Cardiovascular risk factors in Australian indigenous and non-indigenous children: a population-based study

Cardiometabolic Risk Markers for Aboriginal and Torres Strait Islander Children and Youths: A Systematic Review of Data Quality and Population Prevalence

Cardiovascular disease and type 2 diabetes mellitus are leading contributors to the health inequity experienced by Aboriginal and Torres Strait Islander peoples, and their antecedents can be identified from early childhood. We aimed to establish the quality of available data and the prevalence of cardiometabolic risk markers among Aboriginal and Torres Strait Islander children and youths (0-24-year-olds) to inform public health approaches. A systematic review of the peer-reviewed and grey literature was conducted between 1 January 2000-28 February 2021. Included studies reported population prevalence of cardiometabolic risks, including elevated blood pressure, obesity, central adiposity, dyslipidaemia, hyperglycaemia, and 'metabolic syndrome' for Aboriginal and Torres Strait Islander people aged 0-24 years. Fifteen studies provided population estimates. Data quality was limited by low response rates (10/15 studies) and suboptimal outcome measurements. Obesity is the most reported risk (13/15 studies). Aboriginal and Torres Strait Islander children have an excess risk of obesity from early childhood and prevalence increases with age: 32.1% of Aboriginal and Torres Strait Islander 18-24-year-olds had obesity and 50.8% had central adiposity. In a cohort of 486 9-14-year-olds in Darwin, 70% had ≥1 component of metabolic syndrome; 14% met the full criteria for the syndrome. The prevalence of cardiometabolic risk in Aboriginal and Torres Strait Islander young people is difficult to estimate due to limitations in measurement quality and sampling representativeness. Available data suggest that cardiometabolic risk markers are evident from early childhood. The establishment of national and state-level datasets and a core outcome set for cardiometabolic screening would provide opportunities for preventative action.

Can childhood obesity influence later chronic kidney disease?

Childhood overweight and obesity affects more and more children. Whilst associations of childhood overweight with later outcomes such as hypertension, diabetes and cardiovascular disease have been well documented, less is known about the association of childhood overweight and obesity with kidney disease. We review the existing evidence for the association of childhood obesity with markers of childhood and adult kidney disease. Whilst there is some evidence for an association, studies have not been able to distinguish between childhood being a sensitive time to develop later kidney problems, or whether observed associations of childhood obesity with poor outcomes are driven by greater lifelong exposure to obesity.

Epidemiology, Clinical Presentation, and Prognosis of Posterior Circulation Ischemic Stroke in Children

BACKGROUND

Anterior and posterior circulation strokes are often different in terms of presentation and recurrence risk, but there are few studies that focused on posterior circulation stroke.

METHODS

We performed a longitudinal retrospective study of children, birth to 18 years, with posterior circulation ischemic stroke at the Children's Hospital Winnipeg from January 1992 to December 2012. Clinical and radiological features and outcomes were collected using standardized tools.

RESULTS

Of the 158 children with arterial ischemic stroke, 23 (14.5%) children, 21 non-neonates, and 11 males were identified. For posterior circulation ischemic stroke, mean crude incidence of 0.38 and crude mortality rate of 0.11 per 100,000 person-years was estimated. The crude total period prevalence rate for the study period was estimated as 8.1 per 100,000 children. Nonspecific symptoms before stroke presentation were present in 38% and impaired consciousness in 71%. Identifiable risk factors were present in two thirds: vasculopathy 24%, infection 19%, trauma 14%, and congenital heart disease 9.5%. Average Pediatric National Institutes of Health Stroke Scale score at presentation was 11. Poor outcome was noted in 45%. Outcome did not change significantly between 12 and 24 months. Aboriginal ethnicity (P = 0.01), high Pediatric National Institutes of Health Stroke Scale score (P = 0.001), bilateral infarction (P = 0.001), and large caliber artery territory infarction (P = 0.02) predicted poor outcome.

CONCLUSIONS

Our hospital-based incidence and outcome data provide valuable information to help direct treatment strategies and prognosticate children with posterior circulation ischemic stroke. Our study calls for close observation and early management of children with posterior circulation stroke, in particular with aboriginal ancestry and bilateral and large artery territory infarction.

