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Crowther CA, Ashwood P, Middleton PF, McPhee A, Tran T, Harding JE. Prenatal Intravenous Magnesium at 30-34 Weeks' Gestation and Neurodevelopmental Outcomes in Offspring: The MAGENTA Randomized Clinical Trial. JAMA 2023; 330:603-614. [PMID: 37581672 PMCID: PMC10427942 DOI: 10.1001/jama.2023.12357] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/16/2023] [Indexed: 08/16/2023]
Abstract
Importance Intravenous magnesium sulfate administered to pregnant individuals before birth at less than 30 weeks' gestation reduces the risk of death and cerebral palsy in their children. The effects at later gestational ages are unclear. Objective To determine whether administration of magnesium sulfate at 30 to 34 weeks' gestation reduces death or cerebral palsy at 2 years. Design, Setting, and Participants This randomized clinical trial enrolled pregnant individuals expected to deliver at 30 to 34 weeks' gestation and was conducted at 24 Australian and New Zealand hospitals between January 2012 and April 2018. Intervention Intravenous magnesium sulfate (4 g) was compared with placebo. Main Outcomes and Measures The primary outcome was death (stillbirth, death of a live-born infant before hospital discharge, or death after hospital discharge before 2 years' corrected age) or cerebral palsy (loss of motor function and abnormalities of muscle tone and power assessed by a pediatrician) at 2 years' corrected age. There were 36 secondary outcomes that assessed the health of the pregnant individual, infant, and child. Results Of the 1433 pregnant individuals enrolled (mean age, 30.6 [SD, 6.6] years; 46 [3.2%] self-identified as Aboriginal or Torres Strait Islander, 237 [16.5%] as Asian, 82 [5.7%] as Māori, 61 [4.3%] as Pacific, and 966 [67.4%] as White) and their 1679 infants, 1365 (81%) offspring (691 in the magnesium group and 674 in the placebo group) were included in the primary outcome analysis. Death or cerebral palsy at 2 years' corrected age was not significantly different between the magnesium and placebo groups (3.3% [23 of 691 children] vs 2.7% [18 of 674 children], respectively; risk difference, 0.61% [95% CI, -1.27% to 2.50%]; adjusted relative risk [RR], 1.19 [95% CI, 0.65 to 2.18]). Components of the primary outcome did not differ between groups. Neonates in the magnesium group were less likely to have respiratory distress syndrome vs the placebo group (34% [294 of 858] vs 41% [334 of 821], respectively; adjusted RR, 0.85 [95% CI, 0.76 to 0.95]) and chronic lung disease (5.6% [48 of 858] vs 8.2% [67 of 821]; adjusted RR, 0.69 [95% CI, 0.48 to 0.99]) during the birth hospitalization. No serious adverse events occurred; however, adverse events were more likely in pregnant individuals who received magnesium vs placebo (77% [531 of 690] vs 20% [136 of 667], respectively; adjusted RR, 3.76 [95% CI, 3.22 to 4.39]). Fewer pregnant individuals in the magnesium group had a cesarean delivery vs the placebo group (56% [406 of 729] vs 61% [427 of 704], respectively; adjusted RR, 0.91 [95% CI, 0.84 to 0.99]), although more in the magnesium group had a major postpartum hemorrhage (3.4% [25 of 729] vs 1.7% [12 of 704] in the placebo group; adjusted RR, 1.98 [95% CI, 1.01 to 3.91]). Conclusions and Relevance Administration of intravenous magnesium sulfate prior to preterm birth at 30 to 34 weeks' gestation did not improve child survival free of cerebral palsy at 2 years, although the study had limited power to detect small between-group differences. Trial Registration anzctr.org.au Identifier: ACTRN12611000491965.
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Affiliation(s)
- Caroline A. Crowther
- Liggins Institute, University of Auckland, Auckland, New Zealand
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Pat Ashwood
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Philippa F. Middleton
- School of Medicine, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide
| | - Andrew McPhee
- South Australian Health and Medical Research Institute, Adelaide
- Department of Neonatal Medicine, Women’s and Children’s Hospital, Adelaide, Australia
| | - Thach Tran
- School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Comparison of cerebral oxygen desaturation events between children under general anesthesia and chloral hydrate sedation - a randomized controlled trial. BMC Pediatr 2022; 22:720. [PMID: 36529729 PMCID: PMC9762051 DOI: 10.1186/s12887-022-03739-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND During pediatric general anesthesia (GA) and sedation, clinicians aim to maintain physiological parameters within normal ranges. Accordingly, regional cerebral oxygen saturation (rScO2) should not drop below preintervention baselines. Our study compared rScO2 desaturation events in children undergoing GA or chloral hydrate sedation (CHS). METHODS Ninety-two children undergoing long auditory assessments were randomly assigned to two study arms: CHS (n = 40) and GA (n = 52). Data of 81 children (mean age 13.8 months, range 1-36 months) were analyzed. In the GA group, we followed a predefined 10 N concept (no fear, no pain, normovolemia, normotension, normocardia, normoxemia, normocapnia, normonatremia, normoglycemia, and normothermia). In this group, ENT surgeons performed minor interventions in 29 patients based on intraprocedural microscopic ear examinations. In the CHS group, recommendations for monitoring and treatment of children undergoing moderate sedation were met. Furthermore, children received a double-barreled nasal oxygen cannula to measure end-tidal carbon dioxide (etCO2) and allow oxygen administration. Chloral hydrate was administered in the parent's presence. Children had no intravenous access which is an advantage of sedation techniques. In both groups, recommendations for fasting were followed and an experienced anesthesiologist was present during the entire procedure. Adverse event (AE) was a decline in cerebral oxygenation to below 50% or below 20% from the baseline for ≥1 min. The primary endpoint was the number of children with AE across the study arms. Secondary variables were: fraction of inspired oxygen (FIO2), oxygen saturation (SpO2), etCO2, systolic and mean blood pressure (BP), and heart rate (HR); these variables were analyzed for their association with drop in rScO2 to below baseline (%drop_rScO2). RESULTS The incidence of AE across groups was not different. The analysis of secondary endpoints showed evidence that %drop_rScO2 is more dependent on HR and FIO2 than on BP and etCO2. CONCLUSIONS This study highlights the strong association between HR and rScO2 in children aged < 3 years, whereas previous studies had primarily discussed the role of BP and etCO2. Prompt HR correction may result in shorter periods of cerebral desaturation. TRIAL REGISTRATION The study was retrospectively registered with the German Clinical Trials Registry (DRKS00024362, 04/02/2021).
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He Y, Li SM, Zhang Q, Cao K, Kang MT, Liu LR, Li H, Wang N. The performance of an integrated model including retinal information in predicting childhood hypertension. Pediatr Res 2022; 91:1600-1605. [PMID: 33947999 DOI: 10.1038/s41390-021-01535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The objective of this study was to examine the association of an integrated model (composed of retinal arteriolar caliber, height, and sex) with blood pressure (BP) among a group of Chinese children, and assess the predictive value of the integrated model for childhood hypertension. METHODS This study included 1460 candidates aged 12.634 ± 0.420 years. Height, weight, waist circumference, and BP were obtained and ophthalmological measurements were taken. The computer-imaging program (IVAN, University of Wisconsin, Madison, WI) was used to measure calibers of retinal vessels. Receiver-operating characteristic curve (ROC) analyses were performed to assess the accuracy of the integrated model as a diagnostic test of elevated BP in children. RESULTS The accuracy of the integrated model (assessed by area under the curve) for identifying elevated BP was 0.777 (95% confidence interval: 0.742-0.812). The optimal threshold of the integrated model for defining hypertension was 0.153, and the calculation formula for the specific predictive risk was: Logit (p/1 - p) = -5.666 - 0.261 × retinal arteriolar caliber + 0.945 × sex + 0.438 × height. In identifying elevated BP, the sensitivity and specificity were 0.711 and 0.736, respectively. CONCLUSIONS The model containing eye message is a comprehensive and relatively effective index to identify elevated BP in 12-year-old children, which can offer assistance to further understand childhood microcirculation disease. IMPACT We firstly incorporated retinal vascular diameter, sex, and height into one integrated model to identify hypertension in 12-year-old children. The current discrimination of hypertension in children is difficult. There have been some studies to simplify the diagnosis of children's hypertension, but they were limited to anthropometric measurements. We proposed a composed model containing microcirculation information to predict childhood hypertension. Based on the knowledge that microcirculation is not only a means to study the manifestations but also early pathogenic correlates of hypertension, the combined model containing microcirculation message as a method may provide new insights into the diagnosis of childhood hypertension.
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Affiliation(s)
- Yuan He
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China
| | - Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China
| | - Qing Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Meng-Tian Kang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China
| | - Luo-Ru Liu
- Anyang Eye Hospital, Anyang, Henan, China
| | - He Li
- Anyang Eye Hospital, Anyang, Henan, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China.
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Grootjen LN, Trueba-Timmermans DJ, Damen L, Mahabier EF, Kerkhof GF, Hokken-Koelega ACS. Long-Term Growth Hormone Treatment of Children with PWS: The Earlier the Start, the Better the Outcomes? J Clin Med 2022; 11:jcm11092496. [PMID: 35566622 PMCID: PMC9105093 DOI: 10.3390/jcm11092496] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 01/28/2023] Open
Abstract
Long-term effects of growth hormone (GH) treatment in young children with Prader-Willi syndrome (PWS) have never been compared with untreated age-matched controls with PWS, and it is unclear if starting GH in the first year of life is safe and more effective than starting GH in early childhood. We investigated the effects of long-term GH on body composition, anthropometrics and cognition in young children with PWS compared to untreated controls and assessed whether starting GH in the first year of life is optimal and safe. An open-label, prospective study was performed, comparing GH-treated children with untreated controls, and comparing children who started GH in the first year of life (subgroup A) with children who started between 2–5 years (subgroup C). A total of 82 GH-treated children with PWS and 22 age-matched controls with PWS were included. The main outcome measures were body composition, anthropometrics, IQ, and safety parameters. After 8 years, GH-treated children had significantly better body composition and were taller than age-matched controls. Subgroup A had a lower FM% trajectory during treatment than subgroup C and showed a greater and longer-term increase in the LBM index. After 8 years, subgroup A had a lower trunk/peripheral fat ratio (p = 0.043) and higher IQ (p = 0.043). No adverse effects of starting GH in the first year were found. Children with PWS who received long-term GH had a better body composition and growth than untreated age-matched controls and starting GH in the first year of life was optimal and safe.
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Affiliation(s)
- Lionne N. Grootjen
- Dutch Reference Center for Prader-Willi Syndrome, 3015 CN Rotterdam, The Netherlands; (D.J.T.-T.); (L.D.); (E.F.M.); (G.F.K.); (A.C.S.H.-K.)
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
- Dutch Growth Research Foundation, 3016 AH Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-102-251-533
| | - Demi J. Trueba-Timmermans
- Dutch Reference Center for Prader-Willi Syndrome, 3015 CN Rotterdam, The Netherlands; (D.J.T.-T.); (L.D.); (E.F.M.); (G.F.K.); (A.C.S.H.-K.)
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
- Dutch Growth Research Foundation, 3016 AH Rotterdam, The Netherlands
| | - Layla Damen
- Dutch Reference Center for Prader-Willi Syndrome, 3015 CN Rotterdam, The Netherlands; (D.J.T.-T.); (L.D.); (E.F.M.); (G.F.K.); (A.C.S.H.-K.)
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
- Dutch Growth Research Foundation, 3016 AH Rotterdam, The Netherlands
| | - Eva F. Mahabier
- Dutch Reference Center for Prader-Willi Syndrome, 3015 CN Rotterdam, The Netherlands; (D.J.T.-T.); (L.D.); (E.F.M.); (G.F.K.); (A.C.S.H.-K.)
- Dutch Growth Research Foundation, 3016 AH Rotterdam, The Netherlands
| | - Gerthe F. Kerkhof
- Dutch Reference Center for Prader-Willi Syndrome, 3015 CN Rotterdam, The Netherlands; (D.J.T.-T.); (L.D.); (E.F.M.); (G.F.K.); (A.C.S.H.-K.)
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
| | - Anita C. S. Hokken-Koelega
- Dutch Reference Center for Prader-Willi Syndrome, 3015 CN Rotterdam, The Netherlands; (D.J.T.-T.); (L.D.); (E.F.M.); (G.F.K.); (A.C.S.H.-K.)
