1
|
Muanjai P, Haas C, Sies W, Mittag U, Zange J, Schönau E, Duran I, Kamandulis S, Rittweger J. Effect of Whole-body Vibration frequency on muscle tensile state during graded plantar flexor isometric contractions. J Exerc Sci Fit 2023; 21:405-415. [PMID: 37965131 PMCID: PMC10641229 DOI: 10.1016/j.jesf.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
Background Acute physiological and biomechanical alterations have been reported following whole-body vibration (WBV). Stiffening of muscles has only been anecdotally reported in response to WBV. Accordingly, this study investigated active plantar flexor muscle stiffness in response to a single WBV bout at four mechanical vibration frequencies. Methods Thirteen healthy adults (37.1 ± 14.4 years old) randomly received WBV in 4 different frequencies (6, 12, 24, and 0 Hz control) for 5 min. Shear wave speed (SWS) in longitudinal and transverse projections, architecture, and electric muscle activity were recorded in the medial gastrocnemius (MG) and soleus (SOL) muscle during graded plantar flexor contraction. Subjective rating of perceived muscle stiffness was assessed via Likert-scale. Results SWS of the MG at rest was enhanced in response to 5 min of 24 Hz WBV (p = 0.025), while a small reduction in SOL SWS was found during contraction (p = 0.005) in the longitudinal view. Subjective stiffness rating was increased following 12 Hz intervention. After 24 Hz WBV, pennation angle for MG was decreased (p = 0.011) during contraction. As a secondary finding, plantar flexor strength was significantly increased with each visit, which, however, did not affect the study's main outcome because of balanced sequence allocation. Conclusion SWS effects were solely limited to 24 Hz mechanical vibration and in the longitudinal projection. The observed effects are compatible with an interpretation by post-activation potentiation, warm-up, and force-distribution within the triceps surae muscles following 5 min WBV. The outcome may suggest SWS as a useful tool for assessing acute changes in muscle stiffness.
Collapse
Affiliation(s)
- Pornpimol Muanjai
- Department of Physical Therapy, Allied Health Sciences Faculty, Burapha University, Chonburi, Thailand
- Exercise and Nutrition Innovation and Sciences Research Unit, Burapha University, Chonburi, Thailand
| | - Chris Haas
- University of Texas Medical Branch, Galveston, TX, USA
| | - Wolfram Sies
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Uwe Mittag
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Jochen Zange
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Eckhard Schönau
- Center of Prevention and Rehabilitation, Cologne University Hospital and Medical Faculty, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Ibrahim Duran
- Center of Prevention and Rehabilitation, Cologne University Hospital and Medical Faculty, Germany
| | - Sigitas Kamandulis
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| |
Collapse
|
2
|
Martakis K, Alexy U, Stark C, Hahn A, Rawer R, Duran I, Schönau E. Jumping Mechanography: Reference Centiles in Childhood and Introduction of the Nerve-Muscle Index to Quantify Motor Efficiency. J Clin Med 2023; 12:5984. [PMID: 37762925 PMCID: PMC10531761 DOI: 10.3390/jcm12185984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Jumping mechanography provides robust motor function indicators among children. The study aim was to develop centiles for the single 2-leg jump (S2LJ) in German children and adolescents and to identify differences in children with obesity. Data were collected in 2004-2021 through the German DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study. All participants (6-18 years, mean age 11.4) performed annually an S2LJ aiming for maximum height on a Ground Reaction Force Platform. LMS (lambda-mu-sigma), including resampling, was used to develop centiles for velocity (vmax), jump height (hmax), relative force (Fmax/BW), relative power (Pmax/mass), impulse asymmetry and a new parameter to describe jump efficiency, the Nerve-Muscle Index (NMI), defined as vmax/(Fmax/BW). Data from 882 children and adolescents were analyzed (3062 measurements, median 3 per individual). In females, Fmax/BW values were higher in younger age but remained constant in adolescence. vmax, hmax and Pmax/mass increased in childhood, reaching a plateau in adolescence. In males, vmax, hmax and Pmax/mass showed a constant increase and the Fmax/BW remained lower. Children with obesity showed lower Fmax/BW, hmax, vmax and the NMI, hence, lower velocity per relative force unit and less efficient jump. The centiles should be used to monitor motor development in childhood. The NMI is a surrogate for motor efficiency.
Collapse
Affiliation(s)
- Kyriakos Martakis
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (K.M.)
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Feulgen Str. 10-12, 35392 Giessen, Germany
| | - Ute Alexy
- Department of Nutritional Epidemiology, Institute of Nutritional and Food Science, University of Bonn, 53115 Bonn, Germany;
| | - Christina Stark
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937 Cologne, Germany;
| | - Andreas Hahn
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Feulgen Str. 10-12, 35392 Giessen, Germany
| | | | - Ibrahim Duran
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (K.M.)
- Center of Prevention and Rehabilitation, UniReha, Faculty of Medicine and University Hospital Cologne, Lindenburger Allee 44, 50931 Cologne, Germany
| | - Eckhard Schönau
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (K.M.)
- Center of Prevention and Rehabilitation, UniReha, Faculty of Medicine and University Hospital Cologne, Lindenburger Allee 44, 50931 Cologne, Germany
| |
Collapse
|
3
|
Kara JAS, Zange J, Hoffman F, Tank J, Jordan J, Semler O, Schönau E, Rittweger J, Seefried L. Impaired Physical Performance in X-linked Hypophosphatemia Is not Caused by Depleted Muscular Phosphate Stores. J Clin Endocrinol Metab 2023; 108:1634-1645. [PMID: 37043477 DOI: 10.1210/clinem/dgad210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/19/2023] [Accepted: 04/10/2023] [Indexed: 04/13/2023]
Abstract
CONTEXT X-linked hypophosphatemia (XLH) is a rare genetic disease, characterized by renal phosphate wasting and complex musculoskeletal manifestations including decreased physical performance. OBJECTIVE To characterize muscular deficits in patients with XLH and investigate phosphate stores in muscles. METHODS Case-control study (Muscle fatigability in X-linked Hypophosphatemia [MuXLiH]) with a 1-time assessment at the German Aerospace Center (DLR), Cologne, from May to December 2019, including patients with XLH cared for at the Osteology Department, University of Wuerzburg. Thirteen patients with XLH and 13 age/sex/body weight-matched controls aged 18-65 years were included. The main outcome measure was 31P-magnetic resonance spectroscopy (31P-MRS)-based assessment of phosphate metabolites in the soleus muscle at rest. Further analyses included magnetic resonance imaging-based muscle volume measurement, laboratory testing, isokinetic maximum voluntary contraction (MVC), fatigue testing, and jumping mechanography. RESULTS By means of 31P-MRS, no significant differences were observed between XLH and controls regarding phosphate metabolites except for a slightly increased phosphocreatine to inorganic phosphate (PCr/Pi) ratio (XLH: 13.44 ± 3.22, control: 11.01 ± 2.62, P = .023). Quadriceps muscle volume was reduced in XLH (XLH: 812.1 ± 309.0 mL, control: 1391.1 ± 306.2 mv, P < .001). No significant differences were observed regarding isokinetic maximum torque (MVC) adjusted to quadriceps muscle volume. Jumping peak power and jump height were significantly reduced in XLH vs controls (both P < .001). CONCLUSION The content of phosphoric compounds within the musculature of patients with XLH was not observed to be different from controls. Volume-adjusted muscle strength and fatiguability were not different either. Reduced physical performance in patients with XLH may result from long-term adaptation to reduced physical activity due to skeletal impairment.
Collapse
Affiliation(s)
| | - Jochen Zange
- German Aerospace Center, Institute of Aerospace Medicine, 51147 Cologne, Germany
| | - Fabian Hoffman
- German Aerospace Center, Institute of Aerospace Medicine, 51147 Cologne, Germany
| | - Jens Tank
- German Aerospace Center, Institute of Aerospace Medicine, 51147 Cologne, Germany
| | - Jens Jordan
- German Aerospace Center, Institute of Aerospace Medicine, 51147 Cologne, Germany
| | - Oliver Semler
- Department of Pediatrics and Adolescent Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany
| | - Eckhard Schönau
- Department of Pediatrics and Adolescent Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany
| | - Jörn Rittweger
- German Aerospace Center, Institute of Aerospace Medicine, 51147 Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany
| | - Lothar Seefried
- Osteology and Clinical Trial Unit, Orthopedic Department, Julius Maximillian University Würzburg, 97074 Würzburg, Germany
| |
Collapse
|
4
|
Heieis J, Böcker J, D'Angelo O, Mittag U, Albracht K, Schönau E, Meyer A, Voigtmann T, Rittweger J. Curvature of gastrocnemius muscle fascicles as function of muscle-tendon complex length and contraction in humans. Physiol Rep 2023; 11:e15739. [PMID: 37269183 DOI: 10.14814/phy2.15739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 06/04/2023] Open
Abstract
It has been shown that muscle fascicle curvature increases with increasing contraction level and decreasing muscle-tendon complex length. The analyses were done with limited examination windows concerning contraction level, muscle-tendon complex length, and/or intramuscular position of ultrasound imaging. With this study we aimed to investigate the correlation between fascicle arching and contraction, muscle-tendon complex length and their associated architectural parameters in gastrocnemius muscles to develop hypotheses concerning the fundamental mechanism of fascicle curving. Twelve participants were tested in five different positions (90°/105°*, 90°/90°*, 135°/90°*, 170°/90°*, and 170°/75°*; *knee/ankle angle). They performed isometric contractions at four different contraction levels (5%, 25%, 50%, and 75% of maximum voluntary contraction) in each position. Panoramic ultrasound images of gastrocnemius muscles were collected at rest and during constant contraction. Aponeuroses and fascicles were tracked in all ultrasound images and the parameters fascicle curvature, muscle-tendon complex strain, contraction level, pennation angle, fascicle length, fascicle strain, intramuscular position, sex and age group were analyzed by linear mixed effect models. Mean fascicle curvature of the medial gastrocnemius increased with contraction level (+5 m-1 from 0% to 100%; p = 0.006). Muscle-tendon complex length had no significant impact on mean fascicle curvature. Mean pennation angle (2.2 m-1 per 10°; p < 0.001), inverse mean fascicle length (20 m-1 per cm-1 ; p = 0.003), and mean fascicle strain (-0.07 m-1 per +10%; p = 0.004) correlated with mean fascicle curvature. Evidence has also been found for intermuscular, intramuscular, and sex-specific intramuscular differences of fascicle curving. Pennation angle and the inverse fascicle length show the highest predictive capacities for fascicle curving. Due to the strong correlations between pennation angle and fascicle curvature and the intramuscular pattern of curving we suggest for future studies to examine correlations between fascicle curvature and intramuscular fluid pressure.
