarkers and attention deficit hyperactivity disorder. Sci Rep 2020; 10:18285. [PMID: 33106555 PMCID: PMC7588469 DOI: 10.1038/s41598-020-75228-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022] Open
Abstract
The relation between thyroid function biomarkers and attention deficit hyperactivity disorder (ADHD) in children and adolescents is currently unclear. Cross-sectional data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Baseline) was analyzed to assess the association between thyroid function biomarkers and ADHD in a population-based, nationally representative sample. The study cohort included 11,588 children and adolescents with 572 and 559 having an ADHD diagnosis or symptoms, respectively. ADHD symptoms were assessed through the Inattention/Hyperactivity subscale of the Strength and Difficulties Questionnaire. ADHD diagnosis was determined by a physician or psychologist. Serum thyroid stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) concentrations were determined enzymatically. Adjusted regression models were used to relate serum TSH, fT3, and fT4 with risk for ADHD diagnosis or symptoms. In children, a 1 mIU/l higher TSH was related to a 10% lower risk (odds ratio [OR] 0.90; 95% confidence interval [CI] 0.81-1.00) of ADHD diagnosis. We found a significant positive association between fT3 and continuously assessed ADHD symptoms in children (β 0.08; 95% CI 0.03-0.14). Our results suggest that physical maturity may influence the association between thyroid function biomarkers and risk for ADHD.
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Affiliation(s)
- Diana Albrecht
- Institute for Community Medicine, University Medicine Greifswald, 17475, Greifswald, Germany.
- Leibniz Institute for Plasma Science and Technology (INP), 17489, Greifswald, Germany.
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner-Site Greifswald, 17475, Greifswald, Germany
| | - Michael Thamm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 13353, Berlin, Germany
| | - Hans-Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17475, Greifswald, Germany
- German Centre for Neurodegenerative Disease (DZNE), Partner-Site Greifswald, 17475, Greifswald, Germany
| | - Martin Bahls
- German Centre for Cardiovascular Research (DZHK), Partner-Site Greifswald, 17475, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner-Site Greifswald, 17475, Greifswald, Germany
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13
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Translation of EU Food Law and Nutrient Reference Values Into Practice: the German Dietary Scheme for the First Year of Life. J Pediatr Gastroenterol Nutr 2020; 71:550-556. [PMID: 32960545 DOI: 10.1097/mpg.0000000000002846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES European dietary regulations affect national dietary guidelines for child nutrition. The update of the German Dietary Scheme for the first year of life is used to examine the translation of European nutrient references into food-based guidelines while maintaining traditional habits. METHODS Within the Dietary Scheme, intake of energy and nutrients was calculated in the complementary feeding period for each of the 3 daily recommended complementary meals (a vegetable-potato-meat meal, a milk-cereal meal, a cereal-fruit meal) in addition to the daily liquid-milk servings (breast milk or follow-on formula). Pureed-home-made complementary meals were assumed. The adequacy of nutrient intake was evaluated by comparison with the European Food Safety Authority (EFSA) Dietary Reference Values. Macronutrient content of meals was compared to the European complementary food directive. RESULTS Daily intake of most nutrients following the scheme was well in line with EFSA values, whereas the commonly 'critical' nutrients iron and iodine remained far below EFSA values. Substituting breast milk or whole cow's milk with follow-on formula had only a small impact on nutrient supply. Although the different nutrient profiles of meals were not fully in line with European regulations, they add up to an overall balanced daily diet. CONCLUSIONS Taken together, European dietary reference values for energy and nutrients can mostly be met by the modular system of the Dietary Scheme as a total diet concept for infant nutrition in Germany. The different proposed meals generally agree with EU regulations for complementary food.
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14
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Lier LM, Breuer C, Ferrari N, Friesen D, Maisonave F, Schmidt N, Graf C. Cost-effectiveness of a family-based multicomponent outpatient intervention program for children with obesity in Germany. Public Health 2020; 186:185-192. [PMID: 32858303 DOI: 10.1016/j.puhe.2020.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/15/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Facing an epidemic of childhood obesity and budget constraints, public health administrations are showing an urgent interest in interventions that are both health effective and cost-effective. Thus, this study intends to analyze the return on investment of these existing programs. STUDY DESIGN All analyses are based on a comprehensive data set from 249 children with obesity and overweight children who participated in the Children's Health InterventionaL Trial (CHILT), an 11-month outpatient multidisciplinary family-based program. METHODS Cost-effectiveness was assessed by comparing estimated savings associated with a reduction in weight and improvement of obesity-related health parameters with intervention costs. Projected future savings in health care expenditures were modeled on existing research, using estimates of health care costs associated with juvenile obesity and remission thresholds of obesity-related disease. RESULTS On average, participants achieved a 0.19-unit reduction in the body mass index standard deviation score, showed reduction in their blood pressure values (systolic = -1.76 mmHg, diastolic = -2.82 mmHg), and showed improvement in their high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol values (HDL = +1.31 mg/dL, LDL = -4.82 mg/dL). The intervention costs were 1799€ per participant, and the benefits of avoided future health care costs varied by individual. On an aggregated level, future savings amounted to between 1859€ and 1926€ per person, translating into a return on investment of 3.3-7.0%. CONCLUSIONS This study shows that a multicomponent obesity intervention, such as the CHILT, not only results in weight loss and improves important health parameters but also is cost-effective.
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Affiliation(s)
- L M Lier
- MA. Strategy & International Management, BSc Business Administration & Economics Department of Sports Economics and Sport Management, German Sport University Cologne, Cologne, Germany, Eisenstraße 5, 50925, Cologne, Germany.
| | - C Breuer
- Habilitation Sport Science Department of Sports Economics and Sport Management, German Sport University Cologne, Cologne, Germany
| | - N Ferrari
- PhD Sport Science Cologne Center for Prevention and Youth/Heart Center Cologne, University Hospital Cologne, Germany
| | - D Friesen
- MA Sports Science Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - F Maisonave
- Diploma in Sport Science Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - N Schmidt
- BA Sport Science, Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - C Graf
- Habilitation Sport Science, PhD Sports Medicine Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
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15
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Abstract
Vitamin D deficiency is widespread in geriatric patients. While vitamin D deficiency is prevalent in about 50% of healthy older adults, the prevalence in geriatric patients with hip fracture increases to over 80%. This is partly due to the fact that sunlight is unreliable as the main source of vitamin D. In addition to insufficient sun intensity from November to April, skin aging plays an important role; it causes a 4-fold reduction in the skin's own vitamin D production during sunshine exposure in older adults compared with younger people. Immobility and institutionalization are additional risk factors for vitamin D deficiency in geriatric patients. At the same time, vitamin D deficiency (< 20 ng/ml) increases parathyroid hormone levels and thus promotes bone loss and the risk of fracture. Severe vitamin D deficiency (< 10 ng/ml) may also lead to reversible muscle weakness resulting in an increased risk of falling. Since falls affect at least every second geriatric patient and hip fractures increase exponentially after the age of 75, the correction of vitamin D deficiency is an important medical and public health effort in these patients. Several randomized intervention trials, comparing 800-1000 IU vitamin D/day versus placebo or calcium, showed a significant reduction in falls and hip fractures in adults ≥65 years of age who had an increased risk of vitamin D deficiency and of falls or fractures. In geriatric patients, implementing vitamin D supplementation at this dosage is currently preferred. A bolus dose of over 24,000 IU/month should be avoided due to the increased risk of falls and fractures. These recommendations remain relevant after a critical review of the four most recent meta-analyses.
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Affiliation(s)
- H A Bischoff-Ferrari
- Klinik für Geriatrie, Universitätsspital Zürich, Rämistraße 100, 8091, Zürich, Schweiz. .,Zentrum Alter und Mobilität, Universitätsspital Zürich und Stadtspital Waid, Zürich, Schweiz.