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
- Dutch Growth Research Foundation, 3016 AH Rotterdam, The Netherlands
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Perkins DR, Talbot JS, Lord RN, Dawkins TG, Baggish AL, Zaidi A, Uzun O, Mackintosh KA, McNarry MA, Cooper SM, Lloyd RS, Oliver JL, Shave RE, Stembridge M. The influence of maturation on exercise-induced cardiac remodelling and haematological adaptation. J Physiol 2021; 600:583-601. [PMID: 34935156 DOI: 10.1113/jp282282] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/15/2021] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS It has long been hypothesised that cardiovascular adaptation to endurance training is augmented following puberty. We investigated whether differences in cardiac and haematological variables exist, and to what extent, between endurance-trained vs. untrained, pre- and post-peak height velocity (PHV) children, and how these central factors relate to maximal oxygen consumption. Using echocardiography to quantify left ventricular (LV) morphology and carbon monoxide rebreathing to determine blood volume and haemoglobin mass, we identified that training-related differences in LV morphology are evident in pre-PHV children, with haematological differences also observed between pre-PHV girls. However, the breadth and magnitude of cardiovascular remodelling was more pronounced post-PHV. Cardiac and haematological measures provide significant predictive models for maximal oxygen consumption in children that are much stronger post-PHV, suggesting that other important determinants within the oxygen transport chain could account for the majority of variance in before puberty. ABSTRACT Cardiovascular and haematological adaptations to endurance training facilitate greater maximal oxygen consumption, and such adaptations maybe augmented following puberty. Therefore, we compared left ventricular (LV) morphology (echocardiography), blood volume, haemoglobin (Hb) mass (CO-rebreathe) and in endurance-trained and untrained boys (n = 42, age = 9.0-17.1 years, = 61.6±7.2 mL∙kg∙min, and n = 31, age = 8.0-17.7 years, O2max = 46.5±6.1 mL∙kg∙min, respectively) and girls (n = 45, age = 8.2-17.0 years, O2max = 51.4±5.7 mL∙kg∙min and n = 36, age = 8.0-17.6 years, O2max = 39.8±5.7 mL∙kg∙min, respectively). Pubertal stage was estimated via maturity offset, with participants classified as pre- or post-peak height velocity (PHV). Pre-PHV, only a larger LV end-diastolic volume/lean body mass (EDV/LBM) for trained boys (+0.28 mL∙kgLBM , P = 0.007) and a higher Hb mass/LBM for trained girls (+1.65 g∙kgLBM , P = 0.007) were evident compared to untrained controls. Post-PHV, LV mass/LBM (boys:+0.50 g∙kgLBM , P = 0.0003; girls:+0.35 g∙kgLBM , P = 0.003), EDV/LBM (boys:+0.35 mL∙kgLBM , P<0.0001; girls:+0.31 mL∙kgLBM, P = 0.0004), blood volume/LBM (boys:+12.47 mL∙kgLBM , P = 0.004; girls:+13.48 mL∙kgLBM , P = 0.0002.) and Hb mass/LBM (boys:+1.29 g∙kgLBM , P = 0.015; girls:+1.47 g∙kgLBM , P = 0.002) were all greater in trained vs. untrained groups. Pre-PHV, EDV (R2 adj = 0.224, P = 0.001) in boys, and Hb mass and interventricular septal thickness (R2 adj = 0.317, P = 0.002) in girls partially accounted for the variance in O2max . Post-PHV, stronger predictive models were evident via the inclusion of LV wall thickness and EDV in boys (R2 adj = 0.608, P<0.0001), and posterior wall thickness and Hb mass in girls (R2 adj = 0.490, P<0.0001). In conclusion, cardiovascular adaptation to exercise training is more pronounced post-PHV, with evidence for a greater role of central components for oxygen delivery. Abstract figure legend: Schematic diagram depicting cardiac structural and haematological differences between trained and untrained boys and girls, pre-peak height velocity (PHV) and post-PHV alongside cardiac and haematological variables contributions to the variance in O2max . Cardiac and haematological variables are greater in trained vs. untrained pre-pubertal children, and a greater number and magnitude of differences are observed at post-PHV. These variables provide significant predictive models for maximal oxygen consumption in children and are much stronger post-PHV, suggesting that other important determinants within the oxygen transport chain could account for the majority of variance in O2max before puberty. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dean R Perkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Jack S Talbot
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Rachel N Lord
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Tony G Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom.,Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Abbas Zaidi
- University Hospital of Wales, Cardiff, United Kingdom
| | - Orhan Uzun
- University Hospital of Wales, Cardiff, United Kingdom
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Stephen-Mark Cooper
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Rhodri S Lloyd
- Youth Physical Development Centre, Cardiff Metropolitan University, Cardiff, United Kingdom.,Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand.,Centre for Sport Science and Human Performance, Waikato Institute of Technology, Waikato, New Zealand
| | - Jon L Oliver
- Youth Physical Development Centre, Cardiff Metropolitan University, Cardiff, United Kingdom.,Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand
| | - Rob E Shave
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
| | - Mike Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
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BMI metrics and their association with adiposity, cardiometabolic risk factors, and biomarkers in children and adolescents. Int J Obes (Lond) 2021; 46:359-365. [PMID: 34718333 DOI: 10.1038/s41366-021-01006-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/26/2021] [Accepted: 10/15/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are limited data comparing the relative associations of various BMI metrics with adiposity and cardiometabolic risk factors in youth. OBJECTIVE Examine correlations of 7 different BMI metrics with adiposity, cardiometabolic risk factors, and biomarkers (i.e. blood pressure, waist circumference, cholesterol, leptin, insulin, high molecular weight adiponectin, high-sensitivity c-reactive protein (hsCRP)). METHODS This was a cross-sectional analysis of youth in all BMI categories. BMI metrics: BMI z-score (BMIz), extended BMIz (ext.BMIz), BMI percentile (BMIp), percent of the BMI 95th percentile (%BMIp95), percent of the BMI median (%BMIp50), triponderal mass index (TMI), and BMI (BMI). Correlations between these BMI metrics and adiposity, visceral adiposity, cardiometabolic risk factors and biomarkers were summarized using Pearson's correlations. RESULTS Data from 371 children and adolescents ages 8-21 years old were included in our analysis: 52% were female; 20.2% with Class I obesity, 20.5% with Class II, and 14.3% with Class III obesity. BMIp consistently demonstrated lower correlations with adiposity, risk factors, and biomarkers (r = 0.190-0.768) than other BMI metrics. The %BMIp95 and %BMIp50 were marginally more strongly correlated with measures of adiposity as compared to other BMI metrics. The ext.BMIz did not meaningfully outperform BMIz. CONCLUSION Out of all the BMI metrics evaluated, %BMIp95 and %BMIp50 were the most strongly correlated with measures of adiposity. %BMIp95 has the benefit of being used currently to define obesity and severe obesity in both clinical and research settings. BMIp consistently had the lowest correlations. Future research should evaluate the longitudinal stability of various BMI metrics and their relative associations with medium to long-term changes in adiposity and cardiometabolic outcomes in the context of intervention trials.
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Çatli G, Acar S, Cingöz G, Rasulova K, Yarim AK, Uzun H, Küme T, Kızıldağ S, Dündar BN, Abacı A. Oxytocin receptor gene polymorphism and low serum oxytocin level are associated with hyperphagia and obesity in adolescents. Int J Obes (Lond) 2021; 45:2064-2073. [PMID: 34091593 DOI: 10.1038/s41366-021-00876-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 05/12/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES In recent years, oxytocin (OXT) and polymorphisms in the oxytocin receptor (OXTR) gene have been reported to play roles in obesity pathogenesis. However, there was no study evaluating OXTR gene variants in childhood obesity. The aim of the study was to investigate the relation of OXTR gene polymorphisms and serum OXT levels with metabolic and anthropometric parameters in obese and healthy adolescents. SUBJECTS/METHODS The study was a multi-centered case-control study, which was conducted on obese and healthy adolescents aged between 12 and 17 years. Serum OXT and leptin levels were measured, and OXTR gene variants were studied by qPCR (rs53576) and RFLP (rs2254298) methods. RESULTS A total of 250 obese and 250 healthy adolescents were included in this study. In the obese group, serum OXT level was lower and leptin level was higher than the control group. In the obese group, frequencies of homozygous mutant (G/G) and heterozygous (A/G) genotypes for rs53576 polymorphism were higher than the control group. Homozygous mutant(G/G) and heterozygous (A/G) genotypes for rs53576 polymorphism were found to increase the risk of obesity compared to the wild type (A/A) genotype [OR = 6.05 and OR = 3.06; p < 0.001, respectively]. In patients with homozygous mutant (G/G) and heterozygous (A/G) genotype for rs53576 polymorphism, serum OXT levels were lower than the wild type (A/A) genotype. In the obese group, hyperphagia score was higher than the control group and correlated negatively with serum OXT level. CONCLUSIONS This study revealed that low serum OXT level, which is associated with hyperphagia may be an underlying cause for obesity in adolescents. For rs53576 polymorphism of the OXTR gene, obesity risk is higher in patients with homozygous mutant(G/G) and heterozygous(A/G)genotypes.
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Affiliation(s)
- Gönül Çatli
- Department of Pediatric Endocrinology, Izmir KatipÇelebi University, Faculty of Medicine, İzmir, Turkey.
| | - Sezer Acar
- Department of Pediatric Endocrinology, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Gülten Cingöz
- Department of Pediatrics, Sağlik Bilimleri University, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Khayala Rasulova
- Department of Medical Biology and Genetics, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Ayça Kanat Yarim
- Department of Medical Biology and Genetics, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Hamide Uzun
- Department of Nutrition and Dietetics, Sağlik Bilimleri University, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Tuncay Küme
- Department of Biochemistry, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Sefa Kızıldağ
- Department of Medical Biology and Genetics, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Bumin Nuri Dündar
- Department of Pediatric Endocrinology, Izmir KatipÇelebi University, Faculty of Medicine, İzmir, Turkey
| | - Ayhan Abacı
- Department of Pediatric Endocrinology, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
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Amiri P, Rezaei M, Jalali-Farahani S, Karimi M, Cheraghi L, Esbati R, Azizi F. Risk of hypertension in school-aged children with different parental risk: a longitudinal study from childhood to young adulthood. BMC Pediatr 2021; 21:352. [PMID: 34404370 PMCID: PMC8369749 DOI: 10.1186/s12887-021-02807-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 07/07/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Although previous studies have shown the relationship between different parental factors and children's blood pressure status, there is limited data on the cumulative effect of these factors. Considering parental socio-demographic, behavioral and cardio-metabolic characteristics, the current study aimed to distinguish parental risk clusters and their impact on the incidence of hypertension in school-age children over 13 years. METHODS Parental characteristics of 1669 children, including age, education, employment, smoking, physical activity, metabolic syndrome (MetS), hypertension (HTN), weight status, and diabetes were considered to categorize parents into low and high-risk clusters. Crude incidence rates (per 10,000 person-years) of HTN in children were assessed in each maternal and paternal cluster. Using Cox proportional hazard model, results on the association between parental risk clusters and HTN incidence in children were reported in five different models. RESULTS Mean age of children was 13.96 ± 2.89 years, and 51.2% (n = 854) were girls. MetS, HTN, and weight status were the most important factors distinguishing low and high-risk parental clusters, respectively. Crude incidence rates (per 10,000 person-years) of HTN were 86 (95% CI: 71-106) and 38 (95% CI, 29-52) in boys and girls, respectively. Moreover, incidence rates (per 10,000 person-years) of HTN were 50 (95% CI, 40-63) and 80 (95% CI, 64-102) in maternal low and high-risk clusters, respectively. The incidence rates (per 10,000 person-years) of HTN in paternal low and high-risk clusters were 53 (95% CI, 41-70) and 68 (95% CI, 56-84), respectively. CONCLUSION Our findings underscore the prognostic value of maternal characteristics in predicting the incidence of HTN in their offspring. The current results could be valuable in planning related programs to prevent hypertension in similar communities.
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Affiliation(s)
- Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marjan Rezaei
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Jalali-Farahani
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Cheraghi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Biostatistics Department, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Romina Esbati
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Islamic Republic of Iran.
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9
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Cioana M, Deng J, Hou M, Nadarajah A, Qiu Y, Chen SSJ, Rivas A, Banfield L, Chanchlani R, Dart A, Wicklow B, Alfaraidi H, Alotaibi A, Thabane L, Samaan MC. Prevalence of Hypertension and Albuminuria in Pediatric Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e216069. [PMID: 33929524 PMCID: PMC8087958 DOI: 10.1001/jamanetworkopen.2021.6069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
Importance Hypertension and albuminuria are markers of diabetes-related nephropathy and important factors associated with kidney outcomes in pediatric type 2 diabetes. However, their prevalence in these patients is unknown. Objective To measure the prevalence of hypertension and albuminuria in pediatric patients with type 2 diabetes and to evaluate the association of sex and race/ethnicity with these conditions. Data Sources MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, the gray literature, and references of the screened articles were searched for human studies from date of database inception to February 20, 2020. Study Selection Observational studies with at least 10 participants reporting the prevalence of hypertension and/or albuminuria in pediatric patients with type 2 diabetes were included. Three teams of 2 independent reviewers screened 7614 papers, of which 60 fulfilled the eligibility criteria. Data Extraction and Synthesis Three teams of 2 independent reviewers performed data extraction, risk of bias analysis, and level of evidence analyses. The meta-analysis was conducted using a random-effects model and followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Main Outcomes and Measures The primary outcomes included the pooled prevalence rates (percentages with 95% CI) for hypertension and albuminuria. The secondary outcomes assessed pooled prevalence rates by sex and racial/ethnic group. Results Sixty studies were included in the systematic review. Diabetes duration varied from inclusion at diagnosis to 15.0 years after diagnosis, and the reported mean age at diagnosis ranged from 6.5 to 21.0 years. Hypertension prevalence among 3463 participants was 25.33% (95% CI, 19.57%-31.53%). Male participants had higher hypertension risk than female participants (odds ratio [OR], 1.42 [95% CI, 1.10-1.83]), with Pacific Islander and Indigenous youth having the highest prevalence of all racial/ethnic groups (Pacific Islander youth: 26.71% [95% CI, 14.54%-40.72%]; Indigenous youth: 26.48% [95% CI, 17.34%-36.74%]; White youth: 20.95% [95% CI, 12.65%-30.57%]; African American youth: 19.04% [95% CI, 12.01%-27.23%]; Hispanic/Latino youth: 15.11% [95% CI, 6.56%-26.30%]; Asian youth: 18.37% [95% CI, 9.49%-29.23%]). Albuminuria prevalence among 2250 participants was 22.17% (95% CI, 17.34%-27.38%). Pacific Islander youth, Indigenous youth, and Asian youth had higher prevalence rates than White youth (Pacific Islander youth: 31.84% [95% CI, 11.90%-55.47%]; Indigenous youth: 24.27% [95% CI, 14.39%-35.73%]; Asian youth: 23.00% [95% CI, 18.85%-27.41%]; White youth: 12.59% [95% CI, 7.75%-18.33%]), with no sex differences (OR for male vs female participants, 0.68 [95% CI, 0.46-1.01]). Heterogeneity was high among studies, with a low to moderate risk of bias. Conclusions and Relevance In this study, markers of diabetes-related nephropathy were commonly detected in pediatric patients with type 2 diabetes, with a disproportionate burden noted among Pacific Islander and Indigenous youth. Personalized management strategies to target kidney outcomes are urgently needed in pediatric patients with type 2 diabetes to alleviate the burden of this condition on the kidneys.
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Affiliation(s)
- Milena Cioana
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Jiawen Deng
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Maggie Hou
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Ajantha Nadarajah
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Yuan Qiu
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sondra Song Jie Chen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Angelica Rivas
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Rahul Chanchlani
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Nephrology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Haifa Alfaraidi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Division of Endocrinology, Department of Pediatrics, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahlam Alotaibi
- Department of Pediatrics, Division of Pediatric Endocrinology, King Abdullah bin Abdulaziz University Hospital, Princess Noura University, Riyadh, Saudi Arabia
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines, St Joseph’s Health Care, Hamilton, Ontario, Canada
- Biostatistics Unit, St Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - M. Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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10
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Visaria A, Lo D, Maniar P, Dave B. Age and physiologic considerations for the associations among height components, blood pressure, and pulse wave velocity. J Clin Hypertens (Greenwich) 2020; 22:2163-2164. [PMID: 32941669 DOI: 10.1111/jch.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Aayush Visaria
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.,North American Disease Intervention, Rutgers University, New Brunswick, NJ, USA
| | - David Lo
- North American Disease Intervention, Rutgers University, New Brunswick, NJ, USA
| | - Pranay Maniar
- North American Disease Intervention, Rutgers University, New Brunswick, NJ, USA.,New Jersey Institute of Technology, Newark, NJ, USA
| | - Bhoomi Dave
- New Jersey Institute of Technology, Newark, NJ, USA
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11
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Goedegebuure WJ, van der Steen M, Kerkhof GF, Hokken-Koelega ACS. Longitudinal Study on Metabolic Health in Adults SGA During 5 Years After GH With or Without 2 Years of GnRHa Treatment. J Clin Endocrinol Metab 2020; 105:5841626. [PMID: 32436961 DOI: 10.1210/clinem/dgaa287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND In children born small for gestational age (SGA) with persistent short stature, 2 years of gonadotropin-releasing hormone analogue (GnRHa), in addition to long-term growth hormone (GH) treatment, can improve adult height. We assessed safety on metabolic and bone health of GnRHa/GH treatment during 5 years after cessation of GH. METHODS A total of 363 young adults born SGA, previously treated with combined GnRHa/GH or GH-only, were followed for 5 years after attainment of adult height at GH cessation and 2 and 5 years thereafter. Data at 5 years after GH cessation, at age 21 years, were also compared with 145 age-matched adults born appropriate for gestational age (AGA). Frequently sampled intravenous glucose tolerance (FSIGT) tests were used to assess insulin sensitivity, acute insulin response, and β-cell function. Body composition and bone mineral density (BMD) was determined by dual-energy x-ray absorptiometry (DXA) scans. FINDINGS In the GnRHa/GH and GH-only groups, fat mass increased during the 5 years after GH cessation, but the changes in FSIGT results, body composition, blood pressure, serum lipid levels, and BMD were similar in both groups. At age 21 years, the GnRHa/GH group had similar fat mass, FSIGT results, blood pressure, serum lipid levels and BMD-total body as the GH-only group and the AGA control group, a higher BMD-lumbar spine and lower lean body mass than the AGA control group. INTERPRETATION This study during 5 years after GH cessation shows that addition of 2 years of GnRHa treatment to long-term GH treatment of children short in stature born SGA has no unfavorable effects on metabolic and bone health in early adulthood. CLINICAL TRIAL REGISTRATION ISRCTN96883876, ISRCTN65230311 and ISRCTN18062389.