Prevalence and characteristics of overweight and obesity in indigenous Australian children: A systematic review

Evidence-based profiling of obesity and overweight in Indigenous Australian children has been poor. This study systematically reviewed evidence of the prevalence and patterns of obesity/overweight, with respect to gender, age, remoteness, and birth weight, in Indigenous Australian children, 0-18 years (PROSPERO CRD42014007626). Study quality and risk of bias were assessed. Twenty-five publications (21 studies) met inclusion criteria, with large variations in prevalence for obesity or overweight (11 to 54%) reported. A high degree of heterogeneity in study design was observed, few studies (6/21) were representative of the target population, and few appropriately recruited Indigenous children (8/21). Variability in study design, conduct, and small sample sizes mean that it is not possible to derive a single estimate for prevalence although two high-quality studies indicate at least one in four Indigenous Australian children are overweight or obese. Four of six studies reporting on gender, found overweight/obesity higher in girls and eight studies reporting on overweight/obesity by age suggest prevalence increases with age with one high quality large national study reporting total overweight/obesity as 22.4% of children aged 2-4 years, 27.5% of those aged 5-9, 38.5% aged 10-14, and 36.3% aged 15-17. Three of four studies, reporting obesity/overweight by region, found lower rates for children living in more remote areas than urban areas.

Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents

Australia is predicted to have the highest overweight/obesity rate in the world by 2022 outranking the USA and UK. The purpose of this systematic review was to evaluate the associations between childhood obesity and physical and psychological health co-morbidities. Therefore, a systematic literature search was conducted from six databases (2004-2014). Studies were included if they investigated obesity-related co-morbidities with participants residing in Australia aged 0-18 years. Forty-seven studies fulfilled selection criteria. Evidence suggests that overweight/obese Australian children and adolescents, compared to normal-weight peers, had more cardio-metabolic risk factors and higher risk factors of non-alcohol fatty liver disease and were experiencing more negative psychological outcomes (depression, low self-esteem and lower scores of health-related quality of life). Many other health consequences have either not been investigated in Australia, or as frequently as in other countries.

CONCLUSIONS

Given Australia's current overweight/obesity prevalence and trajectory, Australia-based studies are needed to identify the suspected co-morbidities, understand the range of individual, social and environmental mechanisms driving obesity, and help identify policies, interventions and strategies that will change the future trajectory and 'disease burden' both in Australia and internationally.

WHAT IS KNOWN

• Trend analyses have shown that obesity prevalence in Australia is increasing and will outrank UK and the USA by 2022. • Every third Australian child/adolescent between 5 and 19 years old is predicted to be classified as overweight or obese by 2025. • Childhood obesity is associated with multiple immediate physical and psychological health co-morbidities as well as co-morbidities in adulthood. These have often been identified and examined individually. What is New: • This paper presents a holistic picture of childhood obesity and the associated multiple co-morbidities in Australia. • The extensive health-related outcomes from childhood obesity and those requiring further research are identified. • The findings of this paper will influence the development of local/regional, state and national strategies to change Australia's future trajectory.

Indigenous child health: are we making progress?

We identified 244 relevant articles pertinent to indigenous health (4% of the total) with a steady increase in number since 1995. Most Australian publications in the journal (with a small Indigenous population) have focussed on conditions such as malnutrition, diarrhoeal disease, iron deficiency, rheumatic fever, acute glomerulonephritis and respiratory and ear infections, and in settings where nearly all affected children are Indigenous. In contrast, New Zealand publications (with a large Maori and Pacific Islander population) have addressed important health issues affecting all children but emphasised the over-representation of Maori and Pacific Islanders. Publications in the journal are largely descriptive studies with relatively few systematic reviews and randomised trials. Our review attempts to cover the important Indigenous health issues in our region as represented by articles published in the Journal. The studies do document definite improvements in indigenous child health over the last 50 years.

Cardioembolic stroke in children: a clinical presentation and outcome study

BACKGROUND

Cardiac disease is a common cause of ischemic stroke in children. Limited information is available about its incidence and long-term outcome.

METHODS

We undertook a retrospective study of children (age 0-17 years) with cardioembolic arterial ischemic stroke, occurring between 1992 and December 2007. Study subjects were observed at the Winnipeg Children's Hospital and identified using multiple databases and disease code searches.