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16
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Mauz E, Lange M, Houben R, Hoffmann R, Allen J, Gößwald A, Hölling H, Lampert T, Lange C, Poethko-Müller C, Richter A, Rosario AS, von Schenck U, Ziese T, Kurth BM. Cohort profile: KiGGS cohort longitudinal study on the health of children, adolescents and young adults in Germany. Int J Epidemiol 2020; 49:375-375k. [PMID: 31794018 PMCID: PMC7266535 DOI: 10.1093/ije/dyz231] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Elvira Mauz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Michael Lange
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Robin Houben
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Robert Hoffmann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jennifer Allen
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Antje Gößwald
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Heike Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Lampert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Cornelia Lange
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Almut Richter
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Ursula von Schenck
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Bärbel-Maria Kurth
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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17
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Geserick M, Vogel M, Eckelt F, Schlingmann M, Hiemisch A, Baber R, Thiery J, Körner A, Kiess W, Kratzsch J. Children and adolescents with obesity have reduced serum bone turnover markers and 25-hydroxyvitamin D but increased parathyroid hormone concentrations - Results derived from new pediatric reference ranges. Bone 2020; 132:115124. [PMID: 31830529 DOI: 10.1016/j.bone.2019.115124] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/22/2019] [Accepted: 10/26/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND We aimed to establish age- and gender-specific reference ranges for concentrations of the bone markers osteocalcin (OC), procollagen type 1 N-propeptides (PINP) and carboxy-terminal cross-linking telopeptide of type 1 collagen (CTX-I) as well as for the calciotropic hormones 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) in healthy infants, children and adolescents. In addition, the effect of age, gender, puberty and body mass index (BMI) on bone markers was investigated. METHODS 2416 healthy subjects (5714 blood withdrawals), aged 3 months to 17 years, were included to estimate the age- and gender-dependence of reference ranges. Subsequently, measured values of the biomarkers were transformed to standard deviation scores (SDS) and their associations with age, gender and puberty were analyzed. Bone marker-SDS values of the reference cohort were compared with an obese cohort (n = 317 and 489 blood withdrawals) to analyze the effect of BMI. RESULTS OC, PINP and CTX-I showed a distinct age- and gender-dependence with peak levels at 10 to 11 years (girls, Tanner 3) and 13 years (boys, Tanner 3-4). Children with obesity had significantly lower SDS levels for OC (-0.44), PINP (-0.27), CTX-I (-0.33), 25(OH)D (-0.43) and higher SDS levels for PTH (+0.44) than the reference cohort. CONCLUSIONS OC, PINP and CTX-I vary with age, gender and pubertal stage. The body weight status has to be considered in the interpretation of pediatric OC, PINP, CTX-I, 25(OH)D and PTH levels. Consequences of childhood obesity on bone health should be carefully investigated in long-term studies.
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Affiliation(s)
- M Geserick
- LIFE - Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany
| | - M Vogel
- LIFE - Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany
| | - F Eckelt
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM) Leipzig University, Paul-List-Strasse 13-15, 04103 Leipzig, Germany
| | - M Schlingmann
- LIFE - Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany; Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103 Leipzig, Germany
| | - A Hiemisch
- LIFE - Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany; Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103 Leipzig, Germany
| | - R Baber
- LIFE - Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany; Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM) Leipzig University, Paul-List-Strasse 13-15, 04103 Leipzig, Germany
| | - J Thiery
- LIFE - Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany; Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM) Leipzig University, Paul-List-Strasse 13-15, 04103 Leipzig, Germany
| | - A Körner
- LIFE - Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany; Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany
| | - W Kiess
- LIFE - Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany; Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103 Leipzig, Germany
| | - J Kratzsch
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM) Leipzig University, Paul-List-Strasse 13-15, 04103 Leipzig, Germany.
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Schienkiewitz A, Truthmann J, Ernert A, Wiegand S, Schwab KO, Scheidt-Nave C. Age, maturation and serum lipid parameters: findings from the German Health Survey for Children and Adolescents. BMC Public Health 2019; 19:1627. [PMID: 31796007 PMCID: PMC6891966 DOI: 10.1186/s12889-019-7901-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/05/2019] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Recommendations on preventive lipid screening among children and adolescents remain controversial. The aim of the study was to assess age and puberty-related changes in serum lipids, including total cholesterol (TC), and high-density (HDL-C) and non-high-density lipoprotein cholesterol (Non-HDL-C). METHODS Using cross-sectional data from the National Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS 2003-2006; N = 13,676; 1-17 years), changes in distributions of serum lipids were visualized according to sex, age and maturation. Youth aged 10-17 years were classified as prepubescent, early/mid-puberty, and mature/advanced puberty. Multiple linear regressions were used to quantify the impact of pubertal stage on serum lipid levels, adjusted for potential confounding factors. RESULTS Among children 1-9 years mean serum lipid measures increased with age, with higher mean TC and Non-HDL-C among girls than boys. Among children 10-17 years, advanced pubertal stage was independently related to lower lipid measures. Adjusted mean TC, HDL-C and Non-HDL-C was 19.4, 5.9 and 13.6 mg/dL lower among mature/advanced puberty compared to prepubescent boys and 11.0, 4.0 and 7.0 mg/dL lower in mature/advanced puberty compared to prepubescent girls. CONCLUSIONS Lipid concentrations undergo considerable and sex-specific changes during physical growth and sexual maturation and significantly differ between pubertal stages. Screening recommendations need to consider the fluctuations of serum lipids during growth and sexual maturation.
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Affiliation(s)
- Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Julia Truthmann
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Andrea Ernert
- Institute for Biostatistics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Susanna Wiegand
- Institute for Experimental Pediatric Endocrinology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Otfried Schwab
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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Pinho R, Wang B, Becker A, Rothenberger A, Outeiro TF, Herrmann-Lingen C, Meyer T. Attention-deficit/hyperactivity disorder is associated with reduced levels of serum low-density lipoprotein cholesterol in adolescents. Data from the population-based German KiGGS study. World J Biol Psychiatry 2019; 20:496-504. [PMID: 29243550 DOI: 10.1080/15622975.2017.1417636] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: Attention-deficit/hyperactivity disorder (ADHD) is a multifactorial, complex and the most common neurodevelopmental disorder in childhood. In this analysis, we tested the hypothesis that altered serum lipid patterns are associated with ADHD. Methods: Using data from the nationwide, population-based German Health Interview and Examination Survey for Children and Adolescents (KiGGS), we compared serum levels of total cholesterol, high-density (HDL) and low-density lipoprotein (LDL) cholesterol, and also triglycerides, in participants with physician-diagnosed and/or suspected ADHD, as defined by a value of ≥7 on the hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire (SDQ), with non-ADHD controls. Results: Among 6,898 participants aged between 11 and 17 years, 666 (9.7%) had a physician-based diagnosis of ADHD and/or suspected ADHD. We found correlations between the parent-rated SDQ scores on the hyperactivity-inattention subscale and concentrations of triglycerides (r = 0.064, p < .001), total cholesterol (r = -0.026, p = .033), HDL cholesterol (r = -0.059, p < .001) and LDL cholesterol (r = -0.027, p = .031). In multivariate models, low serum levels of LDL cholesterol remained a significant predictor of ADHD (Exp(β) = 0.382, 95% confidence interval = 0.165-0.888, p = .025). Conclusions: Our findings in a large, nationwide and representative sample of German adolescents demonstrated a small, but significant and inverse link between LDL cholesterol levels and symptoms of ADHD. Further studies are required to decipher the biochemical mechanisms behind this relationship.
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Affiliation(s)
- Raquel Pinho
- Department of Experimental Neurodegeneration, Centre for Nanoscale Microscopy and Molecular Physiology of the Brain, University Medical Centre Göttingen , Göttingen , Germany.,Faculty of Medicine, University of Porto , Porto , Portugal
| | - Biyao Wang
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen , Göttingen , Germany
| | - Andreas Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen , Göttingen , Germany
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen , Göttingen , Germany
| | - Tiago F Outeiro
- Department of Experimental Neurodegeneration, Centre for Nanoscale Microscopy and Molecular Physiology of the Brain, University Medical Centre Göttingen , Göttingen , Germany.,Max Planck Institute for Experimental Medicine , Göttingen , Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Göttingen, University of Göttingen, and German Centre for Cardiovascular Research (DZHK) , Göttingen , Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Göttingen, University of Göttingen, and German Centre for Cardiovascular Research (DZHK) , Göttingen , Germany
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20
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Michaelis K, Poethko-Müller C, Kuhnert R, Stark K, Faber M. Hepatitis A virus infections, immunisations and demographic determinants in children and adolescents, Germany. Sci Rep 2018; 8:16696. [PMID: 30420608 PMCID: PMC6232152 DOI: 10.1038/s41598-018-34927-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/28/2018] [Indexed: 12/17/2022] Open
Abstract
Hepatitis A is a vaccine-preventable disease with a global distribution. It predominantly occurs in regions with inadequate living conditions, but also affects populations in industrialised countries. Children are frequently involved in the transmission of hepatitis A virus (HAV) and thus play a central role in the epidemiology of hepatitis A. Here, we investigated HAV infections, immunisations, and associated demographic determinants in a nationwide, population-based, cross-sectional survey conducted in Germany from 2003-2006. Out of 17,640 children and adolescents, complete data sets (HAV serology, demographic information and vaccination card) were available for 12,249 (69%), all aged 3-17 years. We found protective antibody levels (>=20 IU/L) in 1,755 (14%) individuals, 1,395 (11%) were vaccinated against hepatitis A, 360 (3%) individuals were HAV seropositive without prior hepatitis A vaccination, thus indicating a previous HAV infection. Antibody prevalence (attributable to vaccination or infection) increased significantly with age. Multivariate logistic regression revealed that predominantly children and adolescents with migration background-even if they were born in Germany-are affected by HAV infections. Our results provide a rationale to emphasise existing vaccination recommendations and, moreover, to consider additional groups with a higher risk of infection for targeted vaccination, especially children with a migration background.