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Affiliation(s)
- Wesley J Goedegebuure
- Department of Paediatrics, Subdivision Endocrinology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
| | | | - Gerthe F Kerkhof
- Department of Paediatrics, Subdivision Endocrinology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Anita C S Hokken-Koelega
- Department of Paediatrics, Subdivision Endocrinology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
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12
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Charlton GA, Ladd DR, Friesen RM, Friesen RH. Labetalol Infusion Attenuates Paradoxical Hypertension and Decreases Plasma Renin Activity After Repair of Coarctation of the Aorta in Children. J Cardiothorac Vasc Anesth 2020; 34:3348-3351. [PMID: 32593586 DOI: 10.1053/j.jvca.2020.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Paradoxical hypertension after repair of coarctation of the aorta in children is associated with the release of catecholamines and activation of the renin-angiotensin system. The objective of the present study was to describe the effects of labetalol infusion on blood pressure, plasma catecholamine levels, and plasma renin activity in a series of children undergoing repair of coarctation of the aorta. DESIGN Prospective, observational cohort study. SETTING Tertiary children's hospital with university affiliation. PARTICIPANTS The study was comprised of 15 consecutive children older than 1 year undergoing repair of coarctation of the aorta. INTERVENTIONS Intravenous infusion of labetalol, up to 20 µg/kg/min, was administered when patients became hypertensive after release of the aortic cross-clamp. Supplementation with nitroprusside was allowed as needed. MEASUREMENTS AND MAIN RESULTS Blood pressure was maintained below baseline values throughout the labetalol infusion. Plasma norepinephrine increased from 160 ± 81 pg/mL (preoperative) to 657 ± 268 pg/mL (6 h after release of aortic cross-clamp). Plasma renin activity decreased from 16.6 ± 9.7 ng/kg/h (at cross-clamp release) to 2.2 ± 2.2 ng/kg/h (6 h after cross-clamp release). Nitroprusside was added for 12 patients, at a highest mean dose of 2.4 ± 2.5 μg/kg/min. CONCLUSIONS Labetalol inhibited activation of the renin-angiotensin system and helped control paradoxical hypertension after coarctation repair in children.
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Affiliation(s)
- Gareth A Charlton
- Shackleton Department of Anaesthesia, University Hospitals Southampton NHS Trust, Southampton, UK
| | - David R Ladd
- Department of Anesthesiology, Children's Hospital Colorado, Aurora, CO
| | - Richard M Friesen
- Division of Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Robert H Friesen
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
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13
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Armstrong SC, Windom M, Bihlmeyer NA, Li JS, Shah SH, Story M, Zucker N, Kraus WE, Pagidipati N, Peterson E, Wong C, Wiedemeier M, Sibley L, Berchuck SI, Merrill P, Zizzi A, Sarria C, Dressman HK, Rawls JF, Skinner AC. Rationale and design of "Hearts & Parks": study protocol for a pragmatic randomized clinical trial of an integrated clinic-community intervention to treat pediatric obesity. BMC Pediatr 2020; 20:308. [PMID: 32590958 PMCID: PMC7318397 DOI: 10.1186/s12887-020-02190-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/02/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prevalence of child and adolescent obesity and severe obesity continues to increase despite decades of policy and research aimed at prevention. Obesity strongly predicts cardiovascular and metabolic disease risk; both begin in childhood. Children who receive intensive behavioral interventions can reduce body mass index (BMI) and reverse disease risk. However, delivering these interventions with fidelity at scale remains a challenge. Clinic-community partnerships offer a promising strategy to provide high-quality clinical care and deliver behavioral treatment in local park and recreation settings. The Hearts & Parks study has three broad objectives: (1) evaluate the effectiveness of the clinic-community model for the treatment of child obesity, (2) define microbiome and metabolomic signatures of obesity and response to lifestyle change, and (3) inform the implementation of similar models in clinical systems. METHODS Methods are designed for a pragmatic randomized, controlled clinical trial (n = 270) to test the effectiveness of an integrated clinic-community child obesity intervention as compared with usual care. We are powered to detect a difference in body mass index (BMI) between groups at 6 months, with follow up to 12 months. Secondary outcomes include changes in biomarkers for cardiovascular disease, psychosocial risk, and quality of life. Through collection of biospecimens (serum and stool), additional exploratory outcomes include microbiome and metabolomics biomarkers of response to lifestyle modification. DISCUSSION We present the study design, enrollment strategy, and intervention details for a randomized clinical trial to measure the effectiveness of a clinic-community child obesity treatment intervention. This study will inform a critical area in child obesity and cardiovascular risk research-defining outcomes, implementation feasibility, and identifying potential molecular mechanisms of treatment response. CLINICAL TRIAL REGISTRATION NCT03339440 .
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Affiliation(s)
- Sarah C Armstrong
- Department of Pediatrics, Duke University, Durham, NC, 27710, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, 27710, USA
| | | | - Nathan A Bihlmeyer
- Duke Molecular Physiology Institute, Duke University, Durham, NC, 27710, USA
| | - Jennifer S Li
- Department of Pediatrics, Duke University, Durham, NC, 27710, USA
| | - Svati H Shah
- Duke Molecular Physiology Institute, Duke University, Durham, NC, 27710, USA.,Department of Medicine, Duke University, Durham, NC, 27710, USA
| | - Mary Story
- Department of Family Medicine and Community Health, Duke University, Durham, NC, 27710, USA
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, 27710, USA
| | - William E Kraus
- Department of Medicine, Duke University, Durham, NC, 27710, USA
| | - Neha Pagidipati
- Duke Clinical Research Institute, Duke University, Durham, NC, 27710, USA.,Department of Medicine, Duke University, Durham, NC, 27710, USA
| | - Eric Peterson
- Duke Clinical Research Institute, Duke University, Durham, NC, 27710, USA.,Department of Medicine, Duke University, Durham, NC, 27710, USA
| | - Charlene Wong
- Department of Pediatrics, Duke University, Durham, NC, 27710, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, 27710, USA
| | - Manuela Wiedemeier
- Duke Clinical Research Institute, Duke University, Durham, NC, 27710, USA
| | - Lauren Sibley
- University of North Carolina School of Medicine, Chapel Hill, NC, 27516, USA
| | - Samuel I Berchuck
- Department of Statistical Science, Duke University, Durham, NC, 27710, USA
| | - Peter Merrill
- Duke Clinical Research Institute, Duke University, Durham, NC, 27710, USA
| | - Alexandra Zizzi
- Department of Pediatrics, Duke University, Durham, NC, 27710, USA
| | - Charles Sarria
- Department of Pediatrics, Duke University, Durham, NC, 27710, USA
| | - Holly K Dressman
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, 27708, USA
| | - John F Rawls
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, 27708, USA
| | - Asheley C Skinner
- Duke Clinical Research Institute, Duke University, Durham, NC, 27710, USA. .,Department of Population Health Sciences, Duke University, 215 Morris Street, Suite 210, Durham, NC, 27701, USA.
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14
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Donze SH, Codd V, Damen L, Goedegebuure WJ, Denniff M, Samani NJ, van der Velden JAEM, Hokken-Koelega ACS. Evidence for Accelerated Biological Aging in Young Adults with Prader-Willi Syndrome. J Clin Endocrinol Metab 2020; 105:5613535. [PMID: 31689713 PMCID: PMC7150612 DOI: 10.1210/clinem/dgz180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Adults with Prader-Willi syndrome (PWS) are at increased risk of developing age-associated diseases early in life and, like in premature aging syndromes, aging might be accelerated. We investigated leukocyte telomere length (LTL), a marker of biological age, in young adults with PWS and compared LTL to healthy young adults of similar age. As all young adults with PWS were treated with growth hormone (GH), we also compared LTL in PWS subjects to GH-treated young adults born short for gestational age (SGA). DESIGN Cross-sectional study in age-matched young adults; 47 with PWS, 135 healthy, and 75 born SGA. MEASUREMENTS LTL measured by quantitative polymerase chain reaction, expressed as telomere/single copy gene ratio. RESULTS Median (interquartile range) LTL was 2.6 (2.4-2.8) at a median (interquartile range) age of 19.2 (17.7-21.3) years in PWS, 3.1 (2.9-3.5) in healthy young adults and 3.1 (2.8-3.4) in the SGA group. Median LTL in PWS was significantly lower compared to both control groups (P < .01). In PWS, a lower LTL tended to be associated with a lower total IQ (r = 0.35, P = .08). There was no association between LTL and duration of GH treatment, cumulative GH dose, or several risk factors for type 2 diabetes mellitus or cardiovascular disease. CONCLUSIONS Young adults with PWS have significantly shorter median LTL compared to age-matched healthy young adults and GH-treated young adults born SGA. The shorter telomeres might play a role in the premature aging in PWS, independent of GH. Longitudinal research is needed to determine the influence of LTL on aging in PWS.
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Affiliation(s)
- Stephany H Donze
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Correspondence and Reprint Requests: S. H. Donze, Westzeedijk 106, 3016 AH Rotterdam, The Netherlands. E-mail:
| | - Veryan Codd
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Layla Damen
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Wesley J Goedegebuure
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Matthew Denniff
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Janiëlle A E M van der Velden
- Department of Pediatrics, Subdivision of Endocrinology, Radboud University Medical Centre-Amalia Children’s Hospital, Nijmegen, The Netherlands
| | - Anita C S Hokken-Koelega
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
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15
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Goedegebuure WJ, Kerkhof GF, Hokken-Koelega ACS. Glomerular filtration rate, blood pressure and microalbuminuria in adults born SGA: A 5-year longitudinal study after cessation of GH treatment. Clin Endocrinol (Oxf) 2019; 91:892-898. [PMID: 31512772 DOI: 10.1111/cen.14095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Growth hormone treatment increases glomerular filtration rate (GFR), as serum IGF-I stimulates the renin-angiotensin system. Infants born with a low birth weight have a smaller number of nephrons, which cause a lower GFR, a higher blood pressure and a higher albumin-to-creatinine ratio in early adulthood. METHOD A total of 261 young adults born SGA, previously treated with growth hormone (SGA-GH), were longitudinally followed. Glomerular filtration rate, based on serum creatinine levels, was determined at cessation of GH treatment and at 6 months, 2 years and 5 years thereafter. Glomerular filtration rate, blood pressure and urinary albumin-to-creatinine ratio at 5 years after cessation of GH were compared with untreated age-matched controls (56 untreated short subjects born SGA [SGA-S], 118 subjects born SGA with spontaneous catch-up growth [SGA-CU], 135 subjects born appropriate for gestational age [AGA]). RESULTS Glomerular filtration rate decreased significantly only during the first 6 months after cessation of GH treatment, while remaining well within the normal range (124.6 vs 120.2 mL/min/1.73 m2 , P < .001). SGA-GH adults had a similar GFR, blood pressure and urinary albumin-to-creatinine ratio as the healthy controls born SGA and AGA. CONCLUSION In conclusion, our 5 years longitudinal follow-up study shows a decrease in GFR during 6 months after GH cessation, but thereafter GFR remained stable and within the normal range. Glomerular filtration rate, blood pressure and urinary albumin-to-creatinine ratio at 21 years of age were similar in GH-treated young adults born SGA and untreated controls born SGA or AGA. We conclude that long-term GH treatment in children born SGA has no unfavourable effects on kidney function in early adulthood. PRÉCIS: We present a longitudinal study on kidney function in the follow-up of growth hormone-treated young adults who were born small for gestational age.
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Affiliation(s)
- Wesley J Goedegebuure
- Department of Paediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gerthe F Kerkhof
- Department of Paediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Anita C S Hokken-Koelega
- Department of Paediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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16
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Reliability of normative tables in assessing elevated blood pressure in children. J Hum Hypertens 2019; 34:241-247. [DOI: 10.1038/s41371-019-0290-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 11/09/2022]
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17
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Maternal intramuscular dexamethasone versus betamethasone before preterm birth (ASTEROID): a multicentre, double-blind, randomised controlled trial. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:769-780. [PMID: 31523039 DOI: 10.1016/s2352-4642(19)30292-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Antenatal corticosteroids given to women before preterm birth improve infant survival and health. However, whether dexamethasone or betamethasone have better maternal, neonatal, and childhood health outcomes remains unclear. We therefore aimed to assess whether administration of antenatal dexamethasone to women at risk of preterm birth reduced the risk of death or neurosensory disability in their children at age 2 years compared with betamethasone. We also aimed to assess whether dexamethasone reduced neonatal morbidity, had benefits for the mother, or affected childhood body size, blood pressure, behaviour, or general health compared with betamethasone. METHODS In this multicentre, double-blind, randomised controlled trial, we recruited pregnant women from 14 maternity hospitals in Australia and New Zealand that could provide care to preterm babies. Women were eligible for study inclusion if they were at risk of preterm birth before 34 weeks of gestation, had a singleton or twin pregnancy, and had no contraindications to antenatal corticosteroids. We randomly assigned women (1:1) to receive two intramuscular injections of either 12 mg dexamethasone (dexamethasone sodium phosphate) or 11·4 mg betamethasone (Celestone Chronodose), 24 h apart. The randomisation schedule used balanced, variable blocks that were stratified by hospital, gestational age, and number of fetuses (singleton or twins). We masked all participants, staff, and assessors to treatment groups. Analyses were by intention to treat. The primary outcome was death or neurosensory disability at age 2 years (corrected for prematurity). This study is registered with ANZCTR, ACTRN12608000631303. FINDINGS Between Jan 28, 2009, and Feb 1, 2013, we randomly assigned 1346 (78%) women who were pregnant with 1509 fetuses to groups: 679 (50%) women were assigned to receive dexamethasone and 667 (50%) women were assigned to receive betamethasone. 27 (4%) fetuses, infants, or children in the dexamethasone group and 28 (4%) fetuses, infants, or children in the betamethasone group died before age 2 years. The primary outcome of death or neurosensory disability at age 2 years was determined for 603 (79%) of 763 fetuses whose mothers received dexamethasone and 591 (79%) of 746 fetuses whose mothers received betamethasone. We found a similar incidence of death or neurosensory disability in the dexamethasone (198 [33%] of 603 infants) and betamethasone groups (192 [32%] of 591 infants; adjusted relative risk [adjRR] 0·97, 95% CI 0·83 to 1·13; p=0·66). 18 (3%) of 679 women in the dexamethasone group and 28 of 667 (4%) women in the betamethasone group reported side-effects. Discomfort at the injection site, the most frequent side-effect, was less likely in the dexamethasone group than in the betamethasone group (six [1%] women vs 17 [3%] women; p=0·02). INTERPRETATION The incidence of survival without neurosensory disability at age 2 years did not differ between dexamethasone and betamethasone treatment. Our findings indicate that either antenatal corticosteroid can be given to women before preterm birth to improve infant and child health. FUNDING National Health and Medical Research Council (Australia).
