UAE population reference standard charts for body mass index and skinfold thickness, at ages 0-18 years

Associations of prenatal exposure to bisphenols with infant anthropometry: A prospective cohort study

BACKGROUND

Bisphenols (BPs) have been shown to exhibit developmental toxicities. Epidemiological evidence on prenatal BPs exposure and infant growth primarily confined scopes to specific BPs and birth outcomes, with few studies focusing on infant growth and reporting inconsistent findings. The joint effect of prenatal exposure to BPs mixture on infant growth was rarely studied.

OBJECTIVE

This study examined associations of prenatal exposure to individual bisphenol A (BPA) and its analogues (bisphenol F [BPF], bisphenol S [BPS], bisphenol AF [BPAF], and tetrachlorobisphenol A [TCBPA]) and their mixture with infant growth.

METHODS

Urinary concentrations of BPs in pregnant women were quantified. Weight, body mass index, skinfold thickness, and circumference measurements of infants were collected at birth, 6 and 12 months of age, rapid growth and overweight were further defined. Multiple linear regression models and Bayesian kernel machine regression models (BKMR) were used to analyze associations of exposure to individual BPs and BPs mixture with infants' anthropometric measurements, and to identify the important components among mixture. The risks for rapid growth and overweight of each BP were determined using modified Poisson regression models.

RESULTS

A general profile of higher prenatal BPs exposure (mainly BPA, BPF, and BPS) associated with higher anthropometric measurements and higher risks of overweight during infancy was found. We also observed higher risks of rapid growth in infants following prenatal BPs exposure, with risk ratios ranging from 1.46 to 1.91. The joint effect of BPs mixture and single effect of each BP from the BKMR models were consistent with findings from the linear regression models, further suggesting that associations in girls were generally driven by BPA, BPF, or BPS, while in boys mainly by BPF.

CONCLUSION

Prenatal exposure to BPs and their mixture could increase anthropometric measurements of offspring during infancy, with implications of altered growth trajectory in future.

Reference growth curves to identify weight status (underweight, overweight or obesity) in children and adolescents: systematic review

The identification of somatic growth, through reference curves, can be used to create strategies and public policies to reduce public health problems such as malnutrition and obesity and to identify underweight, overweight and obesity. The purpose of this systematic review was to identify studies providing reference growth curves for weight status in children and adolescents. A systematic search was conducted in eight databases and in gray literature (Google scholar). To assess the risk of bias/methodological quality of studies, the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-sectional Studies (NHLBI) was used. Overall, 86 studies that met the inclusion criteria were included. Through the values   of reference growth curves for the identification of underweight, overweight and obesity, it was possible to verify that there is great variability among percentiles for the identification of underweight, overweight and obesity. The most prevalent percentiles for underweight were P3 and P5; for overweight, the most prevalent was P85 and the most prevalent percentiles for obesity were P95 and P97. The most prevalent anthropometric indicators were Body Mass Index (BMI), Waist Circumference (WC), Body Mass (BM) for age and height for age. Conclusion: Such data can demonstrate that the optimal growth must be reached, through the standard growth curves, but that the reference curves demonstrate a cut of the population growth, raising possible variables that can influence the optimal growth, such as an increase in the practice of physical activities and an awareness of proper nutrition.

Optimal cutoff of the abdominal skinfold thickness (AST) to predict hypertension among Chinese children and adolescents

Previous studies have shown that the correlation between the abdominal skinfold thickness (AST) and hypertension is better than that observed using the body mass index (BMI) or waist-to-height ratio (WHtR). We aimed to explore the optimal cutoff of the AST to predict childhood hypertension. The AST percentiles were calculated based on 215,223 students from the Chinese National Survey on Students' Constitution and Health (CNSSCH) in 2010 using the LMS method. Logistic regression model and Receiver operating characteristic (ROC) curves were used to evaluate the optimal cutoff of the AST to predict hypertension based on a sample of 683 children aged 8-15 years. The prevalence of hypertension was 5.71% (5.45% in boys and 6.01% in girls). The area under the ROC curve [AUC (95% CI)] values of the BMI, WHtR and AST to predict hypertension were 0.62 (0.47-0.77), 0.61 (0.45-0.76), and 0.67 (0.54-0.80) in boys and 0.59 (0.46-0.71), 0.65 (0.50-0.80), and 0.70 (0.57-0.83) in girls, respectively. The AUC value at P₈₅ of AST in boys and that at P₉₀ of AST in girls to predict hypertension were higher than other percentile values of AST. The OR (95% CI) values of the optimal cutoff of the AST associated with hypertension were 2.90 (1.17-7.20) and 4.91 (1.81-13.31) in boys and girls, respectively, and were higher than those associated with overweight/obesity (based on BMI) and abdominal obesity (based on WHtR).The AST was more effectively associated with hypertension than the BMI and WHtR, and the optimal cutoff to predict hypertension was at P₈₅ for boys and P₉₀ for girls.