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Affiliation(s)
- Kai Michaelis
- Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), D-13353, Berlin, Germany.
| | - Christina Poethko-Müller
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), D-12101, Berlin, Germany
| | - Ronny Kuhnert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), D-12101, Berlin, Germany
| | - Klaus Stark
- Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), D-13353, Berlin, Germany
| | - Mirko Faber
- Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), D-13353, Berlin, Germany
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21
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Bohn B, Mönkemöller K, Hilgard D, Dost A, Schwab KO, Lilienthal E, Hammer E, Hake K, Fritsch M, Gohlke B, de Beaufort C, Holl RW. Oral contraception in adolescents with type 1 diabetes and its association with cardiovascular risk factors. A multicenter DPV study on 24 011 patients from Germany, Austria or Luxembourg. Pediatr Diabetes 2018; 19:937-944. [PMID: 29411927 DOI: 10.1111/pedi.12656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate differences in cardiovascular risk factors and metabolic control in girls with type 1 diabetes with or without use of oral contraceptives (OC) from the multicenter "diabetes prospective follow-up" (DPV) registry. METHODS Twenty-four thousand eleven adolescent girls (13 to < 18 years of age) from Germany, Austria or Luxembourg with type 1 diabetes from the DPV registry were included in this cross-sectional study. Multivariable regression models were applied to compare clinical characteristics (hemoglobin A1c [HbA1C ], blood pressure, serum lipids, body mass index) and lifestyle factors (smoking, physical inactivity, alcohol consumption) between girls with or without OC use. Confounders: age, diabetes duration and migration background. STATISTICAL ANALYSIS SAS 9.4. RESULTS In girls with type 1 diabetes and OC use, clinical characteristics and lifestyle factors were less favorable compared to non-users. Differences were most pronounced for the prevalence of dyslipidemia (OC-users: 40.0% vs non-users: 29.4; P < .0001) and the number of smokers (OC-users: 25.9% vs non-users: 12.5%; P < .0001). OC use, sociodemographic characteristics and lifestyle factors explained between 1 and 7% of the population variance in serum lipids and blood pressure. The use of OC explained a small additional proportion in all variables considered (<1%). CONCLUSIONS OC use in adolescent girls with type 1 diabetes was associated with a poorer cardiovascular risk profile. Biological risk factors were partly explained by a clustering of sociodemographic and lifestyle factors with a small additional contribution of OC use. Prescription of OC should therefore be combined with a screening for cardiovascular risk factors and targeted education.
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Affiliation(s)
- Barbara Bohn
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich, Germany
| | - Kirsten Mönkemöller
- Department of Paediatrics, Kinderkrankenhaus Amsterdamer Straße, Cologne, Germany
| | - Dörte Hilgard
- Department of Paediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Axel Dost
- Department of Paediatrics, University Hospital Jena, Jena, Germany
| | - Karl Otfried Schwab
- Department of Paediatrics and Adolescent Medicine, University Medical Centre, Freiburg, Germany
| | | | - Elke Hammer
- Department of Paediatrics, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | - Kathrin Hake
- Children's Hospital, Müritzklinikum Waren, Waren, Germany
| | - Maria Fritsch
- Department of Paediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Bettina Gohlke
- Department of Paediatric Endocrinology and Diabetology, University Hospital Bonn, Bonn, Germany
| | - Carine de Beaufort
- Department of Paediatrics, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg.,Department of Paediatrics, University Hospital Brussels, UZB, Brussels, Belgium
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich, Germany
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22
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Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder, which is multifactorial, complex, and seen most commonly in childhood. AIMS The aim of this study was to examine the hypothesis that altered serum lipid profiles are associated with ADHD. METHODS The study inluded 32 boys diagnosed with ADHD according to DSM-IV-R criteria and a control group of 29 healthy subjects. All patients were assessed with The Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version, the Turgay DSM-IV-based Disruptive Behavior Disorders Child and Adolescent Rating and Screening Scale, the Conners Parent Rating Scale-Revised Long Form, and the Conners Teacher Rating Scale. Measurements were taken of fasting plasma total cholesterol (T-Chol), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and 1-day food intake levels, and the groups were compared. RESULTS The mean TC, LDL, and HDL levels were significantly lower in the ADHD group than the control group (p = .005, p < .001, p = .002, respectively). There was no significant difference between the groups' TG levels (p = .295). No significant differences were determined between the combined-type ADHD patients and the predominantly inattentive subtype of ADHD in respect to the lipid profile. CONCLUSION The results of this study add to the growing body of evidence indicating an association between serum cholesterol and ADHD in boys. Further genetic and molecular studies are required to elucidate the biochemical mechanisms underlying this relationship.
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Affiliation(s)
- Sibelnur Avcil
- a Department of Child and Adolescent Psychiatry , Adnan Menderes University Faculty of Medicine , Aydın , Turkey
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23
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Tahmasebi H, Trajcevski K, Higgins V, Adeli K. Influence of ethnicity on population reference values for biochemical markers. Crit Rev Clin Lab Sci 2018; 55:359-375. [DOI: 10.1080/10408363.2018.1476455] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Houman Tahmasebi
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Karin Trajcevski
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Victoria Higgins
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Khosrow Adeli
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
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24
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Kunz C, Hower J, Knoll A, Ritzenthaler KL, Lamberti T. No improvement in vitamin D status in German infants and adolescents between 2009 and 2014 despite public recommendations to increase vitamin D intake in 2012. Eur J Nutr 2018; 58:1711-1722. [PMID: 29777304 PMCID: PMC6561984 DOI: 10.1007/s00394-018-1717-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/11/2018] [Indexed: 12/19/2022]
Abstract
Purpose Vitamin D is a key component for the growth and development of children and adolescents, influencing a multitude of functions. Worldwide epidemiological studies have shown that minimum vitamin D blood levels of ≥ 20.0 ng/ml, often defined as vitamin D sufficiency by international and national nutrition and pediatric organizations, are often not met in practice. In 2012 the D–A–CH (Germany, Austria, Switzerland) nutrition societies increased their vitamin D intake recommendations fourfold from 200 IU (5 µg) to 800 IU (20 µg) per day. The outcome of this study will contribute to answering the question as to whether the new recommendations for increased vitamin D intake improve the highly prevalent vitamin D deficiency status in German children and adolescents. Methods For this 6-year study (January 2009–December 2014) carried out in Mülheim an der Ruhr, Germany, healthy children and adolescents (n = 1929, age range 1–17 years, median age 11.0 years, 46.9% female) consulting a pediatric group practice (KIDS4.0) were recruited. Serum 25(OH)D determinations were performed using a competitive chemoluminescence immunoassay (CLIA, DiaSorin). Results The median serum vitamin D values for each year from 2009 to 2014 were 18.4, 13.0, 20.8, 16.4, 19.4 and 14.9 ng/ml. The summarized median 25(OH)D serum concentrations between the two time periods 2009–2012 and 2013–2014 after increasing recommendations for vitamin D intake did not show a significant difference (17.0 versus 16.8 ng/ml). Conclusions The increased D–A–CH recommendations for vitamin D intake had no influence on vitamin D levels in children and adolescents. The prevalence of vitamin D deficiency has not changed compared to previous studies. Electronic supplementary material The online version of this article (10.1007/s00394-018-1717-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clemens Kunz
- Institute of Nutritional Sciences, Justus Liebig University Giessen, Wilhelmstr. 20, 35392, Giessen, Germany.
| | - Jürgen Hower
- Pediatric Group Practice KIDS 4.0, Melllinghoferstr. 256, 45475, Mülheim, Germany
| | - Anette Knoll
- AK Statistics, Kreppe 2, 85276, Pfaffenhofen, Germany
| | | | - Thomas Lamberti
- Pediatric Group Practice KIDS 4.0, Melllinghoferstr. 256, 45475, Mülheim, Germany
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25
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Relationship between serum 25-hydroxyvitamin D and red blood cell indices in German adolescents. Eur J Pediatr 2018; 177:583-591. [PMID: 29387981 DOI: 10.1007/s00431-018-3092-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED Since the impact of vitamin D on red blood cell formation has not been well studied, we aimed at assessing the putative link between serum 25-hydroxyvitamin D (25[OH]D) concentrations and hematological markers of erythropoiesis in a large cohort of German adolescents aged 11 to 17 years. In total, 5066 participants from the population-based, nationally representative KiGGS study (Kinder- und Jugendgesundheitssurvey, German Health Interview and Examination Survey for Children and Adolescents) were grouped into either tertiles or clinically accepted cutoff levels for serum 25(OH)D. Results demonstrated significant and inverse correlations between 25(OH)D levels and several hematological parameters including hemoglobin concentration (r = - 0.04, p = 0.003), mean corpuscular hemoglobin (r = - 0.11, p < 0.001), red blood cell count (r = - 0.04, p = 0.002), and soluble transferrin receptor (r = - 0.1, p < 0.001), whereas, in contrast, serum 25(OH)D was positively correlated to the mean corpuscular volume of erythrocytes (r = 0.08, p < 0.001). Multinomial regression models adjusted for clinically relevant confounders confirmed statistically significant differences between the two strata of 25(OH)D groups with respect to red blood cell markers (hemoglobin concentration, red blood cell count, mean corpuscular volume, and corpuscular hemoglobin, as well as iron and soluble transferrin receptor). CONCLUSIONS The link between serum 25(OH)D and several important hematological parameters may point to an inhibitory role of vitamin D in the regulation of erythropoiesis in adolescents. What is Known: • The physiological effects of vitamin D on calcium homeostasis and bone metabolism have been established. • However, much less is known about the impact of circulating vitamin D on erythropoiesis. What is New: • Data from the KiGGS study in German adolescents demonstrated significant associations between serum vitamin D concentrations and red blood cell indices. • Further studies should be conducted to decipher the underlying mechanisms of vitamin D on erythropoiesis.