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Impaired systolic and diastolic left ventricular function in children and adolescents with congenital adrenal hyperplasia receiving corticosteroid therapy. Cardiol Young 2019; 29:319-324. [PMID: 30675832 DOI: 10.1017/s1047951118002330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED AimThe present study aimed to evaluate systolic and diastolic myocardial function in children and adolescents with congenital adrenal hyperplasia. METHODS The study included 44 children with the diagnosis of classic congenital adrenal hyperplasia and 39 healthy children whose age, pubertal status, and gender were similar to those of the patient group. Anthropometric parameters and 17-hydroxyprogesterone levels were measured, and bone age was calculated. The average daily hydrocortisone dose was calculated over the last 1-year file records. Hyperandrogenic state was defined according to bone age SD score (⩾2) and 17-hydroxyprogesterone levels (>10 ng/ml). Echocardiographic examinations were assessed by conventional two-dimensional Doppler echocardiography and tissue Doppler imaging. RESULTS Patients had higher morphological parameters, such as left ventricular end-systolic diameter, interventricular septal thickness at end diastole, left ventricular posterior wall thickness at end diastole, left ventricular mass and index, than the control group (p<0.05). On pulsed-wave and tissue Doppler echocardiography, significant subclinical alterations were observed in systolic (isovolumic contraction time), diastolic (isovolumic relaxation time), and global left ventricular functional (myocardial performance index) parameters in the congenital adrenal hyperplasia group compared to the control group (p<0.05). In partial correlation analyses, after controlling the effect of hyperandrogenism, the mean hydrocortisone dosage was positively correlated with isovolumic relaxation time in congenital adrenal hyperplasia group (p<0.05). CONCLUSION This study demonstrated that the patients with congenital adrenal hyperplasia are at risk for left ventricular hypertrophy, systolic and diastolic myocardial subclinical alterations. Overtreatment may be responsible for the increased risk of myocardial dysfunction in patients with congenital adrenal hyperplasia.
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Ezeudu CE, Chukwuka JO, Ebenebe JC, Igwe WC, Egbuonu I. Hypertension and prehypertension among adolescents attending secondary schools in urban area of South-East, Nigeria. Pan Afr Med J 2018; 31:145. [PMID: 31037205 PMCID: PMC6462383 DOI: 10.11604/pamj.2018.31.145.15994] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/30/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction in the past, the need for regular blood pressure screening in children was doubtful, and the main reason against it is that hypertension is an adult illness and there is no evidence that screening healthy children for hypertension was worthwhile. We did this study to determine the prevalence of hypertension and prehypertension as well as some risk factors for hypertension among secondary school adolescents in an urban area of the South-East, Nigeria. Methods this was a cross-sectional study of 984 adolescents aged 10-19 years in secondary schools in Awka South Local Government Area of Anambra state, South-East, Nigeria. The multi-stage sampling method was used to select the subjects. Data were collected from all eligible subjects with the aid of a questionnaire administered to them. Weight, height, and blood pressure were measured and recorded. Results nine hundred and eighty-four adolescents were recruited for this study, and they comprised 470 (47.8%) males and 514 (52.2%) giving a male: female ratio of 1:1.1. Their ages ranged from 10-19 years. The mean systolic blood pressure and mean diastolic BP were 110.5±10.2mmHg 71.5±8.5mmHg respectively. Prevalence of hypertension and pre-hypertension were 6.3% and 5.0% respectively. There were a higher proportion of females (7.3%) than males (5.4%) with hypertension, and more females (5.8%) than males (4.2%) with prehypertension but these were not statistically significant. Overweight and obesity were significantly associated with hypertension. Conclusion hypertension exists among secondary school adolescents in Awka South Local government area of Anambra state, with a prevalence of 6.3%. Early detection and treatment will forestall the early development of complications.
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Affiliation(s)
| | - John Onuora Chukwuka
- Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nnewi Campus, Nigeria
| | - Joy Chinelo Ebenebe
- Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nnewi Campus, Nigeria
| | | | - Ifeoma Egbuonu
- Department of Paediatrics, Chukwuemeka Odimegwu Ojukwu University Teaching Hospital, Awka, Anambra State, Nigeria
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El-Shafie AM, El-Gendy FM, Allhony DM, Abo El Fotoh WMM, Omar ZA, Samir MA, Bahbah WA, Abd El Naby SA, El Zayat RS, Abd El Hady NMS, El Gazar BA, Zannoun MA, Kasemy ZA, El-Bazzar AN, Abd El-Fattah MAEN, Abd El-Monsef AA, Kairallah AM, Raafet HM, Baz GM, Salah AG, Galab WS. Establishment of blood pressure nomograms representative for Egyptian children and adolescents: a cross-sectional study. BMJ Open 2018; 8:e020609. [PMID: 30049691 PMCID: PMC6067375 DOI: 10.1136/bmjopen-2017-020609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To define nomograms for blood pressure in Egyptian children and adolescents. METHODS AND STUDY DESIGN A total of 60 025 Egyptian children from birth to 19 years were enrolled in this cross-sectional randomised study from December 2015 to March 2017. They were selected from diverse geographical districts in Egypt. Healthy children who fulfilled the inclusion criteria, which included good nutritional history, absence of fever or documented underlying disease at the time of examination, no evidence of haemodynamically significant illness, and no antihypertensive drugs or other chronic drug administration, were included in the study. Body weight, recumbent length (for less than 24 months) and height (from 2 years to 19 years), and blood pressure were measured using standard mercury sphygmomanometers. RESULTS Blood pressure increases with age in both boys and girls. The 90th percentile of systolic and diastolic blood pressure among Egyptian children was different from other ethnic populations (American and Turkish children) in both sexes. Systolic and diastolic blood pressure showed a positive correlation with weight and height in both sexes (p<0.001). CONCLUSION We assumed that normal blood pressure curves should be used cautiously during childhood, and it is recommended that every population have its own normal standard curve to define measured blood pressure levels in children. These centiles increased our knowledge and awareness of normal blood pressure among Egyptian children and adolescents. The percentiles will distinguish children and young adolescents with increased blood pressure and will be of value to both medical practice and scientific research.
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Affiliation(s)
- Ali M El-Shafie
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Fady M El-Gendy
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Dalia M Allhony
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | | | - Zein A Omar
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Mohamed A Samir
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Wael A Bahbah
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | | | - Rania S El Zayat
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | | | - Basim A El Gazar
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Mohamed A Zannoun
- Department of Paediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Zeinab A Kasemy
- Department of Public Health and Community Epidemiology and Biostatistics Division, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
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van der Steen M, Kerkhof GF, Smeets CCJ, Hokken-Koelega ACS. Cardiovascular risk factors and carotid intima media thickness in young adults born small for gestational age after cessation of growth hormone treatment: a 5-year longitudinal study. Lancet Diabetes Endocrinol 2017; 5:975-985. [PMID: 29102566 DOI: 10.1016/s2213-8587(17)30311-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/05/2017] [Accepted: 08/09/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Growth hormone treatment reduces blood pressure and lipid concentrations. We assessed long-term changes in blood pressure, lipid concentrations, and carotid intima media thickness over a 5-year period after cessation of growth hormone treatment in adults born small for gestational age. METHODS We did a longitudinal observational study at a medical centre in the Netherlands between April 1, 2004, and April 1, 2016. We included adults born small for gestational age who were treated with growth hormone (1 mg/m2 per day); treatment started during childhood until adult height. Participants were evaluated at cessation of treatment, and 6 months, 2 years, and 5 years later. We compared cardiovascular risk factors with untreated controls from the PROGRAM study. FINDINGS We included 199 participants born small for gestational age and treated with growth hormone along with 285 controls: 51 untreated short adults born small for gestational age, 92 untreated adults born small for gestational age with spontaneous catch-up growth, and 142 adults born appropriate for gestational age. In the 6 months after treatment cessation, systolic blood pressure increased temporarily from 113·00 mm Hg (95% CI 111·18-114·82) to 116·92 mm Hg (115·07 to 118·77; p<0·001) and diastolic blood pressure increased temporarily from 62·19 mm Hg (60·99-63·38) to 66·51 mm Hg (65·14-67·89; p<0·001). At 5 years after treatment cessation, mean systolic blood pressure was 109·2 mm Hg (105·5-113·0) and mean diastolic blood pressure was 63·4 mm Hg (60·9-65·9), similar to the values at cessation. Lipid concentrations were non-significantly higher 5 years after treatment cessation (p values 0·09-0·21) than at treatment cessation. Cessation of growth hormone had no effect on carotid intima media thickness. At 5 years after cessation, total cholesterol was lower in adults treated with growth hormone (mean 4·21 mmol/L, 95% CI 4·04-4·38) than in untreated short adults born small for gestational age (4·66 mmol/L, 4·42-4·92; p=0·0030), as was mean LDL cholesterol (2·28 mmol/L, 2·14-2·43 vs 2·85 mmol/L, 2·62-3·10; p<0·0001); blood pressure and carotid intima media thickness did not differ between these two groups (p values >0·12). At 5 years after cessation, systolic blood pressure, diastolic blood pressure, lipid concentrations, and carotid intima media thickness of adults treated with growth hormone were not different to those in adults born small for gestational age who had spontaneous catch-up growth or adults born appropriate for gestational age. INTERPRETATION Long-term growth hormone treatment in children born small for gestational age has no unfavourable effects on cardiovascular health in early adulthood and improves lipid profiles. FUNDING Novo Nordisk (Netherlands).
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Affiliation(s)
- Manouk van der Steen
- Erasmus University Medical Center, Department of Paediatrics, Subdivision of Endocrinology, Rotterdam, Netherlands.
| | - Gerthe F Kerkhof
- Erasmus University Medical Center, Department of Paediatrics, Subdivision of Endocrinology, Rotterdam, Netherlands
| | - Carolina C J Smeets
- Erasmus University Medical Center, Department of Paediatrics, Subdivision of Endocrinology, Rotterdam, Netherlands
| | - Anita C S Hokken-Koelega
- Erasmus University Medical Center, Department of Paediatrics, Subdivision of Endocrinology, Rotterdam, Netherlands
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Predictors of early adulthood hypertension during adolescence: a population-based cohort study. BMC Public Health 2017; 17:915. [PMID: 29183297 PMCID: PMC5706303 DOI: 10.1186/s12889-017-4922-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/16/2017] [Indexed: 01/03/2023] Open
Abstract
Background Some longitudinal studies have shown that blood pressure tracks from adolescence to adulthood, yet there is limited evidence regarding the predictive factors of adulthood hypertension during adolescence. This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) to investigate the role of some factors in adolescence, measured in the first examination (1999–2001), to predict adulthood hypertension in the 4th examination (2009–2011). Methods Overall, 1579 subjects, aged 10–19 years, were used for the analysis of the current study. Mean age (SD) of participants at the baseline was 14.2 (2.5) years and 55% of them were female. A forward stepwise approach (p-value <0.2 for enter and >0.05 for removal) was considered to keep significant covariates among common variables including gender, body mass index, waist circumference, wrist and hip circumferences, fasting blood sugar, triglycerides, high density lipoprotein cholesterol, total cholesterol (TC), systolic (SBP) and diastolic blood pressure (DBP). Variance inflation factor (VIF) showed some multicollinearity for anthropometric variables (VIFs between 3.5 and 10). Multivariable logistic regression revealed that gender, blood pressure, wrist circumference and total cholesterol in adolescents are important predictors for adulthood hypertension. Results The risk increased by 4% and 39% per each 10 mmHg and 1 mmol/L increase in SBP/DBP and TC, respectively; additionally, females had a 70% lower risk. Among anthropometric variables, wrist circumference remained in the model, with 50% per centimeter increase in the risk of hypertension. Conclusions Wrist circumferences and TC had significant roles in predicting hypertension through adolescence to adulthood. Electronic supplementary material The online version of this article (10.1186/s12889-017-4922-3) contains supplementary material, which is available to authorized users.
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23
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Menale C, Grandone A, Nicolucci C, Cirillo G, Crispi S, Di Sessa A, Marzuillo P, Rossi S, Mita DG, Perrone L, Diano N, Miraglia Del Giudice E. Bisphenol A is associated with insulin resistance and modulates adiponectin and resistin gene expression in obese children. Pediatr Obes 2017; 12:380-387. [PMID: 27187765 DOI: 10.1111/ijpo.12154] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/31/2016] [Accepted: 04/25/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Bisphenol A (BPA) exposure has been associated with increased incidence of diabetes and obesity in adults. OBJECTIVES To evaluate whether an association between BPA urinary levels and insulin resistance as well as adiponectin and resistin production and serum concentrations may occur in obese children. METHODS Clinical and biochemical features of 141 obese children were collected. Serum resistin and adiponectin were evaluated. Insulin resistance and urinary BPA levels were assessed. Moreover, the effect of BPA on adiponectin and resistin gene expression in adipocytes from eight normal weight prepubertal children was investigated by quantitative real-time RT-PCR (qPCR). RESULTS Direct association between BPA and homeostasis model assessment (r = 0.23; p: 0.0069) and a strong inverse association between BPA and adiponectin have been found (r = -0.48; p < 0.0001). In adipocytes, resistin expression was detected only after BPA treatment, while adiponectin expression resulted down-regulated after BPA exposure (p < 0.05 at both 10 and 100 nM BPA concentrations). CONCLUSIONS We suggest the involvement of BPA in the development of insulin resistance in childhood obesity highlighting that urinary BPA levels are directly associated with insulin resistance regardless of BMI. This association may be explained, at least partly, by the findings that BPA affects resistin and adiponectin production in adipose tissue cultures.
