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Moon RJ, D' Angelo S, Curtis EM, Ward KA, Crozier SR, Schoenmakers I, Javaid MK, Bishop NJ, Godfrey KM, Cooper C, Harvey NC. Pregnancy vitamin D supplementation and offspring bone mineral density in childhood follow-up of a randomized controlled trial. Am J Clin Nutr 2024:S0002-9165(24)00746-9. [PMID: 39306330 DOI: 10.1016/j.ajcnut.2024.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 09/12/2024] [Accepted: 09/16/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Findings from the Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial demonstrated a positive effect of gestational cholecalciferol supplementation on offspring bone mineral density (BMD) at age 4 y. Demonstrating the persistence of this effect is important to understanding whether maternal vitamin D supplementation could be a useful public health strategy to improving bone health. OBJECTIVES We investigated whether gestational vitamin D supplementation increases offspring BMD at ages 6-7 y in an exploratory post-hoc analysis of an existing trial. METHODS In the MAVIDOS randomized controlled trial, pregnant females <14 wk' gestation with a singleton pregnancy and serum 25-hydroxyvitamin D 25-100nmol/l at 3 United Kingdom hospitals (Southampton, Sheffield, and Oxford) were randomly assigned to either 1000 IU/d cholecalciferol or placebo from 14 to 17-wk gestation until delivery. Offspring born at term to participants recruited in Southampton were invited to the childhood follow-up at ages 4 and 6-7 y. The children had a dual-energy X-ray absorptiometry (DXA, Hologic discovery) scan of whole-body-less-head (WBLH) and lumbar spine, from which bone area, bone mineral content (BMC), BMD, and bone mineral apparent density (BMAD) were derived. Linear regression was used to compare the 2 groups adjusting for age, sex, height, weight, duration of consumption of human milk, and vitamin D use at 6-7 y. RESULTS A total of 454 children were followed up at ages 6-7 y, of whom 447 had a usable DXA scan. Gestational cholecalciferol supplementation resulted in higher WBLH BMC [0.15 SD, 95% confidence interval (CI): 0.04, 0.26], BMD (0.18 SD, 95% CI: 0.06, 0.31), BMAD (0.18 SD, 95% CI: 0.04, 0.32), and lean mass (0.09 SD, 95% CI: 0.00, 0.17) compared with placebo. The effect of pregnancy cholecalciferol on bone outcomes was similar at ages 4 and 6-7 y. CONCLUSIONS Supplementation with cholecalciferol 1000 IU/d during pregnancy resulted in greater offspring BMD and lean mass in mid-childhood compared with placebo in this exploratory post-hoc analysis. These findings suggest that pregnancy vitamin D supplementation may be an important population health strategy to improve bone health. TRIAL REGISTRATION NUMBER This trial was registered at the ISRCTN (https://doi.org/10.1186/ISRCTN82927713) as 82927713 and EUDRACT (https://www.clinicaltrialsregister.eu/ctr-search/trial/2007-001716-23/results) as 2007-001716-23.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom; Paediatric Endocrinology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, United Kingdom
| | - Stefania D' Angelo
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom
| | - Kate A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom; NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, United Kingdom
| | - Inez Schoenmakers
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - M Kassim Javaid
- NIHR Biomedical Research Centre, University of Oxford, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Nicholas J Bishop
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, United Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, United Kingdom; NIHR Biomedical Research Centre, University of Oxford, United Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, United Kingdom.
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Leck R. The William Houston gold medal of the Royal College of Surgeons of Edinburgh 2022: Two case reports. J Orthod 2024; 51:292-306. [PMID: 37641490 DOI: 10.1177/14653125231191539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
This paper describes the orthodontic treatment of two cases that were successful in winning the William Houston Gold Medal at the Membership in Orthodontics Examinations of the Royal College of Surgeons of Edinburgh in 2022. Both cases discuss the management of palatally impacted maxillary canines and treatment was initiated during the emerging COVID-19 crisis and completed over a 27-month period. The first case describes the management of a 15-year-old female with a Class II division 1 incisor relationship complicated by a palatally impacted upper left canine, moderate upper and lower arch crowding, and a lower centreline discrepancy with an associated right lateral displacement on closure. Treatment involved open surgical exposure of the impacted canine, a quad helix appliance, premolar extractions, and upper and lower fixed appliances. The second case describes the management of a 14-year-old female with a Class III incisor relationship complicated by bilaterally impacted maxillary canines, impeded eruption of the lower right second molar, moderate lower and severe upper arch crowding, and an upper centreline discrepancy. These case reports aim to demonstrate the high standards of care achieved by Orthodontic Specialty Trainee Registrars in the UK and provide aspirational standards for future trainees.
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Affiliation(s)
- Richard Leck
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Zhou WT, Niu JH, Liao C, Ren SK, Ou YW, Liu W, Li CD, Gong J, Tian YJ. Visual deterioration outcomes following optic pathway glioma treatment: a 12-year single institution retrospective study. J Neurooncol 2024:10.1007/s11060-024-04802-3. [PMID: 39167244 DOI: 10.1007/s11060-024-04802-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE The surgical treatment of optic pathway gliomas (OPG) remains controversial, with visual outcomes often unpredictable. The present study explored surgical and clinical factors influencing visual acuity (VA) after OPG treatment and developed anatomical subtypes correlated with clinical symptoms. METHODS Children with OPG who underwent initial partial tumor resection at Beijing Tiantan Hospital from January 2011 to December 2022 were retrospectively analyzed. Multivariate logistic regression and random forest analyses were performed to identify risk factors for post-treatment VA deterioration and a decision tree model was created based on significant factors. RESULTS A total of 140 patients were enrolled. Multivariate logistic regression analysis identified surgical approach and initial VA as independent predictors of post-treatment VA deterioration (P < 0.05). Surgical approach, initial VA, and extent of tumor resection were the most significant factors for risk assessment and were included in the decision tree model, with surgical approach as the most important "root" node. The model demonstrated good predictive performance, with area under the curve values of 0.75 and 0.66 for the training and test datasets, respectively. A simple anatomical classification was developed, which revealed clinical characteristic differences among OPG types. Meanwhile, a correlation analysis of post-treatment visual deterioration was performed for each of the three anatomical types. CONCLUSION This study offers a predictive model for visual outcomes following initial tumor-reduction surgery in OPG patients, which may help in visual outcomes risk stratification. Additionally, the anatomical classification effectively indicates OPG growth direction, offering potential insights into clinical symptoms.
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Affiliation(s)
- Wen-Tao Zhou
- Neurosurgical Centre, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia-Hao Niu
- Neurosurgical Centre, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chihyi Liao
- Neurosurgical Centre, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Si-Kang Ren
- Neurosurgical Centre, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yun-Wei Ou
- Neurosurgical Centre, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- Neurosurgical Centre, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-De Li
- Neurosurgical Centre, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Gong
- Neurosurgical Centre, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Ji Tian
- Neurosurgical Centre, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
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Baroncelli GI, Grandone A, Aversa A, Sessa MR, Pelosini C, Michelucci A, Toschi B, Manca M, Isola A, Comberiati P. Safety and efficacy of burosumab in improving phosphate metabolism, bone health, and quality of life in adolescents with X-linked hypophosphatemic rickets. Eur J Med Genet 2024; 70:104958. [PMID: 38950880 DOI: 10.1016/j.ejmg.2024.104958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 05/21/2024] [Accepted: 06/28/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND AND OBJECTIVE X-linked hypophosphatemic rickets (XLH) is due to loss-of-function mutations in the phosphate-regulating endopeptidase homologue on the X chromosome (PHEX) that lead to increased fibroblast growth factor 23 (FGF23) production. FGF23 excess causes renal phosphate wasting and insufficient 1,25-dihydroxyvitamin D (1,25(OH)2D) synthesis with reduced intestinal phosphate absorption, ultimately resulting in chronic hypophosphatemia. Children with XLH show typical skeletal lesions of rickets, deformities of the lower limbs, stunted growth with disproportionate short stature, bone pain, and physical dysfunctions. Burosumab, a fully human IgG1 monoclonal antibody that binds to FGF23 to inhibit its activity, is more effective to improve the biochemical and clinical signs of XLH than conventional treatment with phosphate supplements and vitamin D active metabolites. Data on adolescents with XLH during the transition period to young adulthood are few. In this prospective case series, we aimed to assess safety and efficacy of burosumab in adolescents with XLH who discontinued long-term conventional therapy. METHODS Five Caucasian adolescents (4 males, 1 female; mean age 15.4 ± 1.5 years) with XLH were recruited and switched from conventional treatment to burosumab (0.8-1.2 mg/kg, s. c. QW2). Burosumab was continued for 12-48 months and, once discontinued, patients were followed-up for 6-12 months. In all patients, serum calcium, phosphate, alkaline phosphatase (ALP), parathyroid hormone (PTH), and 1,25(OH)2D levels, and renal tubular reabsorption of phosphate (TmP/GFR) values were assessed at entry and during burosumab. Intact FGF23 plasma levels were measured at entry. Patient-reported outcomes (PROs) were assessed at entry and every 3-6 months to evaluate the impact of low extremity pain, stiffness, and difficulties performing daily activities. RESULTS At entry, all patients showed hypophosphatemia, increased intact FGF23 levels, reduced TmP/GFR, insufficient 1,25(OH)2D levels, and in four out of five increased ALP levels. Two patients had radiological signs of rickets. During burosumab, all patients showed a significant increase in serum phosphate and 1,25(OH)2D levels, and in TmP/GFR values (P < 0.05 - P < 0.0001). Serum ALP levels significantly declined (P < 0.05) to normal values. No changes of serum calcium and PTH levels (PNS) were found during burosumab. PROs significantly improved (P < 0.02 - P < 0.0001) in all patients. Four patients discontinued burosumab when they turned 18 or 19, whereas one continued the treatment since he was still younger than 18 during the study period. Four patients who suspended burosumab showed a rapid decline in serum phosphate and 1,25(OH)2D levels and in TmP/GFR values; serum ALP levels increased, and PROs progressively worsened with a significant reduction in quality of life. These consequences were not observed in the patient who continued burosumab treatment. DISCUSSION Our data showed that conventional treatment improved only in part the signs and symptoms of XLH. Burosumab was well tolerated and was effective in improving phosphate metabolism, bone health, and PROs. All the benefits of burosumab were lost after its discontinuation. These results suggested that continuing burosumab is required to achieve and maintain the clinical benefits of the treatment during the transition to young adulthood in patients with XLH.
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Affiliation(s)
- Giampiero I Baroncelli
- Pediatric and Adolescent Endocrinology, Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy.
| | - Anna Grandone
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia, Catanzaro, Italy
| | - Maria Rita Sessa
- Chemistry and Endocrinology Laboratory, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - Caterina Pelosini
- Chemistry and Endocrinology Laboratory, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - Angela Michelucci
- Unit of Molecular Genetics, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - Benedetta Toschi
- Section of Medical Genetics, Department of Medical and Oncological Area, University Hospital, Pisa, Italy
| | - Mario Manca
- Unit of Orthopedics, Usl Northwest-Tuscany, Versilia Hospital, Camaiore, Italy
| | - Alessandro Isola
- Unit of Orthopedics, Usl Northwest-Tuscany, Versilia Hospital, Camaiore, Italy
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
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Magerman C, Boros E, Preziosi M, Lhoir S, Gilis N, De Witte O, Heinrichs C, Salmon I, Fricx C, Vermeulen F, Lebrun L, Brachet C, Rodesch M. Childhood craniopharyngioma: a retrospective study of children followed in Hôpital Universitaire de Bruxelles. Front Endocrinol (Lausanne) 2024; 15:1297132. [PMID: 38962684 PMCID: PMC11220494 DOI: 10.3389/fendo.2024.1297132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/11/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Craniopharyngiomas (CPs) are benign brain tumors accounting for 5 - 11% of intracranial tumors in children. These tumors often recur and can cause severe morbidity. Postoperative radiotherapy efficiently controls and prevents progression and recurrence. Despite advancements in neurosurgery, endocrinological, visual, and neuropsychological complications are common and significantly lower the quality of life of patients. Methods We performed a retrospective study, including all patients younger than sixteen diagnosed with CP between July 1989 and August 2022 and followed up in Hôpital Universitaire de Bruxelles. Results Nineteen children with CP were included, with median age of 7 years at first symptoms and 7.5 at diagnosis. Common symptoms at diagnosis were increased intracranial pressure (63%), visual impairment (47%), growth failure (26%), polyuria/polydipsia (16%), and weight gain (10.5%). As clinical signs at diagnosis, growth failure was observed in 11/18 patients, starting with a median lag of 1 year and 4 months before diagnosis. On ophthalmological examination, 27% of patients had papillary edema and 79% had visual impairment. When visual disturbances were found, the average preoperative volume was higher (p=0.039). Only 6/19 patients had gross total surgical resection. After the first neurosurgery, 83% experienced tumor recurrence or progression at a median time of 22 months. Eleven patients (73%) underwent postsurgical radiotherapy. At diagnosis, growth hormone deficiency (GHD) was the most frequent endocrine deficit (8/17) and one year post surgery, AVP deficiency was the most frequent deficit (14/17). Obesity was present in 13% of patients at diagnosis, and in 40% six months after surgery. There was no significant change in body mass index over time (p=0.273) after the first six months post-surgery. Conclusion CP is a challenging brain tumor that requires multimodal therapy and lifelong multidisciplinary follow-up including hormonal substitution therapy. Early recognition of symptoms is crucial for prompt surgical management. The management of long-term sequelae and morbidity are crucial parts of the clinical path of the patients. The results of this study highlight the fundamental importance of carrying out a complete assessment (ophthalmological, endocrinological, neurocognitive) at the time of diagnosis and during follow-up so that patients can benefit from the best possible care.
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Affiliation(s)
- Clémentine Magerman
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Pediatrics, Brussels, Belgium
| | - Emese Boros
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Pediatric Endocrinology Unit, Brussels, Belgium
| | - Marco Preziosi
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Pediatric imaging Department, Brussels, Belgium
| | - Sophie Lhoir
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Department of Ophthalmology, Brussels, Belgium
| | - Nathalie Gilis
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Neurosurgery, Brussels, Belgium
| | - Olivier De Witte
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Neurosurgery, Brussels, Belgium
| | - Claudine Heinrichs
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Pediatric Endocrinology Unit, Brussels, Belgium
| | - Isabelle Salmon
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Pathology, Brussels, Belgium
- DIAPath, Center for Microscopy and Molecular Imaging (CMMI), ULB, Gosselies, Belgium
| | - Christophe Fricx
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Pediatrics, Brussels, Belgium
| | - Françoise Vermeulen
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Pediatrics, Brussels, Belgium
| | - Laetitia Lebrun
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Pathology, Brussels, Belgium
| | - Cécile Brachet
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Pediatric Endocrinology Unit, Brussels, Belgium
| | - Marine Rodesch
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Pediatrics, Brussels, Belgium
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Lara-Pompa NE, Macdonald S, Fawbert K, Shaw V, Wells JC, Fewtrell M, Hill S. Measuring body composition in pediatric patients with complex diagnoses: Acceptability, practicality, and validation of different techniques. Nutr Clin Pract 2024; 39:673-684. [PMID: 38142311 DOI: 10.1002/ncp.11098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/17/2023] [Accepted: 11/05/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Body composition could help identify malnutrition in pediatric patients, but there is uncertainty over which techniques are most suitable and prevailing opinion that measurements are difficult to obtain in practice. This study examined the acceptability, practicality, reliability, and validity of different anthropometric and body composition measurements in patients with complex diagnoses in a tertiary pediatric hospital. METHODS A total of 152 children aged 5-18 years had weight, height, body mass index (BMI), mid-upper arm circumference (MUAC), 4-site skinfold thicknesses (SFT), bioelectrical impedance analysis (BIA), and dual-energy x-ray absorptiometry (DXA) assessed on admission and discharge. Acceptability was assessed in a continuous scale, practicality with number/percentage of successful measurements, reliability with intraclass correlation coefficients and coefficients of repeatability, and validity between "simpler" techniques and DXA with Bland-Altman analysis of agreement and Cohen kappa. RESULTS Techniques were overall acceptable. Measurements were successful in >50%, with patient refusal uncommon. Coefficients of repeatability were good (0.3 cm MUAC and height, 0.2 kg weight, and 1.0 mm SFTs). All techniques significantly overestimated DXA fat mass, but BMI and triceps SFT better identified abnormal fat mass (κ = 0.46 and 0.49). BIA fat-free mass was not significantly different from DXA, with substantial agreement between techniques (κ = 0.65). CONCLUSION Body composition by a range of techniques is acceptable, practical, and reliable in a diverse group of children with complex diagnoses. BIA seems a good alternative to DXA for assessing fat-free mass, triceps SFT, and BMI for fat mass but should be used with care as it could overestimate total fat mass in individuals.