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26
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Prevalence of Anemia in Pediatric IBD Patients and Impact on Disease Severity: Results of the Pediatric IBD-Registry CEDATA-GPGE®. Gastroenterol Res Pract 2017; 2017:8424628. [PMID: 29358946 PMCID: PMC5735663 DOI: 10.1155/2017/8424628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/08/2017] [Indexed: 12/20/2022] Open
Abstract
Aim To determine the prevalence of anemia and its association with disease severity in children and adolescents with IBD. Methods CEDATA-GPGE is a registry for pediatric patients with IBD in Germany and Austria from 90 specialized centers. As markers of disease severity, analysis included patient self-assessment on a Likert scale (1–5; 1 = very good) and physicians' general assessment (0 = no activity to 4 = severe disease) and the disease indices. Anemia was defined as hemoglobin concentration below the 3rd percentile. Results Prevalence of anemia was 65.2% in CD and 60.2% in UC. Anemic CD and UC patients showed significantly worse self-assessment than patients without anemia (average ± standard deviation; CD: 3.0 ± 0.9 versus 2.5 ± 0.9, p < 0.0001; UC: 2.9 ± 0.9 versus 2.3 ± 0.9, p < 0.0001). Accordingly, physicians' general assessment (PGA) was significantly worse in anemic than in nonanemic patients in CD (p < 0.0001) and UC (p < 0.0001). PCDAI in anemic CD, p < 0.0001, and PUCAI in anemic UC patients, p < 0.0001, were significantly higher than in nonanemic patients. 40.0% of anemic CD and 47.8% of anemic UC patients received iron during follow-up. Conclusion Almost 2/3 of pediatric IBD patients are anemic. Patients' self-assessment and disease severity as determined by PGA and activity indices are worse in anemic patients. Contrastingly, only a minority received iron therapy.
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27
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Low 25(OH)-vitamin D concentrations are associated with emotional and behavioral problems in German children and adolescents. PLoS One 2017; 12:e0183091. [PMID: 28832616 PMCID: PMC5568331 DOI: 10.1371/journal.pone.0183091] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/29/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Evidence has accumulated for the association between low vitamin D serum concentrations and mental health disorders in both children and adults. We performed a cross-sectional analysis in a population-based sample of children and adolescents to detect associations between 25(OH)-vitamin D serum [25(OH)D] concentrations and scores of the five Strengths and Difficulties Questionnaire (SDQ) subscales and the total difficulties score in different age groups (age ≥3-<12 years and ≥12-<18 years). METHODS 9068 participants of the population-based, nation-wide German Health Interview and Examination Survey for Children and Adolescents (KIGGS) with information on mental health status assessed by the SDQ and 25(OH)D levels were included in the analysis. For statistical analysis we used linear regression models stratified by gender based on different adjustment sets. For the younger subsample the analysis was additionally adjusted for the frequency of playing outside. We compared the associations based on parent- and self-ratings of the SDQ for children and adolescents aged ≥12-<18 years. RESULTS We found inverse associations between 25(OH)D concentrations and the subscales emotional problems, peer relationship problems and the total difficulties score in both genders after adjustment for potential confounders. The strongest associations were observed in the older subsample for parent-ratings in boys and self-ratings in girls. In the younger subsample the associations were less strong and no longer evident after adjustment for potential confounders such as migration background, socioeconomic status and frequency of playing outside. CONCLUSION Based on the large-scale cross-sectional study in a German population-based sample of children and adolescents we detected inverse associations between 25(OH)D concentrations and both parent- and self-rated SDQ scores of the total difficulties scale and different subscales with the strongest association in the subsample aged ≥12-<18 years for both genders. Migration background and socioeconomic status were detected as relevant confounders. Further studies-particularly in countries with comparatively low mean 25(OH)D concentrations-in childhood and adolescence are warranted. Longitudinal studies are also necessary to infer direction of effects. Finally, RCTs in children and adolescents are required to determine whether Vitamin D is beneficial for mental health.
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28
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Bergmann RL, Bergmann KE, Richter R, Schlaud M, Henrich W, Weichert A. Growth attainment in German children born preterm, and cardiovascular risk factors in adolescence. Analysis of the population representative KiGGS data. J Perinat Med 2017; 45:619-626. [PMID: 28236630 DOI: 10.1515/jpm-2016-0294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 11/30/2016] [Indexed: 11/15/2022]
Abstract
AIM To compare the growth attainment of preterm children and their cardiovascular risk factors at adolescence with the values measured in term children in Germany. METHODS About 17,641 children aged 0 to <18 years were studied between 2003 and 2006 in the population representative German KiGGS survey ("German Health Interview and Examination Survey for Children and Adolescents") using questionnaires, physical examinations, standardized anthropometric and blood pressure measurements, and blood sample analyses. Analysis of covariance (ANCOVA) was employed for the analyses of anthropometric parameters. RESULTS About 11.8% of the 16,737 children with complete and valid data had been born preterm. After adjustment for covariates the estimated z-scores over the total age range were larger in term compared to preterm children for length/height (P<0.001; estimated difference B=0.277, 95% CI 0.191-0.362), head circumference (P<0.001; B=0.238, 95% CI 0.144-0.333), BMI (P=0.001; B=0.160, 95% CI 0.069-0.252), and skinfold thickness (P=0.220; B=0.058, 95% CI -0.035 to 0.151). The onset of pubertal development was slightly (but not significantly) earlier in term compared to preterm children. At 14 to <18 years, anthropometric and biochemical indicators of cardiovascular diseases were not worse in preterm compared to term children. CONCLUSIONS Preterm-born German adolescents remained significantly shorter, lighter, and had a smaller head circumference than term-born adolescents, but the risk indicators for cardiovascular diseases were not higher.
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29
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Meyer T, Becker A, Sundermann J, Rothenberger A, Herrmann-Lingen C. Attention deficit-hyperactivity disorder is associated with reduced blood pressure and serum vitamin D levels: results from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Eur Child Adolesc Psychiatry 2017; 26:165-175. [PMID: 27197525 DOI: 10.1007/s00787-016-0852-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/15/2016] [Indexed: 01/03/2023]
Abstract
Alterations in blood pressure in attention-deficit/hyperactivity disorder (ADHD), specifically during dopaminergic stimulant intake, are not fully understood. It has been reported that vitamin D deficiency might modify dopaminergic pathways and thus influence ADHD symptoms. Using data from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study, we compared blood pressure and vitamin D levels in healthy controls to both diagnosed ADHD patients and suspected ADHD subjects, as defined by a value of ≥7 on the hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire. In a total cohort of n = 6922 study participants aged 11-17 years, mean arterial blood pressure was significantly higher in controls (86.7 ± 8.2 mmHg) than in the two groups of confirmed (85.5 ± 7.8 mmHg, p = 0.004, n = 430) and suspected ADHD patients (84.6 ± 8.2, p < 0.001, n = 399). In addition, we found an inverse association between vitamin D and blood pressure in both ADHD groups (p < 0.003). Regression analyses adjusted for age, sex, body-mass index, psychotropic medication use, and serum vitamin D levels confirmed that low blood pressure was a significant and independent predictor of ADHD. Furthermore, we observed that vitamin D mediated the effect of systolic blood pressure on ADHD diagnosis (b = 0.007, 95 % confidence interval [CI] 0.001-0.013, p = 0.021, R 2 = 0.050). In a large and representative national sample of German adolescents, we found a significant association between low blood pressure and ADHD symptoms. In addition, we observed that circulating vitamin D mediated the inverse relation between blood pressure and ADHD, although the effect size was very low. These findings highlight the role of dysregulated pathways of the autonomic nervous system in ADHD.