Patterns of body mass index, percentage body fat, and skinfold thicknesses in 7- to 18-year-old children and adolescents from Indonesia

Background:

Body mass index (BMI) and skinfold thickness are widely used to evaluate body composition. Information on patterns of skinfold thickness may help to understand changes in body composition during growth. The objectives of this study were to observe patterns of BMI, percentage body fat (%BF), and skinfold thicknesses of Indonesian children and adolescents aged 7–18 years.

Methods:

Weight, height, and four skinfold thicknesses were measured in 2104 school children (924 boys, 1,180 girls) aged 7–18 years from Yogyakarta between 2015 and 2018. BMI and ratios between central and peripheral skinfold thicknesses were determined. %BF was predicted using the equation of Slaughter et al. Data were analyzed using analysis variance (ANOVA), independent sample t-test, and partial correlation (SPSS version 20.0).

Results:

At 7–18 years, boys and girls showed a comparable gain in BMI. The comparable gain in %BF between boys and girls only occurred till age 10 and total skinfolds till age 11 years. While, %BF and skinfold thicknesses were higher in girls at 12–17 years, central to peripheral skinfold ratio were higher in boys. Partial correlation analyses showed that all skinfold thickness parameters and %BF were significantly correlated with BMI (P < 0.001; r = 0.19–0.87).

Conclusions:

The gain in BMI and skinfold thickness between the ages of 7 and 18 years occurred in age- and sex-specific patterns. Instead of comparable BMI, girls showed higher means of total skinfold thickness from age 12 years, while boys had higher central to peripheral adiposity ratio.

Occurrence of Hypothyroidism, Diabetes Mellitus, and Celiac Disease in Emirati Children with Down's Syndrome

Objectives

Autoimmune diseases are known to occur in people with Down's syndrome (DS), especially celiac disease, type 1 diabetes mellitus (DM), and hypothyroidism. Since there are common genetic risk factors involved in the occurrence of these autoimmune disorders, the risks would differ in different populations. We sought to determine the prevalence of type 1 DM, celiac disease, and hypothyroidism in Emirati patients with DS in Abu Dhabi, UAE.

Methods

Ninety-two patients with DS were investigated for the presence of anti-thyroid antibodies, antithyroglobulin, and anti-thyroid peroxidase antibodies for hypothyroidism, anti-glutamic acid decarboxylase antibodies for type 1 DM, and anti-tissue transglutaminase immunoglobulin A antibodies for celiac disease.

Results

Karyotyping was performed on 89 patients. Eighty-seven had non-disjunction of chromosome 21 (97.8%), one was a mosaic, and one had translocation. Of the patients studied, 19.6% had hypothyroidism, 4.3% had type 1 DM, and 1.1% had celiac disease. Out of the 92 patients studied, 66 (71.7%) did not have any autoimmune disease, 25 (27.2%) had one autoimmune disease, and one (1.1%) had two autoimmune diseases.

Conclusions

Celiac disease was the least prevalent autoimmune disease in patients with DS patients, while type 1 DM and hypothyroidism were both significantly associated with DS.

Epidemiology of overweight and obesity in early childhood in the Gulf Cooperation Council countries: a systematic review and meta-analysis protocol

INTRODUCTION

There has been a notable increase in the prevalence of overweight and obesity in school-aged children in many industrialised regions. The worldwide prevalence of childhood overweight and obesity increased from 4.2% in 1990 to 6.7% in 2010. Although many studies have been published, the epidemiological burden of overweight and obesity in the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates) is unclear. There is a need to bring together and appraise relevant studies in order to estimate the epidemiological burden (including incidence, prevalence, risk factors, trend over time) of overweight and obesity in this region and thus help to inform national and regional policies.