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Affiliation(s)
- Nara E Lara-Pompa
- Childhood Nutrition Research Centre, UCL Great Ormond St Institute of Child Health, London, UK
- Clinical Nutrition, Hospital Infantil Teletón de Oncología, Santiago de Querétaro, México
| | - Sarah Macdonald
- Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Katherine Fawbert
- Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Vanessa Shaw
- Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, UCL Great Ormond St Institute of Child Health, London, UK
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, UCL Great Ormond St Institute of Child Health, London, UK
| | - Susan Hill
- Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Prentice A, Jarjou LM, Goldberg GR, Schoenbuchner SM, Moore SE, Ward KA, Cole TJ. Effects of maternal calcium supplementation on offspring blood pressure and growth in childhood and adolescence in a population with a low-calcium intake: follow-up study of a randomized controlled trial. Am J Clin Nutr 2024; 119:1443-1454. [PMID: 38839195 PMCID: PMC11196864 DOI: 10.1016/j.ajcnut.2024.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The World Health Organization recommends calcium supplementation (1500-2000 mg/d) during pregnancy for women with a low-calcium intake. OBJECTIVES The purpose of this study was to investigate whether pregnancy calcium supplementation affects offspring blood pressure and growth in The Gambia where calcium intakes are low (300-400 mg/d). METHODS Follow-up of offspring born during a randomized controlled trial of pregnancy calcium supplementation (ISRCTN96502494, 1996-2000) in which mothers were randomly assigned to 1500 mg Ca/d (Ca) or placebo (P) from 20 wk pregnancy to delivery. Offspring were enrolled at age 3 y in studies where blood pressure and anthropometry were measured under standardized conditions at approximately 2-yearly intervals. Mean blood pressure and growth curves were fitted for females and males separately, using the longitudinal SuperImposition by Translation and Rotation (SITAR) mixed effects model. This generates 3 individual-specific random effects: size, timing, and intensity, reflecting differences in size, age at peak velocity, and peak velocity through puberty relative to the mean curve, respectively. RESULTS Five hundred twenty-three singleton infants were born during the trial (maternal group assignment: Ca/P = 259/264). Four hundred ninety-one were enrolled as children (females: F-Ca/F-P = 122/129 and males: M-Ca/M-P = 119/121) and measured regularly from 3.0 y to mean age 18.4 y; 90% were measured on ≥8 occasions. SITAR revealed differences in the systolic blood pressure and height curves between pregnancy supplement groups in females, but not in males. F-Ca had lower systolic blood pressure than F-P at all ages (size = -2.1 ± SE 0.8 mmHg; P = 0.005) and lower peak height velocity (intensity = -2.9 ± SE 1.1%, P = 0.009). No significant pregnancy supplement effects were seen for other measures. CONCLUSIONS This study showed, in female offspring, that pregnancy calcium supplementation may lower systolic blood pressure and slow linear growth in childhood and adolescence, adding to evidence of offspring sexual dimorphism in responses to maternal supplementation. Further research is warranted on the long-term and intergenerational effects of antenatal supplementations. This trial was registered at ISRCTN Registry as ISRCTN96502494.
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Affiliation(s)
- Ann Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom; MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
| | - Landing Ma Jarjou
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia
| | - Gail R Goldberg
- MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom
| | - Simon M Schoenbuchner
- MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom; Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sophie E Moore
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; Department of Women and Children's Health, Kings College London, London, United Kingdom
| | - Kate A Ward
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Tim J Cole
- Department of Population, Policy and Practice Research and Teaching, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Moon RJ, D'Angelo S, Crozier SR, Fernandes M, Fall C, Gale CR, Godfrey KM, Davies JH, Cooper C, Harvey NC. Cognitive function and skeletal size and mineral density at age 6-7 years: Findings from the Southampton Women's Survey. Bone 2024; 182:117067. [PMID: 38438096 DOI: 10.1016/j.bone.2024.117067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Poor cognitive function and osteoporosis commonly co-exist in later life. In women, this is often attributed to post-menopausal estrogen loss. However, a common early life origin for these conditions and the associations between cognitive function and bone mineral density (BMD) in childhood have not previously been explored. We examined these relationships at age 6-7 years in the Southampton Women's Survey (SWS) mother-offspring cohort. METHODS Child occipitofrontal circumference (OFC), a proxy for brain volume, intelligence quotient (IQ) [Wechsler Abbreviated Scale of Intelligence] and visual recognition and working memory [CANTAB® Delayed Matching to Sample (DMS) and Spatial Span Length (SSP), respectively] were assessed. Whole-body-less-head (WBLH) and lumbar spine dual-energy X-ray absorptiometry [Hologic Discovery] (DXA) were performed to measure bone area (BA), bone mineral content (BMC), BMD and bone mineral apparent density (BMAD). Linear regression was used to examine associations between age and sex standardized variables (β represent standard deviation (SD) difference per SD of cognitive function). RESULTS DXA was performed in 1331 children (mean (SD) age 6.8 (0.33) years, 51.5 % male), with OFC, IQ, DMS and SSP assessed in 1250, 551, 490 and 460, respectively. OFC (β = 0.25 SD/SD, 95%CI 0.20,0.30), IQ (β = 0.11 SD/SD, 95%CI 0.02,0.19), and DMS (β = 0.11, SD/SD, 95%CI 0.01,0.20) were positively associated with WBLH BA, with similar associations for lumbar spine BA. OFC and DMS were also positively associated with WBLH BMC, but only OFC was associated with BMD (WBLH: β = 0.38 SD/SD, 95%CI 0.33,0.43; LS: β = 0.19 SD/SD, 95%CI 0.13,0.24). CONCLUSION Childhood brain volume was positively associated with measures of skeletal size and BMD, whereas IQ and memory were associated only with skeletal size. These findings suggest that common early life determinants for skeletal growth and BMD and cognitive function should be explored to identify potential early-life approaches to preventing osteoporosis and cognitive decline.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; Paediatric Endocrinology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
| | - Stefania D'Angelo
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton SO16 7NP, UK
| | - Michelle Fernandes
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; Department of Neonatal Medicine, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, Tremona Road, Southampton SO16 5YA, UK
| | - Caroline Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Catharine R Gale
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Justin H Davies
- Paediatric Endocrinology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Biomedical Research Centre, University of Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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9
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Essers E, Granés L, Delaney S, Ballester J, Santos S, Petricola S, Yang TC, Fernández-Somoano A, Bereziartua A, Ballester F, Tardón A, Vrijheid M, Lertxundi A, McEachan RRC, El Marroun H, Tiemeier H, Iñiguez C, Guxens M. Ambient air temperature exposure and foetal size and growth in three European birth cohorts. ENVIRONMENT INTERNATIONAL 2024; 186:108619. [PMID: 38603813 DOI: 10.1016/j.envint.2024.108619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/30/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Ambient air temperature may affect birth outcomes adversely, but little is known about their impact on foetal growth throughout pregnancy. We evaluated the association between temperature exposure during pregnancy and foetal size and growth in three European birth cohorts. METHODS We studied 23,408 pregnant women from the English Born in Bradford cohort, Dutch Generation R Study, and Spanish INMA Project. Using the UrbClimTM model, weekly ambient air temperature exposure at 100x100m resolution at the mothers' residences during pregnancy was calculated. Estimated foetal weight, head circumference, and femur length at mid and late pregnancy and weight, head circumference, and length at birth were converted into standard deviation scores (SDS). Foetal growth from mid to late pregnancy was calculated (grams or centimetres/week). Cohort/region-specific distributed lag non-linear models were combined using a random-effects meta-analysis and results presented in reference to the median percentile of temperature (14 °C). RESULTS Weekly temperatures ranged from -5.6 (Bradford) to 30.3 °C (INMA-Sabadell). Cold and heat exposure during weeks 1-28 were associated with a smaller and larger head circumference in late pregnancy, respectively (e.g., for 9.5 °C: -1.6 SDS [95 %CI -2.0; -0.4] and for 20.0 °C: 1.8 SDS [0.7; 2.9]). A susceptibility period from weeks 1-7 was identified for cold exposure and a smaller head circumference at late pregnancy. Cold exposure was associated with a slower head circumference growth from mid to late pregnancy (for 5.5 °C: -0.1 cm/week [-0.2; -0.04]), with a susceptibility period from weeks 4-12. No associations that survived multiple testing correction were found for other foetal or any birth outcomes. CONCLUSIONS Cumulative exposure to cold and heat during pregnancy was associated with changes in foetal head circumference throughout gestation, with susceptibility periods for cold during the first pregnancy trimester. No associations were found at birth, suggesting potential recovery. Future research should replicate this study across different climatic regions including varying temperature profiles.
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Affiliation(s)
- Esmée Essers
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, the Netherlands; Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Laura Granés
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain
| | - Scott Delaney
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Susana Santos
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Sami Petricola
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Tiffany C Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ana Fernández-Somoano
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; IUOPA-Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Ainhoa Bereziartua
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), Leioa, Spain; Group of Environmental Epidemiology and Child Development, IIS Biogipuzkoa, Donostia-San Sebastian, Guipuzcoa, Spain
| | - Ferran Ballester
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Nursing, Universitat de València, Valencia, Spain; Epidemiology and Environmental Health Joint Research Unit, FISABIO- Universitat Jaume I- Universitat de València, Valencia, Spain
| | - Adonina Tardón
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; IUOPA-Department of Medicine, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Aitana Lertxundi
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Rosemary R C McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, the Netherlands; Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus MC, Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, the Netherlands; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Carmen Iñiguez
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Statistics and Operational Research, Universitat de València, València, Spain
| | - Mònica Guxens
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, the Netherlands.
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10
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Baroncelli GI, Sessa MR, Pelosini C, Bertelloni S, Michelucci A, Toschi B, Piaggi P, Peroni D, Comberiati P. Intact FGF23 concentration in healthy infants, children, and adolescents, and diagnostic usefulness in patients with X-linked hypophosphatemic rickets. J Endocrinol Invest 2024; 47:873-882. [PMID: 37991698 DOI: 10.1007/s40618-023-02202-4] [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] [Received: 03/15/2023] [Accepted: 09/14/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE FGF23 measurement may have a diagnostic role to investigate patients with phosphate disorders. However, normal values for infants, children, and adolescents have not been defined. METHODS In a total of 282 (males 145, females 137) healthy infants (n = 30), prepubertal (n = 147), pubertal (n = 59), and postpubertal (n = 46), and in twenty patients with X-linked hypophosphatemic rickets (XLH, age 10.2 ± 5.6 years) serum phosphate (automated analyzer), and plasma intact FGF23 (immunochemiluminescent sandwich assay, DiaSorin) concentrations were measured. RESULTS Intact FGF23 concentrations were higher in healthy infants than in prepubertal (P < 0.01) and postpubertal subjects (P < 0.05); pubertal subjects showed higher values (P < 0.05) than postpubertal subjects. Serum phosphate concentrations were higher (P < 0.001) in healthy infants than in prepubertal, pubertal, and postpubertal subjects. Pubertal subjects had higher (P < 0.001) serum phosphate concentrations than postpubertal subjects. Intact FGF23 and serum phosphate concentrations did not differ (P = NS) by sex, age of menarche, and time after menarche. In healthy subjects, there was no correlation between intact FGF23 and serum phosphate concentrations. Intact FGF23 concentrations were higher (P < 0.0001) in patients with XLH than in healthy subjects according to chronological age and pubertal development. In all patients, intact FGF23 concentrations were above 40 pg/mL; intact FGF23 concentrations were inversely correlated with serum phosphate concentrations (r = -0.65; P < 0.01). CONCLUSION In healthy subjects, chronological age and puberty were main determinants of intact FGF23 concentrations. Intact FGF23 concentrations may be a useful marker for the early diagnosis of XLH in pediatric patients.
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Affiliation(s)
- G I Baroncelli
- Pediatric and Adolescent Endocrinology, Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - M R Sessa
- Chemistry and Endocrinology Laboratory, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - C Pelosini
- Chemistry and Endocrinology Laboratory, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - S Bertelloni
- Pediatric and Adolescent Endocrinology, Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - A Michelucci
- Unit of Molecular Genetics, Department of Laboratory Medicine, University Hospital, Pisa, Italy
| | - B Toschi
- Section of Medical Genetics, Department of Medical and Oncological Area, University Hospital, Pisa, Italy
| | - P Piaggi
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - D Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - P Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
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11
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Edwards KL, Thomas JM, Higgs S, Blissett J. Repeated exposure to models' positive facial expressions whilst eating a raw vegetable increases children's consumption of the modelled vegetable. Eat Behav 2024; 53:101872. [PMID: 38537417 DOI: 10.1016/j.eatbeh.2024.101872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 06/03/2024]
Abstract
Exposing children to adults eating a raw vegetable with positive facial expressions ('positive modelling') increases children's consumption of the modelled vegetable. However, whether repeated versus a single exposure to positive modelling enhances this effect, and whether it generalises to a non-modelled vegetable, remains to be examined. Hence, this study examined the effect of a single exposure, versus repeated, exposure to positive modelling on children's acceptance and intake of a modelled and non-modelled vegetable. Children aged 5-6 years (N = 153; 81 males, 72 females) were randomised to one of three conditions in which they had i) a single or ii) repeated exposure to a video of adults eating raw broccoli with positive facial expressions or iii) were exposed to a no-food control video. Children's acceptance (measured as willingness to try and number of tastes), intake and liking of a modelled (raw broccoli) and non-modelled vegetable (raw mangetout) were measured. Children had greater raw broccoli consumption and liking if they had received repeated exposure to positive modelling, compared to children who had received a single exposure, but not compared to children in the control condition. Children's mangetout intake was greater in the single (versus repeated) positive condition, but this effect was not dependent on time. There was no effect on children's vegetable acceptance. Repeatedly exposing children to adults enjoying a vegetable encourages children's intake of the modelled vegetable in comparison to a single exposure. Thus, repeated exposure to others' food enjoyment may be a practical and useful strategy to encourage children's vegetable consumption.