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Affiliation(s)
- Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, and German Centre for Cardiovascular Research, University of Göttingen, Von-Siebold-Str. 5, Göttingen, Germany.
| | - Andreas Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Jessika Sundermann
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, and German Centre for Cardiovascular Research, University of Göttingen, Von-Siebold-Str. 5, Göttingen, Germany
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Richter A, Rabenberg M, Truthmann J, Heidemann C, Roosen J, Thiele S, Mensink GBM. Associations between dietary patterns and biomarkers of nutrient status and cardiovascular risk factors among adolescents in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS). BMC Nutr 2017. [DOI: 10.1186/s40795-016-0123-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bohn B, Wiegand S, Kiess W, Reinehr T, Stachow R, Oepen J, Langhof H, Hermann T, Widhalm K, Wabitsch M, Gellhaus I, Holl R. Changing Characteristics of Obese Children and Adolescents Entering Pediatric Lifestyle Intervention Programs in Germany over the Last 11 Years: An Adiposity Patients Registry Multicenter Analysis of 65,453 Children and Adolescents. Obes Facts 2017; 10:517-530. [PMID: 29131049 PMCID: PMC5741166 DOI: 10.1159/000479631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/17/2017] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To examine whether characteristics of children and adolescents who start lifestyle intervention (LI) for obesity in Germany changed over the last decade. METHODS 65,453 subjects (<21 years) from the APV database (Adiposity Patients Registry) with a BMI ≥ 90th percentile were included (years 2005-2015). Logistic regression models (confounders: age, sex, migration background) were created for overweight, obesity, extreme obesity, and obesity-related comorbidities. Comorbidities were further adjusted for weight category. Results were stratified by inpatient or outpatient care. RESULTS Extreme obesity was found to be more frequent at the onset of LI (2005: 11.6; 2015: 12.7%) with a similar trend in subgroups (p < 0.001). Obesity increased (2005: 50.3%; 2015: 55.1%), and overweight decreased (2005: 34.1%; 2015: 29.0%) in the whole study population. Trends were similar for inpatient or outpatient care (all p < 0.001). Hypertension increased from 45.7% to 49.2% in the whole study population, and similar data were obtained in the subgroup of inpatients (both p < 0.0001). Dyslipidemia increased in all patients (2005: 21.9%; 2015: 28.0%) and in inpatients (2005: 20.2%; 2015: 25.7%; both p < 0.0001). Abnormal carbohydrate metabolism rose in all patients (from 5.2 to 6.4%; p = 0.0002) without significant trends in subgroups. CONCLUSION During the last decade, children and adolescents presented with higher BMI SDS at the onset of LI and the proportion with obesity-related comorbidities increased. Particularly the presence of comorbidities differed between outpatients and inpatients.
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Affiliation(s)
- Barbara Bohn
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- *Dr. biol. hum. Barbara Bohn; M.Sc. Public Health Nutrition, Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany,
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité University Medicine, Berlin, Germany
| | - Wieland Kiess
- University Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Children's Hospital; University of Witten/Herdecke, Datteln, Germany
| | - Rainer Stachow
- Specialized Clinic Sylt, Rehabilitation Clinic for Children and Adolescents, Westerland, Germany
| | - Johannes Oepen
- Rehabilitation Clinic for Children and Adolescents, Viktoriastift Bad Kreuznach, Bad Kreuznach, Germany
| | | | - Thomas Hermann
- Specialized Rehabilitation Clinic Prinzregent Luitpold, Scheidegg/Allgäu, Germany
| | - Kurt Widhalm
- Division of Clinical Nutrition, Obesity and Lipid Disorders, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, University Hospital for Children and Adolescents, Ulm, Germany
| | - Ines Gellhaus
- Consensus Group Obesity Education for Children and Adolescents (KgAS), Paderborn, Germany
| | - Reinhard Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
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Laass MW, Schmitz R, Uhlig HH, Zimmer KP, Thamm M, Koletzko S. The prevalence of celiac disease in children and adolescents in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:553-60. [PMID: 26356552 DOI: 10.3238/arztebl.2015.0553] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Untreated celiac disease is associated with increased morbidity and mortality. Until now, no up-to-date figures have been available on the prevalence of celiac disease among children and adolescents in Germany, or on the percentage of undiagnosed cases. METHODS To estimate the prevalence of celiac disease, serum samples obtained from 2003 to 2006 from participants in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were studied for celiac disease-specific autoantibodies and total IgA. RESULTS Of the 12 741 study participants aged 1 to 17 years (6546 boys, 6195 girls), 9 (0.07%) had a reported history of celiac disease. An elevated concentration of serum autoantibodies to tissue transglutaminase was found in 91 children with a normal IgA concentration and in 7 with IgA deficiency. The prevalence of undiagnosed celiac disease, based on positive autoantibody findings, was 0.8% (95% confidence interval 0.6-1.0%), and the overall prevalence of the disease was 0.9%. Seropositive children and adolescents had lower ferritin and red blood cell folate concentrations than seronegative ones; they also tended to be shorter and to weigh less as reflected by age- and sex-standardized z-scores. CONCLUSION The 0.9% prevalence of celiac disease in Germany, as determined from a combination of serological findings and clinical histories, is similar to reported prevalences elsewhere in Europe and North America. Pediatricians, primary care physicians, internists, and other specialists should be aware of the broad spectrum of clinical manifestations of this disease. Children who have symptoms suggestive of celiac disease or belong to a group at risk for it should be tested for antibodies against tissue transglutaminase, as should symptomatic adults after the exclusion of other possible causes. It is not yet clear whether asymptomatic adults from high-risk groups should be tested.
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Affiliation(s)
- Martin W Laass
- Institute and Outpatient Clinics of Pediatric and Adolescent Medicine, University Hospital Carl Gustav Carus, Dresden, Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin, Translational Gastroenterology Unit and Department of Pediatrics, John Radcliffe Hospital, Oxford, United Kingdom, Department of General Pediatrics and Neonatology, Center for Pediatric and Adolescent Care, Justus Liebig University, Gießen, Epidemiology Laboratory, Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin, Dr von Hauner Children's Hospital, Campus Innenstadt, Ludwig-Maximilians-Universität München
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Schündeln MM, Hauffa PK, Bauer JJ, Temming P, Sauerwein W, Biewald E, Bornfeld N, Hauffa BP, Grasemann C. Pediatric Survivors of Retinoblastoma Are at Risk for Altered Bone Metabolism After Chemotherapy Treatment Early in Life. Pediatr Hematol Oncol 2016; 32:455-66. [PMID: 26237585 DOI: 10.3109/08880018.2015.1048912] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Survivors of childhood cancer frequently suffer from endocrine late effects, which are, at least partly, attributed to toxic effects of chemotherapy. Treatment of retinoblastoma typically involves chemotherapy at a very young age. The authors conducted a cross-sectional study to assess bone health in a pediatric cohort of 33 survivors of retinoblastoma (mean age: 4.4 years) who had undergone chemotherapy treatment at an especially young age (mean age: 0.76 years). Of these patients, 14 had unilateral and 19 bilateral retinoblastoma. Polychemotherapy consisted of treatment with cyclophosphamide, etoposide, vincristine, and carboplatin. Ten patients had undergone external beam radiotherapy. Clinical and biochemical parameters of growth, pubertal development, and bone health were obtained. A vitamin D deficiency was found in 51.7% of the patients, and 13.7% of patients displayed severe vitamin D deficiency. Secondary hyperparathyroidism and altered readings for bone formation or resorption markers were present in 15%. Nine percent reported bone pain or experienced fractures of the long bones after primary diagnosis. No difference between children with bilateral and unilateral disease or irradiated versus nonirradiated children was observed. The parameters of thyroid function, growth, and pubertal development were within age-appropriate norms in almost all children. In conclusion, altered parameters of bone health can be present in survivors of retinoblastoma at a young age and warrant regular follow-up in these children. The endocrine hypothalamic-pituitary axes, however, were not impaired at this early age in this group of survivors of retinoblastoma.
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Affiliation(s)
- Michael M Schündeln
- a Department of Pediatric Hematology and Oncology, Kinderklinik III , Universitätsklinikum- Essen and the University of Duisburg-Essen , Essen, Germany
| | - Pia K Hauffa
- a Department of Pediatric Hematology and Oncology, Kinderklinik III , Universitätsklinikum- Essen and the University of Duisburg-Essen , Essen, Germany
| | - Jens J Bauer
- d Department of Ophthalmology , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany
| | - Petra Temming
- a Department of Pediatric Hematology and Oncology, Kinderklinik III , Universitätsklinikum- Essen and the University of Duisburg-Essen , Essen, Germany
| | - Wolfgang Sauerwein
- b Department of Pediatric Endocrinology and Diabetology, Kinderklinik II , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany
| | - Eva Biewald
- c Department of Radiation Oncology , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany
| | - Norbert Bornfeld
- c Department of Radiation Oncology , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany
| | - Berthold P Hauffa
- d Department of Ophthalmology , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany
| | - Corinna Grasemann
- d Department of Ophthalmology , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany
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Rieger K, Vogel M, Engel C, Ceglarek U, Thiery J, Kratzsch J, Harms K, Glock F, Hiemisch A, Kiess W. Reference intervals for iron-related blood parameters: results from a population-based cohort study (LIFE Child). ACTA ACUST UNITED AC 2016. [DOI: 10.1515/labmed-2016-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Laass MW, Schmitz R, Uhlig HH, Zimmer KP, Thamm M, Koletzko S. The prevalence of celiac disease in children and adolescents in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015. [PMID: 26356552 DOI: 10.3238/arztebl.2015.0553.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Untreated celiac disease is associated with increased morbidity and mortality. Until now, no up-to-date figures have been available on the prevalence of celiac disease among children and adolescents in Germany, or on the percentage of undiagnosed cases. METHODS To estimate the prevalence of celiac disease, serum samples obtained from 2003 to 2006 from participants in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were studied for celiac disease-specific autoantibodies and total IgA. RESULTS Of the 12 741 study participants aged 1 to 17 years (6546 boys, 6195 girls), 9 (0.07%) had a reported history of celiac disease. An elevated concentration of serum autoantibodies to tissue transglutaminase was found in 91 children with a normal IgA concentration and in 7 with IgA deficiency. The prevalence of undiagnosed celiac disease, based on positive autoantibody findings, was 0.8% (95% confidence interval 0.6-1.0%), and the overall prevalence of the disease was 0.9%. Seropositive children and adolescents had lower ferritin and red blood cell folate concentrations than seronegative ones; they also tended to be shorter and to weigh less as reflected by age- and sex-standardized z-scores. CONCLUSION The 0.9% prevalence of celiac disease in Germany, as determined from a combination of serological findings and clinical histories, is similar to reported prevalences elsewhere in Europe and North America. Pediatricians, primary care physicians, internists, and other specialists should be aware of the broad spectrum of clinical manifestations of this disease. Children who have symptoms suggestive of celiac disease or belong to a group at risk for it should be tested for antibodies against tissue transglutaminase, as should symptomatic adults after the exclusion of other possible causes. It is not yet clear whether asymptomatic adults from high-risk groups should be tested.