Collapse
Affiliation(s)
- Jule Heieis
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
- Faculty of Medical Engineering and Technomathematics, FH Aachen University of Applied Science, Aachen, Germany
- Children's Hospital, University of Cologne, Cologne, Germany
| | - Jonas Böcker
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Olfa D'Angelo
- Institute of Materials Physics in Space, German Aerospace Center, Cologne, Germany
| | - Uwe Mittag
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Kirsten Albracht
- Faculty of Medical Engineering and Technomathematics, FH Aachen University of Applied Science, Aachen, Germany
| | - Eckhard Schönau
- Children's Hospital, University of Cologne, Cologne, Germany
| | - Andreas Meyer
- Institute of Materials Physics in Space, German Aerospace Center, Cologne, Germany
| | - Thomas Voigtmann
- Institute of Materials Physics in Space, German Aerospace Center, Cologne, Germany
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| |
Collapse
|
5
|
Eckert AJ, Linke S, Schwab K, von dem Berge T, Schönau E, Duran I, Dost A, Joisten C, Bartelt H, Braune K, Rosenbauer J, Holl RW. Changes in cardiovascular risk factors among children and young adults with type 1 diabetes during the COVID-19 pandemic compared to previous years-Results from the German DPV registry. J Diabetes 2023; 15:15-26. [PMID: 36621521 PMCID: PMC9870744 DOI: 10.1111/1753-0407.13340] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The diverse stages of the COVID-19 pandemic led to several social circumstances that influenced daily life and health behavior. PURPOSE To evaluate changes in cardiovascular risk factors and physical activity among children and young adults with type 1 diabetes (T1D) during the COVID-19 pandemic in Germany compared to previous years. METHODS A total of 32 785 individuals aged 6-21 years at baseline with T1D from the German diabetes patient follow-up (DPV) registry contributed data on 101 484 person-years between 2016 and 2021. The first treatment year of each individual within this period was considered as baseline. Based on trends from 2016 to 2019, we estimated differences in body mass index-SD score (BMI-SDS), blood pressure (BP-SDS), and lipid levels (non-high-density lipoprotein [non-HDL]) between observed and predicted estimates for the years 2020 and 2021 using linear regression analysis standardized for age, diabetes duration, sex, and migratory background. The proportion doing organized sports and smoking cigarettes was analyzed using multivariable logistic regression models. RESULTS BMI-SDS increased constantly from 2016 to 2021 without a significant increase above expected values for 2020/2021. Systolic BP-SDS (difference observed vs. expected with 95% confidence interval, 2020: 0.10 [0.07-0.14], 2021: 0.17 [0.14-0.20]) and non-HDL (2020: 2.7 [1.3-4.1] mg/dl, 2021: 4.1 [2.7-5.5] mg/dl) were significantly increased (all p < .001) in both pandemic years. The proportion of subjects participating in organized sports was reduced from over 70% in prepandemic years to 35%-65% in diverse stages/waves of the COVID-19 pandemic. The percentage smoking cigarettes did not change. CONCLUSIONS We describe an increase in BP and atherogenic lipid levels coinciding with a reduction in physical activity but no acceleration of the prepandemic increases in BMI-SDS among young people with T1D during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Alexander J. Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMTUniversity of UlmUlmGermany
- German Centre for Diabetes Research (DZD)NeuherbergGermany
| | - Sabine Linke
- Katholisches Kinderkrankenhaus WILHELMSTIFT gGmbHChildren's HospitalHamburgGermany
| | - Karl‐Otfried Schwab
- Faculty of Medicine, Centre for Pediatrics and Adolescent Medicine, Division of Pediatric Diabetology, Endocrinology and Lipidology, Medical CentreUniversity of FreiburgFreiburgGermany
| | - Thekla von dem Berge
- Diabetes Centre for Children and AdolescentsChildren's Hospital Auf der BultHannoverGermany
| | - Eckhard Schönau
- Faculty of Medicine and University Hospital, Department of PediatricsUniversity of CologneCologneGermany
| | - Ibrahim Duran
- Faculty of Medicine and University Hospital, Centre of Prevention and RehabilitationUni Reha, University of CologneCologneGermany
| | - Axel Dost
- Department of PediatricsUniversity Hospital JenaJenaGermany
| | - Christine Joisten
- Department for Physical Activity in Public Health, Institute of Movement and NeurosciencesGerman Sport University CologneCologneGermany
- Cologne Centre for Prevention in Childhood and Youth / Heart Centre CologneUniversity Hospital of CologneCologneGermany
| | - Heike Bartelt
- Department of Endocrinology and DiabetologyUniversity of Leipzig, Hospital for Children and AdolescentsLeipzigGermany
| | - Katarina Braune
- Institute of Medical InformaticsCharité – Universitätsmedizin BerlinBerlinGermany
- Department of Pediatric Endocrinology and DiabetesCharité ‐ Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health at CharitéBerlinGermany
| | - Joachim Rosenbauer
- German Centre for Diabetes Research (DZD)NeuherbergGermany
- German Diabetes Center, Institute for Biometrics and EpidemiologyLeibniz Center for Diabetes Research at Heinrich Heine UniversityDüsseldorfGermany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMTUniversity of UlmUlmGermany
- German Centre for Diabetes Research (DZD)NeuherbergGermany
| |
Collapse
|
6
|
Scorcelletti M, Kara S, Zange J, Jordan J, Semler O, Schönau E, Rittweger J, Ireland A, Seefried L. Lower limb bone geometry in adult individuals with X-linked hypophosphatemia: an observational study. Osteoporos Int 2022; 33:1601-1611. [PMID: 35435480 PMCID: PMC9187561 DOI: 10.1007/s00198-022-06385-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/25/2022] [Indexed: 12/05/2022]
Abstract
UNLABELLED We assessed lower-limb geometry in adults with X-linked hypophosphatemia (XLH) and controls. We found large differences in multiple measures including femoral and tibial torsion, bowing and cross-sectional area and acetabular version and coverage which may contribute to clinical problems such as osteoarthritis, fractures and altered gait common in XLH. PURPOSE Individuals with X-linked hypophosphatemia (XLH) are at risk of lower-limb deformities and early onset of osteoarthritis. These two factors may be linked, as altered biomechanics is a risk factor for osteoarthritis. This exploratory evaluation aims at providing clues and concepts for this association to facilitate future larger-scale and longitudinal studies on that aspect. METHODS For this observational study, 13 patients with XLH, aged 18-65 years (6 female), were compared with sex-, age- and weight-matched healthy individuals at a single German research centre. Femoral and hip joint geometry, including femoral and tibial torsion and femoral and tibial shaft bowing, bone cross-sectional area (CSA) and acetabular version and coverage were measured from magnetic resonance imaging (MRI) scans. RESULTS Total femoral torsion was 29° lower in individuals with XLH than in controls (p < 0.001), mainly resulting from lower intertrochanteric torsion (ITT) (p < 0.001). Femoral lateral and frontal bowing, tibial frontal bowing, mechanical axis, femoral mechanical-anatomical angle, acetabular version and acetabular coverage were all greater and tibial torsion lower in individuals with XLH as compared to controls (all p < 0.05). Greater femoral total and marrow cavity CSA, greater tibial marrow cavity CSA and lower cortical CSA were observed in XLH (all p < 0.05). DISCUSSION We observed large differences in clinically relevant measures of tibia and particularly femur bone geometry in individuals with XLH compared to controls. These differences may plausibly contribute to clinical manifestations of XLH such as early-onset osteoarthritis, pseudofractures and altered gait and therefore should be considered when planning corrective surgeries.
Collapse
Affiliation(s)
- Matteo Scorcelletti
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Serhan Kara
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
| | - Jochen Zange
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
| | - Jens Jordan
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
| | - Oliver Semler
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Eckhard Schönau
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Jörn Rittweger
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Alex Ireland
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Lothar Seefried
- Orthopaedic Department, University of Würzburg, Wurzburg, Germany.
| |
Collapse
|
7
|
Hammersen J, Bettendorf M, Bonfig W, Schönau E, Warncke K, Eckert AJ, Fricke-Otto S, Palm K, Holl RW, Woelfle J. Twenty years of newborn screening for congenital adrenal hyperplasia and congenital primary hypothyroidism – experiences from the DGKED/AQUAPE study group for quality improvement in Germany. MED GENET-BERLIN 2022. [DOI: 10.1515/medgen-2022-2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Congenital primary hypothyroidism (CH) and congenital adrenal hyperplasia (CAH) are targeted by the German and Austrian newborn screening. For both diseases, there are registries for quality improvement, based on standardized observational data from long-term patient follow-up, under the auspices of the DGKED study group. By September 2021, the CH registry HypoDOK includes datasets from 23,348 visits of 1,840 patients, and the CAH registry contains datasets from 36,237 visits of 1,976 patients. Here, we report on the recruitment process, patient characteristics, and research contributions from the registries, and underline that the registries are an important tool to improve patient care and outcomes. Registries for rare conditions should thus be considered as an important public health measure and they should be adequately institutionalized and funded.
Collapse
Affiliation(s)
- Johanna Hammersen
- Department of Paediatrics , University Hospital Erlangen , Erlangen , Germany
| | - Markus Bettendorf
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics , University Hospital Heidelberg , Heidelberg , Germany
| | - Walter Bonfig
- Department of Paediatrics , Klinikum Wels-Grieskirchen , Wels , Austria
| | - Eckhard Schönau
- Children’s Hospital , University Hospital of Cologne and UniReha, University Hospital of Cologne , Cologne , Germany
| | - Katharina Warncke
- Department of Paediatrics, Kinderklinik München Schwabing , Technical University of Munich School of Medicine , Munich , Germany
| | - Alexander J. Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT , Ulm University , Ulm , Germany
- German Center for Diabetes Research (DZD) , Munich-Neuherberg , Germany
| | | | - Katja Palm
- Otto-von-Guericke-University Magdeburg , Department of Paediatrics , Magdeburg , Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT , Ulm University , Ulm , Germany
- German Center for Diabetes Research (DZD) , Munich-Neuherberg , Germany
| | - Joachim Woelfle
- Department of Paediatrics , University Hospital Erlangen , Erlangen , Germany
| |
Collapse
|
8
|
Ferretti JL, Lyritis GP, Rawer R, Rittweger J, Schönau E. Obituary: Hans Schiessl (1949-2022). J Musculoskelet Neuronal Interact 2022; 22:151-153. [PMID: 35234170 PMCID: PMC8919657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- José Luis Ferretti
- Consejo Nacional de Investigaciones Científicas y Técnicas (Arg NRC, CONICET),National University of Rosario, Rosario (SF), Argentina
| | | | - Rainer Rawer
- Stratec Medizintechnik GmbH, Germany,Novotec Medical GmbH, Germany
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany,Department of Pediatrics and Adolescent Medicine, University Hospital Cologne, Cologne, Germany
| | - Eckhard Schönau
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany,University of Cologne, Centre of Prevention and Rehabilitation, Cologne, Germany,University of Cologne, Cologne Center for Musculoskeletal Biomechanics (CCMB), Cologne, Germany
| |
Collapse
|
9
|
Lanzinger S, Altug H, Schikowski T, Khodaverdi S, Rosenbauer J, Rathmann W, Praedicow K, Schönau E, Holl RW. Longitudinal relationship of particulate matter and metabolic control and severe hypoglycaemia in children and adolescents with type 1 diabetes. Environ Res 2022; 203:111859. [PMID: 34389348 DOI: 10.1016/j.envres.2021.111859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/20/2021] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evidence for the metabolic impact of long-term exposure to air pollution on diabetes is lacking. We investigated the association of particulate matter <10 μm (PM10) and <2.5 μm (PM2.5) with yearly averages of HbA1c, daily insulin dose (IU/kg) and rates of severe hypoglycaemia in type 1 diabetes (T1D). METHODS We studied data of 44,383 individuals with T1D < 21 years which were documented in 377 German centres within the diabetes prospective follow-up registry (DPV) between 2009 and 2018. Outcomes were aggregated by year and by patient. PM10-and PM2.5-yearly averages prior to the respective treatment year were linked to individuals via the five-digit postcode areas of residency. Repeated measures linear and negative binomial regression were used to study the association between PM-quartiles (Q1 lowest, Q4 highest concentration) and yearly averages of HbA1c, daily insulin dose and rates of severe hypoglycaemia (confounders: sex, time-dependent age, age at diabetes onset, time-dependent type of treatment, migratory background, degree of urbanisation and socioeconomic index of deprivation). RESULTS Adjusted mean HbA1c increased with PM10 (Q1: 7.96% [95%-CI: 7.95-7.98], Q4: 8.03% [8.02-8.05], p-value<0.001) and with PM2.5 (Q1: 7.97% [7.95-7.99], Q4: 8.02% [8.01-8.04], p < 0.001). Changes in daily insulin dose were inversely related to PM (PM10 and PM2.5: Q1 0.85 IU/kg [0.84-0.85], Q4: 0.83 IU/kg [0.82-0.83], p < 0.001). Adjusted rates of severe hypoglycaemia increased with PM-quartile groups (PM10 Q1:11.2 events/100 PY [10.9-11.5], PM10 Q4: 15.3 [14.9-15.7], p < 0.001; PM2.5 Q1: 9.9 events/100 PY [9.6-10.2], PM2.5 Q4: 14.2 [13.9-14.6], p < 0.001). DISCUSSION Air pollution was associated with higher HbA1c levels and increased risk of severe hypoglycaemia in people with T1D, consequently indicating a higher risk of diabetes complications. Further studies are needed to explore causal pathways of the observed associations.