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Affiliation(s)
- Katie L Edwards
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham B4 7ET, UK.
| | - Jason M Thomas
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham B4 7ET, UK
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
| | - Jacqueline Blissett
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham B4 7ET, UK
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12
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Harris HA, Kininmonth AR, Nas Z, Derks IPM, Quigley F, Jansen PW, Llewellyn C. Prospective associations between early childhood parental feeding practices and eating disorder symptoms and disordered eating behaviors in adolescence. Int J Eat Disord 2024; 57:716-726. [PMID: 38387486 DOI: 10.1002/eat.24159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Nonresponsive parental feeding practices are associated with poorer appetite self-regulation in children. It is unknown whether this relationship extends beyond childhood to be prospectively associated with the onset of eating disorder (ED) symptoms in adolescence. This exploratory study therefore investigated prospective associations between early childhood parental feeding practices and adolescent ED symptoms and disordered eating behaviors. METHODS Data were from two population-based cohorts with harmonized measures: Generation R (Netherlands; n = 4900) and Gemini (UK; n = 2094). Parents self-reported their pressure to eat, restriction and instrumental feeding (i.e., using food as a reward) at child age 4-5 years. Adolescents self-reported their compensatory behaviors (e.g., fasting, purging), binge-eating symptoms, restrained eating, uncontrolled eating, and emotional eating at 12-14 years. Associations between feeding practices and ED symptoms were examined separately in each cohort using generalized linear models. RESULTS In Gemini, pressure to eat in early childhood was associated with adolescents engaging in compensatory behaviors. In Generation R, parental restriction was associated with adolescents engaging in compensatory behaviors, restrained eating, uncontrolled eating, and emotional eating. Instrumental feeding was associated with uncontrolled eating and emotional eating in Generation R. DISCUSSION Nonresponsive parental feeding practices were associated with a greater frequency of specific ED symptoms and disordered eating in adolescence, although effect sizes were small and findings were inconsistent between cohorts. Potentially, the cultural and developmental context in which child-parent feeding interactions occur is important for ED symptoms. Further replication studies are required to better understand parents' role in the development and maintenance of ED-related symptoms. PUBLIC SIGNIFICANCE Prospective research examining how early childhood parental feeding practices might contribute to adolescent ED symptoms is limited. In two population-based cohorts, nonresponsive feeding practices (restriction, instrumental feeding, pressure to eat) predicted increased frequency of some ED symptoms and disordered eating behaviors in adolescence, although associations were small and further replication is required. Findings support the promotion of responsive feeding practices, which may benefit young children's developing relationship with food.
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Affiliation(s)
- Holly A Harris
- Department of Child & Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Alice R Kininmonth
- School of Psychology, University of Leeds, Leeds, UK
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Zeynep Nas
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Ivonne P M Derks
- Department of Child & Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Fiona Quigley
- Institute for Nursing and Health Research, Ulster University, Belfast, Northern Ireland
| | - Pauline W Jansen
- Department of Child & Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Clare Llewellyn
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
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13
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Fitzgerald F, Campbell M, Kearney PE, Cumming S. Exploring the existence, strength, and independence of relative age and maturation selection biases: a case study in Gaelic football talent development programmes. Ann Hum Biol 2024; 51:2349040. [PMID: 38809024 DOI: 10.1080/03014460.2024.2349040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/23/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Biological maturity and relative age player selection biases are well documented in youth sports. However, there has been limited examination of the relationship between these biases. AIM This study investigated the presence, strength, and independence of relative age and biological maturity selection biases in Gaelic football. SUBJECTS AND METHODS A total of 247 male players from U14 to U16, from two talent academies were assessed for relative age (decimal age (DA)) and biological maturity (discrepancy between biological and chronological age (BA-CA)). RESULTS Relative age effects (RAE) were observed in the U14 (DA = 0.62, d = 0.40) and U15 squads (DA = 0.57. d = 0.26) only. A bias towards advanced maturity status was present at U14 (BA-CA = 0.60, d = 0.83), U15 (BA-CA = 0.78, d = 0.89), and U16 (BA-CA, d = 1.01). There was a trivial (U14, r(83) = -0.210; U15, r(88) = 0.060) and low (U16, r(76) = 0.352) correlation between relative age and maturity status. CONCLUSION Substantial maturity selection biases and, to a lesser degree, relative age biases are evident in youth Gaelic football. Critically, these biases are independent constructs. Coaches and policy makers should be educated on the distinct influences of relative age and maturation, and on strategies to address these biases.
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Affiliation(s)
- F Fitzgerald
- Department of Health and Leisure, Munster Technological University Kerry, Tralee, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Sport & Human Performance Research Centre, Limerick, Ireland
- Performance and Research Department, Kerry GAA, Co. Kerry, Ireland
| | - M Campbell
- Department of Physical Education and Sport Sciences, University of Limerick, Sport & Human Performance Research Centre, Limerick, Ireland
| | - P E Kearney
- Department of Physical Education and Sport Sciences, University of Limerick, Sport & Human Performance Research Centre, Limerick, Ireland
| | - S Cumming
- Department for Health, University of Bath, Bath, United Kingdom
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Sanchez-Cerezo J, Neale J, Julius N, Croudace T, Lynn RM, Hudson LD, Nicholls D. Subtypes of avoidant/restrictive food intake disorder in children and adolescents: a latent class analysis. EClinicalMedicine 2024; 68:102440. [PMID: 38333539 PMCID: PMC10850399 DOI: 10.1016/j.eclinm.2024.102440] [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: 09/06/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
Background The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) describes three primary avoidant/restrictive food intake disorder (ARFID) subtypes including sensory sensitivity, lack of interest in food or eating, and fear of aversive consequences. Studies exploring these subtypes have yielded varying results. We used latent class analysis (LCA) based on the psychopathology of ARFID in a sample of children and adolescents to empirically identify classes. Methods We carried out a surveillance study of ARFID in collaboration with the British Paediatric Surveillance Unit (BPSU) and the Child and Adolescent Psychiatry Surveillance System (CAPSS) in the United Kingdom and the Republic of Ireland from 1st of March 2021 to 31st of March 2022. Paediatricians and child and adolescent psychiatrists were contacted monthly to report newly diagnosed cases of ARFID electronically and complete a detailed clinical questionnaire. Cases aged 5-18 years were included. LCA was performed specifying 1-6 classes and likelihood-based tests for model selection. The Bayesian Information Criterion (BIC), the Akaike Information Criterion (AIC) and the Sample-Size Adjusted BIC were used to determine the most parsimonious model. Analysis of variance (ANOVA) and χ2 tests were used to compare the characteristics of the identified classes. A multinomial logistic regression (MLR) was performed to investigate predicting factors for the latent classes. Findings We identified 319 children and adolescents with ARFID. LCA revealed four distinct classes which were labelled as Fear subtype, Lack of Interest subtype, Sensory subtype, and Combined subtype. The probability of being classified as these were 7.2% (n = 23), 25.1% (n = 80), 29.5% (n = 94) and 38.2% (n = 122), respectively. Age at diagnosis, sex, weight loss, distress associated with eating, and autism spectrum disorder diagnosis were identified as predictors of class membership. Interpretation LCA identified four different classes in a sample of children and adolescents with ARFID. The Combined Subtype, a mixed presentation was the most common. The other three classes resembled the subtypes described in the literature. Clinicians should be aware of these different presentations of ARFID as they may benefit from different clinical interventions. Funding This study was funded by the Former EMS Ltd (charity number 1098725, registered October 9th 2017).
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Affiliation(s)
- Javier Sanchez-Cerezo
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- Department of Psychiatry, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Josephine Neale
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- Priory Hospital Ticehurst House, Ticehurst, East Sussex, UK
| | - Nikita Julius
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Tim Croudace
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Richard M. Lynn
- Institute of Child Health, University College London, London, UK
| | - Lee D. Hudson
- Institute of Child Health, University College London, London, UK
| | - Dasha Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
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15
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Wright CM, Chapman S, Cole TJ. How can we best chart children's growth in the paperless age? The UK experience. Arch Dis Child 2024; 109:78-82. [PMID: 37463736 DOI: 10.1136/archdischild-2023-325363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
Growth charts have played an integral part in the monitoring and assessment of children's health for the past 50 years, but their use is now under threat as paperless electronic systems become more widely used. While the obvious solution is to adopt electronic charting systems, this can prove challenging in practice. This article describes the key issues to consider in planning this transition and the charting options available, ranging from bespoke local systems to commercial packages and a new initiative by the Royal College of Paediatrics and Child Health.
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Affiliation(s)
- Charlotte Margaret Wright
- Department of Human Nutrition, School of Medicine Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Simon Chapman
- Department of Child Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Tim J Cole
- Population Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, UK
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16
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Szakszon K, Lourenco CM, Callewaert BL, Geneviève D, Rouxel F, Morin D, Denommé-Pichon AS, Vitobello A, Patterson WG, Louie R, Pinto E Vairo F, Klee E, Kaiwar C, Gavrilova RH, Agre KE, Jacquemont S, Khadijé J, Giltay J, van Gassen K, Merő G, Gerkes E, Van Bon BW, Rinne T, Pfundt R, Brunner HG, Caluseriu O, Grasshoff U, Kehrer M, Haack TB, Khelifa MM, Bergmann AK, Cueto-González AM, Martorell AC, Ramachandrappa S, Sawyer LB, Fasel P, Braun D, Isis A, Superti-Furga A, McNiven V, Chitayat D, Ahmed SA, Brennenstuhl H, Schwaibolf EM, Battisti G, Parmentier B, Stevens SJC. Further delineation of the rare GDACCF (global developmental delay, absent or hypoplastic corpus callosum, dysmorphic facies syndrome): genotype and phenotype of 22 patients with ZNF148 mutations. J Med Genet 2024; 61:132-141. [PMID: 37580113 DOI: 10.1136/jmg-2022-109030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Pathogenic variants in the zinc finger protein coding genes are rare causes of intellectual disability and congenital malformations. Mutations in the ZNF148 gene causing GDACCF syndrome (global developmental delay, absent or hypoplastic corpus callosum, dysmorphic facies; MIM #617260) have been reported in five individuals so far. METHODS As a result of an international collaboration using GeneMatcher Phenome Central Repository and personal communications, here we describe the clinical and molecular genetic characteristics of 22 previously unreported individuals. RESULTS The core clinical phenotype is characterised by developmental delay particularly in the domain of speech development, postnatal growth retardation, microcephaly and facial dysmorphism. Corpus callosum abnormalities appear less frequently than suggested by previous observations. The identified mutations concerned nonsense or frameshift variants that were mainly located in the last exon of the ZNF148 gene. Heterozygous deletion including the entire ZNF148 gene was found in only one case. Most mutations occurred de novo, but were inherited from an affected parent in two families. CONCLUSION The GDACCF syndrome is clinically diverse, and a genotype-first approach, that is, exome sequencing is recommended for establishing a genetic diagnosis rather than a phenotype-first approach. However, the syndrome may be suspected based on some recurrent, recognisable features. Corpus callosum anomalies were not as constant as previously suggested, we therefore recommend to replace the term 'GDACCF syndrome' with 'ZNF148-related neurodevelopmental disorder'.
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Affiliation(s)
- Katalin Szakszon
- Faculty of Medicine Institute of Pediatrics, University of Debrecen, Debrecen, Hungary
- Rare Congenital Malformations and Rare intellectual Disability (ERN ITHACA), European Reference Networks, Debrecen, Hungary
| | - Charles Marques Lourenco
- Neurogenetics Unit - Inborn Errors of Metabolism Clinics, National Reference Center for Rare Diseases, Medicine School of Sao Jose do Rio Preto, Sao Jose do Rio Preto, Brazil
| | - Bert Louis Callewaert
- Center for Medical Genetics, University Hospital Ghent, Gent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - David Geneviève
- Montpellier University, Inserm Unit U1183, Reference Center for Rare Disease: Developmental Anomalies. Clinical Genetic Unit, CHU Montpellier, Montpellier, France
- Rare Congenital Malformations and Rare Intellectual Disability (ERN ITHACA), European Reference Networks, Montpellier, France
| | - Flavien Rouxel
- Génétique Clinique, Départment de Génétique Médicale, Maladies Rares et Médecine Personnalisée, CHU Montpellier, Montpellier University, Centre de Référence Anomalies du Développement SOOR, Montpellier, France
| | - Denis Morin
- Rare Kidney Disease Center, Montpellier University Hospital, Montpellier, France
| | - Anne-Sophie Denommé-Pichon
- Functional Unity of Innovative Diagnosis for Rare Diseases, University of Burgundy, Dijon, France
- Inserm UMR1231 team GAD, University of Burgundy, Dijon, France
| | - Antonio Vitobello
- Functional Unity of Innovative Diagnosis for Rare Diseases, University of Burgundy, Dijon, France
- Inserm UMR1231 team GAD, University of Burgundy, Dijon, France
| | | | - Raymond Louie
- Greenwood Genetic Center Inc, Greenwood, South Carolina, USA
| | - Filippo Pinto E Vairo
- Department of Clinical Genomics, Center for Individualized Medicine, Mayo Clinic Research Rochester, Rochester, Minnesota, USA
| | - Eric Klee
- Department of Clinical Genomics, Center for Individualized Medicine, Mayo Clinic Research Rochester, Rochester, Minnesota, USA
| | - Charu Kaiwar
- Department of Clinical Genomics, Center for Individualized Medicine, Mayo Clinic Research Rochester, Rochester, Minnesota, USA
| | - Ralitza H Gavrilova
- Department of Clinical Genomics, Center for Individualized Medicine, Mayo Clinic Research Rochester, Rochester, Minnesota, USA
| | - Katherine E Agre
- Department of Clinical Genomics, Center for Individualized Medicine, Mayo Clinic Research Rochester, Rochester, Minnesota, USA
| | - Sebastien Jacquemont
- Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Medical Genetics, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Jizi Khadijé
- Department of Medical Genetics, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Jacques Giltay
- Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Koen van Gassen
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gabriella Merő
- Faculty of Medicine Institute of Pediatrics, University of Debrecen, Debrecen, Hungary
| | - Erica Gerkes
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Bregje W Van Bon
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tuula Rinne
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rolph Pfundt
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Han G Brunner
- Klinische Genetica, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Oana Caluseriu
- Medical Genetics Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Ute Grasshoff
- Institute of Medical Genetics and Applied Genomics, University Clinic, Tübingen University, Tübingen, Germany
| | - Martin Kehrer
- Institute of Medical Genetics and Applied Genomics, University Clinic, Tübingen University, Tübingen, Germany
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University Clinic, Tübingen University, Tübingen, Germany
| | | | | | - Anna Maria Cueto-González
- Department of Clinical and Molecular Genetics, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Rare Congenital Malformations and Rare intellectual Disability (ERN ITHACA), European Reference Networks, Barcelona, Spain
| | - Ariadna Campos Martorell
- Pediatric Endocrinology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Endocrinology Group, Vall d'Hebron Barcelona Hospital Campus, Autonomous University of Barcelona, Vall d'Hebron Research Institute, Barcelona, Spain
| | | | - Lindsey B Sawyer
- Department of Medical Genetics, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Pascale Fasel
- Department of Human Genetics, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Dominique Braun
- Department of Human Genetics, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Atallah Isis
- Division of Genetic Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrea Superti-Furga
- Division of Genetic Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Vanda McNiven
- University Health Network and Mount Sinai Hospital, Fred A Litwin Family Centre in Genetic Medicine, Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Syed Anas Ahmed
- University Health Network and Mount Sinai Hospital, Fred A Litwin Family Centre in Genetic Medicine, Toronto, Ontario, Canada
| | | | - Eva Mc Schwaibolf
- Insittute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Gladys Battisti
- Centre de Génétique Humaine, Institut de Pathologie et de Genetique asbl, Gosselies, Belgium
| | - Benoit Parmentier
- Centre de Génétique Humaine, Institut de Pathologie et de Genetique asbl, Gosselies, Belgium
| | - Servi J C Stevens
- Klinische Genetica, Maastricht University Medical Center, Maastricht, The Netherlands
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Castillo L, León-Villagrá P, Chater N, Sanborn A. Explaining the flaws in human random generation as local sampling with momentum. PLoS Comput Biol 2024; 20:e1011739. [PMID: 38181041 PMCID: PMC10796055 DOI: 10.1371/journal.pcbi.1011739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/18/2024] [Accepted: 12/05/2023] [Indexed: 01/07/2024] Open
Abstract
In many tasks, human behavior is far noisier than is optimal. Yet when asked to behave randomly, people are typically too predictable. We argue that these apparently contrasting observations have the same origin: the operation of a general-purpose local sampling algorithm for probabilistic inference. This account makes distinctive predictions regarding random sequence generation, not predicted by previous accounts-which suggests that randomness is produced by inhibition of habitual behavior, striving for unpredictability. We verify these predictions in two experiments: people show the same deviations from randomness when randomly generating from non-uniform or recently-learned distributions. In addition, our data show a novel signature behavior, that people's sequences have too few changes of trajectory, which argues against the specific local sampling algorithms that have been proposed in past work with other tasks. Using computational modeling, we show that local sampling where direction is maintained across trials best explains our data, which suggests it may be used in other tasks too. While local sampling has previously explained why people are unpredictable in standard cognitive tasks, here it also explains why human random sequences are not unpredictable enough.