METHODS AND ANALYSIS

We will conduct a systematic review and meta-analysis on the epidemiology of overweight and obesity in early childhood including incidence, prevalence, risk factors and trends over time in the GCC countries. We will search international electronic databases including MEDLINE, EMBASE, Cochrane Library, ISI Web of Science, CINAHL, Google Scholar, AMED, Psych INFO, CAB International and WHO Global Health Library for published, unpublished and in-progress epidemiological studies of interest published from inception to 2017. In addition, we will contact an international panel of experts on the topic. There will be no restriction on the language of publication of studies. We will use the Effective Public Health Practice Project (EPHPP) to appraise the methodological quality of included studies. Meta-analysis will be undertaken using random effects models.

ETHICS AND DISSEMINATION

Ethical approval is not required. The outcome of the review will be disseminated through conference presentations and peer-reviewed journal publication.

PROSPERO REGISTRATION NUMBER

CRD42017073189.

The Epidemiology and Economic Burden of Obesity and Related Cardiometabolic Disorders in the United Arab Emirates: A Systematic Review and Qualitative Synthesis

BACKGROUND

Noncommunicable diseases (NCDs) are considered as a global health problem and considered as a public health priority with the more considerable increasing trend of obesity and cardiometabolic disorders rates in the Middle Eastern countries. This systematic review aims at assessing the prevalence, incidence rates, and trends, as well as the cost of obesity and related cardiometabolic disorders in the United Arab Emirates (UAE).

METHODS

A highly sensitive strategy was used to retrieve original observational studies, addressing the epidemiology and cost of obesity and related cardiometabolic disorders in the UAE, irrespective of nationality (nationals and expatriates). The search was conducted on April 4, 2017, within numerous electronic databases and the grey literature. Standardized and validated methods were used for data extraction and analysis as well as quality assessment.

RESULTS

6789 records were retrieved, of which 36 were deemed eligible. High prevalence rates were reported for obesity, diabetes, hypertension, and metabolic syndrome in all studies. However, the definitions and methods employed by the studies were highly variable. The risk of bias in the epidemiological studies ranged between low and medium. Only one study reported the cost of illness for diabetes. In this study, the estimated cost per patient was $2,015 (adjusted to the year 2015), and it became twofold and sixfold higher in patients with microvascular and macrovascular complications, respectively.

CONCLUSIONS

Obesity and related cardiometabolic disorders are highly prevalent in the UAE, but quoting a precise prevalence for them is difficult given the methodological heterogeneity of the epidemiological studies addressing them. Nonetheless, we detected a 2-3-fold increase in the prevalence of overweight and obesity in the UAE between 1989 and 2017. It is hopeful that this systematic review will provide an insight into direct future studies, especially longitudinal studies exploring obesity and cardiometabolic risks and their costs.

Patient Satisfaction and Its Influencing Factors of Microtia Reconstruction Using Autologous Cartilage

BACKGROUND

This study aimed to investigate patient perceptions of and satisfaction with surgical outcomes of microtia reconstruction using autologous cartilage. It also analyzes associations between patient background characteristics and their evaluation.

METHODS

Lobule-type microtia patients who had received first-stage surgery were interviewed using a questionnaire, which included assessment of nine auricle substructures, superior and inferior parts and overall impression. Answers were recorded on a five-point Likert-style scale. Satisfaction rate and average scores were used to compare satisfaction with different substructures. Chi-square tests and logistic regression were used to analyze the impact of background characteristics such as gender, age, side and body mass index (BMI) on satisfaction, measured as the total scores for different parts.

RESULTS

The highest level of satisfaction was seen for the helix and the lowest for the tragus. The average score for the helix was significantly higher than for the concha (p < 0.05), tragus (p < 0.05), anti-tragus (p < 0.05), incisura (p < 0.05) and lobe (p < 0.05). The overall satisfaction was significantly correlated with work on the inferior part (ρ = 0.63, p < 0.05). Satisfaction from children under 12 years old was significantly higher than from children above 12 years old for superior structures and overall evaluation (p < 0.05). Left-sided microtia patients showed significantly higher satisfaction for inferior structures and overall evaluation than right-sided patients (p < 0.05). Overweight and obese patients were less satisfied with the tragus-incisura-anti-tragus complex compared with the rest (p < 0.05).

CONCLUSION

Microtia patients were most satisfied with the helix and least satisfied with the tragus. Overall patient satisfaction was more dependent on inferior structures; the characteristics of younger age (<12 years), proper BMI (under overweight or obese) and left-sided microtia were linked with higher ratings.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Percentile reference values for anthropometric body composition indices in European children from the IDEFICS study

INTRODUCTION

To characterise the nutritional status in children with obesity or wasting conditions, European anthropometric reference values for body composition measures beyond the body mass index (BMI) are needed. Differentiated assessment of body composition in children has long been hampered by the lack of appropriate references.