Collapse
Affiliation(s)
- Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Germany; German Centre for Diabetes Research (DZD), München-Neuherberg, Germany.
| | - Hicran Altug
- Leibniz Research Institute for Environmental Medicine (IUF), Düsseldorf, Germany
| | - Tamara Schikowski
- Leibniz Research Institute for Environmental Medicine (IUF), Düsseldorf, Germany
| | - Semik Khodaverdi
- Clinic for Children and Adolescent Medicine, Clinical Centre Hanau, Germany
| | - Joachim Rosenbauer
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany; Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University Düsseldorf, Germany
| | - Wolfgang Rathmann
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany; Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University Düsseldorf, Germany
| | - Kirsten Praedicow
- Clinic for Children and Adolescent Medicine, Diabetology and Endocrinology, Helios Clinical Centre Aue, Germany
| | - Eckhard Schönau
- University of Cologne, Department of Pediatrics, Cologne, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Germany; German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| |
Collapse
|
10
|
Wunram HL, Hamacher S, Oberste M, Neufang S, Belke L, Jänicke F, Graf C, Schönau E, Bender S, Fricke O. Influence of motivational placebo-related factors on the effects of exercise treatment in depressive adolescents. Eur Child Adolesc Psychiatry 2022; 31:1-14. [PMID: 33709258 PMCID: PMC9343287 DOI: 10.1007/s00787-021-01742-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
Abstract
Recent meta-analyses reveal a moderate effect of physical activity (PA) in the treatment of adolescent depression. However, not only the underlying neurobiological mechanisms, also the influences of placebo-related motivational factors (beliefs and expectancies in sporting, enjoyment and prior sports experiences), are still unclear. Based on the data of our prior study "Mood Vibes", we hypothesized that placebo-inherent factors like positive prior sports experiences and motivational factors, (positive beliefs, expectancies, and enjoyment related to PA), would increase the effects of an add-on exercise-therapy in juvenile depression. From 64 included depressed adolescents, 41 underwent an intensive add-on PA-therapy. Motivational factors were assessed using sport-specific scales. The changes in depression scores under treatment were rated by self-rating scale (German "Childhood Depression Inventory", (DIKJ)). A mixed model for repeated measures (MMRM) was used to analyze the effects of the different motivational variates on DIKJ. While prior sports experiences had no impact, motivational factors showed a significant effect on PA-induced changes in DIKJ scores (p = 0.002). The demotivated participants improved less, whereas it was sufficient to be neutral towards sporting to benefit significantly more. Motivational placebo-related factors (beliefs, expectancies and enjoyment regarding PA) affected the outcomes of an exercise treatment in depressed adolescents. Yet, a neutral mindset was sufficient to profit more from PA. Prior sporting in the sense of positive conditioning and as a protective factor did not play a role. Knowledge about these influences could in a second step help to develop tailored therapies.
Collapse
Affiliation(s)
- Heidrun Lioba Wunram
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, Cologne, Germany
| | - Stefanie Hamacher
- Department of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany
| | - Max Oberste
- Department of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany
- Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Düsseldorf, Germany
| | - Luisa Belke
- Children’s Hospital Amsterdam Street, Cologne, Germany
| | | | - Christine Graf
- Institute of Movement and Neuroscience, German Sport University Cologne, Cologne, Germany
| | - Eckhard Schönau
- Children’s Hospital, University Hospital of Cologne and UniReha®, University Hospital of Cologne, Cologne, Germany
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, Cologne, Germany
| | - Oliver Fricke
- Department of Child and Adolescent Psychiatry, Psychotherapy and Child Neurology, Gemeinschaftskrankenhaus Herdecke and Chairs of Child and Adolescent Psychiatry, Witten/Herdecke University, Witten, Germany
| |
Collapse
|
11
|
Thot GK, Berwanger C, Mulder E, Lee JK, Lichterfeld Y, Ganse B, Giakoumaki I, Degens H, Duran I, Schönau E, Clemen CS, Brachvogel B, Rittweger J. Effects of long-term immobilisation on endomysium of the soleus muscle in humans. Exp Physiol 2021; 106:2038-2045. [PMID: 34387385 DOI: 10.1113/ep089734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022]
Abstract
NEW FINDINGS What is the central question of this study? While muscle fibre atrophy in response to immobilisation has been extensively examined, intramuscular connective tissue, particularly endomysium, has been largely neglected: does endomysium content of the soleus muscle increase during bed rest? What is the main finding and its importance? Absolute endomysium content did not change, and previous studies reporting an increase are explicable by muscle fibre atrophy. It must be expected that even a relative connective tissue accumulation will lead to an increase in muscle stiffness. ABSTRACT Muscle fibres atrophy during conditions of disuse. Whilst animal data suggest an increase in endomysium content with disuse, that information is not available for humans. We hypothesised that endomysium content increases during immobilisation. To test this hypothesis, biopsy samples of the soleus muscle obtained from 21 volunteers who underwent 60 days of bed rest were analysed using immunofluorescence-labelled laminin γ-1 to delineate individual muscle fibres as well as the endomysium space. The endomysium-to-fibre-area ratio (EFAr, as a percentage) was assessed as a measure related to stiffness, and the endomysium-to-fibre-number ratio (EFNr) was calculated to determine whether any increase in EFAr was absolute, or could be attributed to muscle fibre shrinkage. As expected, we found muscle fibre atrophy (P = 0.0031) that amounted to shrinkage by 16.6% (SD 28.2%) on day 55 of bed rest. ENAr increased on day 55 of bed rest (P < 0.001). However, when analysing EFNr, no effect of bed rest was found (P = 0.62). These results demonstrate that an increase in EFAr is likely to be a direct effect of muscle fibre atrophy. Based on the assumption that the total number of muscle fibres remains unchanged during 55 days of bed rest, this implies that the absolute amount of connective tissue in the soleus muscle remained unchanged. The increased relative endomysium content, however, could be functionally related to an increase in muscle stiffness.
Collapse
Affiliation(s)
- Georgina K Thot
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Carolin Berwanger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Edwin Mulder
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Jessica K Lee
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Yannick Lichterfeld
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Bergita Ganse
- Department of Life Sciences, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, UK.,Department of Surgery, Innovative Implant Development, Saarland University, Homburg, Germany
| | - Ifigeneia Giakoumaki
- Department of Life Sciences, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, UK
| | - Hans Degens
- Department of Life Sciences, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, UK.,Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Ibrahim Duran
- Center of Prevention and Rehabilitation, Cologne University Hospital and Medical Faculty, Cologne, Germany
| | - Eckhard Schönau
- Center of Prevention and Rehabilitation, Cologne University Hospital and Medical Faculty, Cologne, Germany.,Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Christoph S Clemen
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.,Institute of Vegetative Physiology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Bent Brachvogel
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.,Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| |
Collapse
|
12
|
Wunram HL, Oberste M, Hamacher S, Neufang S, Grote N, Krischer MK, Bloch W, Schönau E, Bender S, Fricke O. Immunological Effects of an Add-On Physical Exercise Therapy in Depressed Adolescents and Its Interplay with Depression Severity. Int J Environ Res Public Health 2021; 18:6527. [PMID: 34204400 PMCID: PMC8296386 DOI: 10.3390/ijerph18126527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pro-inflammatory cytokines (PICs) have gained attention in the pathophysiology and treatment of depressive disorders. At the same time, the therapeutic effect of physical activity seems to work via immunomodulatory pathways. The interventional study "Mood Vibes" analyzed the influence of exercise on depression severity (primary endpoint) in depressive adolescents; the influence of PICs on the clinical outcome was analyzed as a secondary endpoint. METHODS Clinically diagnosed depressed adolescents (N = 64; 28.1% male; mean age = 15.9; mean BMI = 24.6) were included and participated either in Whole Body Vibration (WBV) (n = 21) or bicycle ergometer training (n = 20) in addition to treatment-as-usual (TAU). Patients in the control treatment group received TAU only (n = 23). The PICs (interleukin-6-IL-6 and tumor necrosis factor-α-TNF-α) were analyzed before intervention, after 6 weeks of training (t1), and 8 weeks post-intervention (t2). The effects of the treatment on depression severity were rated by self-rating "Depression Inventory for Children and Adolescents" (DIKJ). RESULTS Basal IL-6 decreased in all groups from t0 to t1, but it increased again in WBV and controls at t2. TNF-α diminished in ergometer and controls from baseline to t1. PIC levels showed no correlation with depression severity at baseline. The influence on DIKJ scores over time was significant for IL-6 in the WBV group (p = 0.008). Sex had an impact on TNF-α (p < 0.001), with higher concentrations in male patients. Higher body mass index was associated with higher IL-6 concentrations over all measurement points (p < 0.001). CONCLUSIONS The positive effects of an intensive add-on exercise therapy on adolescent depression seem to be partly influenced by immunomodulation. A small sample size and non-randomized controls are limitations of this study.
Collapse
Affiliation(s)
- Heidrun Lioba Wunram
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Max Oberste
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, 50937 Cologne, Germany; (M.O.); (S.H.)
- Department for Molecular and Cellular Sports Medicine, German Sport University Cologne, 50933 Cologne, Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, 50937 Cologne, Germany; (M.O.); (S.H.)
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, 40225 Düsseldorf, Germany;
| | - Nils Grote
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Maya Kristina Krischer
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Wilhelm Bloch
- Institute of Movement and Neuroscience, German Sport University Cologne, 50933 Cologne, Germany;
| | - Eckhard Schönau
- Children’s Hospital, University Hospital of Cologne & UniReha, University Hospital of Cologne, 50933 Cologne, Germany;
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry Psychosomatic and Psychotherapy, University Hospital of Cologne, 50937 Cologne, Germany; (N.G.); (M.K.K.); (S.B.)
| | - Oliver Fricke
- Department of Child and Adolescent Psychiatry, Psychotherapy and Child Neurology, Gemeinschaftskrankenhaus Herdecke & Chair of Child and Adolescent Psychiatry, Witten/Herdecke University, 58313 Witten/Herdecke, Germany;
| |
Collapse
|
13
|
Schaible F, Maier F, Buchwitz TM, Schwartz F, Hoock M, Schönau E, Libuda M, Hordt A, van Eimeren T, Timmermann L, Eggers C. Effects of Lee Silverman Voice Treatment BIG and conventional physiotherapy on non-motor and motor symptoms in Parkinson's disease: a randomized controlled study comparing three exercise models. Ther Adv Neurol Disord 2021; 14:1756286420986744. [PMID: 33680093 PMCID: PMC7897809 DOI: 10.1177/1756286420986744] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Parkinson’s disease (PD) patients experience disabling motor dysfunctions as well as non-motor symptoms (NMSs) that can highly impact their perceived quality of life. Besides pharmacological treatment options, active intervention programs have set some attention in managing these symptoms. However, previous studies mainly assessed the effectiveness of active intervention programs on functional mobility and motor symptoms. Objective: This study aimed to investigate the effect of Lee Silverman Voice Treatment (LSVT) BIG, an intensified and personalized physiotherapy (INTENSIVE), and a conventional physiotherapy (NORMAL) on NMSs in PD. Method: Forty-four patients with mild to moderate PD were randomly assigned to one of the three treatment groups. LSVT BIG and INTENSIVE were delivered one-on-one in 16 1-hour sessions within 4 weeks (4×/week). Patients assigned to NORMAL received 16 individual 1-hour sessions within 8 weeks (2×/week). The primary outcome measure was the difference in change from baseline in the non-motor symptom assessment scale for Parkinson’s disease (NMSS) between treatment groups to follow up at week 8. Patients were blinded for the NMSS being the primary outcome, but not the different treatment groups. Results: ANCOVA (Analysis of Covariance) showed reduced NMSS scores for all groups, with INTENSIVE being superior to NORMAL (p = 0.033). For secondary outcome measures (stride length, gait velocity and chair rising test) LSVT BIG and INTENSIVE were both superior to NORMAL. Conclusions: The study provides evidence that all three exercise programs are effective techniques to improve NMSs as well as motor function in PD. DRKS registration number: DRKS00008732
Collapse
Affiliation(s)
- Fabian Schaible
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Franziska Maier
- Department of Psychiatry, University Hospital of Cologne, Medical Faculty, Cologne, Germany
| | | | - Frank Schwartz
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Marius Hoock
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Eckhard Schönau
- Pediatric Endocrinology, University Hospital of Cologne, Cologne, Germany University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Germany
| | - Miriam Libuda
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Germany
| | - Anke Hordt
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Germany
| | - Thilo van Eimeren
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Baldingerstr. 1, Marburg 35033, Germany Marburg Center of Mind, Brain and Behavior, Marburg, Germany
| |
Collapse
|
14
|
Mallmann C, Drinhaus H, Fuchs H, Schiffmann LM, Cleff C, Schönau E, Bruns CJ, Annecke T, Schröder W. [Perioperative enhanced recovery after surgery program for Ivor Lewis esophagectomy : First experiences of a high-volume center]. Chirurg 2021; 92:158-167. [PMID: 32548695 DOI: 10.1007/s00104-020-01216-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVE Transthoracic esophagectomy is generally accepted as the standard of surgical care for patients with esophageal cancer. Despite improvements in the perioperative management this surgical procedure is associated with a clinically relevant morbidity. Fast-track protocols (synonym: enhanced recovery after surgery, ERAS) are conceived to perioperatively maintain the physiological homoeostasis and thereby to accelerate postoperative rehabilitation and reduce morbidity. In this prospective observational study the initial experiences of a high-volume center with the implementation of an ERAS protocol after transthoracic esophagectomy were analyzed. MATERIAL AND METHODS A total of 26 patients with esophageal cancer and a low index of comorbidities prior to hybrid Ivor Lewis esophagectomy were included in this study. According to an ERAS protocol all patients underwent a standardized perioperative treatment pathway aiming to discharge the patients from the inpatient treatment on postoperative day 10. The primary outcome parameter was the rate of major complications (Clavien-Dindo IIIb/IV), which was compared to a cohort of 52 non-ERAS patients. RESULTS AND CONCLUSION The ERAS programs with the various core elements can be implemented in patients scheduled for transthoracic esophagectomy, although the organizational and personnel expenditure of this fast-track protocol is high. The length of hospital stay appears to be reduced without compromising patient safety. The limiting variable of the ERAS protocol remains the early and adequate enteral feeding load of the gastric conduit before discharge on postoperative day 10.