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Affiliation(s)
- Lucas Castillo
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Pablo León-Villagrá
- Cognitive, Linguistic & Psychological Sciences, Brown University, Providence, Rhode Island, United States of America
| | - Nick Chater
- Warwick Business School, University of Warwick, Coventry, United Kingdom
| | - Adam Sanborn
- Department of Psychology, University of Warwick, Coventry, United Kingdom
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18
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Mathewlynn S, Beriwal S, Ioannou C, Cavallaro A, Impey L. Abnormal umbilical artery pulsatility index in appropriately grown fetuses in the early third trimester: an observational cohort study. J Matern Fetal Neonatal Med 2023; 36:2152670. [PMID: 36482725 DOI: 10.1080/14767058.2022.2152670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine if appropriately grown fetuses (those that are not small-for-gestational-age) with a raised umbilical artery pulsatility index (>95th centile) in the mid third trimester are at increased risk of placental dysfunction and adverse outcome. METHODS This is a 5-year retrospective cohort study using routinely collected data. Inclusion criteria were singleton, non-anomalous pregnancies having a growth scan with umbilical artery Doppler velocimetry between 28 + 0 and 33 + 6 weeks' gestation. Small-for-gestational-age fetuses were excluded. Cases were classified as group 1 (those with an umbilical artery pulsatility index >95th centile at any scan during target window) or group 2 (those where the umbilical artery pulsatility index was ≤95th centile at all scans). p-Values and odds ratios were calculated. Logistic regression was used to compute odds ratios adjusted for baseline estimated weight z-score, gestational age at delivery, and labor induction. RESULTS After exclusions, there were 202 pregnancies in group 1 and 7950 in group 2. Differences in baseline characteristics between the groups include age (median age was 30 for group 1 and 32 for group 2, p < .001), smoking (group 1 were more likely to smoke, p < .001) and labor induction (more common in group 1, p = .03). Among those delivering ≥34 + 0, group 1 were more likely to be small-for-gestational-age and have an abnormal cerebro-placental ratio at the final scan (OR 6.76, CI 4.23-10.80 and OR 5.07, CI 3.37-7.63 respectively), and to develop features of growth restriction (OR 9.85, CI 6.27-15.49). Group 1 were also more likely to deliver <37 + 0 weeks' gestation (OR 1.71, CI 1.13-2.58) and to have birthweight <10th or <3rd centile (OR 5.26, CI 3.65-7.58 and OR 6.13, CI 3.00-12.54 respectively). These associations remained significant when adjusted for estimated weight at the initial scan. CONCLUSIONS These data suggest that raised umbilical artery pulsatility index in an appropriately grown fetus at 28 + 0 to 33 + 6 weeks' gestation is associated with subsequent development of growth restriction markers and an increased risk of moderate and severe small-for-gestational-age at birth. This is independent of the estimated weight of these babies at the index scan.
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Affiliation(s)
- Sam Mathewlynn
- Fetal Medicine Unit, Level 6, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Sridevi Beriwal
- Fetal Medicine Unit, Level 6, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Christos Ioannou
- Fetal Medicine Unit, Level 6, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Angelo Cavallaro
- Fetal Medicine Unit, Level 6, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Lawrence Impey
- Fetal Medicine Unit, Level 6, Women's Centre, John Radcliffe Hospital, Oxford, UK
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19
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Billich N, O'Brien K, Fredwall SO, Lee M, Savarirayan R, Davidson ZE. A scoping review of nutrition issues and management strategies in individuals with skeletal dysplasia. Genet Med 2023; 25:100920. [PMID: 37330695 DOI: 10.1016/j.gim.2023.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE Skeletal dysplasia are heterogeneous conditions affecting the skeleton. Common nutrition issues include feeding difficulties, obesity, and metabolic complications. This systematic scoping review aimed to identify key nutrition issues, management strategies, and gaps in knowledge regarding nutrition in skeletal dysplasia. METHODS The databases Ovid MEDLINE, Ovid EMBASE, Ebsco CINAHL, Scopus, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews were searched. Reference lists and citing literature for included studies were searched. Eligible studies included participants with skeletal dysplasia and described: anthropometry, body composition, nutrition-related biochemistry, clinical issues, dietary intake, measured energy or nutrition requirements, or nutrition interventions. RESULTS The literature search identified 8509 references from which 138 studies were included (130 observational, 3 intervention, 2 systematic reviews, and 3 clinical guidelines). Across 17 diagnoses identified, most studies described osteogenesis imperfecta (n = 50) and achondroplasia or hypochondroplasia (n = 47). Nutrition-related clinical issues, biochemistry, obesity, and metabolic complications were most commonly reported, and few studies measured energy requirements (n = 5). CONCLUSION Nutrition-related comorbidities are documented in skeletal dysplasia; yet, evidence to guide management is scarce. Evidence describing nutrition in rarer skeletal dysplasia conditions is lacking. Advances in skeletal dysplasia nutrition knowledge is needed to optimize broader health outcomes.
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Affiliation(s)
- Natassja Billich
- Murdoch Children's Research Institute, Parkville, VIC, Australia; The University of Queensland, St Lucia, QLD, Australia.
| | - Katie O'Brien
- Royal Children's Hospital, Parkville, VIC, Australia; Monash University, Clayton, VIC, Australia
| | - Svein O Fredwall
- Murdoch Children's Research Institute, Parkville, VIC, Australia; TRS National Resource Centre for Rare Disorders, Sunnaas Rehabiliation Hospital, Nesodden, Norway
| | | | - Ravi Savarirayan
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Parkville, VIC, Australia
| | - Zoe E Davidson
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Monash University, Clayton, VIC, Australia
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20
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Hennessy Á, McCarthy EK, Ní Chaoimh C, Murray DM, Kiely ME. Poor Quality Diets Characterized by Low-Nutrient Density Foods Observed in One-Quarter of 2-Year-Olds in a High Resource Setting. J Nutr 2023; 153:2678-2688. [PMID: 37356499 DOI: 10.1016/j.tjnut.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/17/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Young children have high nutritional requirements relative to their body size, making healthy diets critical for normal growth and development. OBJECTIVE We aimed to integrate analysis of dietary patterns among 2-y-old children with indicators of dietary quality, micronutrient status, and body weight status. METHODS Data from the 2-y follow-up of the Cork BASELINE Birth Cohort included dietary assessment using a 2-d weighed food diary, vitamin D and iron status biomarkers, and anthropometry (n = 468). K-means cluster analysis identified predominant dietary patterns based on energy contributions and associations with nutrient intakes and status and body weight were investigated. RESULTS Four dietary patterns emerged: "Cows' milk" (unmodified cows' milk: 32% of total energy (TE)); "Traditional" (wholemeal breads, butter, fresh meat, fruit); "Low Nutrient Density (LND) foods" (confectionary, processed meat, convenience foods) and "Formula" (young child formula: 23%TE). The LND pattern was associated with excessive free sugar intake (14%TE) and salt intake (153% of daily limit). No differences in patterns of overweight were observed between the 4 groups; however, the LND group had 3-fold higher odds of being underweight [aOR (95% CI): 3.2 (1.2, 8.5)]. Children consuming >400ml/d of cows' milk or formula exhibited lower dietary variety, fewer family-type meals, and continued use of feeding bottles (75% and 81%, respectively, vs. 35-37% in the other groups). CONCLUSIONS Unhealthy eating habits are common among young children. Dietary guidance to support families to provide healthy diets needs to maintain currency with eating habits and focus on food choices for meals, snacks, and beverages.
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Affiliation(s)
- Áine Hennessy
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
| | - Elaine K McCarthy
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
| | - Carol Ní Chaoimh
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
| | - Deirdre M Murray
- The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, College of Science, Engineering and Food Science, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland.
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21
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Brettell E, Högler W, Woolley R, Cummins C, Mathers J, Oppong R, Roy L, Khan A, Hunt C, Dattani M. The Growth Hormone Deficiency (GHD) Reversal Trial: effect on final height of discontinuation versus continuation of growth hormone treatment in pubertal children with isolated GHD-a non-inferiority Randomised Controlled Trial (RCT). Trials 2023; 24:548. [PMID: 37605233 PMCID: PMC10440873 DOI: 10.1186/s13063-023-07562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Growth hormone deficiency (GHD) is the commonest endocrine cause of short stature and may occur in isolation (I-GHD) or combined with other pituitary hormone deficiencies. Around 500 children are diagnosed with GHD every year in the UK, of whom 75% have I-GHD. Growth hormone (GH) therapy improves growth in children with GHD, with the goal of achieving a normal final height (FH). GH therapy is given as daily injections until adult FH is reached. However, in many children with I-GHD their condition reverses, with a normal peak GH detected in 64-82% when re-tested at FH. Therefore, at some point between diagnosis and FH, I-GHD must have reversed, possibly due to increase in sex hormones during puberty. Despite increasing evidence for frequent I-GHD reversal, daily GH injections are traditionally continued until FH is achieved. METHODS/DESIGN Evidence suggests that I-GHD children who re-test normal in early puberty reach a FH comparable to that of children without GHD. The GHD Reversal study will include 138 children from routine endocrine clinics in twelve UK and five Austrian centres with I-GHD (original peak GH < 6.7 mcg/L) whose deficiency has reversed on early re-testing. Children will be randomised to either continue or discontinue GH therapy. This phase III, international, multicentre, open-label, randomised controlled, non-inferiority trial (including an internal pilot study) will assess whether children with early I-GHD reversal who stop GH therapy achieve non-inferior near FH SDS (primary outcome; inferiority margin 0.55 SD), target height (TH) minus near FH, HRQoL, bone health index and lipid profiles (secondary outcomes) than those continuing GH. In addition, the study will assess cost-effectiveness of GH discontinuation in the early retesting scenario. DISCUSSION If this study shows that a significant proportion of children with presumed I-GHD reversal generate enough GH naturally in puberty to achieve a near FH within the target range, then this new care pathway would rapidly improve national/international practice. An assumed 50% reversal rate would provide potential UK health service cost savings of £1.8-4.6 million (€2.05-5.24 million)/year in drug costs alone. This new care pathway would also prevent children from having unnecessary daily GH injections and consequent exposure to potential adverse effects. TRIAL REGISTRATION EudraCT number: 2020-001006-39.
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Affiliation(s)
- Elizabeth Brettell
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Wolfgang Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Krankenhausstrasse 26-30, Linz, 4020, Austria.
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Raymond Oppong
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura Roy
- Child Growth Foundation, Aston House, Redburn Road, Newcastle Upon Tyne, UK
| | - Adam Khan
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Charmaine Hunt
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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22
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Moon RJ, D’Angelo S, Holroyd CR, Crozier SR, Godfrey KM, Davies JH, Cooper C, Harvey NC. Parent-Offspring Associations in Body Composition: Findings From the Southampton Women's Survey Prospective Cohort Study. J Clin Endocrinol Metab 2023; 108:e726-e733. [PMID: 36943299 PMCID: PMC10438875 DOI: 10.1210/clinem/dgad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Indexed: 03/23/2023]
Abstract
CONTEXT Children born to parents who are overweight or obese have a high risk of adult obesity, but it is unclear if transgenerational associations relating to unfavorable body composition differ by parent. OBJECTIVE To examine differential mother-offspring and father-offspring associations in body composition in early childhood. METHODS A total of 240 mother-father-offspring trios from a prospective UK population-based pre-birth cohort (Southampton Women's Survey) were included for anthropometry and dual-energy x-ray absorptiometry assessment of whole-body-less-head body composition in the offspring at 3 different ages (4, 6-7, and 8-9 years) and in the mother and father at the 8- to 9-year offspring visit. Associations were assessed using linear regression adjusting for the other parent. RESULTS Positive associations between mother-daughter body mass index (BMI) and fat mass were observed at ages 6 to 7 (BMI: β = .29 SD/SD, 95% CI = .10, .48; fat mass β = .27 SD/SD, 95% CI = .05, .48) and 8 to 9 years (BMI: β = .33 SD/SD, 95% CI = .13, .54; fat mass β = .31 SD/SD, 95% CI = .12, .49), with similar associations at age 4 years but bounding the 95% CI. The mother-son, father-son, and father-daughter associations for BMI and fat mass were weaker at each of the ages studied. CONCLUSION A strong association between the fat mass of mothers and their daughters but not their sons was observed. In contrast, father-offspring body composition associations were not evident. The dimorphic parent-offspring effects suggest particular attention should be given to early prevention of unfavorable body composition in girls born to mothers with excess adiposity.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Stefania D’Angelo
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - Christopher R Holroyd
- Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, SO16 7NP, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Justin H Davies
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford OX4 2PG, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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23
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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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Bomberg EM, Miller BS, Addo OY, Rogol AD, Jaber MM, Sarafoglou K. Sex non-specific growth charts and potential clinical implications in the care of transgender youth. Front Endocrinol (Lausanne) 2023; 14:1227886. [PMID: 37635973 PMCID: PMC10455911 DOI: 10.3389/fendo.2023.1227886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) created separate growth charts for girls and boys because growth patterns and rates differ between sexes. However, scenarios exist in which this dichotomizing "girls versus boys" approach may not be ideal, including the care of non-binary youth or transgender youth undergoing transitions consistent with their gender identity. There is therefore a need for growth charts that age smooth differences in pubertal timing between sexes to determine how youth are growing as "children" versus "girls or boys" (e.g., age- and sex-neutral, compared to age- and sex-specific, growth charts). Methods Employing similar statistical techniques and datasets used to create the CDC 2000 growth charts, we developed age-adjusted, sex non-specific growth charts for height, weight, and body mass index (BMI), and z-score calculators for these parameters. Specifically, these were created using anthropometric data from five US cross-sectional studies including National Health Examination Surveys II-III and National Health and Nutrition Examination Surveys I-III. To illustrate contemporary clinical practice, we overlaid our charts on CDC 2000 girls and boys growth charts. Results 39,119 youth 2-20 years old (49.5% female; 66.7% non-Hispanic White; 21.7% non-Hispanic Black) were included in the development of our growth charts, reference ranges, and z-score calculators. Respective curves were largely superimposable through around 10 years of age after which, coinciding with pubertal onset timing, differences became more apparent. Discussion We conclude that age-adjusted, sex non-specific growth charts may be used in clinical situations such as transgender youth in which standard "girls versus boys" growth charts are not ideal. Until longitudinal auxological data are available in these populations, our growth charts may help to assess a transgender youth's growth trajectory and weight classification, and expectations surrounding these.