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Affiliation(s)
- Ciro Menale
- Department of Experimental Medicine, Second University of Naples, Naples, Italy.,National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Biophysics Laboratory, Institute of Genetics and Biophysics - CNR, Naples, Italy
| | - Anna Grandone
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Carla Nicolucci
- Department of Experimental Medicine, Second University of Naples, Naples, Italy.,National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Department of Experimental Medicine, University of Messina, Messina, Italy
| | - Grazia Cirillo
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Stefania Crispi
- Gene Expression and Molecular Genetics Laboratory, Institute of Biosciences and Bioresources - CNR Naples, Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Sergio Rossi
- Biophysics Laboratory, Institute of Genetics and Biophysics - CNR, Naples, Italy
| | - Damiano Gustavo Mita
- National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Biophysics Laboratory, Institute of Genetics and Biophysics - CNR, Naples, Italy
| | - Laura Perrone
- National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Nadia Diano
- Department of Experimental Medicine, Second University of Naples, Naples, Italy.,National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Biophysics Laboratory, Institute of Genetics and Biophysics - CNR, Naples, Italy
| | - Emanuele Miraglia Del Giudice
- National Laboratory on Endocrine Disruptors of the National Institute of Biostructures and Biosystems, c/o Institute of Genetics and Biophysics - CNR, Naples, Italy.,Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
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Dong Y, Ma J, Song Y, Dong B, Wang Z, Yang Z, Wang X, Prochaska JJ. National Blood Pressure Reference for Chinese Han Children and Adolescents Aged 7 to 17 Years. Hypertension 2017; 70:897-906. [PMID: 28923902 DOI: 10.1161/hypertensionaha.117.09983] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/17/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022]
Abstract
We sought to develop and validate a national blood pressure (BP) reference based on age, sex, and height for Chinese children. Data were obtained on 197 430 children aged 7 to 17 who participated in the Chinese National Survey on Students' Constitution and Health in 2010. BP percentiles were estimated and fitted using the lambda, mu, and sigma method and then compared with a US reference and China existing reference. In an external independent validation sample of 59 653 children aged 7 to 18 from 7 Chinese provinces in 2013, the prevalence of elevated BP was compared applying the 3 references. BP values were similar for boys and girls at the younger ages (7-13 years) and lower height percentiles, whereas higher at the older ages (14-17 years) for boys than girls. At medial height in boys and girls aged 7 to 13, the 50th, 90th, 95th, and 99th percentiles of BP for the new national reference were consistent with US reference and lower than current Chinese reference. In the independent sample, elevated BP prevalence, based on the new national reference, ranged from 7.8% to 18.5% among children aged 7 to 17, which was higher than the US reference values (4.3%-14.5%) and lower than the current Chinese reference (12.9%-25.5%) in each age group. The new national BP reference for Chinese children based on age, sex, and height from large-scale and nationally representative data seems to improve the ability for identifying Chinese hypertensive children and for stratifying them with regard to cardiovascular risk.
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Affiliation(s)
- Yanhui Dong
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
| | - Jun Ma
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.).
| | - Yi Song
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.).
| | - Bin Dong
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
| | - Zhenghe Wang
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
| | - Zhaogeng Yang
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
| | - Xijie Wang
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
| | - Judith J Prochaska
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
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Acar S, Paketçi A, Küme T, Tuhan H, Gürsoy Çalan Ö, Demir K, Böber E, Abacı A. Serum galectin-1 levels are positively correlated with body fat and negatively with fasting glucose in obese children. Peptides 2017; 95:51-56. [PMID: 28728946 DOI: 10.1016/j.peptides.2017.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/08/2017] [Accepted: 07/13/2017] [Indexed: 01/03/2023]
Abstract
Galectin-1, a recently identified peptide, is primarily released from the adipose tissue. Although galectin-1 was shown to have an anti-inflammatory effect, its specific function is not clearly understood. We aimed to evaluate the relationship of serum galectin-1 levels with clinical and laboratory parameters in childhood obesity. A total of 45 obese children (mean age: 12.1±3.1years) and 35 normal-weight children (mean age: 11.8±2.2years) were enrolled. Clinical [body mass index (BMI), waist circumference (WC), percentage of body fat and blood pressure] and biochemical [glucose, insulin, lipids, galectin-1, high-sensitive C-reactive protein (hsCRP) and leptin levels] parameters were assessed. Serum galectin-1, hsCRP and leptin levels were significantly higher in obese children than those in normal-weight children (12.4 vs 10.2ng/mL, p<0.001; 3.28 vs 0.63mg/L, p<0.001; 8.3 vs 1.2ng/mL, p<0.001, respectively). In obese children, galectin-1 levels correlated negatively with fasting glucose (r=-0.346, p=0.020) and positively with fat mass (r=0.326, p=0.026) and WC standard deviation score (SDS) (r=0.451, p=0.002). The multivariate regression analysis demonstrated that serum galectin-1 levels were significantly associated with fasting glucose and WC SDS. This study showed that obese children had significantly higher galectin-1 levels in proportion to fat mass in obese cases than those in healthy children, which may be interpreted as a compensatory increase in an attempt to improve glucose metabolism.
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Affiliation(s)
- Sezer Acar
- Division of Pediatric Endocrinology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ahu Paketçi
- Division of Pediatric Endocrinology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Tuncay Küme
- Department of Biochemistry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Hale Tuhan
- Division of Pediatric Endocrinology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Özlem Gürsoy Çalan
- Department of Biochemistry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Korcan Demir
- Division of Pediatric Endocrinology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ece Böber
- Division of Pediatric Endocrinology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ayhan Abacı
- Division of Pediatric Endocrinology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
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Pérez Fernández GA, Grau Abalo R. [Nomograms for diagnosis of arterial hypertension in adolescence. The native experience must always be the best]. HIPERTENSION Y RIESGO VASCULAR 2017; 34:184-187. [PMID: 28826593 DOI: 10.1016/j.hipert.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/12/2017] [Indexed: 11/18/2022]
Affiliation(s)
- G A Pérez Fernández
- Departamento de Cardiología, Hospital Universitario «Celestino Hernández Robau», Santa Clara, Villa Clara, Cuba.
| | - R Grau Abalo
- Centro de Estudios Informáticos, Universidad Central de las Villas, Santa Clara, Villa Clara, Cuba
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Küme T, Acar S, Tuhan H, Çatlı G, Anık A, Gürsoy Çalan Ö, Böber E, Abacı A. The Relationship between Serum Zonulin Level and Clinical and Laboratory Parameters of Childhood Obesity. J Clin Res Pediatr Endocrinol 2017; 9:31-38. [PMID: 28008865 PMCID: PMC5363162 DOI: 10.4274/jcrpe.3682] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To investigate the relationship between zonulin levels and clinical and laboratory parameters of childhood obesity. METHODS The study included obese children with a body mass index (BMI) >95th percentile and healthy children who were of similar age and gender distribution. Clinical (BMI, waist circumferences, mid-arm circumference, triceps skinfold, percentage of body fat, systolic blood pressure, diastolic blood pressure) and biochemical (glucose, insulin, lipid levels, thyroid function tests, cortisol, zonulin and leptin levels) parameters were measured. RESULTS A total of 43 obese subjects (23 males, mean age: 11.1±3.1 years) and 37 healthy subjects (18 males, mean age: 11.5±3.5 years) were included in this study. Obese children had significantly higher insulin, homeostasis model assessment of insulin resistance, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), zonulin and leptin levels than healthy children (p<0.05), while glucose levels were not different (p>0.05). Comparison of the obese children with and without insulin resistance showed no statistically significant differences for zonulin levels (p>0.05). Zonulin levels were found to negatively correlate with HDL-C and positively correlate with leptin levels, after adjusting for age and BMI. CONCLUSION To the best of our knowledge, this is the first study investigating the relationship between circulating zonulin level (as a marker of intestinal permeability) and insulin resistance and leptin (as markers of metabolic disturbances associated with obesity) in childhood obesity. The results showed that zonulin was significantly higher in obese children when compared to healthy children, a finding indicating a potential role of zonulin in the etiopathogenesis of obesity and related disturbances.
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Affiliation(s)
- Tuncay Küme
- Dokuz Eylül University Faculty of Medicine, Department of Medical Biochemistry, İzmir, Turkey
| | - Sezer Acar
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Hale Tuhan
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Gönül Çatlı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ahmet Anık
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Özlem Gürsoy Çalan
- Dokuz Eylül University Faculty of Medicine, Department of Medical Biochemistry, İzmir, Turkey
| | - Ece Böber
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey Phone: +90 232 412 60 76 E-mail:
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Kuppens RJ, Bakker NE, Siemensma EPC, Donze SH, Stijnen T, Hokken-Koelega ACS. Metabolic health profile in young adults with Prader-Willi syndrome: results of a 2-year randomized, placebo-controlled, crossover GH trial. Clin Endocrinol (Oxf) 2017; 86:297-304. [PMID: 27689944 DOI: 10.1111/cen.13247] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/16/2016] [Accepted: 09/25/2016] [Indexed: 01/22/2023]
Abstract
CONTEXT Patients with Prader-Willi syndrome (PWS) have an increased fat mass and decreased lean body mass. GH-treated young adults with PWS who have attained adult height benefit from continuation of growth hormone (GH) treatment, as GH maintained their improved body composition, whereas fat mass increased during the placebo period. Adults with PWS are predisposed to T2DM and cardiovascular disease. Whether GH affects metabolic health profile of this patient group is unknown. OBJECTIVE To investigate the effects of GH vs placebo on metabolic health, in young adults with PWS who were GH-treated for many years during childhood and had attained adult height (AH). METHOD A 2-year, randomized, double-blind, placebo-controlled crossover study with stratification for gender and BMI in 27 young adults with PWS. Intervention with GH (0·67 mg/m2 /day) and placebo, both for 1-year duration. RESULTS Compared to placebo, GH treatment resulted in similar glucose and insulin levels during oral glucose tolerance test. Only fasting glucose and insulin were slightly higher during GH vs placebo (+0·2 mmol/l and +18·4 pmol/l), although both remained within normal ranges in both phases. Blood pressure and lipid profile were similar after GH vs placebo. At baseline (AH) and during GH, no patients had metabolic syndrome, while 1 developed it during placebo treatment. CONCLUSIONS Growth hormone treatment has no adverse effects on metabolic health profile. Thus, GH-treated young adults with PWS who have attained AH benefit from continuation of GH treatment without safety concerns regarding metabolic health.
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Affiliation(s)
- R J Kuppens
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - N E Bakker
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - E P C Siemensma
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - S H Donze
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - T Stijnen
- Department Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - A C S Hokken-Koelega
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
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van der Steen M, Smeets CCJ, Kerkhof GF, Hokken-Koelega ACS. Metabolic health of young adults who were born small for gestational age and treated with growth hormone, after cessation of growth hormone treatment: a 5-year longitudinal study. Lancet Diabetes Endocrinol 2017; 5:106-116. [PMID: 28011067 DOI: 10.1016/s2213-8587(16)30422-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/28/2016] [Accepted: 11/02/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Growth hormone treatment reduces fat mass and insulin sensitivity and increases lean body mass. Data are only available for short-term longitudinal changes after cessation of growth hormone treatment in young adults born small for gestational age. We aimed to assess long-term changes over a 5-year period following cessation of growth hormone treatment. METHODS We did a longitudinal study of young adults born small for gestational age and previously treated with growth hormone. Individuals were followed up for 5 years after attainment of adult height, when growth hormone treatment was discontinued: assessments were done at cessation of growth hormone treatment and at 6 months, 2 years, and 5 years thereafter. Data 5 years after cessation of growth hormone were compared with untreated age-matched controls. We used dual-energy x-ray absorptiometry to assess body composition, and did frequently sampled intravenous glucose tolerance tests to assess insulin sensitivity, acute insulin response, and the disposition index (a measure of β-cell function). This study is registered with ISRCTN, numbers ISRCTN96883876 and ISRCTN65230311. FINDINGS Between April, 2004, and April, 2016, we followed up 199 young adults born small for gestational age and previously treated with growth hormone, during the 5 years after cessation of growth hormone treatment. Data at 5 years for these individuals were compared with those for 51 untreated adults born small for gestational age with short stature, 92 untreated adults born small for gestational age with spontaneous catch-up growth, and 142 adults born appropriate for gestational age and unexposed to growth hormone treatment. In young adults born small for gestational age and previously treated with growth hormone, 5 years after cessation of growth hormone treatment, there were increases in fat mass (estimated marginal mean 10·73 kg [95% CI 9·95-11·50] at cessation of treatment vs 16·12 kg [14·77-17·46] at 5 years; p<0·0001), trunk fat (5·34 kg [4·94-5·73] vs 7·86 kg [7·12-8·60]; p<0·0001), and limb fat (4·87 kg [4·49-5·25] vs 7·41 kg [6·78-8·05]; p<0·0001); furthermore, lean body mass had decreased (42·41 kg [95% CI 41·09-43·73] at cessation of treatment vs 41·42 kg [40·17-42·66] at 5 years; p=0·0013). Insulin sensitivity increased within 6 months of cessation and was sustained 5 years after treatment cessation (estimated marginal mean 4·14 mU/L [95% CI 3·79-4·53] at cessation of treatment vs 6·15 mU/L [5·21-7·24] at 5 years; p<0·0001), and acute insulin response was diminished at 6 months, which persisted at 5 year follow-up (597·63 mU/L [539·62-661·86] vs 393·69 mU/L [337·56-459·15]; p<0·0001). The disposition index was increased 6 months after treatment but values at 5 years were similar to those at cessation of treatment (2483·94 [95% CI 2233·43-2762·54] at cessation of treatment vs 2367·83 [2033·43-2757·22] at 5 years; p=0·49). 5 years after cessation of growth hormone treatment, adults born small for gestational age and previously treated with growth hormone had fat mass, insulin sensitivity, and disposition index similar to those of untreated adults born small for gestational age with short stature, but lean body mass (adjusted for sex and height) was lower (46·47 kg [44·95-48·00] in those born small for gestational age with short stature vs 44·32 kg [43·35-45·30] in those born small for gestational age and treated with growth hormone; p=0·007). In adults previously treated with growth hormone born small for gestational age, at 5 years after cessation of growth hormone treatment, compared with adults born small for gestational age with spontaneous catch-up growth and adults born appropriate for gestational age, lean body mass was lower and results from frequently sampled intravenous glucose tolerance tests were similar. INTERPRETATION Significant changes in body composition and insulin sensitivity were recorded 5 years after cessation of growth hormone treatment in adults born small for gestational age, reflecting a loss of pharmacological effects of growth hormone. 5 years after cessation of treatment, fat mass, insulin sensitivity, and β-cell function of previously treated adults were similar to untreated adults born small for gestational age with short stature, indicating that long-term growth hormone treatment in children born small for gestational age has no unfavourable effects on metabolic health in early adulthood. FUNDING Novo Nordisk Farma BV (Netherlands).