Collapse
Affiliation(s)
- C Mallmann
- Medizinische Fakultät und Uniklinik, Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - H Drinhaus
- Medizinische Fakultät und Uniklinik, Klinik für Anästhesiologie und Operative Intensivmedizin, Universität zu Köln, Köln, Deutschland
| | - H Fuchs
- Medizinische Fakultät und Uniklinik, Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - L M Schiffmann
- Medizinische Fakultät und Uniklinik, Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - C Cleff
- Medizinische Fakultät und Uniklinik, Klinik für Anästhesiologie und Operative Intensivmedizin, Universität zu Köln, Köln, Deutschland
| | - E Schönau
- UniReha, Zentrum für Prävention und Rehabilitation der Uniklinik Köln, Köln, Deutschland
| | - C J Bruns
- Medizinische Fakultät und Uniklinik, Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - T Annecke
- Medizinische Fakultät und Uniklinik, Klinik für Anästhesiologie und Operative Intensivmedizin, Universität zu Köln, Köln, Deutschland
| | - W Schröder
- Medizinische Fakultät und Uniklinik, Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| |
Collapse
|
15
|
Duran I, Martakis K, Rehberg M, Stark C, Schafmeyer L, Schönau E. Reference Centiles for the Evaluation of Nutritional Status in Children using Body Fat Percentage, Fat Mass and Lean Body Mass Index. J Clin Densitom 2020; 23:349-363. [PMID: 30827819 DOI: 10.1016/j.jocd.2019.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Body fat percentage (BF%), fat mass index (FMI), and lean body mass index (LBMI) are often used to evaluate the nutritional status of children. Until now, no pediatric FMI reference centiles are applicable for GE Healthcare Lunar DXA systems. The aim of the study was to generate age-specific BF%, FMI, and LBMI references centiles for GE Healthcare Lunar DXA systems. METHODOLOGY Published values from the National Health and Nutrition Examination Survey 1999-2004 (age 8-20 years) were used to generate the reference centiles for the non-Hispanic black, non-Hispanic white, and Mexican American NHANES population. The LMS and LMSP methods were used to generate the reference centiles. RESULTS Data of 2433 non-Hispanic black children (972 females), 2026 non-Hispanic white children (873 females), and 2547 Mexican American children (1010 females) were eligible. CONCLUSIONS We presented age-specific reference centiles for BF%, FMI, and LBMI for children and adolescents which were ethnicity specific (non-Hispanic black, non-Hispanic white, and Mexican American) and directly applicable to Prodigy and iDXA GE Healthcare Lunar systems with software version 14.0. We proposed the use of BF%, FMI, and LBMI together to evaluate nutritional status in children.
Collapse
Affiliation(s)
- Ibrahim Duran
- University of Cologne, Center of Prevention and Rehabilitation, UniReha, Germany.
| | - Kyriakos Martakis
- University of Cologne, Children's and Adolescents' Hospital, Germany; Maastricht University, Department of International Health, School CAPHRI, Care and Public Health Research Institute, the Netherlands
| | - Mirko Rehberg
- University of Cologne, Children's and Adolescents' Hospital, Germany
| | - Christina Stark
- University of Cologne, Children's and Adolescents' Hospital, Germany
| | - Leonie Schafmeyer
- University of Cologne, Center of Prevention and Rehabilitation, UniReha, Germany
| | - Eckhard Schönau
- University of Cologne, Center of Prevention and Rehabilitation, UniReha, Germany; University of Cologne, Children's and Adolescents' Hospital, Germany
| |
Collapse
|
16
|
Abstract
New therapeutic approaches have been established in the field of rare skeletal diseases (e.g., for osteogenesis imperfecta, achondroplasia, hypophosphatemic rickets, hypophosphatasia, and fibrodysplasia ossificans progressiva). After elucidation of the underlying genotypes and pathophysiologic alterations of these diseases, new treatment options have been designed. Most drugs are based on an interaction with the disease-specific cascade of enzymes and proteins involved in the disease. Thereby an approved treatment is available for children with severe forms of hypophosphatasia and hypophosphatemic rickets (asfotase alfa, burosumab). Additionally, there are different phase 3 trials ongoing assessing the efficacy and safety of drugs for osteogenesis imperfecta, achondroplasia, and fibrodysplasia ossificans progressiva (denosumab, vosoritide, palovarotene).Because all these diseases are rare, the number of investigated patients in the trials is small, and the knowledge about rare side effects and long-term outcome is limited. Therefore it is recommended to treat the patients in specialized centers where the effects of the drugs can be evaluated and data about safety, side effects, and efficacy can be collected.Based on the fact that most drugs for rare diseases are highly expensive clear indications for start of a treatment, evaluation of the therapy and recommendations how long a treatment has to be administrated are urgently needed.
Collapse
Affiliation(s)
- Heike Hoyer-Kuhn
- Faculty of Medicine, University of Cologne, Cologne, Germany.
- Department of Paediatrics, University Hospital Cologne, Cologne, Germany.
| | - Eckhard Schönau
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Paediatrics, University Hospital Cologne, Cologne, Germany
- Center for Prevention and Rehabilitation, Unireha, University of Cologne, Cologne, Germany
| |
Collapse
|
17
|
Martakis K, Stark C, Alberg E, Bossier C, Semler O, Schönau E, Duran I. Motor Function Improvement in Children with Ataxia Receiving Interval Rehabilitation, Including Vibration-Assisted Hometraining: A Retrospective Study. Klin Padiatr 2019; 231:304-312. [PMID: 31724139 DOI: 10.1055/a-1001-2284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Physiotherapy, including vibration-assisted therapy, has been proven to be effective for patients with ataxic cerebral palsy. Herewith, we studied the effect of a functional, goal-oriented interval rehabilitation program, including vibration-assisted home-training on the motor function of children with congenital ataxias. PATIENTS 45 children (mean age 7.7 years, SD 4.70) with ataxia, having received a 6-month home-based side-alternating vibration-assisted therapy combined with intensive, goal-oriented, functional rehabilitation intervals, were included in the study, classified according to the progressive or non-progressive ataxia character. METHOD Retrospective analysis of the prospectively collected data of the registry of the Cologne rehabilitation program "Auf die Beine". Motor abilities have been assessed prior to the intervention (M0), after 6 months of home-training (M6) as well as in a follow-up 6 months later (M12). We performed a gait analysis, a 1-minute walking test (1-MWT), and the Gross Motor Function Measure (GMFM-66). RESULTS The GMFM-66 improvement (M6-M0 vs. M12-M6) was statistically significant with median improvement of 2.4 points (non-progressive) and 2.9 points (progressive) respectively, and clinically relevant. The 1-MWT improvement was statistically significant and clinically relevant for non-progressive ataxia. CONCLUSION The intensive training, including vibration-assisted therapy significantly improved the motor function of children with ataxia. Six months later the skills were preserved in children with progressive ataxia and could be further developed in non-progressive forms.
Collapse
Affiliation(s)
- Kyriakos Martakis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany.,CAPHRI-School of Public Health and Primary Care, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Department of International Health, Maastricht, Netherlands.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Prevention and Rehabilitation, UniReha GmbH, Cologne, Germany.,Department of Pediatric Neurology, University Children's Hospital (UKGM) and Medical Faculty, Justus Liebig University of Giessen, Giessen, Germany
| | - Christina Stark
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany
| | - Evelyn Alberg
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Prevention and Rehabilitation, UniReha GmbH, Cologne, Germany
| | - Christiane Bossier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Prevention and Rehabilitation, UniReha GmbH, Cologne, Germany
| | - Oliver Semler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Prevention and Rehabilitation, UniReha GmbH, Cologne, Germany
| | - Eckhard Schönau
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Prevention and Rehabilitation, UniReha GmbH, Cologne, Germany
| | - Ibrahim Duran
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Prevention and Rehabilitation, UniReha GmbH, Cologne, Germany
| |
Collapse
|
18
|
Esche J, Shi L, Hartmann MF, Schönau E, Wudy SA, Remer T. Glucocorticoids and Body Fat Inversely Associate With Bone Marrow Density of the Distal Radius in Healthy Youths. J Clin Endocrinol Metab 2019; 104:2250-2256. [PMID: 30715368 DOI: 10.1210/jc.2018-02108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/25/2019] [Indexed: 01/28/2023]
Abstract
CONTEXT Elevated bone marrow adipose tissue (BMAT) is associated with lower bone quality, higher fracture rates, and an unfavorable overall metabolic profile. Apart from age, particularly glucocorticoids (GC), body fat, and diet are discussed to influence BMAT. We hypothesized that already in healthy youths, higher fat intake, higher fat mass index (FMI), and higher GC secretion, still within the normal range, may associate with increased BMAT. DESIGN In a subsample of healthy 6- to 18-year-old participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study, peripheral quantitative CT of the nondominant proximal forearm was used to determine bone marrow density of the distal radius as an inverse surrogate parameter for BMAT. In those participants (n = 172) who had collected two, 24-hour urines within around one year before bone measurement, major urinary GC metabolites were measured by gas chromatography-mass spectrometry and summed up to assess daily adrenal GC secretion (ΣC21). Dietary intake was assessed by 3-day weighed dietary records. FMI was anthropometrically calculated. Separate multiple linear regression models were used to analyze the relationships of ΣC21, FMI, and fat intake with BMAT. RESULTS After controlling for confounders, such as age, energy intake, and forearm muscle area, ΣC21 (β = -0.042) and FMI (β = -0.002) showed inverse relationships with bone marrow density (P < 0.05), whereas fat intake did not associate significantly. CONCLUSION Our results indicate that already a moderately elevated GC secretion and higher body fatness during adolescence may adversely impact BMAT, an indicator for long-term bone health.
Collapse
Affiliation(s)
- Jonas Esche
- Dortmund Nutritional and Anthropometric Longitudinally Designed Study Center, Institute of Nutrition and Food Science, Nutritional Epidemiology, University of Bonn, Dortmund, Germany
| | - Lijie Shi
- Dortmund Nutritional and Anthropometric Longitudinally Designed Study Center, Institute of Nutrition and Food Science, Nutritional Epidemiology, University of Bonn, Dortmund, Germany
| | - Michaela F Hartmann
- Steroid Research and Mass Spectrometry Unit, Center of Child and Adolescent Medicine, Justus-Liebig-University, Giessen, Germany
| | - Eckhard Schönau
- Children's Hospital, University of Cologne, Cologne, Germany
| | - Stefan A Wudy
- Steroid Research and Mass Spectrometry Unit, Center of Child and Adolescent Medicine, Justus-Liebig-University, Giessen, Germany
| | - Thomas Remer
- Dortmund Nutritional and Anthropometric Longitudinally Designed Study Center, Institute of Nutrition and Food Science, Nutritional Epidemiology, University of Bonn, Dortmund, Germany
| |
Collapse
|
19
|
Pfäffle R, Land C, Schönau E, Holterhus PM, Ross JL, Piras de Oliveira C, Child CJ, Benabbad I, Jia N, Jung H, Blum WF. Growth Hormone Treatment for Short Stature in the USA, Germany and France: 15 Years of Surveillance in the Genetics and Neuroendocrinology of Short-Stature International Study (GeNeSIS). Horm Res Paediatr 2019; 90:169-180. [PMID: 30199857 DOI: 10.1159/000492397] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To describe characteristics, auxological outcomes and safety in paediatric patients with growth disorders treated with growth hormone (GH), for cohorts from the USA, Germany and France enrolled in GeNeSIS, a post-authorisation surveillance programme. METHODS Diagnosis and biochemical measurement data were based on reporting from, and GH treatment was initiated at the discretion of, treating physicians. Auxological outcomes during the first 4 years of GH treatment and at near-adult height (NAH) were analysed. Serious and treatment-emergent adverse events were described. RESULTS Children in the USA (n = 9,810), Germany (n = 2,682) and France (n = 1,667) received GH (dose varied between countries), most commonly for GH deficiency. Across diagnostic groups and countries, mean height velocity standard deviation score (SDS) was > 0 and height SDS increased from baseline during the first 4 years of treatment, with greatest improvements during year 1. Most children achieved NAH within the normal range (height SDS >-2). No new or unexpected safety concerns were noted. CONCLUSION GH treatment improved growth indices to a similar extent for patients in all three countries despite variations in GH doses. Data from these three countries, which together contributed > 60% of patients to GeNeSIS, indicated no new safety signals and the benefit-risk profile of GH remains unchanged.