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Affiliation(s)
- Eric Morris Bomberg
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Bradley Scott Miller
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Oppong Yaw Addo
- Department of Global Health, Rollins School of Emory University, Atlanta, GA, United States
| | - Alan David Rogol
- Division of Diabetes and Endocrinology, Department of Pediatrics, University of Virginia, Charlottesville, VA, United States
| | - Mutaz M. Jaber
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
| | - Kyriakie Sarafoglou
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
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25
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Cromb D, Bonthrone AF, Maggioni A, Cawley P, Dimitrova R, Kelly CJ, Cordero-Grande L, Carney O, Egloff A, Hughes E, Hajnal JV, Simpson J, Pushparajah K, Rutherford MA, Edwards AD, O'Muircheartaigh J, Counsell SJ. Individual Assessment of Perioperative Brain Growth Trajectories in Infants With Congenital Heart Disease: Correlation With Clinical and Surgical Risk Factors. J Am Heart Assoc 2023:e8599. [PMID: 37421268 PMCID: PMC10382106 DOI: 10.1161/jaha.122.028565] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 06/02/2023] [Indexed: 07/10/2023]
Abstract
Background Infants with congenital heart disease (CHD) are at risk of neurodevelopmental impairments, which may be associated with impaired brain growth. We characterized how perioperative brain growth in infants with CHD deviates from typical trajectories and assessed the relationship between individualized perioperative brain growth and clinical risk factors. Methods and Results A total of 36 infants with CHD underwent preoperative and postoperative brain magnetic resonance imaging. Regional brain volumes were extracted. Normative volumetric development curves were generated using data from 219 healthy infants. Z-scores, representing the degree of positive or negative deviation from the normative mean for age and sex, were calculated for regional brain volumes from each infant with CHD before and after surgery. The degree of Z-score change was correlated with clinical risk factors. Perioperative growth was impaired across the brain, and it was associated with longer postoperative intensive care stay (false discovery rate P<0.05). Higher preoperative creatinine levels were associated with impaired brainstem, caudate nuclei, and right thalamus growth (all false discovery rate P=0.033). Older postnatal age at surgery was associated with impaired brainstem and right lentiform growth (both false discovery rate P=0.042). Longer cardiopulmonary bypass duration was associated with impaired brainstem and right caudate growth (false discovery rate P<0.027). Conclusions Infants with CHD can have impaired brain growth in the immediate postoperative period, the degree of which associates with postoperative intensive care duration. Brainstem growth appears particularly vulnerable to perioperative clinical course, whereas impaired deep gray matter growth was associated with multiple clinical risk factors, possibly reflecting vulnerability of these regions to short- and long-term hypoxic injury.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
| | - Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
| | - Alessandra Maggioni
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
| | - Paul Cawley
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
- Medical Research Council Centre for Neurodevelopmental Disorders King's College London London United Kingdom
| | - Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
- Department for Forensic and Neurodevelopmental Sciences Institute of Psychiatry, Psychology and Neuroscience, King's College London London United Kingdom
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
- Biomedical Image Technologies, Escuela Técnica Superior de Ingenieros (ETSI) de Telecomunicación Universidad Politécnica de Madrid and Centro de Investigación Biomédica en Red Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) Madrid Spain
| | - Olivia Carney
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
| | - John Simpson
- Paediatric Cardiology Department Evelina London Children's Healthcare London United Kingdom
| | - Kuberan Pushparajah
- Paediatric Cardiology Department Evelina London Children's Healthcare London United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
- Medical Research Council Centre for Neurodevelopmental Disorders King's College London London United Kingdom
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
- Department for Forensic and Neurodevelopmental Sciences Institute of Psychiatry, Psychology and Neuroscience, King's College London London United Kingdom
- Medical Research Council Centre for Neurodevelopmental Disorders King's College London London United Kingdom
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom
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Pinto A, Daly A, Rocha JC, Ashmore C, Evans S, Jackson R, Hickson M, MacDonald A. Preliminary Data on Free Use of Fruits and Vegetables Containing Phenylalanine 76-100 mg/100 g of Food in 16 Children with Phenylketonuria: 6 Months Follow-Up. Nutrients 2023; 15:3046. [PMID: 37447372 DOI: 10.3390/nu15133046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/17/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
In phenylketonuria (PKU), a previous intervention study assessing the patients ability to tolerate fruits and vegetables containing phenylalanine 76-100 mg/100 g without limit or measurement, found that an extra 50 mg/day phenylalanine, but not 100 mg/day, was tolerated from these fruits and vegetables. In a further 6-month extension study, we examined the effect of the 'free' use of this group of fruits and vegetables on blood phenylalanine control. For 6 months, the patients ate fruits and vegetables containing phenylalanine 76-100 mg/100 g without limit or measurement. Three-day diet diaries and the patients' weights were collected monthly. Blood phenylalanine spots were collected weekly aiming for blood phenylalanine levels <360 μmol/L. Retrospective blood phenylalanine was collected 6 months pre-trial. All 16 patients (69% females) from the intervention study took part in the extension study. Most of the patients (n = 14/16) had classical PKU with a median age of 10.5 years (range: 6-13). There was no statistically significant difference in the median blood phenylalanine pre-study (270, range: 50-760 μmol/L) compared to the 6-month extension study (250, range: 20-750 μmol/L) (p= 0.4867). The patients had a median of 21 and 22 bloodspots, pre- and post-trial, respectively. In the extension study, the patients had an actual mean intake of 11 g/day (4-37) natural protein and 65 g/day (60-80) protein equivalent from a protein substitute. The mean phenylalanine intake was 563 mg/day (200-1850) with only 19 mg/day (0-146) phenylalanine from fruits and vegetables containing phenylalanine 76-100 mg/100 g. The weight z-scores remained unchanged (1.52 vs. 1.60, p = 0.4715). There was no adverse impact on blood phenylalanine control when fruits and vegetables containing phenylalanine 76-100 mg/100 g were eaten without limit or measurement. However, the fruits and vegetable portion sizes eaten were small (60 g/week). Further longitudinal work is necessary to examine the 'free' use of fruits and vegetables containing phenylalanine 76-100 mg/100 g on metabolic control in patients with PKU.
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Affiliation(s)
- Alex Pinto
- Birmingham Women's and Children's Hospital, Birmingham B4 6NH, UK
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Anne Daly
- Birmingham Women's and Children's Hospital, Birmingham B4 6NH, UK
| | - Júlio César Rocha
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisboa, Portugal
| | | | - Sharon Evans
- Birmingham Women's and Children's Hospital, Birmingham B4 6NH, UK
| | - Richard Jackson
- Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Liverpool L69 3GL, UK
| | - Mary Hickson
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Anita MacDonald
- Birmingham Women's and Children's Hospital, Birmingham B4 6NH, UK
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
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Stokes H, Jones J, Worth C, Nicholson J, Fullwood C, Banerjee I. Integration of nurse-led virtual reviews with growth hormone device-linked patient adherence information: a mixed methods feasibility study. Front Endocrinol (Lausanne) 2023; 14:1167854. [PMID: 37324260 PMCID: PMC10266208 DOI: 10.3389/fendo.2023.1167854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Easypod-connect™ for childhood growth disorders is a unique connected system that enables transmission of injection adherence information for recombinant human growth hormone (r-hGH). Although this system has the potential to facilitate greater adherence, observational studies have shown declining adherence over prolonged periods when used without additional support. Supplemental nurse practitioner support has been envisaged but not investigated; in this study, we have undertaken feasibility analysis of nurse-led virtual reviews (NVR) in combination with easypod-connect™ in a single centre using quantitative and qualitative analyses. Aims We aimed to test feasibility by assessing compliance with NVR, height standard deviation score (SDS) gain, adherence improvement and patient opinions. Methods Patients using easypod™ r-hGH were recruited prospectively to a 12-month study with two telephone NVR appointments in addition to standard of care in-person hospital outpatient visits. A subset was recruited for a semi-structured interview for qualitative thematic analysis. Results Forty-three patients of median (range) age 10.7 (6.7, 15.2) were recruited for a period of 1.1 (0.7, 1.8) years. Thirty-three (76.7%) patients were fully compliant with NVR integration with easypod-connect™, establishing feasibility. Median (inter-quartile range, IQR) height SDS improved from -1.85 (-2.44, -1.37) to -1.48 (-2.14, -1.07) (p<0.001) while adherence remained similar in the majority from study start [96.5 (88.8, 100.0)] to end [99.0 (94.0, 100.0)]. Qualitative analysis identified themes supporting patient benefit: practicalities of appointments, perceived purpose and significance of virtual reviews, and the importance of optimising growth. Four patients complained of injection pain, of whom two switched to an alternative r-hGH device. Conclusion Our study has demonstrated the feasibility of nurse-led virtual review integration with easypod-connect™ in a mixed methods study, laying the foundation for research in larger groups over longer periods. Nurse practitioner supported application of easypod-connect™ offers the potential for improved growth outcomes in all r-hGH devices providing adherence information.
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Affiliation(s)
- Helen Stokes
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Julie Jones
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Chris Worth
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, United Kingdom
- Department of Computer Science, University of Manchester, Manchester, United Kingdom
| | - Jacqueline Nicholson
- Paediatric Psychosocial Service, Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Catherine Fullwood
- Research and Innovation, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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28
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Clarke R, Heath G, Nagakumar P, Farrow C. Influence of parental anxiety and beliefs about medicines on feeding and exercise in children living with asthma. J Child Health Care 2023:13674935231171453. [PMID: 37122084 DOI: 10.1177/13674935231171453] [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: 05/02/2023]
Abstract
This study's primary objective was to establish differences in beliefs about medicines, levels of asthma-related anxiety and diet and exercise behaviours between parents of children with well controlled and poorly controlled asthma. Secondary objectives were to explore how asthma control might shape relationships between parental cognitions and parenting practices concerning paediatric asthma. Parents of children with asthma aged 10-16 years (N = 310) completed standardised questionnaires measuring beliefs about medicines, parental asthma-related anxiety, parenting attitudes towards child activity, parental feeding and asthma control. Parents of children with poorly controlled asthma reported significantly greater asthma medication necessity and concern, asthma-related anxiety, control of child activity, pressure to exercise and unhealthy feeding practices. Moderation analyses indicated that the relationship between parental concern about asthma medicine and parental control of child activity was strongest in children with poorly controlled asthma. Also, the relationship between parental asthma-related anxiety and use of food to regulate child emotion was only significant when asthma was poorly controlled. Parental beliefs about asthma medicines and asthma-related anxiety may indirectly influence asthma outcomes through unhealthy parenting practices around exercise and diet. Eliciting and understanding parents' perceptions of asthma medications and anxiety may facilitate personalised interventions to improve asthma control.
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Affiliation(s)
- Rebecca Clarke
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Gemma Heath
- School of Psychology, Aston University, Birmingham, UK
| | - Prasad Nagakumar
- Department of Paediatric Respiratory Medicine and Cystic Fibrosis, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Claire Farrow
- School of Psychology, Aston University, Birmingham, UK
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29
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Kininmonth AR, Herle M, Tommerup K, Haycraft E, Farrow C, Croker H, Pickard A, Edwards K, Blissett J, Llewellyn C. Parental feeding practices as a response to child appetitive traits in toddlerhood and early childhood: a discordant twin analysis of the Gemini cohort. Int J Behav Nutr Phys Act 2023; 20:39. [PMID: 37016417 PMCID: PMC10074660 DOI: 10.1186/s12966-023-01440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/15/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Parental feeding practices (PFPs) have been implicated in the development of children's eating behaviours. However, evidence suggests that feeding practices may also develop in response to their child's weight or emerging appetitive traits. We used the twin design to test the hypothesis that parents develop their feeding practices partly in response to their child's appetite. METHODS Data were from Gemini, a population-based cohort of 2402 British families with twins born in 2007. Psychometric measures of PFPs and appetite were completed by parents when their twins were 16-months and 5-years. Within-family analyses including all twins with available data in the sample (n = 1010-1858 pairs), examined if within-pair differences in PFPs were associated with differences in appetitive traits, controlling for differences in birth weight-SDS, early feeding method and child sex. In a subsample of twin pairs who were considerably discordant for appetitive traits by ≥ 1SD (n = 122-544 pairs), the direction and magnitude of within-pair differences in feeding practices was explored. RESULTS Within-family variation in parental feeding practices in toddlerhood and early childhood was low (discordance ranged from 0.1 to 6% of the sample), except for pressure to eat (toddlerhood: 19%; early childhood: 32%). Within-pair differences in all appetitive traits were associated with differential use of 'pressure to eat' at both 16-months and 5-years. In the subsample of twins most discordant for appetitive traits, parents used more pressure with the twin expressing lower food responsiveness, lower emotional overeating, lower food enjoyment, higher satiety responsiveness, slower speed of eating, higher emotional undereating and greater fussiness in toddlerhood and early childhood (p-values < 0.001). Effect sizes were small to large at 16-months (η2=0.02-0.09) and 5-years (η2=0.05-0.21). CONCLUSION Parents rarely varied their feeding practices between twins in toddlerhood and early childhood, except for pressure. Parents exerted greater pressure on their twin who expressed a poorer appetite compared to their co-twin, suggesting that parents develop a pressuring feeding style when their child expresses a poorer appetite or lower interest in, and enthusiasm for, eating. These findings could be used to guide interventions seeking to support parents in feeding their children in a way that nurtures the development of healthy eating behaviours.
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Affiliation(s)
- Alice R Kininmonth
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.
| | - Moritz Herle
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kristiane Tommerup
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Claire Farrow
- School of Psychology & Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - Helen Croker
- World Cancer Research Fund International, London, UK
| | - Abigail Pickard
- School of Psychology & Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - Katie Edwards
- School of Psychology & Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - Jacqueline Blissett
- School of Psychology & Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - Clare Llewellyn
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
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30
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Poole RL, Bijlsma EK, Houge G, Jones G, Mikštienė V, Preikšaitienė E, Thompson L, Tatton-Brown K. The PHF21A neurodevelopmental disorder: an evaluation of clinical data from 13 patients. Clin Dysmorphol 2023; 32:49-54. [PMID: 36876344 DOI: 10.1097/mcd.0000000000000455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Potocki-Shaffer syndrome (PSS) is a rare neurodevelopmental disorder caused by deletions involving the 11p11.2-p12 region, encompassing the plant homeodomain finger protein 21A (PHF21A) gene. PHF21A has an important role in epigenetic regulation and PHF21A variants have previously been associated with a specific disorder that, whilst sharing some features of PSS, has notable differences. This study aims to expand the phenotype, particularly in relation to overgrowth, associated with PHF21A variants. Analysis of phenotypic data was undertaken on 13 individuals with PHF21A constitutional variants including four individuals described in the current series. Of those individuals where data were recorded, postnatal overgrowth was reported in 5/6 (83%). In addition, all had both an intellectual disability and behavioural issues. Frequent associations included postnatal hypotonia (7/11, 64%); and at least one afebrile seizure episode (6/12, 50%). Although a recognizable facial gestalt was not associated, subtle dysmorphic features were shared amongst some individuals and included a tall broad forehead, broad nasal tip, anteverted nares and full cheeks. We provide further insight into the emerging neurodevelopmental syndrome associated with PHF21A disruption. We present some evidence that PHF21A might be considered a new member of the overgrowth-intellectual disability syndrome (OGID) family.