RESULTS

We identified 84 children with arterial ischemic stroke, 17 (20%) of which were cardioembolic stroke (15 non-neonates; 10 females; mean age 4.6 years). The crude annual incidence rate for cardioembolic stroke was estimated to be 0.39 and mortality rate of 0.046 per 100,000 person-years. Stroke occurred commonly in children <5 years (65%) and during hospitalization (65%). Initial presenting symptoms were focal deficits 12 (71%), altered consciousness 5 (29%), seizures 5 (29%), and headache 3 (18%). The mean stroke severity measured by Pediatric National Institutes of Health Stroke Scale was 14.5 (range 2-40) at presentation and 3.7 (range 0-9) at discharge, with mean acute recovery from stroke presentation to discharge of 9.94 (0-32). At 2 years, poor outcome was evident in 10 (59%) children: 2 or >2 Pediatric Stroke Outcome Measure score in 6 (35%), death in 2 (12%), and recurrent stroke in 2 (12%). Factors associated with poor outcome included headache (P = 0.048), high Pediatric National Institutes of Health Stroke Scale at presentation (r = 0.57; P = 0.05) and discharge (r = 0.58; P = 0.05), and high Pediatric Stroke Outcome Measure at discharge (r = 0.77; P = 0.0008).

CONCLUSION

Our cohort provides hospital-based incidence estimates for children with cardioembolic stroke. Pediatric National Institutes of Health Stroke Scale performed at different time points can be a helpful tool in measuring stroke recovery and needs to be further explored.

Temporal trends in weight and current weight-related behaviour of Australian Aboriginal school-aged children

OBJECTIVES

To report 13-year trends in weight status of Australian Aboriginal children, and to describe weight-related behaviour in children in 2010, by Aboriginality.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional population surveys of children aged 5-16 years (n = 18 983) conducted in New South Wales schools in Term 1 of 1997, 2004 and 2010.

MAIN OUTCOME MEASURES

For trend analysis: body mass index and waist-to-height ratio (WtHr). Analyses of weight-related behaviour from 2010 survey data included indicators of dietary habits, screen time (ST) and physical activity.

RESULTS

Between 1997 and 2010, the relative increase in prevalence of overweight/obesity and WtHr ≥ 0.5 was 22.4% and 113.6%, respectively, among Aboriginal children, and 11.8% and 3.4%, respectively, among non-Aboriginal children. In 2010, Aboriginal children had 1.52 (95% CI, 1.03-2.24) greater odds of having a WtHr ≥ 0.5 than non-Aboriginal children. Compared with non-Aboriginal children, Aboriginal children also had significantly lower odds of eating breakfast daily (adjusted odds ratio [AOR], 0.72; 95% CI, 0.52-0.99) and significantly greater odds of drinking ≥ 1 cup of soft drink daily (AOR, 1.61; 95% CI, 1.13-2.29), having a television in their bedroom (AOR, 2.75; 95% CI, 2.04-3.70), having no ST rules (AOR, 1.34; 95% CI, 1.04-1.73) and exceeding ST recommendations on weekdays (AOR, 1.78; 95% CI, 1.32-2.39).

CONCLUSIONS

Overweight/obesity and WtHr have increased more rapidly in Aboriginal than non-Aboriginal children in NSW. Unhealthy weight-related behaviour was frequent among all children, but lack of daily breakfast, excessive ST and soft drink consumption appear particularly problematic among Aboriginal children. Raising awareness with families of the consequences of excessive ST and encouraging strategies to limit ST (such as rethinking placement of televisions in children's bedrooms and implementing ST rules) hold promise.

Early life influences on cardio-metabolic disease risk in aboriginal populations--what is the evidence? A systematic review of longitudinal and case-control studies

BACKGROUND

We systematically reviewed the published evidence for the developmental origins of health and disease hypothesis among aboriginal populations from Australia, Canada, New Zealand and the USA.

METHODS

Medline, EMBASE and the Informit Health databases were systematically searched (March 2012) using medical subject headings and keywords for studies that examined the effect of prenatal factors and birth outcomes on later life (≥3 years) cardio-metabolic diseases. Quality of studies was independently assessed by two reviewers using a risk of bias assessment tool; main findings from studies with a low to moderate risk of bias were summarised qualitatively.

RESULTS

In all, 844 studies were found; 50 were included in the review of which 41 had a low-moderate risk of bias. There was strong evidence for an association between birth weight and type 2 diabetes (6/7 studies), impaired kidney function (6/7 studies) and high blood pressure (5/6 studies), whereas there was limited evidence for an association with metabolic abnormalities (4/7 studies) and adiposity (4/7). Exposure to maternal diabetes was strongly associated with type 2 diabetes (9/10 studies) and metabolic abnormalities (5/7 studies), whereas the association with adiposity was low (3/9 studies); the limited number of studies, to date, also show a relationship with high blood pressure (2/2 studies).