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Affiliation(s)
- Manouk van der Steen
- Subdivision of Endocrinology, Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands.
| | - Carolina C J Smeets
- Subdivision of Endocrinology, Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Gerthe F Kerkhof
- Subdivision of Endocrinology, Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Anita C S Hokken-Koelega
- Subdivision of Endocrinology, Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
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Iwani NAKZ, Jalaludin MY, Zin RMWM, Fuziah MZ, Hong JYH, Abqariyah Y, Mokhtar AH, Wan Nazaimoon WM. Triglyceride to HDL-C Ratio is Associated with Insulin Resistance in Overweight and Obese Children. Sci Rep 2017; 7:40055. [PMID: 28059134 PMCID: PMC5216403 DOI: 10.1038/srep40055] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/30/2016] [Indexed: 01/19/2023] Open
Abstract
The purpose of this study was to investigate the usefulness of triglyceride to hdl-c ratio (TG:HDL-C) as an insulin resistance (IR) marker for overweight and obese children. A total of 271 blood samples of obese and overweight children aged 9-16 years were analysed for fasting glucose, lipids and insulin. Children were divided into IR and non-insulin resistance, using homeostasis model assessment (HOMA). The children were then stratified by tertiles of TG: HDL-C ratio. The strength between TG:HDL-C ratio and other parameters of IR were quantified using Pearson correlation coefficient (r). Odds ratio was estimated using multiple logistic regression adjusted for age, gender, pubertal stages and IR potential risk factors. Children with IR had significantly higher TG:HDL-C ratio (2.48) (p = 0.01). TG:HDL-C ratio was significantly correlated with HOMA-IR (r = 0.104, p < 0.005) and waist circumference (r = 0.134, p < 0.001). Increasing tertiles of TG:HDL-C ratio showed significant increase in mean insulin level (p = 0.03), HOMA-IR (p = 0.04) and significantly higher number of children with acanthosis nigricans and metabolic syndrome. The odds of having IR was about 2.5 times higher (OR = 2.47; 95% CI 1.23, 4.95; p = 0.01) for those in the highest tertiles of TG:HDL-C ratio. Hence, TG:HDL-C may be a useful tool to identify high risk individuals.
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Affiliation(s)
- Nur Ahmad Kamil Zati Iwani
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Diabetes and Endocrine Unit, Institute For Medical Research, Kuala Lumpur, Malaysia
| | | | - Ruziana Mona Wan Mohd Zin
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Diabetes and Endocrine Unit, Institute For Medical Research, Kuala Lumpur, Malaysia
| | - Md Zain Fuziah
- Department of Paediatrics, Putrajaya Hospital, Putrajaya, Malaysia
| | | | - Yahya Abqariyah
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Abdul Halim Mokhtar
- Department of Sports Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Çatlı G, Küme T, Tuhan HÜ, Anık A, Çalan ÖG, Böber E, Abacı A. Relation of serum irisin level with metabolic and antropometric parameters in obese children. J Diabetes Complications 2016; 30:1560-1565. [PMID: 27539885 DOI: 10.1016/j.jdiacomp.2016.07.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to investigate the relationship between serum irisin level and metabolic and anthropometric parameters in obese children. METHODS The study included 36 obese children with a body mass index (BMI) of ≥95th percentile and 30 healthy children with a BMI ranging from the 5th to the 85th percentile. Healthy and obese children had similar age, gender and pubertal stage distribution. Anthropometric and biochemical parameters (fasting glucose, insulin, lipid profile, leptin and irisin levels) were measured. Bioelectric impedance analysis was used to determine the body composition parameters, including body fat percentage and fat mass. RESULTS Serum irisin and leptin levels of the obese children were significantly higher than those of the healthy children [median irisin levels, 141.2 & 107.6ng/mL, p=0.024; median leptin levels, 10.9 & 2.9pg/mL, P<0.001, respectively). No statistically significant difference was found when leptin and irisin levels were compared among obese patients in terms of the presence of insulin resistance. Irisin levels significantly correlated with high-density lipoprotein cholesterol (HDL-C), fasting insulin and homeostasis model assessment-insulin resistance (HOMA-IR) with adjustment for age and BMI. The multivariate regression analysis showed that age, HOMA-IR and HDL-C had a significant association with the serum irisin level, which explained 30.6% of the variance. CONCLUSION This study demonstrated that obese children had significantly higher irisin levels than healthy children. Additionally, it provides evidence regarding the role of irisin on insulin sensitivity and lipid metabolism in childhood obesity.
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Affiliation(s)
- Gönül Çatlı
- Department of Pediatric Endocrinology, Katip Celebi University, Faculty of Medicine, Izmir.
| | - Tuncay Küme
- Department of Biochemistry, Dokuz Eylul University, Faculty of Medicine, Izmir
| | - Hale Ünver Tuhan
- Department of Pediatric Endocrinology, Dokuz Eylul University, Faculty of Medicine, Izmir
| | - Ahmet Anık
- Department of Pediatric Endocrinology, Adnan Menderes University, Faculty of Medicine, Aydın
| | - Özlem Gürsoy Çalan
- Department of Biochemistry, Dokuz Eylul University, Faculty of Medicine, Izmir
| | - Ece Böber
- Department of Pediatric Endocrinology, Dokuz Eylul University, Faculty of Medicine, Izmir
| | - Ayhan Abacı
- Department of Pediatric Endocrinology, Dokuz Eylul University, Faculty of Medicine, Izmir
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Banker A, Bell C, Gupta-Malhotra M, Samuels J. Blood pressure percentile charts to identify high or low blood pressure in children. BMC Pediatr 2016; 16:98. [PMID: 27430884 PMCID: PMC4950817 DOI: 10.1186/s12887-016-0633-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/09/2016] [Indexed: 12/23/2022] Open
Abstract
Background The goal was to develop familiar blood pressure (BP) charts representing BP percentile curves similar to CDC growth charts to improve screening of both high and low BP in children. Methods Since height accounts for substantially more BP variability than age and is a more direct measure of body size and maturation in children, height-specific BP percentile curves were drawn separately for males and females. We used the 2004 Fourth Report data source and equations to calculate the BP threshold value for each gender and 5 cm height group. By slightly underestimating a child’s BP percentile for high BP and slightly overestimating a child’s BP percentile for low BP, these charts guarantee 100 % sensitivity in detecting abnormal BP. Sensitivity and specificity of the chart cut-offs were confirmed in a sample of 1254 healthy children from a school-based blood pressure screening program. Results The 1st, 5th, 25th, 50th, 75th, 90th, 95th, and 99th BP percentile curves are depicted in the chart for each corresponding gender and height from 85 to 190 cm, mimicking the ubiquitous CDC “growth charts”. Shaded areas of the chart differentiate abnormal BP status categories: hypotension, normal BP, prehypertension, Stage 1 hypertension, and Stage 2 hypertension. Sensitivity was confirmed to be 100 % with specificity above 94 %. Conclusions These simplified BP charts improve upon currently available BP screening reference with the following features: (a) tracking BP longitudinally in an individual child, (b) full physiological range of BP percentiles represented in percentile curve format for rapid identification both high and low BP, (c) easy to use with absolute height alone avoiding the additional step of determining height percentile, (d) incorporation of adult threshold for pre-hypertension to assist in accurate transition from adolescence into adulthood, (e) high sensitivity and specificity to ensure all children at risk are identified with very few false positives.
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Affiliation(s)
- Ashish Banker
- Division of Pediatric Cardiology, University of Texas McGovern Medical School at Houston / Children's Memorial Hermann Hospital, TexasMedical Center, 6431 Fannin Street, MSB 3-121, Houston, 77030, TX, USA
| | - Cynthia Bell
- Divisions of Pediatric Nephrology & Hypertension, University of Texas McGovern Medical School at Houston / Children's Memorial Hermann Hospital, Texas Medical Center, 6431 Fannin Street, MSB 3-121, Houston, 77030, TX, USA
| | - Monesha Gupta-Malhotra
- Division of Pediatric Cardiology, University of Texas McGovern Medical School at Houston / Children's Memorial Hermann Hospital, TexasMedical Center, 6431 Fannin Street, MSB 3-121, Houston, 77030, TX, USA
| | - Joshua Samuels
- Divisions of Pediatric Nephrology & Hypertension, University of Texas McGovern Medical School at Houston / Children's Memorial Hermann Hospital, Texas Medical Center, 6431 Fannin Street, MSB 3-121, Houston, 77030, TX, USA.
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Warris LT, van den Akker ELT, Bierings MB, van den Bos C, Zwaan CM, Sassen SDT, Tissing WJE, Veening MA, Pieters R, van den Heuvel-Eibrink MM. Acute Activation of Metabolic Syndrome Components in Pediatric Acute Lymphoblastic Leukemia Patients Treated with Dexamethasone. PLoS One 2016; 11:e0158225. [PMID: 27362350 PMCID: PMC4928792 DOI: 10.1371/journal.pone.0158225] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/13/2016] [Indexed: 11/18/2022] Open
Abstract
Although dexamethasone is highly effective in the treatment of pediatric acute lymphoblastic leukemia (ALL), it can cause serious metabolic side effects. Because studies regarding the effects of dexamethasone are limited by their small scale, we prospectively studied the direct effects of treating pediatric ALL with dexamethasone administration with respect to activation of components of metabolic syndrome (MetS); in addition, we investigated whether these side effects were correlated with the level of dexamethasone. Fifty pediatric patients (3–16 years of age) with ALL were studied during a 5-day dexamethasone course during the maintenance phase of the Dutch Childhood Oncology Group ALL-10 and ALL-11 protocols. Fasting insulin, glucose, total cholesterol, HDL, LDL, and triglycerides levels were measured at baseline (before the start of dexamethasone; T1) and on the fifth day of treatment (T2). Dexamethasone trough levels were measured at T2. We found that dexamethasone treatment significantly increased the following fasting serum levels (P<0.05): HDL, LDL, total cholesterol, triglycerides, glucose, and insulin. In addition, dexamethasone increased insulin resistance (HOMA-IR>3.4) from 8% to 85% (P<0.01). Dexamethasone treatment also significantly increased the diastolic and systolic blood pressure. Lastly, dexamethasone trough levels (N = 24) were directly correlated with high glucose levels at T2, but not with other parameters. These results indicate that dexamethasone treatment acutely induces three components of the MetS. Together with the weight gain typically associated with dexamethasone treatment, these factors may contribute to the higher prevalence of MetS and cardiovascular risk among survivors of childhood leukemia who received dexamethasone treatment.
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Affiliation(s)
- Lidewij T. Warris
- Department of Pediatric Oncology, Erasmus MC- Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Pediatric Endocrinology, Erasmus MC- Sophia Children’s Hospital, Rotterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- * E-mail:
| | - Erica L. T. van den Akker
- Department of Pediatric Endocrinology, Erasmus MC- Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Marc B. Bierings
- Department of Pediatric Hematology and Oncology, University Medical Center Utrecht – Wilhelmina Children’s Hospital, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Cor van den Bos
- Department of Pediatric Oncology, Academic Medical Center – Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Christian M. Zwaan
- Department of Pediatric Oncology, Erasmus MC- Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Sebastiaan D. T. Sassen
- Department of Pediatric Oncology, Erasmus MC- Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Wim J. E. Tissing
- Department of Pediatric Hematology and Oncology, University of Groningen Medical Center, Groningen, The Netherlands
| | - Margreet A. Veening
- Department of Pediatric Hematology and Oncology, VU Medical Center, Amsterdam, The Netherlands
| | - Rob Pieters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marry M. van den Heuvel-Eibrink
- Department of Pediatric Oncology, Erasmus MC- Sophia Children’s Hospital, Rotterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Wang M, Chu C, Mu J. Relationship between body mass index changes and blood pressure changes from childhood to adulthood in a general Chinese population: a 26 year cohort follow-up study. Blood Press 2016; 25:319-26. [PMID: 27138219 DOI: 10.3109/08037051.2016.1168969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to estimate the relationship between body mass index (BMI) and blood pressure (BP) in a Chinese population with 26 year follow-up. The study included 4211 schoolchildren aged 6-17 years in Hanzhong, Shaanxi Province, China. Body weight, height, waist circumference, and BP were measured in 1987, 1989, 1992, 1995 and 2013. Cox proportional hazards model were fitted to examine the effect of BMI on BP. At the 26 year follow-up, 6.93% of male and 3.43% of female subjects had high SBP, and 12.8% of male and 4.56% of female had high DBP. The average age of subjects with high SBP was 40.3 years in males and 41.4 years in females; while the average age with high DBP was 38.1 years in males and 38.9 years in females. Obese subjects were 2.96 times and 2.88 times more likely to have high SBP and high DBP than normal weight counterparts, respectively; while overweight subjects were 1.81 times and 2.03 times more likely to have high SBP and high DBP, respectively. These findings underscore the urgent need to prevent increasing body weight. Targeting intervention in adolescence may be a critical method for preventing high BP in later life.
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Affiliation(s)
- Man Wang
- a Department of Cardiology , First Affiliated Hospital of Medical College, Xi'an Jiaotong University , Xi'an , PR China ;,b Department of Cardiology , Xi'an No. 4 Hospital , Xi'an , PR China
| | - Chao Chu
- a Department of Cardiology , First Affiliated Hospital of Medical College, Xi'an Jiaotong University , Xi'an , PR China
| | - Jianjun Mu
- a Department of Cardiology , First Affiliated Hospital of Medical College, Xi'an Jiaotong University , Xi'an , PR China
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Ghobrial EE, Abdelaziz DM, Sheba MF, Abdel-Azeem YS. Value of Ultrasound in Detecting Urinary Tract Anomalies After First Febrile Urinary Tract Infection in Children. Clin Pediatr (Phila) 2016; 55:415-20. [PMID: 26084536 DOI: 10.1177/0009922815590224] [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] [Indexed: 11/17/2022]
Abstract
Background Urinary tract infection (UTI) is an infection that affects part of the urinary tract. Ultrasound is a noninvasive test that can demonstrate the size and shape of kidneys, presence of dilatation of the ureters, and the existence of anatomic abnormalities. The aim of the study is to estimate the value of ultrasound in detecting urinary tract anomalies after first attack of UTI. Methods This study was conducted at the Nephrology Clinic, New Children's Hospital, Faculty of Medicine, Cairo University, from August 2012 to March 2013, and included 30 children who presented with first attack of acute febrile UTI. All patients were subjected to urine analysis, urine culture and sensitivity, serum creatinine, complete blood count, and imaging in the form of renal ultrasound, voiding cysto-urethrography, and renal scan. Results All the patients had fever with a mean of 38.96°C ± 0.44°C and the mean duration of illness was 6.23 ± 5.64 days. Nineteen patients (63.3%) had an ultrasound abnormality. The commonest abnormalities were kidney stones (15.8%). Only 2 patients who had abnormal ultrasound had also vesicoureteric reflux on cystourethrography. Sensitivity of ultrasound was 66.7%, specificity was 37.5%, positive predictive value was 21.1%, negative predictive value was 81.8%, and total accuracy was 43.33%. Conclusion We concluded that ultrasound alone was not of much value in diagnosing and putting a plan of first attack of febrile UTI. It is recommended that combined investigations are the best way to confirm diagnosis of urinary tract anomalies.