Collapse
Affiliation(s)
- Roland Pfäffle
- Department of Paediatric Endocrinology, Children's Hospital, Leipzig, Germany
| | - Christof Land
- Practice for Children's Endocrinology and Diabetology, Gauting, Germany
| | - Eckhard Schönau
- Department of Paediatrics, University Hospital of Cologne, Cologne, Germany
| | - Paul-Martin Holterhus
- Division of Paediatric Endocrinology and Diabetes, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Judith L Ross
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Imane Benabbad
- Medical Diabetes, Lilly France, Neuilly-sur-Seine, France
| | - Nan Jia
- Eli Lilly, Indianapolis, Indiana, USA
| | - Heike Jung
- Medical Department Diabetes, Lilly Deutschland, Bad Homburg,
| | - Werner F Blum
- Children's Hospital, University of Giessen, Giessen, Germany
| |
Collapse
|
20
|
Riedl S, Röhl FW, Bonfig W, Brämswig J, Richter-Unruh A, Fricke-Otto S, Bettendorf M, Riepe F, Kriegshäuser G, Schönau E, Even G, Hauffa B, Dörr HG, Holl RW, Mohnike K. Genotype/phenotype correlations in 538 congenital adrenal hyperplasia patients from Germany and Austria: discordances in milder genotypes and in screened versus prescreening patients. Endocr Connect 2019; 8:86-94. [PMID: 30620712 PMCID: PMC6365666 DOI: 10.1530/ec-18-0281] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/08/2019] [Indexed: 12/27/2022]
Abstract
Congenital adrenal hyperplasia (CAH) due to CYP21A2 gene mutations is associated with a variety of clinical phenotypes (salt wasting, SW; simple virilizing, SV; nonclassical, NC) depending on residual 21-hydroxylase activity. Phenotypes and genotypes correlate well in 80-90% of cases. We set out to test the predictive value of CAH phenotype assignment based on genotype classification in a large multicenter cohort. A retrospective evaluation of genetic data from 538 CAH patients (195 screened) collected from 28 tertiary centers as part of a German quality control program was performed. Genotypes were classified according to residual 21-hydroxylase activity (null, A, B, C) and assigned clinical phenotypes correlated with predicted phenotypes, including analysis of Prader stages. Ultimately, concordance of genotypes with clinical phenotypes was compared in patients diagnosed before or after the introduction of nationwide CAH-newborn screening. Severe genotypes (null and A) correlated well with the expected phenotype (SW in 97 and 91%, respectively), whereas less severe genotypes (B and C) correlated poorly (SV in 45% and NC in 57%, respectively). This was underlined by a high degree of virilization in girls with C genotypes (Prader stage >1 in 28%). SW was diagnosed in 90% of screening-positive babies with classical CAH compared with 74% of prescreening patients. In our CAH series, assigned phenotypes were more severe than expected in milder genotypes and in screened vs prescreening patients. Diagnostic discrimination between phenotypes based on genotypes may prove overcome due to the overlap in their clinical presentations.
Collapse
Affiliation(s)
- Stefan Riedl
- Division of Pediatric Pulmology, Allergology and Endocrinology, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
- Correspondence should be addressed to S Riedl:
| | | | - Walter Bonfig
- Department of Pediatrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Jürgen Brämswig
- Department of Pediatrics, Pediatric Endocrinology, Westfälische Wilhelmsuniversität Münster, Münster, Germany
| | - Annette Richter-Unruh
- Department of Pediatrics, Pediatric Endocrinology, Westfälische Wilhelmsuniversität Münster, Münster, Germany
| | - Susanne Fricke-Otto
- Department of Pediatrics, Pediatric Endocrinology, Helios Klinikum Krefeld, Krefeld, Germany
| | - Markus Bettendorf
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Felix Riepe
- Pediatric Endocrinology, Kronshagen, Kiel, Germany
| | - Gernot Kriegshäuser
- Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Steyr, Austria
| | - Eckhard Schönau
- Department of Pediatrics, Pediatric Endocrinology, Universität zu Köln, Cologne, Germany
| | - Gertrud Even
- Department of Pediatrics, Pediatric Endocrinology, Universität zu Köln, Cologne, Germany
| | - Berthold Hauffa
- Department of Pediatric Endocrinology, University of Duisburg-Essen, Essen, Germany
| | - Helmuth-Günther Dörr
- Department of Pediatrics, Pediatric Endocrinology, Friedrich Alexander Universität Erlangen, Erlangen, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany
| | - Klaus Mohnike
- Department of Pediatrics, Pediatric Endocrinology, Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| | | |
Collapse
|
21
|
Quitmann J, Bloemeke J, Silva N, Bullinger M, Witt S, Akkurt I, Dunstheimer D, Vogel C, Böttcher V, Kuhnle Krahl U, Bettendorf M, Schönau E, Fricke-Otto S, Keller A, Mohnike K, Dörr HG. Quality of Life of Short-Statured Children Born Small for Gestational Age or Idiopathic Growth Hormone Deficiency Within 1 Year of Growth Hormone Treatment. Front Pediatr 2019; 7:164. [PMID: 31111024 PMCID: PMC6501464 DOI: 10.3389/fped.2019.00164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/09/2019] [Indexed: 11/13/2022] Open
Abstract
Aside from clinical endpoints like height gain, health-related quality of life has also become an important outcome indicator in the medical field. However, the data on short stature and health-related quality of life is inconsistent. Therefore, we examined changes in health-related quality of life in German children with idiopathic growth hormone deficiency or children born small for gestational age before and after 12 months of human growth hormone treatment. Children with idiopathic short stature without treatment served as a comparison group. At baseline, health-related quality of life data of 154 patients with idiopathic growth hormone deficiency (n = 65), born small for gestational age (n = 58), and idiopathic short stature (n = 31) and one parent each was collected. Of these, 130 completed health-related quality of life assessments after 1-year of human growth hormone treatment. Outcome measures included the Quality of Life in Short Stature Youth questionnaire, as well as clinical and sociodemographic data. Our results showed that the physical, social, and emotional health-related quality of life of children treated with human growth hormone significantly increased, while untreated patients with idiopathic short stature reported a decrease in these domains. Along with this, a statistically significant increase in height in the treated group can be observed, while the slight increase in the untreated group was not significant. In conclusion, the results showed that human growth hormone treatment may have a positive effect not only on height but also in improving patient-reported health-related quality of life of children with idiopathic growth hormone deficiency and children born small for gestational age.
Collapse
Affiliation(s)
- Julia Quitmann
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janika Bloemeke
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Neuza Silva
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Faculty of Psychology and Education Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Monika Bullinger
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Witt
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ilker Akkurt
- Children and Adolescent Endocrinology, MVZ am AKK GmbH, Hamburg, Germany
| | | | - Christian Vogel
- Clinic for Children and Adolescent Medicine, Chemnitz Hospital, Chemnitz, Germany
| | | | | | - Markus Bettendorf
- Center for Children and Adolescent Medicine, University Clinic of Heidelberg, Heidelberg, Germany
| | - Eckhard Schönau
- Pediatric Endocrinology, University Clinic of Cologne, Cologne, Germany
| | - Susanne Fricke-Otto
- Center for Children and Adolescent Medicine, HELIOS Hospital, Krefeld, Germany
| | | | - Klaus Mohnike
- University Children's Clinic, Otto von Geuricke University, Magdeburg, Germany
| | - Helmuth-Günther Dörr
- Clinic for Children and Adolescents, Erlangen-Nürnberg Universtiy, Erlangen, Germany
| |
Collapse
|
22
|
Bonfig W, Roehl F, Riedl S, Brämswig J, Richter-Unruh A, Fricke-Otto S, Hübner A, Bettendorf M, Schönau E, Dörr H, Holl RW, Mohnike K. Sodium Chloride Supplementation Is Not Routinely Performed in the Majority of German and Austrian Infants with Classic Salt-Wasting Congenital Adrenal Hyperplasia and Has No Effect on Linear Growth and Hydrocortisone or Fludrocortisone Dose. Horm Res Paediatr 2018; 89:7-12. [PMID: 29073619 DOI: 10.1159/000481775] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/25/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sodium chloride supplementation in salt-wasting congenital adrenal hyperplasia (CAH) is generally recommended in infants, but its implementation in routine care is very heterogeneous. OBJECTIVE To evaluate oral sodium chloride supplementation, growth, and hydrocortisone and fludrocortisone dose in infants with salt-wasting CAH due to 21-hydroxylase in 311 infants from the AQUAPE CAH database. RESULTS Of 358 patients with classic CAH born between 1999 and 2015, 311 patients had salt-wasting CAH (133 females, 178 males). Of these, 86 patients (27.7%) received oral sodium chloride supplementation in a mean dose of 0.9 ± 1.4 mmol/kg/day (excluding nutritional sodium content) during the first year of life. 225 patients (72.3%) were not treated with sodium chloride. The percentage of sodium chloride-supplemented patients rose from 15.2% in children born 1999-2004 to 37.5% in children born 2011-2015. Sodium chloride-supplemented and -unsupplemented infants did not significantly differ in hydrocortisone and fludrocortisone dose, target height-corrected height-SDS, and BMI-SDS during the first 2 years of life. CONCLUSION In the AQUAPE CAH database, approximately one-third of infants with salt-wasting CAH receive sodium chloride supplementation. Sodium chloride supplementation is performed more frequently in recent years. However, salt supplementation had no influence on growth, daily fludrocortisone and hydrocortisone dose, and frequency of adrenal crisis.
Collapse
Affiliation(s)
- Walter Bonfig
- Department of Pediatrics, Klinikum Wels-Grieskirchen, Wels-Grieskirchen, Austria.,Pediatric Endocrinology, Department of Pediatrics, Technische Universität München, München, Germany
| | - Friedhelm Roehl
- Department of Biometrics, Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| | - Stefan Riedl
- Pediatric Endocrinology, St. Anna Kinderspital, University of Vienna, Vienna, Austria
| | - Jürgen Brämswig
- Pediatric Endocrinology, Department of Pediatrics, Universitätsklinikum Münster, Westfälische Wilhelmsuniversität Münster, Münster, Germany
| | - Annette Richter-Unruh
- Pediatric Endocrinology, Department of Pediatrics, Universitätsklinikum Münster, Westfälische Wilhelmsuniversität Münster, Münster, Germany
| | - Susanne Fricke-Otto
- Pediatric Endocrinology, Department of Pediatrics, Helios Klinikum Krefeld, Krefeld, Germany
| | - Angela Hübner
- Pediatric Endocrinology, Department of Pediatrics, Universitätsklinikum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Markus Bettendorf
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Universitätsklinikum Heidelberg, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Eckhard Schönau
- Pediatric Endocrinology, Department of Pediatrics, Universitätsklinikum Köln, Universität zu Köln, Köln, Germany
| | - Helmut Dörr
- Pediatric Endocrinology, Department of Pediatrics, Universitätsklinikum Erlangen, Friedrich Alexander Universität Erlangen, Erlangen, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany
| | - Klaus Mohnike
- Pediatric Endocrinology, Department of Pediatrics, Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| |
Collapse
|
23
|
Soucek O, Schönau E, Lebl J, Willnecker J, Hlavka Z, Sumnik Z. A 6-Year Follow-Up of Fracture Incidence and Volumetric Bone Mineral Density Development in Girls With Turner Syndrome. J Clin Endocrinol Metab 2018; 103:1188-1197. [PMID: 29300907 DOI: 10.1210/jc.2017-02381] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/20/2017] [Indexed: 02/03/2023]
Abstract
CONTEXT Patients with Turner syndrome (TS) are at risk for osteoporotic fractures. OBJECTIVE The aims of this study were to assess the incidence of clinically important fractures in girls with TS and prospectively describe the development of volumetric bone mineral density (BMD). DESIGN Peripheral quantitative computerized tomography (pQCT) of the radius every other year over the 6 years of observation. SETTING Government-funded university referral center. PARTICIPANTS Thirty-two girls with TS, aged 6 to 16 years, were included in the analyses. Fracture incidence was compared with the data in the general population. Bone density and strength were compared with data from 185 healthy girls. OUTCOMES The main clinical outcome was the fracture occurrence. The secondary outcomes were the changes in Z-scores of the bone parameters. RESULTS Three girls with TS sustained four fractures during 6 years of observation. The fracture rate in TS was not substantially higher than the downward-biased fracture-rate estimate from age-matched, healthy controls (P = 0.48). Whereas the trabecular BMD Z-score decreased with age (β estimate -0.21 ± 0.04, P < 0.001), total bone cross-sectional area correspondingly increased (+0.16 ± 0.04, P < 0.001), which led to normal bone strength. A positive history of incident fractures was not significantly associated with any of the pQCT-derived bone parameters. CONCLUSIONS Current pediatric TS patients that are treated with growth hormone and estrogens are not at risk for osteoporotic fractures. Low BMD in TS may be counterweighted by enlarged bone radius, which leads to normal bone strength at the appendicular skeleton.