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Affiliation(s)
- Rebecca L Poole
- South East of Scotland Clinical Genetics Service, Western General Hospital, Edinburgh, UK
| | - Emilia K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gunnar Houge
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Gabriela Jones
- Nottingham Clinical Genetics Service, Nottingham City Hospital, Nottingham, UK
| | - Violeta Mikštienė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Eglė Preikšaitienė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Louise Thompson
- South East of Scotland Clinical Genetics Service, Western General Hospital, Edinburgh, UK
| | - Katrina Tatton-Brown
- St George's University of London
- South West Thames Regional Genetics Department, St George's University Hospitals NHS Foundation Trust, London, UK
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Villadsen A, Asaria M, Skarda I, Ploubidis GB, Williams MM, Brunner EJ, Cookson R. Clustering of adverse health and educational outcomes in adolescence following early childhood disadvantage: population-based retrospective UK cohort study. Lancet Public Health 2023; 8:e286-e293. [PMID: 36965983 DOI: 10.1016/s2468-2667(23)00029-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Disadvantage in early childhood (ages 0-5 years) is associated with worse health and educational outcomes in adolescence. Evidence on the clustering of these adverse outcomes by household income is scarce in the generation of adolescents born since the turn of the millennium. We aimed to describe the association between household income in early childhood and physical health, psychological distress, smoking behaviour, obesity, and educational outcomes at age 17 years, including the patterning and clustering of these five outcomes by income quintiles. METHODS In this population-based, retrospective cohort study, we used data from the Millennium Cohort Study in which individuals born in the UK between Sept 1, 2000, and Jan 1, 2002, were followed up. We collected data on five adverse health and social outcomes in adolescents aged 17 years known to limit life chances: psychological distress, self-assessed ill health, smoking, obesity, and poor educational achievement. We compared how single and multiple outcomes were distributed across early childhood quintile groups of income, as an indicator of disadvantage, and modelled the potential effect of three income-shifting scenarios in early childhood for reducing adverse outcomes in adolescence. FINDINGS We included 15 245 adolescents aged 17 years, 7788 (51·1%) of whom were male and 7457 (48·9%) of whom were female. Adolescents in the lowest income quintile group in childhood were 12·7 (95% CI 6·4-25·1) times more likely than those in the highest quintile group to have four or five adverse adolescent outcomes, with poor educational achievement (risk ratio [RR] 4·6, 95% CI 4·2-5·0) and smoking (3·6, 3·0-4·2), showing the largest single risk ratios. Shifting up to the second lowest, middle, and highest income groups would reduce multiple adolescent adversities by 4·9% (95% CI -23·8 to 33·6), 32·3% (-2·7 to 67·3), and 83·9% (47·2 to 120·7), respectively. Adjusting for parental education and single parent status moderately attenuated these estimates. INTERPRETATION Early childhood disadvantage is more strongly correlated with multiple adolescent adversities than any of the five single adverse outcomes. However, shifting children from the lowest income quintile group to the next lowest group is ineffective. Tackling multiple adolescent adversities requires managing early childhood disadvantage across the social gradient, with income redistribution as a central element of coordinated cross-sectoral action. FUNDING UK Prevention Research Partnership.
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Affiliation(s)
- Aase Villadsen
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK.
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics, London, UK; REAL Centre, The Health Foundation, London, UK
| | - Ieva Skarda
- Centre for Health Economics, University of York, York, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | | | - Eric John Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
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Al-Din Y, Dryden C, MacGregor G, Young D, Coelho C. Ivacaftor: Five-year outcomes in the West of Scotland cystic fibrosis population. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:473-477. [PMID: 36938952 DOI: 10.1111/crj.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/02/2023] [Accepted: 02/27/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Ivacaftor has shown to be effective in patients with cystic fibrosis (CF) with a G551D mutation. OBJECTIVES This work aims to evaluate ivacaftor's effectiveness and safety in the real world, over 5 years, in the West of Scotland CF population. METHODS We evaluated ivacaftor's effect on pulmonary function, body mass index (BMI), hospital bed occupancy, and adverse effects in patients ≥6 years with at least one G551D mutation. RESULTS Statistically significant increases from baseline were observed in mean per cent predicted forced expiratory volume in 1 s (FEV1 ) at year 1 (which was maintained at years 2 and 5) and BMI over 5 years in our adolescent/adult cohort. Improvements were observed in per cent predicted FEV1 within the paediatric cohort with a suggestion of a plateau effect. The increase in paediatric BMI z-score was nonstatistically significant. There was a reduction in the number of pulmonary exacerbations requiring intravenous antibiotics and hospital bed occupancy. Ivacaftor was well tolerated. CONCLUSION Ivacaftor was effective in our population.
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Affiliation(s)
- Yasmin Al-Din
- Department of Pharmacy, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Carol Dryden
- Department of Paediatrics, University Hospital Wishaw, NHS Lanarkshire, Wishaw, UK
| | - Gordon MacGregor
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Cristina Coelho
- Department of Pharmacy, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
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Kininmonth AR, Herle M, Haycraft E, Farrow C, Croker H, Pickard A, Edwards K, Blissett J, Llewellyn C. Prospective associations between parental feeding practices used in toddlerhood and preschool children's appetite vary according to appetite avidity in toddlerhood. Appetite 2023; 185:106541. [PMID: 36948251 DOI: 10.1016/j.appet.2023.106541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
Parental feeding practices are a key modifiable component of children's food environments. Evidence suggests that certain feeding practices may differentially influence children's eating behaviour or weight, depending on the child's temperament (e.g. emotionality). Building on this work, we tested the hypothesis that feeding practices during toddlerhood influence children's developing eating behaviours differently, depending on their appetite avidity (which is characterised by a larger appetite and greater interest in food). Data were from Gemini, a population-based cohort of British twin children born in 2007. Parental feeding practices were assessed at 15-months, and child appetite at 15-months and 5-years, using validated psychometric measures (n = 1858 children). Complex samples general linear models examined prospective associations between PFPs at 15-months and child appetitive traits at 5-years, adjusting for clustering of twins within families and for the corresponding child appetitive trait at 15-months, difference in age between timepoints, child sex, gestational age, and socioeconomic status. Moderation analyses revealed that pressuring a child to eat led to greater increases in emotional overeating from 15-months to 5-years, only for children with high (1 SD above the mean: B = 0.13; SE± = 0.03,p < 0.001) or moderate emotional overeating (mean: B = 0.07 ± 0.03,p < 0.001) in toddlerhood. Greater covert restriction predicted greater reductions in emotional overeating and food responsiveness from 15-months to 5-years, only for children with high emotional overeating (1 SD above the mean: B = -0.06 ± 0.03,p = 0.03) and low food responsiveness (1 SD below the mean: B = -0.06 ± 0.03,p = 0.04) in toddlerhood. These findings are consistent with the hypothesis that children with a more avid appetite in toddlerhood are differentially affected by parental feeding practices; caregivers of toddlers may therefore benefit from feeding advice that is tailored to their child's unique appetite.
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Affiliation(s)
- Alice R Kininmonth
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
| | - Moritz Herle
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Claire Farrow
- School of Psychology & Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Helen Croker
- World Cancer Research Fund International, London, United Kingdom
| | - Abigail Pickard
- School of Psychology & Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Katie Edwards
- School of Psychology & Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Jacqueline Blissett
- School of Psychology & Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Clare Llewellyn
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
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Ng NSL, Gajendran S, Plant N, Shenoy M. Evaluation of height centile growth patterns compared with parental-adjusted target height following kidney transplantation. Pediatr Transplant 2023; 27:e14508. [PMID: 36919675 DOI: 10.1111/petr.14508] [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] [Received: 10/17/2022] [Revised: 02/02/2023] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Early steroid withdrawal (ESW) improves growth following kidney transplant (KT). It is not known whether these children achieve target height within mid-parental height range post-KT. METHODS Retrospective analysis of growth patterns of KT recipients following ESW in our center between 2009 and 2020 had minimum follow-up period of 12 months. RESULTS Forty-eight (female 29.2%) KT recipients, median age 5.3 years at first KT, were included. At KT, 29 (60.4%) recipients had normal height (SDS≥-1.88) and in 23 (47.9%), the height was within their target height (parental-adjusted height SDS within ±1.55). The proportion of children achieving normal height at 1-, 2-, 3-, and 5-years post-KT (median 5.5 years) were 75%, 83.3%, 86.5%, and 88% respectively. The proportion of children achieving target height measured at the same intervals was 68.8%, 73.8%, 73%, and 80%, respectively. Children <6 years were most growth impaired at KT but were most likely to achieve target height within first-year post-KT (72%; p = .023). All 19 children with short stature at KT received dialysis. Three children received growth hormone post-KT. Children who did not achieve target height post-KT (n = 14), five had eGFR <60 mL/min/1.73 m2 , and eight were on corticosteroid therapy at latest follow-up. CONCLUSIONS Although vast majority of children achieved normal height post-KT following ESW during the first 5 years post-KT, 20% of these children had not achieved their target height post-KT.
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Affiliation(s)
- Natasha Su Lynn Ng
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Sellathurai Gajendran
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Nicholas Plant
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Mohan Shenoy
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
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Poole RL, Badonyi M, Cozens A, Foulds N, Marsh JA, Rahman S, Ross A, Schooley J, Straub V, Quigley AJ, FitzPatrick D, Lampe A. Expanding the neurodevelopmental phenotype associated with HK1 de novo heterozygous missense variants. Eur J Med Genet 2023; 66:104696. [PMID: 36639056 DOI: 10.1016/j.ejmg.2023.104696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/30/2022] [Accepted: 01/07/2023] [Indexed: 01/12/2023]
Abstract
Neurodevelopmental disorder with visual defects and brain anomalies (NEDVIBA) is a recently described genetic condition caused by de novo missense HK1 variants. Phenotypic data is currently limited; only seven patients have been published to date. This descriptive case series of a further four patients with de novo missense HK1 variants, alongside integration of phenotypic data with the reported cases, aims to improve our understanding of the associated phenotype. We provide further evidence that de novo HK1 variants located within the regulatory-terminal domain and alpha helix are associated with neurological problems and visual problems. We highlight for the first time an association with a raised cerebrospinal fluid lactate and specific abnormalities to the basal ganglia on brain magnetic resonance imaging, as well as associated respiratory issues and swallowing/feeding difficulties. We propose that this distinctive neurodevelopmental phenotype could arise through disruption of the regulatory glucose-6-phosphate binding site and subsequent gain of function of HK1 within the brain.
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Affiliation(s)
- Rebecca L Poole
- South East of Scotland Clinical Genetics Service, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK.
| | - Mihaly Badonyi
- Medical Research Council Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Alison Cozens
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh Bio Quarter, Edinburgh, EH16 4TJ, UK
| | - Nicola Foulds
- Wessex Clinical Genetics Services, University of Southampton NHS Foundation Trust, Southampton, UK
| | - Joseph A Marsh
- Medical Research Council Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Shamima Rahman
- Genetics and Genomic Medicine Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Alison Ross
- North of Scotland Regional Genetics Service, Clinical Genetics Centre, Ashgrove House, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZA, UK
| | - Joanna Schooley
- Wessex Clinical Genetics Services, University of Southampton NHS Foundation Trust, Southampton, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 3BZ, UK
| | - Alan J Quigley
- Paediatric Imaging Department, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh Bio Quarter, Edinburgh, EH16 4TJ, UK
| | - David FitzPatrick
- Medical Research Council Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Anne Lampe
- South East of Scotland Clinical Genetics Service, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
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Burden CA, Smith GC, Sovio U, Clayton GL, Fraser A. Maternal hemoglobin levels and adverse pregnancy outcomes: individual patient data analysis from 2 prospective UK pregnancy cohorts. Am J Clin Nutr 2023; 117:616-624. [PMID: 36872020 DOI: 10.1016/j.ajcnut.2022.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 09/05/2022] [Accepted: 10/28/2022] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Hemoglobin (Hb) is a modifiable risk factor for adverse pregnancy outcomes. Studies have reported conflicting associations between maternal Hb levels and adverse pregnancy outcomes, including preterm birth (PTB), low birth weight (LBW), and perinatal mortality. OBJECTIVE In this study, we aimed to estimate the shape and magnitude of associations between maternal Hb levels in early (7-12 wk gestation) and late pregnancy (27-32 wk gestation) and pregnancy outcomes in a high-income setting. METHODS We used data from 2 UK population-based pregnancy cohorts: the Avon Longitudinal Study of Parents and Children (ALSPAC) and Pregnancy Outcome Prediction Study (POPS). We used multivariable logistic regression models to examine the relationship between Hb and pregnancy outcomes, adjusting for maternal age, ethnicity, BMI, smoking status, and parity. Main outcome measures were PTB, LBW, small for gestational age (SGA), pre-eclampsia (PET), and gestational diabetes mellitus (GDM). RESULTS Mean Hb in ALSPAC were 12.5 g/dL (SD = 0.90) and 11.2 g/dL (SD = 0.92) in early and late pregnancy, respectively, and 12.7 g/dL (SD = 0.82) and 11.4 g/dL (SD = 0.82) in POPS. In the pooled analysis, there was no evidence of associations between a higher Hb in early pregnancy (7-12 wk gestation) and PTB (OR per 1 g/dL of Hb: 1.09; 95% CI: 0.97, 1.22), LBW (1.12: 0.99, 1.26), and SGA (1.06; 0.97, 1.15). Higher Hb in late pregnancy (27-32 wk gestation) was associated with PTB (1.45: 1.30, 1.62), LBW (1.77: 1.57, 2.01), and SGA (1.45: 1.33, 1.58). Higher Hb in early and late pregnancy was associated with PET in ALSPAC (1.36: 1.12, 1.64) and (1.53: 1.29, 1.82), respectively, but not in POPS (1.17:0.99, 1.37) and (1.03: 0.86, 1.23). There was an association with a higher Hb and GDM in ALSPAC in both early and late pregnancy [(1.51: 1.08, 2.11) and (1.35: 1.01, 1.79), respectively], but not in POPS [(0.98: 0.81, 1.19) and (0.83: 0.68, 1.02)]. CONCLUSIONS Higher maternal Hb may identify the risk of adverse pregnancy outcomes. Further research is required to investigate if this association is causal and to identify the underlying mechanisms.
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Affiliation(s)
- Christy A Burden
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom.
| | - Gordon C Smith
- Department of Obstetrics and Gynaecology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Gemma L Clayton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
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Mytton OT, Nicholls D, Saxena S, Viner RM. Approach to a child or young person with concerns about excess weight. BMJ 2023; 380:e074255. [PMID: 36796840 DOI: 10.1136/bmj-2022-074255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Oliver T Mytton
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dasha Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, UK
| | - Russell M Viner
- UCL Great Ormond Street Institute of Child Health, London, UK
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Olga L, van Diepen JA, Chichlowski M, Petry CJ, Vervoort J, Dunger DB, Kortman GAM, Gross G, Ong KK. Butyrate in Human Milk: Associations with Milk Microbiota, Milk Intake Volume, and Infant Growth. Nutrients 2023; 15:916. [PMID: 36839274 PMCID: PMC9963357 DOI: 10.3390/nu15040916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
Butyrate in human milk (HM) has been suggested to reduce excessive weight and adipo-sity gains during infancy. However, HM butyrate's origins, determinants, and its influencing mechanism on weight gain are not completely understood. These were studied in the prospective longitudinal Cambridge Baby Growth and Breastfeeding Study (CBGS-BF), in which infants (n = 59) were exclusively breastfed for at least 6 weeks. Infant growth (birth, 2 weeks, 6 weeks, 3 months, 6 months, and 12 months) and HM butyrate concentrations (2 weeks, 6 weeks, 3 months, and 6 months) were measured. At age 6 weeks, HM intake volume was measured by deuterium-labelled water technique and HM microbiota by 16S sequencing. Cross-sectionally at 6 weeks, HM butyrate was associated with HM microbiota composition (p = 0.036) although no association with the abundance of typical butyrate producers was detected. In longitudinal analyses across all time points, HM butyrate concentrations were overall negatively associated with infant weight and adiposity, and associations were stronger at younger infant ages. HM butyrate concentration was also inversely correlated with HM intake volume, supporting a possible mechanism whereby butyrate might reduce infant growth via appetite regulation and modulation of HM intake.