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Affiliation(s)
| | | | - Maha F Sheba
- Faculty of Medicine, Cairo University, Cairo, Egypt
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Ma C, Liu Y, Liu X, Yin F, Lu Q. Comparison of Different Screening Methods for Hypertension in Han Adolescents. Clin Pediatr (Phila) 2016; 55:363-7. [PMID: 26134554 DOI: 10.1177/0009922815591886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to compare different methods of screening for hypertension in Han adolescents. We analyzed data on 3136 Han adolescents (1601 boys and 1535 girls) aged 13 to 17 years from the adolescents hypertension survey of Qinhuangdao in 2006. The blood pressure was classified as without hypertension and with hypertension, consistent with the 2004 Working Group on High Blood Pressure in Children and Adolescents guidelines and the selected screening methods. Sensitivity and specificity were then calculated according to gender range. Somu's formulas and the table proposed by Chiolero had low sensitivities (58.4% to 83.1%), despite good specificities (99.0% to 100.0%). The tables proposed by Mitchell and Kaelber had high sensitivities (100%), but their specificities were low (62.0% to 73.8%). Blood pressure-to-height ratio (BPHR) was a good compromise between sensitivities (boys 99.1% and girls 98.9%) and specificities (boys 91.0% and girls 94.9%). As screening tools, the table proposed by Mitchell and Kaelber and BPHR have high sensitivities. However, BPHR demonstrated specific advantages, and it does not require tables.
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Affiliation(s)
- Chunming Ma
- The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Yue Liu
- The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiaoli Liu
- The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Fuzai Yin
- The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Qiang Lu
- The First Hospital of Qinhuangdao, Qinhuangdao, China
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Cantinotti M, Giordano R, Scalese M, Molinaro S, Murzi B, Assanta N, Crocetti M, Marotta M, Ghione S, Iervasi G. Strengths and limitations of current pediatric blood pressure nomograms: a global overview with a special emphasis on regional differences in neonates and infants. Hypertens Res 2015; 38:577-87. [PMID: 25876830 DOI: 10.1038/hr.2015.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/13/2015] [Accepted: 02/09/2015] [Indexed: 01/25/2023]
Abstract
The availability of robust nomograms is essential for the correct evaluation of blood pressure (BP) values in children. A literature search was conducted by accessing the National Library of Medicine by using the keywords BP, pediatric and reference values/nomograms. A total of 43 studies that evaluated pediatric BP nomograms were included in this review. Despite the accuracy of the latest studies, many numerical and methodological limitations still remain. The numerical limitations include the paucity of data for neonates/infants and for some geographic areas (Africa/South America/East Europe/Asia) and ethnicities. Furthermore, the data on ambulatory BP and response to exercise are extremely limited, and the criteria for stress-test interruption are lacking. There was heterogeneity in the methodologies employed to perform the measurements, in the inclusion/exclusion criteria (often not reported), in the data normalization and the data expression (Z-scores/percentiles/mean values). Although most studies adjusted the measurements for age and/or height, the classification by specific age/height subgroups varied. Gender differences were generally considered, whereas other confounders (that is, ethnicity/geographic area/environment) were seldom evaluated. As a result, nomograms were heterogeneous, and when comparable, at times showed widely different confidence intervals. These differences are most likely because of both methodological limitations and differences among the populations studied. Some robust nomograms exist (particularly those from the USA); however, it has been demonstrated that if adopted in other countries/continents, they may generate an unpredictable bias in the evaluation of BP values in children. Actual pediatric BP nomograms present consistent limitations that affect the evaluation of BP in children. Comprehensive nomograms, which are based on a large population of healthy children (including neonates/infants) and use standardized methodology, are warranted for every country/region.
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Affiliation(s)
- Massimiliano Cantinotti
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy.,Department of Cardiology, Institute of Clinical Physiology, Pisa, Italy
| | - Raffaele Giordano
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy
| | - Marco Scalese
- Department of Cardiology, Institute of Clinical Physiology, Pisa, Italy
| | - Sabrina Molinaro
- Department of Cardiology, Institute of Clinical Physiology, Pisa, Italy
| | - Bruno Murzi
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy
| | - Nadia Assanta
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy
| | - Maura Crocetti
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy
| | - Marco Marotta
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy
| | - Sergio Ghione
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy.,Department of Cardiology, Institute of Clinical Physiology, Pisa, Italy
| | - Giorgio Iervasi
- Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy.,Department of Cardiology, Institute of Clinical Physiology, Pisa, Italy
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White MJ, Eren F, Agirbasli D, Williams SM, Agirbasli M. SHBG gene polymorphism (rs1799941) associates with metabolic syndrome in children and adolescents. PLoS One 2015; 10:e0116915. [PMID: 25647406 PMCID: PMC4380117 DOI: 10.1371/journal.pone.0116915] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 12/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background Metabolic syndrome (MetS) is a complex disorder characterized by coexistence
of several cardiometabolic (CM) factors, i.e. hyperlipidemia, obesity, high
blood pressure and insulin resistance. The presence of MetS is strongly
associated with increased risk of cardiovascular disease (CVD). The syndrome
was originally defined as an adult disorder, but MetS has become
increasingly recognized in children and adolescents. Methods Genetic variants influence biological components common to the CM factors
that comprise MetS. We investigated single locus associations between six
single nucleotide polymorphisms (SNPs), previously shown to modulate lipid
or sex hormone binding globulin (SHBG) levels, with MetS in a Turkish
pediatric cohort (37 cases, 323 controls). Results Logistic regression analysis revealed a significant association between
rs1799941, located in SHBG, and MetS (OR = 3.09, p-value = 0.006). The
association with MetS remained after sequential adjustment for each CM
factor included in the syndrome definition, indicating that the identified
association is not being driven by any single trait. A relationship between
rs1799941 and SHBG levels, was also discovered, but it was dependent on MetS
status. In control subjects, the A allele of rs1799941 associated with a
significant increase in SHBG levels (p = 0.012), while in cases there was no
association between rs1799941 and SHBG levels (p = 0.963). Conclusions The significant association between rs1799941 and MetS in children is not
contingent on any single CM trait. Additionally, the presence of MetS may
abrogate effect of rs1799941 polymorphism on SHBG levels in children.
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Affiliation(s)
- Marquitta J. White
- Center for Human Genetic Research, Vanderbilt University, Nashville,
Tennessee, United States of America
- Department of Genetics, Institute for Quantitative Biomedical Sciences,
Dartmouth College, Hanover, New Hampshire, United States of
America
| | - Fatih Eren
- Department of Medical Biology, Marmara University School of Medicine,
Istanbul, Turkey
| | - Deniz Agirbasli
- Department of Medical Biology, Acıbadem University School of
Medicine, Istanbul, Turkey
| | - Scott M. Williams
- Department of Genetics, Institute for Quantitative Biomedical Sciences,
Dartmouth College, Hanover, New Hampshire, United States of
America
| | - Mehmet Agirbasli
- Department of Cardiology, Marmara University School of Medicine,
Istanbul, Turkey
- * E-mail:
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Çatli G, Kir M, Anik A, Yilmaz N, Böber E, Abaci A. The effect of L-thyroxine treatment on left ventricular functions in children with subclinical hypothyroidism. Arch Dis Child 2015; 100:130-7. [PMID: 25210105 DOI: 10.1136/archdischild-2014-306381] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to search for evidence suggesting treatment for childhood subclinical hypothyroidism (SH) by evaluating left ventricular (LV) functions of children with SH by using M-mode and tissue Doppler echocardiography (TDE). METHODS Children with SH and euthyroid healthy children (control group) were enrolled in the study. At baseline and 6 months after euthyroidism was achieved, M-mode and TDE were performed and LV functions were evaluated. Pretreatment parameters of the SH group were compared with those of controls and post-treatment parameters. RESULTS 31 children with SH and 32 euthyroid healthy children were enrolled in the study. The groups had similar age, gender, puberty and body mass index. Interventricular septum thickness and LV mass index, which are the parameters for LV morphology, were slightly increased in the SH group than in the controls (p<0.05). In TDE, children with SH had significant changes in LV diastolic (lower E'm, higher E/E'm ratio and longer isovolumic relaxation time) and systolic functions (lower isovolumic contraction time) compared with controls (p<0.05). Six months after euthyroidism was achieved, TDE showed a significant improvement of some of the diastolic and systolic parameters (p<0.05). CONCLUSIONS The results of this study showed that SH is associated with subclinical alterations in LV function, and LT4 replacement may improve LV systolic and diastolic parameters. However, since SH is usually a self-limiting process, these improvements in LV functions may simply be associated with the natural course of the disease and/or physiological linear growth of the children.
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Affiliation(s)
- Gönül Çatli
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Balcova, Turkey
| | - Mustafa Kir
- Department of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, Balcova, Turkey
| | - Ahmet Anik
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Balcova, Turkey
| | - Nuh Yilmaz
- Department of Pediatric Cardiology, Faculty of Medicine, Dokuz Eylül University, Balcova, Turkey
| | - Ece Böber
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Balcova, Turkey
| | - Ayhan Abaci
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Balcova, Turkey
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Sayeemuddin M, Sharma D, Pandita A, Sultana T, Shastri S. Blood pressure profile in school children (6-16 years) of southern India: a prospective observational study. Front Pediatr 2015; 3:24. [PMID: 25874192 PMCID: PMC4379873 DOI: 10.3389/fped.2015.00024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/16/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS AND OBJECTIVE To determine normal blood pressure (BP) in apparently healthy, asymptomatic school children in the age group of 6-16 years and to determine the correlation of BP values with different sex, weight, height, and body mass index (BMI) and also to find out prevalence of hypertension in school going population. MATERIALS AND METHODS This prospective, observational study enrolled 3,302 urban children (1,658 boys and 1,644 girls) in the age group of 6-16 years. These were analyzed to study the distribution pattern of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at different ages, sex, weight, height, and BMI. The SBP and DBP were noted as per age and sex. The association was seen between mean SBP and mean DBP with weight, height, and BMI. Information was collected about the family history of hypertension and was correlated with the obtained SBP and DBP readings. RESULTS The mean SBP in males at 6 years was 99.69 ± 3.62 mm of Hg, at 10 years was 102.20 ± 2.16 mm of Hg, and at 16 years was 115.33 ± 1.26 mm of Hg. The mean SBP in females at 6 years was 96.55 ± 2.86 mm of Hg, at 10 years was 101.16 ± 2.12 mm of Hg, and at 16 years was 112.41 ± 1.06 mm of Hg. The correlation coefficient for relationship between age and SBP in males and females was 0.89 and 0.91, respectively, and for DBP was 0.92 and 0.90, respectively. The correlation coefficient for relationship between height and SBP in males and females was 0.91 and 0.93, respectively, and for DBP was 0.92 and 0.88, respectively. The correlation coefficient for relationship between weight and SBP in males and females was 0.92 and 0.92, respectively, and for DBP was 0.94 and 0.91, respectively. In the nomogram obtained in the study, 95% of study population fall between mean +2SD and -2SD. CONCLUSION The blood pressure (BP) (SBP and DBP) tends to increase with age, weight, height, and BMI. The BP values (SBP and DBP) increases grossly after 11 years of age. The students with positive family history of hypertension had higher valve when compared to other student. The BP of children and adolescents can be evaluated using the reference table according to age. The table provided helps to classify as "normal" or "hypertension" (>+2SD).
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Affiliation(s)
| | - Deepak Sharma
- Department of Paediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences , Haryana , India
| | - Aakash Pandita
- Department of Paediatrics, Sri Maharaja Gulab Singh (SMGS) Hospital , Jammu , India
| | - Tabassum Sultana
- Mediciti Institute of Medical Sciences (MIMS) , Hyderabad , India
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Shalitin S, Tauman R, Meyerovitch J, Sivan Y. Are frequency and severity of sleep-disordered breathing in obese children and youth with and without type 2 diabetes mellitus different? Acta Diabetol 2014; 51:757-64. [PMID: 24682536 DOI: 10.1007/s00592-014-0583-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
Obstructive sleep apnea (OSA) is a risk factor for insulin resistance and type 2 diabetes mellitus (T2DM) in adults. Data in children are limited. The aim was to study the frequency and severity of OSA and its association with cardiometabolic risk factors in obese children and adolescents with and without T2DM. In this prospective cross-sectional study, obese children and adolescents with and without T2DM underwent polysomnography and blood tests for fasting lipids, insulin, glucose, liver functions, and C-reactive protein. All participants completed a questionnaire on past and present sleep-disordered breathing (SDB). Results were compared between T2DM and obese non-diabetic controls matched for body mass index-standard deviation score (BMI-SDS) and also according to the glycemic status: T2DM, impaired glucose tolerance (IGT), and normal glycemic control. Eleven patients with T2DM (age 15.9 ± 3.6 years) and 30 BMI-SDS matched non-diabetic subjects (age 12.7 ± 3.0 years) were studied. Among the entire cohort, 45 % had a history of snoring, 26 % reported apneic episodes during sleep, and 65 % had daytime fatigue. There were no significant between-group differences in SDB history or abnormal polysomnographic results [apnea-hypopnea index (AHI) >5/h]. The percentage of subjects with AHI >5/h was 45.5 % in T2DM patients, 25 % in obese patients with IGT, and 18.2 % in obese patients without IGT, although the difference was not statistically significant (p = 0.25). Plasma C-reactive protein levels were related to both glycemic status and OSA severity. The severity of OSA in obese children and adolescents is unrelated to the presence of diabetes. OSA may play a minor role in the development and progression of T2DM in children and adolescents. Further studies in larger cohorts are required.
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Affiliation(s)
- Shlomit Shalitin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
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42
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Forman MR, Zhu Y, Hernandez LM, Himes JH, Dong Y, Danish RK, James KE, Caulfield LE, Kerver JM, Arab L, Voss P, Hale DE, Kanafani N, Hirschfeld S. Arm span and ulnar length are reliable and accurate estimates of recumbent length and height in a multiethnic population of infants and children under 6 years of age. J Nutr 2014; 144:1480-7. [PMID: 25031329 PMCID: PMC4130829 DOI: 10.3945/jn.114.194340] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Surrogate measures are needed when recumbent length or height is unobtainable or unreliable. Arm span has been used as a surrogate but is not feasible in children with shoulder or arm contractures. Ulnar length is not usually impaired by joint deformities, yet its utility as a surrogate has not been adequately studied. In this cross-sectional study, we aimed to examine the accuracy and reliability of ulnar length measured by different tools as a surrogate measure of recumbent length and height. Anthropometrics [recumbent length, height, arm span, and ulnar length by caliper (ULC), ruler (ULR), and grid (ULG)] were measured in 1479 healthy infants and children aged <6 y across 8 study centers in the United States. Multivariate mixed-effects linear regression models for recumbent length and height were developed by using ulnar length and arm span as surrogate measures. The agreement between the measured length or height and the predicted values by ULC, ULR, ULG, and arm span were examined by Bland-Altman plots. All 3 measures of ulnar length and arm span were highly correlated with length and height. The degree of precision of prediction equations for length by ULC, ULR, and ULG (R(2) = 0.95, 0.95, and 0.92, respectively) was comparable with that by arm span (R(2) = 0.97) using age, sex, and ethnicity as covariates; however, height prediction by ULC (R(2) = 0.87), ULR (R(2) = 0.85), and ULG (R(2) = 0.88) was less comparable with arm span (R(2) = 0.94). Our study demonstrates that arm span and ULC, ULR, or ULG can serve as accurate and reliable surrogate measures of recumbent length and height in healthy children; however, ULC, ULR, and ULG tend to slightly overestimate length and height in young infants and children. Further testing of ulnar length as a surrogate is warranted in physically impaired or nonambulatory children.