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Affiliation(s)
- Martin W Laass
- Institute and Outpatient Clinics of Pediatric and Adolescent Medicine, University Hospital Carl Gustav Carus, Dresden, Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin, Translational Gastroenterology Unit and Department of Pediatrics, John Radcliffe Hospital, Oxford, United Kingdom, Department of General Pediatrics and Neonatology, Center for Pediatric and Adolescent Care, Justus Liebig University, Gießen, Epidemiology Laboratory, Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin, Dr von Hauner Children's Hospital, Campus Innenstadt, Ludwig-Maximilians-Universität München
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Kunz C, Zittermann A. Vitamin D im Kindes- und Jugendalter in Deutschland. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bergmann K, Bergmann R, Richter R, Henrich W, Weichert A. Vitamin-D-Mangel bei Kindern- und Jugendlichen in Deutschland (Teil 1). Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3389-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
OBJECTIVES Nutrition in toddlerhood may have short- and long-term impacts on health and nutrition behavior. The objectives of the present article are to describe intake of energy and nutrients from the end of infancy to toddlerhood, and to examine dietary and socioeconomic factors (socioeconomic status [SES]) associated with total nutrient adequacy measured by a nutrient-based index (Nutrient Quality Index [NQI]). METHODS In the German Representative Study of Toddler Alimentation from 2008, 7-day estimated dietary records were collected cross-sectionally from toddlers ages 10 to 36 months (n = 525). The study population was recruited in the TNS access panel. The intakes of energy and 18 nutrients were evaluated and the NQI was determined. Age trends in nutrient intake were tested with analysis of variance. Analysis of the association between SES and the NQI was performed by multiple linear regression analysis. RESULTS In all of the age groups, energy intake was close to the reference value representing moderate physical activity. The mean intake of most vitamins and minerals reached the respective reference values, but nutrient density decreased with age. Dietary intakes of iron, iodine, and vitamin D are low in our study. The NQI reached approximately 80 points and was lower in older children than in younger children. NQI was not affected by SES but by formula use. CONCLUSIONS Nutritional quality measured by total nutrient intake is altogether high in German toddlers, although NQI decreased with increasing age. The NQI is independent of social class. The positive association with formula intake can be explained by the general enrichment of vitamins and minerals of these products.
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Hermann G, Thon A, Mönkemöller K, Lilienthal E, Klinkert C, Holder M, Hörtenhuber T, Vogel-Gerlicher P, Haberland H, Schebek M, Holl RW. Comorbidity of type 1 diabetes and juvenile idiopathic arthritis. J Pediatr 2015; 166:930-5.e1-3. [PMID: 25641245 DOI: 10.1016/j.jpeds.2014.12.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/13/2014] [Accepted: 12/11/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the prevalence of juvenile idiopathic arthritis (JIA) and diabetes end points in pediatric patients with type 1 diabetes. STUDY DESIGN Patients with type 1 diabetes, recorded from 1995 up to September 2013 in the Diabetes Patienten Verlaufsdokumentation database (n = 54,911, <16 years of age, 47% girls), were analyzed. The patients' height, weight, and body mass index SDS, glycosylated hemoglobin A1c (HbA1c); insulin dose; hypertension and dyslipidemia prevalence; rate of hypoglycemic events; and ketoacidosis were compared between patients with and without JIA. To adjust for age, sex, diabetes duration, and migration background, data were analyzed in hierarchic multivariable regression models. RESULTS The prevalence of JIA in type 1 diabetes was 106 of 54,911 patients; 66% were girls. Diabetes onset was earlier in children with JIA (7.2 years vs 8.3 years, P = .04). Children with JIA were smaller (SDS: -0.22 vs 0.09, P = .004). Correspondingly, weight SDS was lower in patients with JIA (-0.02 vs 0.22, P = .01). Body mass index SDS did not differ. HbA1c was marginally lower in children with JIA (63 mmol/mol [8.0%] vs 67 mmol/mol [8.3%], P = .06). Insulin requirement was greater in patients with JIA (1.03 vs 0.93 insulin units/weight/day, P = .003). Hypertension and dyslipidemia were comparable in both groups. CONCLUSIONS The JIA-prevalence in patients with type 1 diabetes (0.19%) was considerably greater than in the general population (0.05%). Growth is influenced negatively by JIA. Surprisingly, HbA1c was somewhat lower in children with JIA, possibly because of a more intensive treatment or a latent hemolysis caused by the inflammation.
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Affiliation(s)
- Gerhard Hermann
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
| | - Angelika Thon
- Department of Pediatric Pneumology, Allergology & Neonatology, Children's Hospital, Hanover Medical School, Hanover, Germany
| | | | - Eggert Lilienthal
- Department of Pediatrics, Ruhr University of Bochum, Bochum, Germany
| | | | - Martin Holder
- Department of Pediatric Endocrinology and Diabetology, Olgahospital, Stuttgart Clinical Center, Stuttgart, Germany
| | - Thomas Hörtenhuber
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Petra Vogel-Gerlicher
- German Center for Pediatric and Adolescent Rheumatology with Center for Social Pediatrics, Garmisch-Partenkirchen, Germany
| | - Holger Haberland
- Hospital for Children and Adolescents, Sana Hospital Lichtenberg, Berlin Lichtenberg, Germany
| | - Martin Schebek
- Department of Pediatrics and Adolescent Medicine, Kassel Clinical Center, Kassel, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
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Bohn B, Müller MJ, Simic-Schleicher G, Kiess W, Siegfried W, Oelert M, Tuschy S, Berghem S, Holl RW. BMI or BIA: Is Body Mass Index or Body Fat Mass a Better Predictor of Cardiovascular Risk in Overweight or Obese Children and Adolescents? A German/Austrian/Swiss Multicenter APV Analysis of 3,327 Children and Adolescents. Obes Facts 2015; 8:156-65. [PMID: 26087841 PMCID: PMC5644847 DOI: 10.1159/000381227] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/18/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Body fat (BF) percentiles for German children and adolescents have recently been published. This study aims to evaluate the association between bioelectrical impedance analysis (BIA)-derived BF and cardiovascular risk factors and to investigate whether BF is better suited than BMI in children and adolescents. METHODS Data of 3,327 children and adolescents (BMI > 90th percentile) were included. Spearman's correlation and receiver operating characteristics (ROCs) were applied determining the associations between BMI or BF and cardiovascular risk factors (hypertension, dyslipidemia, elevated liver enzymes, abnormal carbohydrate metabolism). Area under the curve (AUC) was calculated to predict cardiovascular risk factors. RESULTS A significant association between both obesity indices and hypertension was present (all p < 0.0001), but the correlation with BMI was stronger (r = 0.22) compared to BF (r = 0.13). There were no differences between BMI and BF regarding their correlation with other cardiovascular risk factors. BF significantly predicted hypertension (AUC = 0.61), decreased HDL-cholesterol (AUC = 0.58), elevated LDL-cholesterol (AUC = 0.59), elevated liver enzymes (AUC = 0.61) (all p < 0.0001), and elevated triglycerides (AUC = 0.57, p < 0.05), but not abnormal carbohydrate metabolism (AUC = 0.54, p = 0.15). For the prediction of cardiovascular risk factors, no significant differences between BMI and BF were observed. CONCLUSION BIA-derived BF was not superior to BMI to predict cardiovascular risk factors in overweight or obese children and adolescents.