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Affiliation(s)
- Laurentya Olga
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Janna A van Diepen
- Medical and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Evansville, IN 47721, USA
| | - Maciej Chichlowski
- Medical and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Evansville, IN 47721, USA
| | - Clive J Petry
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Jacques Vervoort
- Department of Agrotechnology and Food Sciences, Wageningen University, 6708 WE Wageningen, The Netherlands
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0SL, UK
| | | | - Gabriele Gross
- Medical and Scientific Affairs, Reckitt/Mead Johnson Nutrition Institute, Evansville, IN 47721, USA
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge, Cambridge CB2 0QQ, UK
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0SL, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK
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Gaccioli F, Sovio U, Gong S, Cook E, Charnock-Jones DS, Smith GC. Increased Placental sFLT1 (Soluble fms-Like Tyrosine Kinase Receptor-1) Drives the Antiangiogenic Profile of Maternal Serum Preceding Preeclampsia but Not Fetal Growth Restriction. Hypertension 2023; 80:325-334. [PMID: 35866422 PMCID: PMC9847691 DOI: 10.1161/hypertensionaha.122.19482] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Preeclampsia and fetal growth restriction (FGR) are both associated with an increased ratio of sFLT1 (soluble fms-like tyrosine kinase-1) to PlGF (placenta growth factor) in maternal serum. In preeclampsia, it is assumed that increased placental release of sFLT1 results in PlGF being bound and inactivated. However, direct evidence for this model is incomplete, and it is unclear whether the same applies in FGR. METHODS We conducted a prospective cohort study where we followed 4212 women having first pregnancies from their dating ultrasound, obtained blood samples serially through the pregnancy, and performed systematic sampling of the placenta after delivery. The aim of the present study was to determine the relationship between protein levels of sFLT1 and PlGF in maternal serum measured at ≈36 weeks and placental tissue lysates obtained after term delivery in 82 women with preeclampsia, 50 women with FGR, and 132 controls. RESULTS The sFLT1:PlGF ratio was increased in both preeclampsia and FGR in both the placenta and maternal serum. However, in preeclampsia, the maternal serum ratio of sFLT1:PlGF was strongly associated with placental sFLT1 level (r=0.45; P<0.0001) but not placental PlGF level (r=-0.17; P=0.16). In contrast, in FGR, the maternal serum ratio of sFLT1:PlGF was strongly associated with placental PlGF level (r=-0.35; P=0.02) but not sFLT1 level (r=0.04; P=0.81). CONCLUSIONS We conclude that the elevated sFLT1:PlGF ratio is primarily driven by increased placental sFLT1 in preeclampsia, whereas in FGR, it is primarily driven by decreased placental PlGF.
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Affiliation(s)
- Francesca Gaccioli
- Department of Obstetrics and Gynaecology (F.G., U.S., S.G., E.C., D.S.C.-J., G.C.S.S.), University of Cambridge, United Kingdom
- Centre for Trophoblast Research (F.G., U.S., D.S.C.-J., G.C.S.S.), University of Cambridge, United Kingdom
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology (F.G., U.S., S.G., E.C., D.S.C.-J., G.C.S.S.), University of Cambridge, United Kingdom
- Centre for Trophoblast Research (F.G., U.S., D.S.C.-J., G.C.S.S.), University of Cambridge, United Kingdom
| | - Sungsam Gong
- Department of Obstetrics and Gynaecology (F.G., U.S., S.G., E.C., D.S.C.-J., G.C.S.S.), University of Cambridge, United Kingdom
| | - Emma Cook
- Department of Obstetrics and Gynaecology (F.G., U.S., S.G., E.C., D.S.C.-J., G.C.S.S.), University of Cambridge, United Kingdom
| | - D. Stephen Charnock-Jones
- Department of Obstetrics and Gynaecology (F.G., U.S., S.G., E.C., D.S.C.-J., G.C.S.S.), University of Cambridge, United Kingdom
- Centre for Trophoblast Research (F.G., U.S., D.S.C.-J., G.C.S.S.), University of Cambridge, United Kingdom
| | - Gordon C.S. Smith
- Department of Obstetrics and Gynaecology (F.G., U.S., S.G., E.C., D.S.C.-J., G.C.S.S.), University of Cambridge, United Kingdom
- Centre for Trophoblast Research (F.G., U.S., D.S.C.-J., G.C.S.S.), University of Cambridge, United Kingdom
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40
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Pitts WJ, Cave TL, Cavadino A, Shypailo RJ, Maessen SE, Hofman PL, Wong W, Anderson YC. Comparison of percentile tables and algorithm-based calculators for classification of blood pressures in children and adolescents with obesity: A secondary analysis of a clinical trial. J Paediatr Child Health 2023; 59:242-246. [PMID: 36404725 PMCID: PMC10100042 DOI: 10.1111/jpc.16270] [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] [Received: 06/09/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022]
Abstract
AIM Obesity as a major risk factor for childhood hypertension necessitates careful blood pressure (BP) monitoring of those affected. This study aimed to compare BP classification in a cohort of children affected by obesity using tables versus digital calculations in two sets of guidelines. METHODS This study was a secondary analysis of data collected from a randomised clinical trial of a multidisciplinary life-style assessment and intervention program. Baseline data from 237 children with a body mass index >99th percentile or >91st percentile with weight-related comorbidities and available BP measurements were analysed. We assessed agreement between tables and algorithms in classification of elevated BP/pre-hypertension and hypertension based on the American Academy of Paediatrics (AAP) clinical practice guidelines (CPG) and the older Fourth Report using Cohen's weighted kappa. The prevalence of hypertensive diagnoses was also compared between the two guidelines. RESULTS Agreement between BP tables and algorithmic calculation of percentiles was discordant, though improved in the AAP CPG compared to the Fourth Report (Cohen's kappa = 0.70 vs. 0.57, respectively). None (0%) were missed diagnoses, and 59 (24.9%) were false positives for the Fourth Report, and 0 (0%) were missed diagnoses, and 49 (20.9%) were false positives for the AAP CPG. Under the recent guidelines, there was an increase in prevalence of 6.0% (95% confidence interval (CI) 2.5-9.4%; P = 0.0001) for BP ≥90th percentile, and of 3.0% (95% CI 0.4-5.6%; p = 0.016) for hypertension (BP ≥ 95th percentile) in the cohort (18.0% and 6.8%, respectively, increased from 12.0% and 3.8%). CONCLUSIONS Digital calculators over tables in clinical practice are recommended where possible to improve the accuracy of paediatric BP classification. Substantial rates of elevated BP/Hypertension were found in this cohort of children and adolescents with overweight and obesity.
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Affiliation(s)
- William J Pitts
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Roman J Shypailo
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah E Maessen
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - William Wong
- Department of Paediatric Nephrology, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,Telethon Kids Institute, Perth Children's Hospital, Perth, Western Australia, Australia.,Community Health, Child and Adolescent Health Service, Perth, Western Australia, Australia
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41
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Ly HJ, Lindberg A, Fors H, Dahlgren J. Comparison of two prediction models in a clinical setting to predict growth in prepubertal children on recombinant growth hormone. Growth Horm IGF Res 2023; 68:101523. [PMID: 36669261 DOI: 10.1016/j.ghir.2023.101523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/06/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Prediction models that calculate the growth response in children on recombinant growth hormone (GH) have shown to be helpful tools in deciding who should start treatment, as identifying GH deficiency can be a challenge. The aim of the study is to compare two prediction models; the KIGS (Pfizer International Growth Study) prediction models which are more accessible and the Gothenburg model which has previously been clinically validated. DESIGN All prepubertal patients who commenced GH treatment at Queen Silvia Children's Hospital in Gothenburg during a 13-year-period were candidates for the study. Children were excluded if suspected syndrome, malignant disease, chronic disease, or poor adherence to treatment were found. The KIGS model and the Gothenburg model were used to make predictions. Data was obtained from medical charts for the period from birth to the end of the first year of treatment. The predicted height outcome was compared against observed. RESULTS The study included 123 prepubertal children (76 males). The average age at treatment start and standard deviation (SD) was 5.7 (1.8) years. Correlation analyses were performed between predicted growth by both the Gothenburg and KIGS models versus the first year observed growth response showing strong correlations of r = 0.990 and r = 0.991 respectively with studentized residuals of 0.10 (0.81) for the Gothenburg model and 0.03 (0.96) for the KIGS model. CONCLUSION We found that both the Gothenburg model and the KIGS model are equivalent when applying to our clinical cohort. Both models are very precise, hence it is encouraged to use either based on accessibility for the clinic.
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Affiliation(s)
- Helena-Jamin Ly
- Göteborg Pediatric Growth Research Center, Institute of Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Västra Götalands Region, Queen Silvia Children's Hospital, Vitaminvägen 21, 416 50 Gothenburg, Sweden.
| | - Anders Lindberg
- Göteborg Pediatric Growth Research Center, Institute of Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Fors
- Göteborg Pediatric Growth Research Center, Institute of Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Västra Götalands Region, Queen Silvia Children's Hospital, Vitaminvägen 21, 416 50 Gothenburg, Sweden
| | - Jovanna Dahlgren
- Göteborg Pediatric Growth Research Center, Institute of Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Västra Götalands Region, Queen Silvia Children's Hospital, Vitaminvägen 21, 416 50 Gothenburg, Sweden
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Deussen AR, Louise J, Dodd JM. Childhood follow-up of the GRoW randomized trial: Metformin in addition to dietary and lifestyle advice for pregnant women with overweight or obesity. Pediatr Obes 2023; 18:e12974. [PMID: 36093602 PMCID: PMC10909565 DOI: 10.1111/ijpo.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Metformin for women with overweight or obesity during pregnancy has been evaluated in randomized trials to reduce adverse pregnancy and birth outcomes. The effect on longer-term child health remains of interest. OBJECTIVES To evaluate the effect of in-utero exposure to metformin on child health compared with no exposure. METHODS We assessed children born to 513 women who participated in the Metformin in addition to dietary and lifestyle advice for pregnant women with overweight or obesity: the GRoW randomized trial, where women were randomized to receive either metformin or placebo during pregnancy. Child weight, height, anthropometry, diet, physical activity and neurodevelopment were assessed at six and 18 months and three to five years of age. The main outcome was BMI z-score > 85th centile for age and sex. RESULTS The number of children with BMI >85th centile was similar between treatment groups at all time points. At 18 months and three to five years of age, more than half of the children had a BMI z-score > 85th centile, indicating a high risk of childhood obesity. CONCLUSIONS We did not show evidence of the benefit of metformin for children of women with overweight or obesity during pregnancy adding to the growing literature on the lack of effect of pregnancy interventions in reducing longer-term risks of childhood obesity.
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Affiliation(s)
- Andrea R. Deussen
- Discipline of Obstetrics & Gynaecology, and The Robinson Research InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Jennie Louise
- Discipline of Obstetrics & Gynaecology, and The Robinson Research InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Jodie M. Dodd
- Discipline of Obstetrics & Gynaecology, and The Robinson Research InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
- Women's and Babies Division, Department of Obstetrics and GynaecologyThe Women's and Children's HospitalNorth AdelaideSouth AustraliaAustralia
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Egnell C, Närhinen H, Merker A, Jonsson ÓG, Lepik K, Niinimäki R, Schmiegelow K, Stabell N, Klug Albertsen B, Vaitkeviciene G, Ranta S, Harila‐Saari A. Changes in body mass index during treatment of childhood acute lymphoblastic leukemia with the Nordic ALL2008 protocol. Eur J Haematol 2022; 109:656-663. [PMID: 36006839 PMCID: PMC9825898 DOI: 10.1111/ejh.13848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Children with acute lymphoblastic leukemia (ALL) have a tendency to gain weight during treatment. As overweight and obesity associate with health problems, prophylactic interventions are warranted. Therefore, it is important to identify the children most prone to gain weight. METHODS Patients aged 2.0-17.9 years at ALL diagnosis were identified from the NOPHO ALL2008 registry. Registry data was complemented with height and weight at the end of therapy from questionnaires. Body mass index (BMI) was classified according to international age- and sex-adjusted International Obesity Task Force BMI cut-offs. BMI values were transformed into standard deviation scores (SDS) to calculate the difference in BMISDS during treatment. RESULTS Data on BMI change were available for 765 children. Overweight and obesity doubled during treatment: 9.7% were overweight and 2.1% obese at diagnosis and 21.8% and 5.4% at the end of therapy, respectively. The mean BMISDS change was +0.64. Younger (2.0-5.9 years) and healthy weight children were most prone to become overweight (mean change in BMI SDS +0.85 and + 0.65, respectively). CONCLUSIONS Younger children (2.0-5.9 years) with healthy weight at diagnosis were most prone to becoming overweight and therefore are an important group to target while considering interventions.
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Affiliation(s)
- Christina Egnell
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, and the Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Hanna Närhinen
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Andrea Merker
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, and the Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | | | - Kristi Lepik
- Department of Haematology and OncologyTallinn Children's hospitalTallinnEstonia
| | - Riitta Niinimäki
- PEDEGO Research Unit, Medical Research Center Oulu and Department of Children and AdolescentsOulu University Hospital and University of OuluOuluFinland
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; and Institute of Clinical Medicine, Faculty of MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Niklas Stabell
- Department of PaediatricsUniversity Hospital of North NorwayTromsøNorway
| | - Birgitte Klug Albertsen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, and Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Goda Vaitkeviciene
- Children's HospitalAffiliate of Vilnius University Hospital Santaros Klinikos and Vilnius UniversityVilniusLithuania
| | - Susanna Ranta
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, and the Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Arja Harila‐Saari
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden,Department of Pediatric OncologyUppsala University HospitalUppsalaSweden
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The technique 'joint and individual variance explained' highlights persistent aspects of the diet using longitudinal food frequency data. Br J Nutr 2022; 128:2054-2062. [PMID: 34915946 DOI: 10.1017/s0007114521004955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Dietary pattern analysis is typically based on dimension reduction and summarises the diet with a small number of scores. We assess 'joint and individual variance explained' (JIVE) as a method for extracting dietary patterns from longitudinal data that highlights elements of the diet that are associated over time. The Auckland Birthweight Collaborative Study, in which participants completed an FFQ at ages 3·5 (n 549), 7 (n 591) and 11 (n 617), is used as an example. Data from each time point are projected onto the directions of shared variability produced by JIVE to yield dietary patterns and scores. We assess the ability of the scores to predict future BMI and blood pressure measurements of the participants and make a comparison with principal component analysis (PCA) performed separately at each time point. The diet could be summarised with three JIVE patterns. The patterns were interpretable, with the same interpretation across age groups: a vegetable and whole grain pattern, a sweets and meats pattern and a cereal v. sweet drinks pattern. The first two PCA-derived patterns were similar across age groups and similar to the first two JIVE patterns. The interpretation of the third PCA pattern changed across age groups. Scores produced by the two techniques were similarly effective in predicting future BMI and blood pressure. We conclude that when data from the same participants at multiple ages are available, JIVE provides an advantage over PCA by extracting patterns with a common interpretation across age groups.