Collapse
Affiliation(s)
- Ondrej Soucek
- Department of Pediatrics, Second Medical Faculty, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Eckhard Schönau
- Department of Pediatrics, University Hospital Cologne and Cologne University, Cologne, Germany
| | - Jan Lebl
- Department of Pediatrics, Second Medical Faculty, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | - Zdenek Hlavka
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
| | - Zdenek Sumnik
- Department of Pediatrics, Second Medical Faculty, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| |
Collapse
|
24
|
Krause A, Schönau E, Gollhofer A, Duran I, Ferrari-Malik A, Freyler K, Ritzmann R. Alleviation of Motor Impairments in Patients with Cerebral Palsy: Acute Effects of Whole-body Vibration on Stretch Reflex Response, Voluntary Muscle Activation and Mobility. Front Neurol 2017; 8:416. [PMID: 28861038 PMCID: PMC5561012 DOI: 10.3389/fneur.2017.00416] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/31/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Individuals suffering from cerebral palsy (CP) often have involuntary, reflex-evoked muscle activity resulting in spastic hyperreflexia. Whole-body vibration (WBV) has been demonstrated to reduce reflex activity in healthy subjects, but evidence in CP patients is still limited. Therefore, this study aimed to establish the acute neuromuscular and kinematic effects of WBV in subjects with spastic CP. METHODS 44 children with spastic CP were tested on neuromuscular activation and kinematics before and immediately after a 1-min bout of WBV (16-25 Hz, 1.5-3 mm). Assessment included (1) recordings of stretch reflex (SR) activity of the triceps surae, (2) electromyography (EMG) measurements of maximal voluntary muscle activation of lower limb muscles, and (3) neuromuscular activation during active range of motion (aROM). We recorded EMG of m. soleus (SOL), m. gastrocnemius medialis (GM), m. tibialis anterior, m. vastus medialis, m. rectus femoris, and m. biceps femoris. Angular excursion was recorded by goniometry of the ankle and knee joint. RESULTS After WBV, (1) SOL SRs were decreased (p < 0.01) while (2) maximal voluntary activation (p < 0.05) and (3) angular excursion in the knee joint (p < 0.01) were significantly increased. No changes could be observed for GM SR amplitudes or ankle joint excursion. Neuromuscular coordination expressed by greater agonist-antagonist ratios during aROM was significantly enhanced (p < 0.05). DISCUSSION The findings point toward acute neuromuscular and kinematic effects following one bout of WBV. Protocols demonstrate that pathological reflex responses are reduced (spinal level), while the execution of voluntary movement (supraspinal level) is improved in regards to kinematic and neuromuscular control. This facilitation of muscle and joint control is probably due to a reduction of spasticity-associated spinal excitability in favor of giving access for greater supraspinal input during voluntary motor control.
Collapse
Affiliation(s)
- Anne Krause
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| | - Eckhard Schönau
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - Albert Gollhofer
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| | - Ibrahim Duran
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - Anja Ferrari-Malik
- Center of Prevention and Rehabilitation, University of Cologne, Cologne, Germany
| | - Kathrin Freyler
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| | - Ramona Ritzmann
- Department of Sport Science, University of Freiburg, Freiburg, Germany
| |
Collapse
|
25
|
Choukair D, Kneppo C, Feneberg R, Schönau E, Lindner M, Kölker S, Hoffmann GF, Tönshoff B. Analysis of the functional muscle-bone unit of the forearm in patients with phenylketonuria by peripheral quantitative computed tomography. J Inherit Metab Dis 2017; 40:219-226. [PMID: 27878409 DOI: 10.1007/s10545-016-0002-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/19/2016] [Accepted: 11/02/2016] [Indexed: 12/22/2022]
Abstract
Bone disease in patients with phenylketonuria (PKU) is incompletely characterized. We therefore analyzed, in a cross-sectional study radius macroscopic bone architecture and forearm muscle size by peripheral quantitative computed tomography (pQCT) and muscle strength by hand dynamometry in a large cohort (n = 56) of adolescent and adult patients with PKU aged 26.0 ± 8.9 (range, 11.8-41.5) years. Data were compared with a reference population (n = 700) from the DONALD study using identical methodology. We observed a significant reduction of cortical thickness (z-score -1.01 ± 0.79), Strength-Strain Index (SSI) (z-score -0.81 ± 1.03), and total bone mineral density (BMD) of the distal radius (z-score -1.05 ± 1.00). Mean muscle cross-sectional area (z-score -0.98 ± 1.19) and muscle grip force (z-score -0.64 ± 1.26) were also significantly reduced, indicating an impaired muscular system as part of the clinical phenotype of PKU. SSI positively correlated (r = 0.53, P < 0.001) with the corresponding muscle cross-sectional area in the reference population; however, the regression line slope in PKU patients was less steep (P < 0.001), indicating that bone strength is not adequately adapted to muscle force. In conclusion, the radial bone in PKU patients is characterized by reduced bone strength in relation to muscular force, decreased cortical thickness, and impaired total BMD at the metaphyseal site. These alterations indicate a mixed bone defect in PKU, both of which are due to primary alterations of bone metabolism and to secondary alterations in response to neuromuscular abnormalities.
Collapse
Affiliation(s)
- Daniela Choukair
- Department of Pediatrics I, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
| | - Carolin Kneppo
- Department of Pediatrics I, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Reinhard Feneberg
- Department of Pediatrics I, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
- ICON Clinical Research GmbH, Langen, Germany
| | | | - Martin Lindner
- Division of Neuropediatrics and Metabolic Medicine, Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
- University Children's Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Kölker
- Division of Neuropediatrics and Metabolic Medicine, Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Georg F Hoffmann
- Department of Pediatrics I, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
- Division of Neuropediatrics and Metabolic Medicine, Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| |
Collapse
|
26
|
Gerhardt F, Dumitrescu D, Gärtner C, Beccard R, Viethen T, Kramer T, Baldus S, Hellmich M, Schönau E, Rosenkranz S. Oscillatory whole-body vibration improves exercise capacity and physical performance in pulmonary arterial hypertension: a randomised clinical study. Heart 2017; 103:592-598. [PMID: 28100544 PMCID: PMC5529961 DOI: 10.1136/heartjnl-2016-309852] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/23/2016] [Accepted: 09/29/2016] [Indexed: 01/11/2023] Open
Abstract
Objective In patients with pulmonary arterial hypertension (PAH), supportive therapies may be beneficial in addition to targeted medical treatment. Here, we evaluated the effectiveness and safety of oscillatory whole-body vibration (WBV) in patients on stable PAH therapy. Methods Twenty-two patients with PAH (mean PAP≥25 mm Hg and pulmonary arterial wedge pressure (PAWP)≤15 mm Hg) who were in world health organization (WHO)-Functional Class II or III and on stable PAH therapy for≥3 months, were randomised to receive WBV (16 sessions of 1-hour duration within 4 weeks) or to a control group, that subsequently received WBV. Follow-up measures included the 6-min walking distance (6MWD), cardiopulmonary exercise testing (CPET), echocardiography, muscle-power, and health-related quality of life (HRQoL; SF-36 and LPH questionnaires). Results When compared to the control group, patients receiving WBV exhibited a significant improvement in the primary endpoint, the 6MWD (+35.4±10.9 vs −4.4±7.6 m), resulting in a net benefit of 39.7±7.8 m (p=0.004). WBV was also associated with substantial improvements in CPET variables, muscle power, and HRQoL. The combined analysis of all patients (n=22) indicated significant net improvements versus baseline in the 6MWD (+38.6 m), peakVO2 (+65.7 mL/min), anaerobic threshold (+40.9 mL VO2/min), muscle power (+4.4%), and HRQoL (SF-36 +9.7, LPH −11.5 points) (all p<0.05). WBV was well tolerated in all patients, and no procedure-related severe adverse events (SAEs) occurred. Conclusions WBV substantially improves exercise capacity, physical performance, and HRQoL in patients with PAH who are on stable targeted therapy. This methodology may be utilised in structured training programmes, and may be feasible for continuous long-term physical exercise in these patients. Trial registration number NCT01763112; Results.
Collapse
Affiliation(s)
- Felix Gerhardt
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
| | - Daniel Dumitrescu
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
| | - Carina Gärtner
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
| | - Ralf Beccard
- Klinik und Poliklinik für Allgemeine Kinderheilkunde, Universität zu Köln, Cologne, Germany
| | - Thomas Viethen
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
| | - Tilmann Kramer
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany
| | - Stephan Baldus
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany.,Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institut für Medizinische Statistik, Informatik und Epidemiologie, Universität zu Köln, Cologne, Germany
| | - Eckhard Schönau
- Klinik und Poliklinik für Allgemeine Kinderheilkunde, Universität zu Köln, Cologne, Germany
| | - Stephan Rosenkranz
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Cologne, Germany.,Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of Cologne, Cologne, Germany
| |
Collapse
|
27
|
Esche J, Johner S, Shi L, Schönau E, Remer T. Urinary Citrate, an Index of Acid-Base Status, Predicts Bone Strength in Youths and Fracture Risk in Adult Females. J Clin Endocrinol Metab 2016; 101:4914-4921. [PMID: 27676395 DOI: 10.1210/jc.2016-2677] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Diet can impact on bone strength via metabolic shifts in acid-base status. In contrast to the strongly diet-dependent biomarker urinary potential renal acid load (uPRAL), the amount of renally excreted citrate integrates nutritional and systemic influences on acid-base homeostasis with high citrate indicating prevailing alkalization. OBJECTIVE To examine the association between urinary citrate excretion and bone strength as well as long-term fracture risk. DESIGN AND PARTICIPANTS Prospective cross-sectional analysis; 231 healthy children (6-18 y) of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study were included, with at least 2 urine collections available during the 4 years preceding peripheral quantitative computed tomography (pQCT) of the nondominant proximal forearm. uPRAL, urinary citrate, and urinary nitrogen excretion were quantified in 857 24-hour urine samples. Data on overall fracture incidence were collected within a 15-year follow-up after pQCT measurement. MAIN OUTCOME MEASURES Parameters of bone quality and geometry (pQCT) as well as long-term fracture incidence. RESULTS After controlling for confounders, especially forearm length, muscle area, and urinary nitrogen (biomarker of protein intake), urinary citrate excretion was positively associated with various parameters of bone quality and geometry (P < .05). Fracture risk in adult females, but not in males, was inversely associated with urinary citrate and positively with uPRAL (P < .05). CONCLUSIONS Although urinary citrate has to be confirmed as an integrated noninvasive biomarker of systemic acid-base status in further studies, our results substantiate dietary and metabolic acidity as potentially adverse for bone health in the long run from childhood onward.
Collapse
Affiliation(s)
- Jonas Esche
- DONALD Study Dortmund (J.E., S.J., L.S., T.R.), Department of Nutritional Epidemiology, Institute of Nutritional and Food Sciences (IEL), University of Bonn, 44225 Dortmund, Germany; and Children's Hospital (E.S.), University of Cologne, 50937 Cologne, Germany
| | - Simone Johner
- DONALD Study Dortmund (J.E., S.J., L.S., T.R.), Department of Nutritional Epidemiology, Institute of Nutritional and Food Sciences (IEL), University of Bonn, 44225 Dortmund, Germany; and Children's Hospital (E.S.), University of Cologne, 50937 Cologne, Germany
| | - Lijie Shi
- DONALD Study Dortmund (J.E., S.J., L.S., T.R.), Department of Nutritional Epidemiology, Institute of Nutritional and Food Sciences (IEL), University of Bonn, 44225 Dortmund, Germany; and Children's Hospital (E.S.), University of Cologne, 50937 Cologne, Germany
| | - Eckhard Schönau
- DONALD Study Dortmund (J.E., S.J., L.S., T.R.), Department of Nutritional Epidemiology, Institute of Nutritional and Food Sciences (IEL), University of Bonn, 44225 Dortmund, Germany; and Children's Hospital (E.S.), University of Cologne, 50937 Cologne, Germany
| | - Thomas Remer
- DONALD Study Dortmund (J.E., S.J., L.S., T.R.), Department of Nutritional Epidemiology, Institute of Nutritional and Food Sciences (IEL), University of Bonn, 44225 Dortmund, Germany; and Children's Hospital (E.S.), University of Cologne, 50937 Cologne, Germany
| |
Collapse
|
28
|
Stahl M, Müller FM, Holfelder C, Kneppo C, Kieser M, Kasperk C, Schönau E, Sommerburg O, Tönshoff B. WS12.2 Increased fracture rate in relation to macroscopic bone architecture in young patients with cystic fibrosis. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30127-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
29
|
Bonfig W, Roehl FW, Riedl S, Dörr HG, Bettendorf M, Brämswig J, Schönau E, Riepe F, Hauffa B, Holl RW, Mohnike K. Blood Pressure in a Large Cohort of Children and Adolescents With Classic Adrenal Hyperplasia (CAH) Due to 21-Hydroxylase Deficiency. Am J Hypertens 2016; 29:266-72. [PMID: 26071487 DOI: 10.1093/ajh/hpv087] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 05/19/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Data on blood pressure (BP) in children and adolescents with classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency are conflicting in the literature. PATIENTS AND METHODS BP data of n = 716 children and adolescents (aged 3-18 years) from a national CAH database were analyzed. BP data were adjusted for height and compared to contemporary national reference data. A systolic and diastolic BP above the 95th centile was defined as hypertensive. RESULTS Overall prevalence of hypertension was 12.5%. Prevalence of hypertension was higher in younger children than in adolescents (18.5% vs. 4.9%). Until 8 years of age, fludrocortisone dose/m(2)/day correlated significantly with BP in regression analysis (P < 0.0001). BP correlated significantly with body mass index standard deviation score (BMI-SDS) (P < 0.0001), but not with hydrocortisone dose. In patients with salt-wasting CAH, BMI-SDS and BP were significantly higher compared to patients with simple virilising CAH, P < 0.01. CONCLUSION Especially young CAH children seem to be at risk for-most likely transient-hypertension, since the prevalence of hypertension decreases with age. In children up to 8 years of age, the used fludrocortisone dose is a significant risk factor for hypertension. Therefore we recommend accurate measurement of BP and careful fludrocortisone dosing in children with CAH.