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Affiliation(s)
- Barbara Bohn
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- *M.Sc. Public Health Nutrition Barbara Bohn, Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany
| | - Manfred James Müller
- Institute of Human Nutrition and Food Science, Christian-Albrechts University, Kiel, Germany
| | | | - Wieland Kiess
- University Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | | | - Monika Oelert
- Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Sabine Tuschy
- SANA Clinic Lichtenberg, Department of Pediatric Medicine, SPZ – Adiposity Diseases, Berlin, Germany
| | - Stefan Berghem
- Rehabilitation Clinic ‘Klaus Störtebeker’ for Children and Adolescents, Kölpinsee, Germany
| | - Reinhard W. Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
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Martin L, Oepen J, Reinehr T, Wabitsch M, Claussnitzer G, Waldeck E, Ingrisch S, Stachow R, Oelert M, Wiegand S, Holl R. Ethnicity and cardiovascular risk factors: evaluation of 40,921 normal-weight, overweight or obese children and adolescents living in Central Europe. Int J Obes (Lond) 2014; 39:45-51. [PMID: 25214149 DOI: 10.1038/ijo.2014.167] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 08/09/2014] [Accepted: 09/02/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular disease (CVD) is a major global health problem and the leading cause of death in Europe. Risk factors such as obesity and hypertension that accelerate the development of CVD begin in childhood. Ethnicity is a known risk factor for CVD in adults. The aim of this study is to explore differences in the prevalence of hypertension and dyslipidemia among overweight/obese and normal-weight children/adolescents of three different ethnic origins living in Central Europe. METHODS AND PROCEDURES Prevalence of hypertension and dyslipidemia was calculated among obese/overweight children/adolescents (n = 25,986; mean age 12.7 ± 3.0 years; range: 0-18 years; 46% males) documented in the German-Austrian-Swiss APV (Prospective Documentation of Overweight Children and Adolescents) registry and among normal-weight subjects (n = 14,935; mean age: 8.8 ± 5.1 years; range 0-18 years; 51% males) from the population-based cross-sectional German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study. In both cohorts, subjects were categorized into three ethnic groups (Central European: Germany, Austria, Switzerland; Southeastern European: Turkish; Southern European: Spain, Portugal, Italy, Greece, Cyprus, Malta) based on the country of birth of both parents. Regression models were used to examine ethnic differences after adjustment for age and gender and body mass index (BMI) category. RESULTS Age-, gender- and BMI category-adjusted prevalence of hypertension were 38% and 39% for the ethnic minority groups, compared with 35% among German/Austrian/Swiss counterparts. Turkish ethnicity was significantly associated with hypertension (odds ratio (OR) 1.14; 95% confidence interval: 1.02-1.27; P = 0.0446). No significant ethnic differences were found in lipid levels. Prevalence of hypertension found among normal-weight subjects (Central European vs Southeastern vs Southern European: 6.8% vs 6.3% vs 7.2%) did not differ significantly. CONCLUSIONS Turkish obese/overweight children/adolescents showed a significantly higher prevalence of hypertension relative to their peers of Central European descent. No significant ethnic difference in the prevalence of hypertension was found among normal-weight children/adolescents. The high prevalence of hypertension among Turkish obese/overweight children/adolescents indicates the need for greater preventive and therapeutic efforts to reduce cardiovascular risk factors among vulnerable populations.
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Affiliation(s)
- L Martin
- Department of Pediatric Endocrinology and Diabetology, Charité Children's Hospital, Charité University Medicine, Berlin, Germany
| | - J Oepen
- Viktoriastift Bad Kreuznach, Rehabilitation Clinic for Children and Adolescents, Bad Kreuznach, Germany
| | - T Reinehr
- Vestische Children's Hospital, University of Witten/Herdecke, Datteln, Germany
| | - M Wabitsch
- Divison of Pediatric Endocrinology, Diabetes and Obesity Unit, University Children's Hospital, University of Ulm, Ulm, Germany
| | - G Claussnitzer
- Spessart-Klinik, Rehabilitation Clinic for Children and Adolescents, Bad Orb, Germany
| | - E Waldeck
- Edelsteinklinik, Rehabilitation Clinic for Children and Adolescents, Bruchweiler, Germany
| | - S Ingrisch
- Fachklinik Gaißach, Rehabilitation Clinic, Gaißach, Germany
| | - R Stachow
- Fachklinik Sylt, Rehabilitation Clinic for Children and Adolescents, Westerland, Germany
| | - M Oelert
- Katholisches Kinderkrankenhaus Wilhelmstift, Wilhelmstift Catholic Children's Hospital, Hamburg, Germany
| | - S Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité Children's Hospital, Charité University Medicine, Berlin, Germany
| | - R Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
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Johner SA, Thamm M, Stehle P, Nöthlings U, Kriener E, Völzke H, Gärtner R, Remer T. Interrelations between thyrotropin levels and iodine status in thyroid-healthy children. Thyroid 2014; 24:1071-9. [PMID: 24547873 PMCID: PMC4080866 DOI: 10.1089/thy.2013.0480] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Worldwide, iodine prophylaxis measures have improved iodine status in populations. Several studies have reported an increase in thyrotropin (TSH) levels coinciding with this prophylaxis. Whether this implies an increased risk for hypothyroidism or simply reflects a physiologic TSH adaptation mechanism is not clear. METHODS Data on iodine and thyroid status of 6-17 year old children and adolescents (n=9175), collected between 2003 and 2006 in the German-wide Health Interview and Examination Survey for Children and Adolescents (KiGGS) Study, provided the basis for the analyses of mutual relationships of urinary iodine status (assessed by iodine/creatinine ratio in spot urines), serum TSH levels, and thyroid volume (determined by ultrasound). For data analyses (multivariable linear regression analysis), only those children were included for whom none of the available parameters (including free triiodothyronine [fT3], free thyroxine [fT4], and thyroperoxidase antibody [TPO-Ab] measurements) indicated a potential pathophysiologic thyroid status (n=6101). RESULTS In this population-based sample of thyroid-healthy children, higher urinary iodine excretion was associated with higher TSH levels (p<0.05), adjusted for sex, age, body surface area, body mass index, fT3/fT4 ratio, and time of blood sampling. Higher TSH levels were not associated with a higher prevalence of TPO-Ab but with lower thyroid volume (p<0.001, fully adjusted). For the present study sample, one-time spot measurements of urinary iodine excretion were not related to thyroid volume, the long-term marker of iodine status. CONCLUSION Our findings show for the first time in thyroid-healthy children that smaller thyroid volume is associated with higher normal TSH levels. A decreased thyroid cell mass and cell amount, as induced by an improved iodine status, does presumably require a higher TSH signal to maintain a constant thyroid hormone production, suggesting an underlying physiologic adaptation. Correspondingly, an increased TSH level should not be used as the single criterion to evaluate the prevalence of hypothyroidism, and the repeatedly observed parallel increases of iodine supply and TSH levels should not readily be interpreted as evidence for an increased hypothyroidism risk. These insights, contradicting conventional interpretations, may contribute to dispel uncertainties about the safety of iodine prophylaxis measures.
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Affiliation(s)
- Simone A. Johner
- DONALD Study Centre at the Research Institute of Child Nutrition, University of Bonn, Dortmund, Germany
- Department of Nutritional Epidemiology, Institute of Nutrition and Food Science (IEL), University of Bonn, Bonn, Germany
| | - Michael Thamm
- Central Epidemiology Laboratory, Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany
| | - Peter Stehle
- Department of Nutritional Physiology, Institute of Nutrition and Food Science (IEL), University of Bonn, Bonn, Germany
| | - Ute Nöthlings
- Department of Nutritional Epidemiology, Institute of Nutrition and Food Science (IEL), University of Bonn, Bonn, Germany
| | - Eugen Kriener
- Landratsamt Würzburg, Board of Health, Würzburg, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Roland Gärtner
- Medizinische Klinik IV, Department of Endocrinology, University of Munich, Munich, Germany
| | - Thomas Remer
- DONALD Study Centre at the Research Institute of Child Nutrition, University of Bonn, Dortmund, Germany
- Department of Nutritional Epidemiology, Institute of Nutrition and Food Science (IEL), University of Bonn, Bonn, Germany
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44
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Kohse KP. KiGGS — The German survey on children's health as data base for reference intervals and beyond. Clin Biochem 2014; 47:742-3. [DOI: 10.1016/j.clinbiochem.2014.05.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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45
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Schnabel C, Dahm S, Streichert T, Thierfelder W, Kluwe L, Mautner VF. Differences of 25-hydroxyvitamin D3 concentrations in children and adults with neurofibromatosis type 1. Clin Biochem 2014; 47:560-3. [PMID: 24613576 DOI: 10.1016/j.clinbiochem.2014.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder, frequently associated with reduced bone mineral density. Serum 25-hydroxyvitamin D3 concentrations in NF1 adults are lower than in healthy controls in autumn respectively winter and are inversely correlated with the number of dermal neurofibromas. We investigated 25-hydroxyvitamin D3 levels in children and adults with neurofibromatosis type 1 in winter and summer and compared them to healthy controls to get more pathogenic insights in vitamin D3 metabolism in NF1 patients. DESIGN AND METHODS NF1 patients were clinically examined and serum 25-hydroxyvitamin D3 concentrations were measured in 58 NF1 adults and 46 children in winter as well as in summer and compared to sex-, age- and month-matched controls. RESULTS 52 adults suffered from 10 to 5000 dermal neurofibromas, whereas none of the children presented neurofibromas. 25-Hydroxyvitamin D3 increased from winter to summer (mean: 21.0 to 46.5nmol/l) in NF1 adults. This increase was even larger (p=0.0001) than in healthy controls (mean: 50.5 to 60.5nmol/l). However, there were no differences of 25-hydroxyvitamin D3 concentrations in NF1 children and healthy controls both in winter and in summer. CONCLUSIONS Only adults with NF1 showed lower 25-hydroxyvitamin D3 levels in winter and summer, which are unlikely due to impaired UV-dependent dermal synthesis, but rather might be caused by an accelerated catabolism.