CONCLUSIONS

This review highlights that interventions to reduce the burden of cardio-metabolic disease among aboriginal populations should focus on improving maternal health, particularly by reducing the prevalence of diabetes in pregnancy. Future research should also be directed towards potential protective actions, such as breastfeeding.

Chronic kidney disease among high school students of Kinshasa

Background

Chronic kidney disease (CKD) is a major worldwide health problem. However, its burden among adolescents and young adults is unknown, especially in sub-Saharan Africa. The aim of this study was to investigate its prevalence in the school environment. The concordance of usual formulas used to estimate renal function was also assessed.

Methods

In an epidemiological cross sectional study, a random sample of 524 pupils (263 boys, mean age of 18.7 ± 1.4 years) from school environment of Kinshasa were studied. Recorded parameters of interest were anthropometric, proteinuria, serum creatinine and estimated glomerular filtration rate (eGFR) according to the Schwartz formula using uncalibrated creatinine levels from one random measurement. CKD was defined as the presence of kidney damage (daily proteinuria ≥ 300 mg) and/or reduced kidney function (eGFR < 60 ml/min/1.73 m²). Concordances between eGFR according to Schwartz, Cockcroft-Gault (C-G) indexed for BSA and modification of diet in renal disease (MDRD) study equations were computed using the kappa coefficient.

Results

The prevalence of CKD by the Schwartz formula was 1.5%. By stage, 0.8% had CKD stage 1 (proteinuria with normal eGFR) and 0.8% had CKD stage 3 (eGFR, 30 to 59 ml/min/1.73 m²). The prevalence of proteinuria ≥ 300 mg/day was 1% (one case had 2.7g/day). Agreement between eGFR according to Schwartz formula and the MDRD formula was excellent (kappa: 88.8%). Although correlations between all formulas were excellent (0.99; 0.87, and 0.89), agreement was poor between eGFR according to Schwartz and C-G indexed BSA equation (kappa: 52.7%) and, poorer with C-G unadjusted for BSA (kappa: 26.9%).

Conclusion

In the large African city of Kinshasa, 2% of high school students have CKD. This high prevalence rate emphasizes the need for appropriate detection and prevention measures in this vulnerable young age population group.

Fetal, developmental, and parental influences on cystatin C in childhood: the Uppsala Family Study

BACKGROUND

The aim was to identify determinants (biomedical and social characteristics of children and their parents) of cystatin C levels in healthy children drawn from a population sample.

STUDY DESIGN

Cross-sectional study.

SETTING & PARTICIPANTS

425 pairs of consecutive full siblings born 1987-1995 in Uppsala were identified using the Swedish Medical Birth Registry and invited with their parents for examination in 2000-2001.

OUTCOME

Serum cystatin C level was log-transformed and analyzed using random-effects models.

MEASUREMENTS

The examination in parents and children consisted of a nonfasting blood sample, anthropometry, and questionnaires about lifestyle and socioeconomic position. Tanner stage was used for assessment of pubertal status.

RESULTS

In age-, height-, and body mass index-adjusted analyses, cystatin C level increased by 2.6% (95% CI, 0.3%-4.8%) higher in Tanner stage 2 vs 1 girls, and 1.6% (95%CI, 0.2%-3.1%) lower in boys than girls. For every 10% increase in maternal cystatin C level, offspring cystatin C level increased by 3.0% (95% CI, 2.2%-3.8%); the equivalent effect for paternal cystatin C level was 2.1% (95% CI, 1.3%-2.9%). Lower maternal education was associated with a 2.4% (95% CI, 0.3%-4.6%) higher cystatin C level in their offspring.

LIMITATIONS

Cross-sectional study design, missing cystatin C values for subset of parents, lack of urinary measurements, no gold-standard measurement of glomerular filtration rate.

CONCLUSIONS

There are intergenerational associations of cystatin C level in families in line with previous reports of heritability of kidney disease. Lower maternal education is associated with higher cystatin C levels in their children. Further studies of healthy children are needed to explore the biological mechanisms for these findings. If cystatin C is measured, these studies will need to record pubertal stages.