Collapse
Affiliation(s)
- Walter Bonfig
- Pediatric Endocrinology, Department of Pediatrics, Technische Universität München, Munich, Germany;
| | | | - Stefan Riedl
- Pediatric Endocrinology, St. Anna Kinderspital, University of Vienna, Wien/Vienna, Austria
| | - Helmut Günther Dörr
- Pediatric Endocrinology, Department of Pediatrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Markus Bettendorf
- Pediatric Endocrinology, Department of Pediatrics, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jürgen Brämswig
- Pediatric Endocrinology, Department of Pediatrics, Universitätsklinikum Münster, Münster, Germany
| | - Eckhard Schönau
- Pediatric Endocrinology, Department of Pediatrics, Universitätsklinik zu Köln, Köln/Cologne, Germany
| | | | - Berthold Hauffa
- Pediatric Endocrinology, Department of Pediatrics, Universitätsklinikum Essen, Essen, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Klaus Mohnike
- Pediatric Endocrinology, Department of Pediatrics, Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| |
Collapse
|
30
|
Ellerbroek VL, Bonfig W, Dörr HG, Bettendorf M, Hauffa B, Fricke-Otto S, Rohrer T, Reschke F, Schönau E, Schwab KO, Kapelari K, Röhl FW, Mohnike K, Holl RW. Long-term Surveillance of Children with Congenital Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (AQUAPE "Hypo Dok"). Klin Padiatr 2015; 227:199-205. [PMID: 26038964 DOI: 10.1055/s-0035-1549978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The German study group for quality assurance in pediatric endocrinology and the University of Ulm have established a software ("Hypo Dok") for the documentation of longitudinal data of patients with congenital primary hypothyroidism (CH). Aim of this study was to analyse the long-term follow-up of patients with CH and to compare treatment with current guidelines. METHODS/PATIENTS Anonymised data of 1,080 patients from 46 centres were statistically analysed. RESULTS Newborn screening result was available at a mean age of 7.3 days. Confirmation of the diagnosis was established at 8.4 days and therapy was started at 11 days. The average screening TSH was 180.0 mIU/L. During the first 3 months mean levothyroxine (LT4) dose was 10.7 µg/kg/day or 186.0 µg/m²/day. Weight-, BMI- and height-SDS did not differ significantly from the normal population. Only 25% of the patients (n=262) underwent formal EQ/IQ-testing. Their average IQ was 98.8 ± 13.2 points. DISCUSSION In Germany screening, confirmation and start of treatment of CH are within the recommended time frame of 14 days. Initial LT4-doses are adequate. The auxological longterm outcome of young CH patients is normal. The implementation of standardized IQ testing has to be improved in routine patient care. CONCLUSION Longitudinal data of patients with CH was analysed and compared to current guidelines. Confirmation and start of treatment are according to the recommendations. However standardised IQ testing requires improvement.
Collapse
Affiliation(s)
- V L Ellerbroek
- Children's Hospital Schwabing, Pediatric Endocrinology, Munich, Germany
| | - W Bonfig
- Children's Hospital Schwabing, Pediatric Endocrinology, Munich, Germany
| | - H-G Dörr
- Department of Pediatrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - M Bettendorf
- Pediatric Endocrinology and Diabetes, University Hospital Heidelberg, Heidelberg, Germany
| | - B Hauffa
- Department of Pediatric Hematology, Oncology and Endocrinology, University Hospital Essen, Essen, Germany
| | - S Fricke-Otto
- Departement of Pediatrics, Hospital Krefeld, Krefeld, Germany
| | - T Rohrer
- Center of Pediatrics, Children's University Hospital of Saarland, Homburg, Germany
| | - F Reschke
- Pediatric Endocrinology, University of Dresden, Dresden, Germany
| | - E Schönau
- Children's University Hospital Cologne, Cologne, Germany
| | - K O Schwab
- Pediatric Endocrinology, University of Freiburg, Freiburg, Germany
| | - K Kapelari
- Pediatric Endocrinology, University of Innsbruck, Innsbruck, Austria
| | - F-W Röhl
- Otto-von-Guericke University Magdeburg, Institute of Biometry and Medical Informatics, Magdeburg, Germany
| | - K Mohnike
- Department of Pediatrics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - R W Holl
- Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
| |
Collapse
|
31
|
Eydam M, Kottoor N, Schönau E, Semler O, Hoyer-Kuhn H, Körber S, Maintz D, Körber F. Therapiemonitoring unter Bisphosponat bei Kindern mit Osteogenesis imperfecta mittels „Cologne-Osteogenesis-Imperfecta-Numeric-(COIN)-Score“: Detektion von Nicht-Respondern in Korrelation zur Genetik. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
32
|
Kottoor N, Eydam M, Schönau E, Semler O, Hoyer-Kuhn H, Körber S, Maintz D, Körber F. Anwendung und Modifikation einer automatisierten Wirbelkörperanalyse für die Ermittlung des „Cologne-Osteogenesis-imperfecta-Numeric-(COIN)-Scores“ – Erste Ergebnisse. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Koerber F, Schönau E, Semler O, Hoyer-Kuhn H, Körber S, Kottoor N, Eydam M, Maintz D. Anwendung des „Cologne-Osteogenesis-Imperfecta-Numeric-Score“ (COIN-Score) bei Kindern und Jugendlichen mit Osteogenesis imperfecta (OI) unter Bisphosphonat-Therapie – eine Kohortenstudie. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
34
|
Soucek O, Schönau E, Lebl J, Sumnik Z. Artificially low cortical bone mineral density in Turner syndrome is due to the partial volume effect. Osteoporos Int 2015; 26:1213-8. [PMID: 25288443 DOI: 10.1007/s00198-014-2901-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 09/09/2014] [Indexed: 12/15/2022]
Abstract
UNLABELLED We aimed to show that the decrease in the cortical bone mineral density (BMD) in the radius in Turner syndrome (TS) is artificially caused by the partial volume effect. We confirmed that the partial volume effect-corrected cortical BMD is not decreased in TS compared to in the healthy controls. Other factors are responsible for the increased fracture rate in TS. INTRODUCTION Decreased cortical bone mineral density (BMD) has been reported in Turner syndrome (TS), using peripheral quantitative computerised tomography, and it is perceived as one of the major factors leading to increased fracture risk. We tested the hypothesis that low cortical BMD in the radius is caused artificially by the partial volume effect. METHODS A cross-sectional study was conducted at the university hospital referral centre between March and October 2013. Thirty-two participants with TS who consented to the study were included (mean age 15.3 ± 3.2 years). We assessed the cortical BMD in the radius as well as the tibia, where the cortex is thicker compared with the radius. RESULTS Whereas the cortical BMD was decreased in the radius (mean ± SD Z-score -0.6 ± 1.5, p = 0.037), it was increased in the tibia (mean Z-score 0.83 ± 1.0, p < 0.001). After correcting the cortical BMD for the partial volume effect, the mean Z-score was normal in the radius in TS (0.4 ± 1.3, p = 0.064). The corrected cortical BMD values were similar in the radius and tibia (1108 ± 52 vs. 1104 ± 48, group difference p = 0.75). CONCLUSIONS The cortical BMD is not decreased in TS. The partial volume effect is responsible for previous findings of decreased cortical BMD in the radius. Altered bone geometry or other factors rather than low cortical BMD likely play a role in the increased fracture risk in TS.
Collapse
Affiliation(s)
- O Soucek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, 150 06, Praha 5, Czech Republic,
| | | | | | | |
Collapse
|
35
|
Shi L, Sánchez-Guijo A, Hartmann MF, Schönau E, Esche J, Wudy SA, Remer T. Higher glucocorticoid secretion in the physiological range is associated with lower bone strength at the proximal radius in healthy children: importance of protein intake adjustment. J Bone Miner Res 2015; 30:240-8. [PMID: 25196629 DOI: 10.1002/jbmr.2347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 08/08/2014] [Accepted: 08/25/2014] [Indexed: 01/18/2023]
Abstract
Whether higher production of glucocorticoids (GCs) within the physiological range may already be affecting bone status in healthy children is unknown. Because dietary protein intake affects both bone and GCs, we examined the association of urinary measures of glucocorticoid status and cortical bone in healthy non-obese children, after particularly controlling for protein intake. Proximal forearm bone parameters were measured by peripheral quantitative computed tomography (pQCT). Subjects studied (n = 175, 87 males, aged 6 to 18 years) had two 24-hour urine samples collected: the first sample at 1 year before bone measurement, and the second sample at the time of bone measurement. Major urinary GC metabolites were measured by mass spectrometry and summed to assess daily adrenal GC secretion (∑C21). Urinary free cortisol (UFF) and cortisone (UFE) were summed to assess potentially bioactive free GCs (UFF + UFE). After controlling for several covariates and especially urinary nitrogen (the biomarker of protein intake) cortisol secretion ∑C21 was inversely associated with all analyzed pQCT measures of bone quality. ∑C21 also predicted a higher endosteal and lower periosteal circumference, explaining both a smaller cortical area and (together with lower BMD) a lower strength-strain-index (SSI). UFF + UFE, UFE itself, and a urinary metabolite-estimate of 11beta-hydroxysteroid dehydrogenase type1 (11beta-HSD1) activity showed corresponding reciprocal associations (p < 0.05) with BMD and bone mineral content, but not with SSI and bone geometry variables. In conclusion, higher GC levels, even within the physiological range, appear to exert negative influences on bone modeling and remodeling already during growth. Our physiological data also suggest a relevant role of cortisone as the direct source for intracrine-generated cortisol by bone cell 11beta-HSD1.
Collapse
Affiliation(s)
- Lijie Shi
- Institute of Nutritional and Food Sciences-Nutritional Epidemiology, University of Bonn, Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study Center at the Research Institute of Child Nutrition Dortmund, Germany
| | | | | | | | | | | | | |
Collapse
|
36
|
Ireland A, Rittweger J, Schönau E, Lamberg-Allardt C, Viljakainen H. Time since onset of walking predicts tibial bone strength in early childhood. Bone 2014; 68:76-84. [PMID: 25132490 DOI: 10.1016/j.bone.2014.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/01/2014] [Accepted: 08/08/2014] [Indexed: 11/25/2022]
Abstract
Bone strength in adulthood is known to be affected by health at birth and early childhood. Habitual bone loading is a primary determinant of bone strength in later childhood and adulthood. However, the effects of physical activity in early childhood (e.g. crawling, standing and walking) on bone strength are unknown. Fifty-three children (twenty-seven males) were included in a longitudinal study in their early infancy. Shortly after birth (0.3±0.3months), details of mass and height were obtained along with a pQCT scan at 20% distal-proximal tibia length. At 14.8±0.5months of age the same data were collected, along with details of age at onset of standing, crawling, supported and unsupported walking. Time since onset of walking unsupported was associated with greater bone mass, cortical bone area, pericortical circumference and polar moment of inertia of both total and cortical bone (all P<0.05). There were no significant associations between other physical activity timepoints and bone measures. Age at onset of walking was not significantly related to mass, length or bone measures at birth. The results suggest that time since attainment of independent walking - representing exposure of the tibia to the large reaction and muscular forces associated with locomotion - is a primary determinant of bone strength in early childhood. This finding raises the possible opportunity of physical activity interventions at young age in paediatric populations associated with low childhood bone strength and late walking (e.g. low birth weight, cerebral palsy and Down's Syndrome, etc.).