OBJECTIVES

The aim of our study is to provide percentiles for body composition indices in normal weight European children, based on the IDEFICS cohort (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS).

METHODS

Overall 18,745 2.0-10.9-year-old children from eight countries participated in the study. Children classified as overweight/obese or underweight according to IOTF (N=5915) were excluded from the analysis. Anthropometric measurements (BMI (N=12 830); triceps, subscapular, fat mass and fat mass index (N=11,845-11,901); biceps, suprailiac skinfolds, sum of skinfolds calculated from skinfold thicknesses (N=8129-8205), neck circumference (N=12,241); waist circumference and waist-to-height ratio (N=12,381)) were analysed stratified by sex and smoothed 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th and 99th percentile curves were calculated using GAMLSS.

RESULTS

Percentile values of the most important anthropometric measures related to the degree of adiposity are depicted for European girls and boys. Age- and sex-specific differences were investigated for all measures. As an example, the 50th and 99th percentile values of waist circumference ranged from 50.7-59.2 cm and from 51.3-58.7 cm in 4.5- to <5.0-year-old girls and boys, respectively, to 60.6-74.5 cm in girls and to 59.9-76.7 cm in boys at the age of 10.5-10.9 years.

CONCLUSION

The presented percentile curves may aid a differentiated assessment of total and abdominal adiposity in European children.

Waist Circumference, Waist-to-Height Ratio and Body Mass Index of Thai Children: Secular Changes and Updated Reference Standards

BACKGROUND

The prevalence of obesity in pediatric age group has been increasing globally. Body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) are commonly used to define obesity. The cut-off references for these parameters vary between racial and ethnic groups. We aimed to measure the secular changes and update the reference standards for these three parameters for Thai children in this study.

MATERIALS AND METHODS

We completed a cross-sectional survey of 3,885 school children 6.0-12.99 y of age in Ongkharak district of central Thailand during May to June 2013. Weight, height and WC were recorded by trained staff using sensitive and calibrated instruments. BMI and WHtR were calculated by standard formulae. The summary estimates were described by gender and whole year age groups. Age and gender specific smoothened percentile curves were created by using least mean squares method. The data was compared with that from a 2008 cohort from the same area.

RESULTS

Age and gender specific percentile data and curves of WC, WHtR and BMI have been provided for Thai children. BMI and WC increased but WHtR changed relatively little with age in both genders. In comparison to 2008, WC and WHtR have increased consistently across all age groups and both genders. The 75th percentile for WHtR corresponded closely to 0.50 in both genders which has been the suggested cut-off.

CONCLUSION

Since 2008, there have been significant increase in WC and WHtR across all age groups and in both genders in Thai children. These indicate increasing prevalence of central obesity and upcoming cardio-metabolic health problems. This needs to be tackled urgently by creating awareness and promotion of healthy diets and physical activities in school children. WC and WHtR should be routinely measured in paediatric examination for early diagnosis of central obesity.

National growth charts for United Arab Emirates children with Down syndrome from birth to 15 years of age

Background

Specific centile growth charts for children with Down syndrome (DS) have been produced in many countries and are known to differ from those of normal children. Since growth assessment depends on the growth pattern characteristic for these conditions, disorder-specific charts are desirable for various ethnic groups.

Aims

To provide cross-sectional weight, height, and head circumference (HC) references for healthy United Arab Emirates (UAE) children with DS.

Methods

A retrospective and cross-sectional growth study of Emirati children with DS, aged 0 to 18 years old, was conducted. Height, weight, and HC were measured in each child. Cole’s LMS statistical method was applied to estimate age-specific percentiles, and measurements were compared to UAE reference values for normal children.

Results

Incidence of DS in the UAE population is 1 in 374 live births (267 in 10 000 live births). We analyzed 1263 growth examinations of 182 children with DS born between 1994 and 2012. The male-to-female ratio was 1.6:1. Height, weight, and HC centile charts were constructed for ages 0 to 13 years. The prevalence of overweight and obesity in DS children aged 10 to 13 years of age was 32% and 19%, respectively. The DS children were significantly shorter and heavier than normal children in the UAE.

Conclusions

Weight, height, and HC growth charts were created for children with DS. These can be used as a reference standard for the UAE children with DS. Overweight and obesity are quite common in DS children ≥10 years of age, as DS children tend to be shorter and heavier than non-DS children.