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45
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Kennedy H, Haynes SL, Shelton CL. Maternal body weight and estimated circulating blood volume: a non-linear approach. Br J Anaesth 2022; 129:716-725. [PMID: 36167682 DOI: 10.1016/j.bja.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/27/2022] Open
Abstract
Postpartum haemorrhage continues to be a leading cause of morbidity and mortality in the obstetric population worldwide, especially in patients at extremes of body weight. Quantification of blood loss has been considered extensively in the literature. However, these volumes must be contextualised to appreciate the consequences of blood loss for individual parturients. Knowledge of a patient's peripartum circulating blood volume is essential to allow accurate interpretation of the significance of haemorrhage and appropriate resuscitation. Greater body weight in obesity can lead to overestimation of blood volume, resulting in inappropriately high thresholds for blood product transfusion and delays in treatment. The most recent Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) surveillance report demonstrated the risk to this population, with more than half of all maternal mortality recorded in parturients who were either overweight or obese. Current linear calculations used to estimate circulating blood volumes based on patients' weights could be contributing to this phenomenon, as blood volume increases at a disproportional rate to body composition. In this review, we summarise the relevant physiology and explore the existing literature on the estimation of circulating blood volume, both during pregnancy and in obesity. Building on key works and principal findings, we present a practical, nonlinear approach to the adjustment of estimated blood volume with increasing body mass. This clinical tool aims to reduce the clinical bias influencing the management of obstetric haemorrhage in a population already at increased risk of morbidity and mortality. Discussion of the limitations of this approach and the call for further research within this field completes this review.
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Affiliation(s)
- Helen Kennedy
- North West School of Anaesthesia, Health Education England Northwest, Manchester, UK.
| | - Sarah L Haynes
- Department of Autologous Transfusion, Wythenshawe Hospital, Manchester, UK; Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Clifford L Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester, UK; Lancaster Medical School, Lancaster University, Lancaster, UK
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Mathewlynn S, Impey L, Ioannou C. Detection of small- and large-for-gestational age using different combinations of prenatal and postnatal charts. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:373-380. [PMID: 35708532 DOI: 10.1002/uog.24971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/07/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine the extent to which the detection rate of small-for-gestational age (SGA) and large-for-gestational age (LGA) at birth is influenced by the use of different combinations of estimated-fetal-weight (EFW) and birth-weight (BW) charts. METHODS This was a cohort study of all pregnant women with a singleton term birth receiving care in a university hospital during a 3-year period. All participants underwent a universal 36-week ultrasound scan for EFW measurement and had BW recorded at delivery. Five different reference charts were used for EFW and BW centile calculation. Two-by-two contingency tables were constructed using EFW as the screening test variable and BW as the outcome variable in order to calculate sensitivity, specificity, positive predictive value (PPV) and negative predictive value for all possible chart combinations. RESULTS The cohort included 17 678 pregnancies. The sensitivity of EFW < 10th centile for the detection of BW < 10th centile ranged from 10.8% to 66.8% and the sensitivity of EFW < 3rd centile for the detection of BW < 3rd centile ranged from 4.1% to 66.8%, depending on the charts used. The sensitivity of EFW > 90th centile for BW > 90th centile ranged between 22.9% and 68.3%. When locally derived charts for EFW and BW were used, the sensitivity of detection of BW < 10th centile using EFW < 10th centile was 43.7% (PPV, 45.5%); for the detection of BW < 3rd centile using EFW < 3rd centile, the sensitivity was 25.6% (PPV, 26.7%) and, for the detection of BW > 90th centile using EFW > 90th centile, it was 49.6% (PPV, 49.0%). CONCLUSIONS Different combinations of EFW and BW charts can yield vastly different detection rates (sensitivity) in the same population cohort and time period. If SGA and LGA detection rates are to be used as a meaningful performance indicator, healthcare systems should follow a clear and predefined methodology that includes explicit definitions of common reference standards. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Mathewlynn
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
| | - L Impey
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
| | - C Ioannou
- Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
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Lokulo‐Sodipe O, Giabicani E, Canton AM, Ferrand N, Child J, Wakeling EL, Binder G, Netchine I, Mackay DJG, Inskip HM, Byrne C, Temple IK, Davies JH. Height and body mass index in molecularly confirmed Silver-Russell syndrome and the long-term effects of growth hormone treatment. Clin Endocrinol (Oxf) 2022; 97:284-292. [PMID: 35261046 PMCID: PMC9545243 DOI: 10.1111/cen.14715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/25/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Silver-Russell syndrome (SRS) causes short stature. Growth hormone (GH) treatment aims to increase adult height. However, data are limited on the long-term outcomes of GH in patients with molecularly confirmed SRS. This study evaluated height, body mass index (BMI) and GH treatment in molecularly confirmed SRS. DESIGN An observational study with retrospective data collection. PATIENTS Individuals with molecularly confirmed SRS aged ≥13 years. MEASUREMENTS Data were collected on height, height gain (change in height standard deviation score [SDS] from childhood to final or near-final height), BMI and gain in BMI (from childhood to adulthood) and previous GH treatment. RESULTS Seventy-one individuals (40 female) were included. The median age was 22.0 years (range 13.2-69.7). The molecular diagnoses: H19/IGF2:IG-DMR LOM in 80.3% (57/71); upd(7)mat in 16.9% (12/71) and IGF2 mutation in 2.8% (2/71). GH treatment occurred in 77.5% (55/71). Total height gain was greater in GH-treated individuals (median 1.53 SDS vs. 0.53 SDS, p = .007), who were shorter at treatment initiation (-3.46 SDS vs. -2.91 SDS, p = .04) but reached comparable heights to GH-untreated individuals (-2.22 SDS vs. -2.74 SDS, p = .7). In GH-treated individuals, BMI SDS was lower at the most recent assessment (median -1.10 vs. 1.66, p = .002) with lower BMI gain (2.01 vs. 3.58, p = .006) despite similar early BMI SDS to GH-untreated individuals (median -2.65 vs. -2.78, p = .3). CONCLUSIONS These results support the use of GH in SRS for increasing height SDS. GH treatment was associated with lower adult BMI which may reflect improved metabolic health even following discontinuation of therapy.
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Affiliation(s)
- Oluwakemi Lokulo‐Sodipe
- Human Development and HealthFaculty of Medicine University of SouthamptonSouthamptonUK
- Department of Paediatric EndocrinologyUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
- Present address:
Oluwakemi Lokulo‐Sodipe, Oluwakemi Lokulo‐Sodipe, Department of Paediatric Endocrinology, Oxford University Hospitals NHS Foundation TrustJohn Radcliffe Hospital, Headley WayOxfordUK
| | - Eloïse Giabicani
- INSERM, UMR_S 938—Centre de Recherche Saint Antoine, APHP, Hôpital Armand Trousseau, Explorations Fonctionnelles EndocriniennesSorbonne UniversitéParisFrance
| | - Ana P. M. Canton
- INSERM, UMR_S 938—Centre de Recherche Saint Antoine, APHP, Hôpital Armand Trousseau, Explorations Fonctionnelles EndocriniennesSorbonne UniversitéParisFrance
- Division of Endocrinology & Metabolism, Development Endocrinology Unit, Laboratory of Hormones and Molecular Genetics/LIM42, Clinical Hospital, Sao Paulo Medical SchoolUniversity of Sao PauloSao PauloBrazil
| | - Nawfel Ferrand
- Pediatric EndocrinologyUniversity Children's HospitalTübingenGermany
| | | | - Emma L. Wakeling
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Gerhard Binder
- Pediatric EndocrinologyUniversity Children's HospitalTübingenGermany
| | - Irène Netchine
- INSERM, UMR_S 938—Centre de Recherche Saint Antoine, APHP, Hôpital Armand Trousseau, Explorations Fonctionnelles EndocriniennesSorbonne UniversitéParisFrance
| | - Deborah J. G. Mackay
- Human Development and HealthFaculty of Medicine University of SouthamptonSouthamptonUK
- Wessex Regional Genetics LaboratorySalisbury Hospital NHS Foundation TrustSalisburyUK
| | - Hazel M. Inskip
- MRC Epidemiology UnitFaculty of Medicine University of SouthamptonSouthamptonUK
| | - Christopher D. Byrne
- Cancer SciencesFaculty of Medicine University of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - I. Karen Temple
- Human Development and HealthFaculty of Medicine University of SouthamptonSouthamptonUK
- Wessex Clinical Genetics ServiceUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Justin H. Davies
- Human Development and HealthFaculty of Medicine University of SouthamptonSouthamptonUK
- Department of Paediatric EndocrinologyUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
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Cronin FM, Hurley SM, Buckley T, Mancebo Guinea Arquez D, Lakshmanan N, O’Gorman A, Layte R, Stanistreet D. Mediators of socioeconomic differences in overweight and obesity among youth in Ireland and the UK (2011–2021): a systematic review. BMC Public Health 2022; 22:1585. [PMID: 35987999 PMCID: PMC9392918 DOI: 10.1186/s12889-022-14004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background By 2025, adult obesity prevalence is projected to increase in 44 of 53 of European-region countries. Childhood obesity tracks directly onto adult obesity, and children of low socioeconomic position families are at disproportionately higher risk of being obese compared with their more affluent peers. A previous review of research from developed countries identified factors mediating this relationship. This systematic review updates and extends those findings specifically within the context of Ireland and the United Kingdom. Objective The aim of this systematic review is to summarise peer-reviewed research completed in Ireland and the United Kingdom between 2011–2021 examining mediators of socioeconomic differentials in adiposity outcomes for youth. Design An electronic search of four databases, Ovid MEDLINE, Embase, Web of Science and EBSCOhost was conducted. Quantitative studies, published in the English language, examining mediators of socioeconomic differentials in adiposity outcomes in youth, and conducted in Ireland and the United Kingdom between 2011–2021 were included. An appraisal of study quality was completed. The systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Following screening, a total of 23 papers were eligible for inclusion. Results indicate socioeconomic differentials for Ireland and the United Kingdom follow similar patterns to other developed countries and have similar mediating factors including early life and parent-level factors. However, this review identified additional factors that mediate the relationship, namely access to green space and favorable neighborhood conditions. Identifying these factors present further opportunities for potential interventions and confirm the requirement for tailored and appropriate research and interventions for Ireland and the United Kingdom. Conclusion This review identified several modifiable factors that should be considered when planning interventions aimed at reducing socioeconomic differentials in adiposity among youth in Ireland and the United Kingdom. Support was found for interventions to be made as early as possible in an at-risk child’s life, with the prenatal and preschool periods considered the most efficacious. Results were equivocal about the role of physical activity in the risk of childhood overweight and obesity. While multi-country analyses provide excellent overviews, country- or area-specific research may produce more nuanced, and potentially more powerful findings, which can help better inform policy responses and interventions.
Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14004-z.
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Holmgren A, Niklasson A, Nierop AFM, Butler G, Albertsson-Wikland K. Growth pattern evaluation of the Edinburgh and Gothenburg cohorts by QEPS height model. Pediatr Res 2022; 92:592-601. [PMID: 34732814 DOI: 10.1038/s41390-021-01790-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The QEPS-growth-model, developed and validated in GrowUp-Gothenburg cohorts, used for developing growth references and investigating healthy/pathological growth, lacks external validation from other longitudinal cohorts of healthy individuals. AIM To investigate if the QEPS-model can fit the longitudinal Edinburgh growth study of another design than GrowUp-Gothenburg cohorts, and to compare growth patterns in the individuals born in mid-1970s in North-Western Europe. METHODS Longitudinal growth data were obtained from the Edinburgh and the GrowUp1974Gothenburg cohorts. The QEPS-model was used to describe length/height from birth to adult height with confidence interval, and the multivariable regression model for estimating the contribution of the different QEPS-functions to adult height. RESULTS The QEPS-model fitted the Edinburgh cohort well, with high accuracy, and low confidence intervals indicating high precision. Despite 3 cm shorter stature (less QE-function growth) in Scottish children, the growth patterns of the cohorts were similar, especially for specific pubertal growth. The contribution to adult height from different QEPS functions was similar. CONCLUSION The QEPS-model is validated for the first time in a longitudinal study of healthy individuals of another design and found to fit with high accuracy and precision. The Scottish and Western-Swedish cohorts born in mid-1970s showed similar growth patterns for both sexes, especially pubertal growth. IMPACT For the first time, the QEPS height model was used and found to fit another longitudinal cohort of healthy individuals other than the Swedish longitudinal cohorts. With large numbers of individual measurements in each growth phase, the QEPS model calculates growth estimates with narrow confidence intervals (high precision) and high accuracy. The two different cohorts born in the mid-1970s from Scotland and Western Sweden have similar growth patterns, despite a 3 cm difference in adult height.
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Affiliation(s)
- Anton Holmgren
- GP-GRC, Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Pediatrics, Halland Hospital, Halmstad, Sweden.
| | - Aimon Niklasson
- GP-GRC, Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas F M Nierop
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Muvara bv, Multivariate Analysis of Research Data, Leiderdorp, The Netherlands
| | - Gary Butler
- UCL Great Ormond Street Institute of Child Health, and University College London Hospital, London, UK
| | - Kerstin Albertsson-Wikland
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Upners EN, Raket LL, Petersen JH, Thankamony A, Roche E, Shaikh G, Kirk J, Hoey H, Ivarsson SA, Söder O, Juul A, Jensen RB. Timing of Puberty, Pubertal Growth, and Adult Height in Short Children Born Small for Gestational Age Treated With Growth Hormone. J Clin Endocrinol Metab 2022; 107:2286-2295. [PMID: 35521800 DOI: 10.1210/clinem/dgac282] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Growth hormone (GH) is used to treat short children born small for gestational age (SGA); however, the effects of treatment on pubertal timing and adult height are rarely studied. OBJECTIVE To evaluate adult height and peak height velocity in short GH-treated SGA children. METHODS Prospective longitudinal multicenter study. Participants were short children born SGA treated with GH therapy (n = 102). Adult height was reported in 47 children. A reference cohort of Danish children was used. Main outcome measures were adult height, peak height velocity, age at peak height, and pubertal onset. Pubertal onset was converted to SD score (SDS) using Danish reference data. RESULTS Gain in height SDS from start of treatment until adult height was significant in both girls (0.94 [0.75; 1.53] SDS, P = .02) and boys (1.57 [1.13; 2.15] SDS, P < .001). No difference in adult height between GH dosage groups was observed. Peak height velocity was lower than a reference cohort for girls (6.5 [5.9; 7.6] cm/year vs 7.9 [7.4; 8.5] cm/year, P < .001) and boys (9.5 [8.4; 10.7] cm/year vs 10.1 [9.7; 10.7] cm/year, P = .002), but no difference in age at peak height velocity was seen. Puberty onset was earlier in SGA boys than a reference cohort (1.06 [-0.03; 1.96] SDS vs 0 SDS, P = .002) but not in girls (0.38 [-0.19; 1.05] SDS vs 0 SDS, P = .18). CONCLUSION GH treatment improved adult height. Peak height velocity was reduced, but age at peak height velocity did not differ compared with the reference cohort. SGA boys had an earlier pubertal onset compared with the reference cohort.
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Affiliation(s)
- Emmie N Upners
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Lars Lau Raket
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jørgen H Petersen
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Ajay Thankamony
- Department of Pediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Edna Roche
- Department of Pediatrics, CHI at Tallaght University Hospital, Trinity College Dublin, The University of Dublin, Dublin 24, Ireland
| | - Guftar Shaikh
- Department of Endocrinology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Jeremy Kirk
- Department of Endocrinology, Birmingham Children's Hospital, Birmingham B4 6NH, UK
| | - Hilary Hoey
- Department of Pediatrics, CHI at Tallaght University Hospital, Trinity College Dublin, The University of Dublin, Dublin 24, Ireland
| | - Sten-A Ivarsson
- Department of Clinical Sciences, Endocrine and Diabetes Unit, University of Lund, 22100 Lund, Sweden
| | - Olle Söder
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institute, 17177 Stockholm, Sweden
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Rikke Beck Jensen
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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