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Affiliation(s)
- Claudia Schnabel
- Institute of Clinical Chemistry, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | | | - Thomas Streichert
- Institute of Clinical Chemistry, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | | | - Lan Kluwe
- Department of Neurology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Victor F Mautner
- Department of Neurology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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46
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Ridefelt P, Hellberg D, Aldrimer M, Gustafsson J. Estimating reliable paediatric reference intervals in clinical chemistry and haematology. Acta Paediatr 2014; 103:10-5. [PMID: 24112315 DOI: 10.1111/apa.12438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/23/2013] [Accepted: 09/26/2013] [Indexed: 11/29/2022]
Abstract
UNLABELLED Very few high-quality studies on paediatric reference intervals for general clinical chemistry and haematology analytes have been performed. Three recent prospective community-based projects utilising blood samples from healthy children in Sweden, Denmark and Canada have substantially improved the situation. CONCLUSION The present review summarises current reference interval studies for common clinical chemistry and haematology analyses.
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Affiliation(s)
- Peter Ridefelt
- Department of Medical Sciences, Clinical Chemistry; Uppsala University; Uppsala Sweden
| | - Dan Hellberg
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Center for Clinical Research; Falun Sweden
| | - Mattias Aldrimer
- Department of Clinical Chemistry; County Hospital of Falun; Falun Sweden
| | - Jan Gustafsson
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
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47
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Hower J, Knoll A, Ritzenthaler KL, Steiner C, Berwind R. Vitamin D fortification of growing up milk prevents decrease of serum 25-hydroxyvitamin D concentrations during winter: a clinical intervention study in Germany. Eur J Pediatr 2013; 172:1597-605. [PMID: 23851699 DOI: 10.1007/s00431-013-2092-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/02/2013] [Indexed: 11/29/2022]
Abstract
Vitamin D plays an important role in human health. Current recommendations for vitamin D intake and endogenous supply through sun exposure are not met in German pre-school children, and suboptimal serum 25-hydroxyvitamin D concentrations, especially during the winter months, are common. Consequently, vitamin D supplementation or fortification have gained increased acceptance. The KiMi trial (Kindermilch=growing up milk) was a prospective, randomized, and double-blind study in which young children (2-6 years of age, n=92) were assigned to receive either vitamin D-fortified growing up milk (2.85 μg/100 ml) or semi skimmed cow's milk without added vitamin D. Daily consumption of fortified growing up milk contributed to the prevention of an otherwise frequently observed decrease in serum 25-hydroxyvitamin D concentration during winter (before winter: median 21.5 ng/mL (10.1-43.0 ng/mL) intervention vs. median 18.4 ng/mL (11.0-44.9 ng/mL) control; after winter: median 24.8 ng/mL (7.0-48.2 ng/mL) intervention vs. median 13.6 ng/mL (7.0-36.8 ng/mL) control) and proved to be safe during summer (median 27.6 ng/mL (18.8-40.5 ng/mL) intervention vs. median 27.4 ng/mL (17.8-38.7 ng/mL) control). Due to the high prevalence of vitamin D deficiency, fortification of growing up milk with vitamin D at a level used in this study could be an effective measure to improve vitamin D status.
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Affiliation(s)
- Jürgen Hower
- Überörtliche Gemeinschaftspraxis für Kinder- und Jugendmedizin Standort Dümpten, Mellinghofer Straße 256, 45475, Mülheim an der Ruhr, Germany,
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48
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A systematic review of statistical methods used in constructing pediatric reference intervals. Clin Biochem 2013; 46:1220-7. [DOI: 10.1016/j.clinbiochem.2013.05.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 05/13/2013] [Accepted: 05/15/2013] [Indexed: 11/23/2022]
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49
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Wagner MO, Bös K, Jekauc D, Karger C, Mewes N, Oberger J, Reimers AK, Schlenker L, Worth A, Woll A. Cohort profile: the Motorik-Modul Longitudinal Study: physical fitness and physical activity as determinants of health development in German children and adolescents. Int J Epidemiol 2013; 43:1410-6. [PMID: 23847291 DOI: 10.1093/ije/dyt098] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Motorik-Modul (MoMo) Longitudinal Study aims to contribute to long-term improvement in the health of German children and adolescents by focusing on: (i) the development of physical fitness and physical activity (including period effects); (ii) the individual and physical/social environmental determinants of the development of physical fitness and physical activity; and (iii) the impact of physical fitness and physical activity on the development of physical and mental health. The MoMo Longitudinal Study began with a nationwide representative sample of 4529 children and adolescents who ranged in age from 4-17 years at the study baseline (2003-2006). The first survey wave of the MoMo Longitudinal Study was conducted between 2009 and 2012, with two subsequent survey waves to be conducted between 2014 and 2016 and 2018 and 2020, respectively. The MoMo Longitudinal Study includes a physical fitness test profile, a physical activity questionnaire, and subjective and objective measures of health from the German Health Interview and Examination Survey (KiGGS). Data access is provided on request (alexander.woll@kit.edu). For further information, including a complete list of publications please visit www.motorik-modul.de.
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Affiliation(s)
- Matthias O Wagner
- University of Konstanz, Konstanz, Germany, Karlsruhe Institute of Technology, Karlsruhe, Germany and University of Education Karlsruhe, Karlsruhe, Germany
| | - Klaus Bös
- University of Konstanz, Konstanz, Germany, Karlsruhe Institute of Technology, Karlsruhe, Germany and University of Education Karlsruhe, Karlsruhe, Germany
| | - Darko Jekauc
- University of Konstanz, Konstanz, Germany, Karlsruhe Institute of Technology, Karlsruhe, Germany and University of Education Karlsruhe, Karlsruhe, Germany
| | - Claudia Karger
- University of Konstanz, Konstanz, Germany, Karlsruhe Institute of Technology, Karlsruhe, Germany and University of Education Karlsruhe, Karlsruhe, Germany
| | - Nadine Mewes
- University of Konstanz, Konstanz, Germany, Karlsruhe Institute of Technology, Karlsruhe, Germany and University of Education Karlsruhe, Karlsruhe, Germany
| | - Jennifer Oberger
- University of Konstanz, Konstanz, Germany, Karlsruhe Institute of Technology, Karlsruhe, Germany and University of Education Karlsruhe, Karlsruhe, Germany
| | - Anne K Reimers
- University of Konstanz, Konstanz, Germany, Karlsruhe Institute of Technology, Karlsruhe, Germany and University of Education Karlsruhe, Karlsruhe, Germany University of Konstanz, Konstanz, Germany, Karlsruhe Institute of Technology, Karlsruhe, Germany and University of Education Karlsruhe, Karlsruhe, Germany
| | - Lars Schlenker
- University of Konstanz, Konstanz, Germany, Karlsruhe Institute of Technology, Karlsruhe, Germany and University of Education Karlsruhe, Karlsruhe, Germany
| | - Annette Worth
- University of Konstanz, Konstanz, Germany, Karlsruhe Institute of Technology, Karlsruhe, Germany and University of Education Karlsruhe, Karlsruhe, Germany
| | - Alexander Woll
- University of Konstanz, Konstanz, Germany, Karlsruhe Institute of Technology, Karlsruhe, Germany and University of Education Karlsruhe, Karlsruhe, Germany
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50
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Heimbeck I, Wjst M, Apfelbacher CJ. Low vitamin D serum level is inversely associated with eczema in children and adolescents in Germany. Allergy 2013; 68:906-10. [PMID: 23751100 DOI: 10.1111/all.12167] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recent studies have yielded heterogeneous results regarding the relationship between vitamin D and atopic conditions. The aim of this study was to investigate the association between serum vitamin D level and the prevalence of eczema in German children and adolescents. METHODS Data were drawn for children aged 1-17 from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a nationwide cross-sectional representative survey. 25-hydroxyvitamin D (25(OH)D) serum concentration was measured in 9838 individuals with eczema and categorized into quartiles. We investigated the association of vitamin D level and eczema by means of logistic regression models. RESULTS Weighted prevalence of eczema was 13.5% (95% confidence interval (CI) 12.6-14.4%). Mean vitamin D level was significantly higher in those with eczema compared with those without (P < 0.0001). Logistic regression revealed an inverse association between low levels of vitamin D and eczema (multivariate OR for quartile 1 vs quartile 2: 0.76 (95% CI 0.61-0.94)). CONCLUSIONS This study suggests that low serum vitamin D level is inversely associated with eczema in German children and adolescents. Prospective studies are required to confirm this result, to discuss a potential opportunity for prevention of eczema.
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Affiliation(s)
| | | | - C. J. Apfelbacher
- Medical Sociology; Department of Epidemiology and Preventive Medicine; University of Regensburg; Regensburg; Germany
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