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Affiliation(s)
- Michele R. Forman
- Department of Nutritional Sciences, School of Human Ecology, University of Texas at Austin, Austin, TX,To whom correspondence should be addressed. E-mail:
| | - Yeyi Zhu
- Department of Nutritional Sciences, School of Human Ecology, University of Texas at Austin, Austin, TX
| | - Ladia M. Hernandez
- Department of Nutritional Sciences, School of Human Ecology, University of Texas at Austin, Austin, TX
| | - John H. Himes
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Yongquan Dong
- Department of Nutritional Sciences, School of Human Ecology, University of Texas at Austin, Austin, TX
| | - Robert K. Danish
- Department of Pediatrics, the University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Kyla E. James
- Department of Nutritional Sciences, School of Human Ecology, University of Texas at Austin, Austin, TX
| | - Laura E. Caulfield
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jean M. Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
| | - Lenore Arab
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Daniel E. Hale
- Department of Pediatrics, the University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Nadim Kanafani
- Department of Pediatrics, School of Medicine, Saint Louis University, St. Louis, MO; and
| | - Steven Hirschfeld
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
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Catli G, Anik A, Tuhan HÜ, Kume T, Bober E, Abaci A. The relation of leptin and soluble leptin receptor levels with metabolic and clinical parameters in obese and healthy children. Peptides 2014; 56:72-6. [PMID: 24703965 DOI: 10.1016/j.peptides.2014.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 03/18/2014] [Accepted: 03/21/2014] [Indexed: 11/21/2022]
Abstract
We investigated the relation of serum leptin, soluble leptin receptor (sLR) and free leptin index (FLI) with metabolic and anthropometric parameters in obese and healthy children. Height, weight, waist circumference (WC), fasting serum glucose, insulin, lipid profile, leptin and sLR levels of 35 obese children and 36 healthy children were measured and FLI was calculated as the ratio of leptin to sLR. In obese children, serum leptin and FLI were found significantly higher, while sLR level was significantly lower than the healthy children. Comparison of obese children regarding the insulin resistance showed significantly higher serum leptin and FLI in the insulin resistant group; however sLR level was not different between the insulin resistant and non-resistant obese children. In obese children, sLR was not correlated with any of the metabolic parameters except total cholesterol, while FLI was significantly and positively correlated with BMI, WC, TC, fasting insulin, and HOMA-IR. However, regression analysis confirmed that the HOMA-IR was the only independent variable significantly correlated with FLI in obese children. Findings of this study suggest that in obese children and adolescents (i) serum leptin and FLI were found significantly higher, while sLR level was significantly lower than the healthy children, (ii) increased FLI might be a compensatory mechanism for increasing leptin effect in peripheral tissue, (iii) FLI is a more accurate marker to evaluate leptin resistance than leptin or sLR alone, and (iv) increased FLI may contribute toward the development of hyperinsulinemia and insulin resistance.
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Affiliation(s)
- Gonul Catli
- Department of Pediatric Endocrinology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ahmet Anik
- Department of Pediatric Endocrinology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Hale Ünver Tuhan
- Department of Pediatric Endocrinology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Tuncay Kume
- Department of Biochemistry, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ece Bober
- Department of Pediatric Endocrinology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ayhan Abaci
- Department of Pediatric Endocrinology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
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Zhang YX, Wang SR, Zhou JY, Zhao JS, Chu ZH. Percentiles of waist-hip ratio and the relationship with blood pressure among children and adolescents in Shandong, China. Ann Hum Biol 2014; 41:383-8. [PMID: 24617792 DOI: 10.3109/03014460.2013.815273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Anthropometric indices such as waist circumference (WC), waist-to-height ratio (WHtR) and waist-hip ratio (WHR) have been recognized as useful alternatives to visceral fat measurement in epidemiological studies. WHR has been used extensively in adults. However, there are very few published data for WHR among children and adolescents. AIM The present study examined the distribution of WHR and the relationship with blood pressure (BP) among children and adolescents in Shandong, PR China. SUBJECTS AND METHODS Data for this study were obtained from a large cross-sectional survey of schoolchildren carried out in 2010. A total of 38,822 students (19,456 boys and 19,366 girls) aged 7-17 years participated in this study. WC, Hip circumference (HC), systolic blood pressure (SBP) and diastolic blood pressure (DBP) of all subjects were measured; WHR was calculated as WC divided by HC. Abdominal obesity was defined by previously published WHR references based on Chinese children and adolescents living in Beijing. All subjects were divided into two groups (group 1 with WHR <85th; group 2 with WHR ≥85th) according to the percentiles of WHR and comparisons of the SBP and DBP between the two groups were made. RESULTS The WHR levels in Shandong boys and girls were lower than those from German and Pakistani. The overall prevalence of abdominal obesity was 9.53% (95% CI = 9.12-9.95%) for boys and 9.82% (95% CI = 9.40-10.24%) for girls, no statistical differences between the two genders were observed (p > 0.05). In both boys and girls, the Z-scores of SBP and DBP were all significantly lower in group 1 than in group 2 (p < 0.01), indicating that children and adolescents with high WHR tended to have higher BP values. CONCLUSION WHR is useful in identifying children and adolescents at risk of developing high BP. These findings, together with the known tracking of BP from adolescence into adulthood, highlight the importance of preventing overweight and obesity among children and adolescents in order to prevent the development of hypertension in adults.
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Affiliation(s)
- Ying-Xiu Zhang
- Shandong Center for Disease Control and Prevention , Shandong , PR China and
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45
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Guo X, Zheng L, Li Y, Zhang X, Yu S, Sun Y. Blood pressure to height ratio: A novel method for detecting hypertension in paediatric age groups. Paediatr Child Health 2014; 18:65-9. [PMID: 24421658 DOI: 10.1093/pch/18.2.65] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A novel method for detecting hypertension in paediatric age groups has recently been formulated using ratios of systolic blood pressure to height (SBPHR) and diastolic blood pressure to height (DBPHR). AIM To validate this approach and assess its applicability to children. METHODS A cross-sectional study of 6837 children and adolescents five to 18 years of age was conducted. Blood pressure (BP) readings obtained were stratified using population-based percentiles from the United States. RESULTS For SBPHR and DBPHR, areas under the ROC curve were >0.9 for BP at or above the 95th percentile. Performance of the cut-off points for detecting elevated BP in adolescents 13 to 18 years of age compared favourably with previous studies, showing high sensitivity and specificity (>95%). SBPHR and DBPHR also proved satisfactory when applied to children five to 12 years of age. Nevertheless, performance was lower for BP between the 90th and 95th percentiles. CONCLUSIONS BP to height ratios are a practical means for detecting elevated BP in adolescents and children.
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Affiliation(s)
- Xiaofan Guo
- Department of Cardiology, the First Hospital of China Medical University; Shenyang, People's Republic of China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yang Li
- Department of Cardiology, the First Hospital of China Medical University; Shenyang, People's Republic of China
| | - Xingang Zhang
- Department of Cardiology, the First Hospital of China Medical University; Shenyang, People's Republic of China
| | - Shasha Yu
- Department of Cardiology, the First Hospital of China Medical University; Shenyang, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, the First Hospital of China Medical University; Shenyang, People's Republic of China
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Andreassen OA, McEvoy LK, Thompson WK, Wang Y, Reppe S, Schork AJ, Zuber V, Barrett-Connor E, Gautvik K, Aukrust P, Karlsen TH, Djurovic S, Desikan RS, Dale AM. Identifying common genetic variants in blood pressure due to polygenic pleiotropy with associated phenotypes. Hypertension 2014; 63:819-26. [PMID: 24396023 DOI: 10.1161/hypertensionaha.113.02077] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Blood pressure is a critical determinant of cardiovascular morbidity and mortality. It is affected by environmental factors, but has a strong heritable component. Despite recent large genome-wide association studies, few genetic risk factors for blood pressure have been identified. Epidemiological studies suggest associations between blood pressure and several diseases and traits, which may partly arise from a shared genetic basis (genetic pleiotropy). Using genome-wide association studies summary statistics and a genetic pleiotropy-informed conditional false discovery rate method, we systematically investigated genetic overlap between systolic blood pressure (SBP) and 12 comorbid traits and diseases. We found significant enrichment of single nucleotide polymorphisms associated with SBP as a function of their association with body mass index, low-density lipoprotein, waist/hip ratio, schizophrenia, bone mineral density, type 1 diabetes mellitus, and celiac disease. In contrast, the magnitude of enrichment due to shared polygenic effects was smaller with the other phenotypes (triglycerides, high-density lipoproteins, type 2 diabetes mellitus, rheumatoid arthritis, and height). Applying the conditional false discovery rate method to the enriched phenotypes, we identified 62 loci associated with SBP (false discovery rate <0.01), including 42 novel loci. The observed polygenic overlap between SBP and several related disorders indicates that the epidemiological associations are not mediated solely via lifestyle factors but also reflect an etiologic relation that warrants further investigation. The new gene loci identified implicate novel genetic mechanisms related to lipid biology and the immune system in SBP.
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Affiliation(s)
- Ole A Andreassen
- Department of Radiology, University of California, San Diego, 8950 Villa La Jolla Dr, Suite C101, La Jolla, CA 92037-0841. ; and Ole A. Andreassen, NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål, PO Box 4956 Nydalen, 0424 Oslo, Norway. Email
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Association between body mass index, skinfold thickness and blood pressure in 12-year-old children. Eur J Pediatr 2013; 172:1167-71. [PMID: 23636285 DOI: 10.1007/s00431-013-2014-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The present study examined the association between body mass index (BMI) and skinfold thickness (SFT) with blood pressure (BP) in 12-year-old children in Shandong, China. A total of 920 (464 boys and 456 girls) 12-year-old students participated in this study. All subjects were divided into four groups (BMI < 25th, 25th ≤ BMI < 50th, 50th ≤ BMI < 75th, and BMI ≥ 75th) according to the percentile of BMI and into four groups (SFT < 25th, 25th ≤ SFT < 50th, 50th ≤ SFT < 75th, and SFT ≥ 75th) according to the percentile of SFT, respectively. Comparisons of BP among different groups were made by one-way ANOVA. High BP status was defined as systolic blood pressure (SBP) ≥ 95th and/or diastolic blood pressure (DBP) ≥ 95th percentile for age and gender. BMI and SFT were all significantly (P < 0.001) and positively related to SBP and DBP in both boys and girls. The prevalence of high BP in each group is rising with the percentiles of BMI and SFT in both boys and girls. CONCLUSION There is a strong positive relationship between BMI, SFT, and BP in 12-year-old children; the present findings emphasize the importance of preventing excess BMI and SFT in order to prevent future-related problems such as hypertension in children and adolescents.
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Zhang YX, Wang SR. The relationship of waist circumference distribution to blood pressure levels among children and adolescents in Shandong, China. Int J Cardiol 2013; 168:1516-20. [DOI: 10.1016/j.ijcard.2012.12.097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/10/2012] [Accepted: 12/25/2012] [Indexed: 10/27/2022]
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Comparison of blood pressure levels among children and adolescents with different body mass index and waist circumference: study in a large sample in Shandong, China. Eur J Nutr 2013; 53:627-34. [PMID: 23917448 DOI: 10.1007/s00394-013-0571-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 07/26/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE Several anthropometric indicators [such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR)] have been used to investigate the association between adiposity and high blood pressure (BP) in both adults and children. The present study compared the BP levels among children and adolescents with different BMI and WC in a large population in Shandong, China. METHODS A total of 38,822 students (19,456 boys and 19,366 girls) aged 7-17 years participated in this study. Height, weight, WC, and BP of all subjects were measured, and BMI was calculated. The prevalence of overweight and obesity was obtained according to the International Obesity Task Force (IOTF) cutoffs; central obesity was defined as WC ≥ 90th percentile (P 90); relatively high BP status was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥ 95th percentile for age and gender. RESULTS Within each BMI categories (normal weight, overweight, and obesity), children and adolescents with WC ≥ P 90 had higher BP levels than those with WC < P 90 (p < 0.01). When BMI and WC were combined, the highest and lowest prevalences of relatively high BP were noted in obese with WC ≥ P 90 group (54.52% for boys and 48.71% for girls) and normal weight with WC < P 90 group (17.00% for boys and 14.13% for girls). CONCLUSION Children and adolescents with high BMI and high WC might have an increased risk of elevated BP. Our results suggest that the additional measurement of WC is better than BMI alone to help identify high BP risks.
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Nisbet LC, Yiallourou SR, Walter LM, Horne RSC. Blood pressure regulation, autonomic control and sleep disordered breathing in children. Sleep Med Rev 2013; 18:179-89. [PMID: 23850404 DOI: 10.1016/j.smrv.2013.04.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/10/2013] [Accepted: 04/29/2013] [Indexed: 02/07/2023]
Abstract
Sleep disordered breathing (SDB) ranges in severity from primary snoring (PS) to obstructive sleep apnoea (OSA). In adults, SDB is associated with adverse cardiovascular consequences which are mediated, in part, by autonomic dysfunction. Although SDB is common in children, fewer paediatric studies have investigated these cardiovascular effects. Initial research focused on those with OSA, indeed children with PS were occasionally utilised as the comparison control group. However, it is essential to understand the ramifications of this disorder in all its severities, as currently the milder forms of SDB are often untreated. Methodologies used to assess autonomic function in children with SDB include blood pressure (BP), BP variability, baroreflex sensitivity, heart rate variability, peripheral arterial tonometry and catecholamine assays. The aim of this review was to summarise the findings of paediatric studies to date and explore the relationship between autonomic dysfunction and SDB in children, paying particular attention to the roles of disease severity and/or age. This review found evidence of autonomic dysfunction in children with SDB during both wakefulness and sleep. BP dysregulation, elevated generalised sympathetic activity and impairment of autonomic reflexes occur in school-aged children and adolescents with SDB. The adverse effects of SDB seem somewhat less in young children, although more studies are needed. There is mounting evidence that the cardiovascular and autonomic consequences of SDB are not limited to those with OSA, but are also evident in children with PS. The severity of disease and age of onset of autonomic consequences may be important guides for the treatment of SDB.
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Affiliation(s)
- Lauren C Nisbet
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia
| | - Stephanie R Yiallourou
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia
| | - Lisa M Walter
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Australia.
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