Collapse
Affiliation(s)
- Alex Ireland
- Cognitive Motor Function Research Group, Manchester Metropolitan University, UK.
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Centre, Germany
| | | | | | - Heli Viljakainen
- Department of Food and Environmental Sciences, University of Helsinki, Finland
| |
Collapse
|
37
|
Koy A, Pauls KAM, Flossdorf P, Becker J, Schönau E, Maarouf M, Liebig T, Fricke O, Fink GR, Timmermann L. Young Adults with Dyskinetic Cerebral Palsy Improve Subjectively on Pallidal Stimulation, but not in Formal Dystonia, Gait, Speech and Swallowing Testing. Eur Neurol 2014; 72:340-8. [DOI: 10.1159/000360984] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 02/26/2014] [Indexed: 11/19/2022]
|
38
|
Niehoff A, Lechner P, Ratiu O, Reuter S, Hamann N, Brüggemann GP, Schönau E, Bloch W, Beccard R. Effect of whole-body vibration and insulin-like growth factor-I on muscle paralysis-induced bone degeneration after botulinum toxin injection in mice. Calcif Tissue Int 2014; 94:373-83. [PMID: 24292598 DOI: 10.1007/s00223-013-9818-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Abstract
Botulinum toxin A (BTX)-induced muscle paralysis results in pronounced bone degradation with substantial bone loss. We hypothesized that whole-body vibration (WBV) and insulin-like growth factor-I (IGF-I) treatment can counteract paralysis-induced bone degradation following BTX injections by activation of the protein kinase B (Akt) signaling pathway. Female C57BL/6 mice (n = 60, 16 weeks) were assigned into six groups (n = 10 each): SHAM, BTX, BTX+WBV, BTX+IGF-I, BTX+WBV+IGF-I, and a baseline group, which was killed at the beginning of the study. Mice received a BTX (1.0 U/0.1 mL) or saline (SHAM) injection in the right hind limb. The BTX+IGF-I and BTX+WBV+IGF-I groups obtained daily subcutaneous injections of human IGF-I (1 μg/day). The BTX+WBV and BTX+WBV+IGF-I groups underwent WBV (25 Hz, 2.1 g, 0.83 mm) for 30 min/day, 5 days/week for 4 weeks. Femora were scanned by pQCT, and mechanical properties were determined. On tibial sections TRAP staining, static histomorphometry, and immunohistochemical staining against Akt, phospho-Akt, IGF-IR (IGF-I receptor), and phospho-IGF-IR were conducted. BTX injection decreased trabecular and cortical bone mineral density. The WBV and WBV+IGF-I groups showed no difference in trabecular bone mineral density compared to the SHAM group. The phospho-IGF-IR and phospho-Akt stainings were not differentially altered in the injected hind limbs between groups. We found that high-frequency, low-magnitude WBV can counteract paralysis-induced bone loss following BTX injections, while we could not detect any effect of treatment with IGF-I.
Collapse
Affiliation(s)
- Anja Niehoff
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany,
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Tallen G, Bielack S, Henze G, Horneff G, Korinthenberg R, Lawrenz B, Niehues T, Peitz J, Placzek R, Schmittenbecher P, Schönau E, Wessel L, Wirth T, Mentzel HJ, Creutzig U. Musculoskeletal Pain: A New Algorithm for Differential Diagnosis of a Cardinal Symptom in Pediatrics. Klin Padiatr 2014; 226:86-98. [DOI: 10.1055/s-0034-1366989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- G. Tallen
- Department of Pediatric Oncology/Hematology, Charite-Medical School, Berlin, Germany
| | - S. Bielack
- Children’s Hospital Stuttgart, “Pediatrics 5”, – Olgahospital, Stuttgart, Germany
| | - G. Henze
- Department of Pediatric Oncology/Hematology, Charite-Medical School, Berlin, Germany
| | - G. Horneff
- Department of Pediatrics, Asklepios Hospital, Sankt Augustin, Germany
| | - R. Korinthenberg
- Department of Pediatric Neurology and Muscle Diseases, Children’s Hospital Freiburg, Freiburg-Medical School, Freiburg, Germany
| | | | - T. Niehues
- Department of Pediatrics, HELIOS Clinics Krefeld, Krefeld, Germany
| | - J. Peitz
- Department of Pediatics, University Hospital Cologne, Cologne, Germany
| | - R. Placzek
- Department of Pediatric Orthopedics and Neuroorthopedics, University Hospital Bonn, Bonn, Germany
| | | | - E. Schönau
- Department of General Pediatrics, University Hospital Cologne, Cologne, Germany
| | - L. Wessel
- Department of Pediatrics, Heidelberg Medical School/Hospital Mannheim, Mannheim, Germany
| | - T. Wirth
- Department of Pediatrics/Division of Pediatric Orthopedics, Hospital Stuttgart, Stuttgart, Germany
| | - H.-J. Mentzel
- Department of Pediatric Radiology, Jena University Hospital, Jena, Germany
| | - U. Creutzig
- Department of Pediatric Hematology and Oncology, Medical High School Hanover, Hanover
| |
Collapse
|
40
|
Shi L, Sánchez-Guijo A, Hartmann MF, Schönau E, Wudy SA, Remer T. Higher 24-h urinary free cortisone, but not cortisol is associated with impaired cortical bone status at the proximal radius in healthy children. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
41
|
Hartmann K, Ittner J, Müller-Rossberg E, Schönau E, Stephan R, Ullrich KP, Hoppe B, Ramseger R, Brämswig J. Growth hormone treatment adherence in prepubertal and pubertal children with different growth disorders. Horm Res Paediatr 2014; 80:1-5. [PMID: 23860437 DOI: 10.1159/000351800] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 05/03/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Treatment of children with growth disorders with recombinant human growth hormone is necessary for improved outcomes, including final height. METHODS Adherence data from the Observational Study Saizen®-online, recorded with the easypod™ device collected between October 2009 and May 2011, were analyzed in pediatric patients receiving recombinant human growth hormone treatment for a variety of growth disorders. RESULTS Data from 75 children (46 boys, 29 girls) with different growth disorders were analyzed over a period of 343 ± 201 (SD) days. Boys and girls showed similar mean ± SD adherence rates of 90.5 ± 3.1% and 92.2 ± 10.7%, respectively. Pubertal children (n = 41) had a significantly lower adherence rate (89.1 ± 13.7%) than prepubertal children (n = 29) (96.5 ± 3.9%; p < 0.005). There were nonsignificant differences in adherence rates according to diagnosis: growth hormone deficiency (n = 48) 91.4 ± 11.0%, small for gestational age (n = 18) 91.1 ± 15.3%, Turner syndrome (n = 6) 86.0 ± 14.5%, and chronic renal failure (n = 3) 99.3 ± 1.0%, although the latter two groups were small. CONCLUSION Our data indicate that only a small number of pediatric patients using the easypod device had poor adherence to treatment. Further reliable adherence data are required to identify factors affecting long-term adherence in this population.
Collapse
Affiliation(s)
- Klaus Hartmann
- Medical Centre of Childhood and Adolescence, Frankfurt, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Vry J, Schubert IJ, Semler O, Haug V, Schönau E, Kirschner J. Whole-body vibration training in children with Duchenne muscular dystrophy and spinal muscular atrophy. Eur J Paediatr Neurol 2014; 18:140-9. [PMID: 24157400 DOI: 10.1016/j.ejpn.2013.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 09/14/2013] [Accepted: 09/23/2013] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Whole-body-vibration training is used to improve muscle strength and function and might therefore constitute a potential supportive therapy for neuromuscular diseases. OBJECTIVE To evaluate safety of whole-body vibration training in ambulatory children with Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA). METHODS 14 children with DMD and 8 with SMA underwent an 8-week vibration training programme on a Galileo MedM at home (3 × 3 min twice a day, 5 days a week). Primary outcome was safety of the training, assessed clinically and by measuring serum creatine kinase levels. Secondary outcome was efficacy as measured by changes in time function tests, muscle strength and angular degree of dorsiflexion of the ankles. RESULTS All children showed good clinical tolerance. In boys with DMD, creatine kinase increased by 56% after the first day of training and returned to baseline after 8 weeks of continuous whole-body vibration training. No changes in laboratory parameters were observed in children with SMA. Secondary outcomes showed mild, but not significant, improvements with the exception of the distance walked in the 6-min walking test in children with SMA, which rose from 371.3 m to 402.8 m (p < 0.01). INTERPRETATION Whole-body vibration training is clinically well tolerated in children with DMD and SMA. The relevance of the temporary increase in creatine kinase in DMD during the first days of training is unclear, but it is not related to clinical symptoms or deterioration.
Collapse
Affiliation(s)
- Julia Vry
- Department of Paediatrics and Adolescent Medicine, University Medical Centre Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany.
| | - Isabel J Schubert
- Department of Paediatrics and Adolescent Medicine, University Medical Centre Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany
| | | | - Verena Haug
- Department of Paediatrics and Adolescent Medicine, University Medical Centre Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany
| | | | - Janbernd Kirschner
- Department of Paediatrics and Adolescent Medicine, University Medical Centre Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany
| |
Collapse
|
43
|
Barbe MT, Amarell M, Snijders AH, Florin E, Quatuor EL, Schönau E, Fink GR, Bloem BR, Timmermann L. Gait and upper limb variability in Parkinson’s disease patients with and without freezing of gait. J Neurol 2013; 261:330-42. [DOI: 10.1007/s00415-013-7199-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/08/2013] [Accepted: 11/20/2013] [Indexed: 12/16/2022]
|
44
|
Slizewski A, Schönau E, Shaw C, Harvati K. Muscle area estimation from cortical bone. Anat Rec (Hoboken) 2013; 296:1695-707. [PMID: 24123941 DOI: 10.1002/ar.22788] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/23/2013] [Accepted: 07/02/2013] [Indexed: 11/06/2022]
Abstract
This article investigates the relationship between the cortical bone of the radius and the muscle area of the forearm. The aim of this study was to develop a method for muscle area estimation from cortical bone area at 65% of radius length where the muscle area at the forearm is largest. Muscle area and cortical area were measured directly in vivo by peripheral Quantitative Computed Tomography (pQCT). We found significant correlations between muscle area and cortical area (r = 0.881) in the forearm that are in line with previous studies. We have set up a regression model by testing relevant parameters such as age, sex, forearm length, and stature that were all highly correlated to muscle area. The influence of age and sex on the proportion of muscle area to cortical area is strong and potentially related to the effects of testosterone and estrogen on the muscle-bone-unit. Muscle area estimation from cortical bone is possible with a Percent Standard Error of Estimate (%SEE) ranging from 12.03% to 14.83%, depending on the parameters available and the age and sex of the individual. Muscle area estimation from cortical bone can provide new information for the study of skeletal and/or fossil human remains.
Collapse
Affiliation(s)
- Astrid Slizewski
- Paleoanthropology, Department of Early Prehistory and Quaternary Ecology, Senckenberg Center for Human Evolution and Paleoenvironment, Eberhard Karls University of Tübingen, Tübingen, Germany
| | | | | | | |
Collapse
|
45
|
Keupp K, Beleggia F, Kayserili H, Barnes A, Steiner M, Semler O, Fischer B, Yigit G, Janda C, Becker J, Breer S, Altunoglu U, Grünhagen J, Krawitz P, Hecht J, Schinke T, Makareeva E, Lausch E, Cankaya T, Caparrós-Martín J, Lapunzina P, Temtamy S, Aglan M, Zabel B, Eysel P, Koerber F, Leikin S, Garcia K, Netzer C, Schönau E, Ruiz-Perez V, Mundlos S, Amling M, Kornak U, Marini J, Wollnik B. Mutations in WNT1 cause different forms of bone fragility. Am J Hum Genet 2013; 92:565-74. [PMID: 23499309 PMCID: PMC3617378 DOI: 10.1016/j.ajhg.2013.02.010] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 02/25/2013] [Accepted: 02/27/2013] [Indexed: 12/13/2022] Open
Abstract
We report that hypofunctional alleles of WNT1 cause autosomal-recessive osteogenesis imperfecta, a congenital disorder characterized by reduced bone mass and recurrent fractures. In consanguineous families, we identified five homozygous mutations in WNT1: one frameshift mutation, two missense mutations, one splice-site mutation, and one nonsense mutation. In addition, in a family affected by dominantly inherited early-onset osteoporosis, a heterozygous WNT1 missense mutation was identified in affected individuals. Initial functional analysis revealed that altered WNT1 proteins fail to activate canonical LRP5-mediated WNT-regulated β-catenin signaling. Furthermore, osteoblasts cultured in vitro showed enhanced Wnt1 expression with advancing differentiation, indicating a role of WNT1 in osteoblast function and bone development. Our finding that homozygous and heterozygous variants in WNT1 predispose to low-bone-mass phenotypes might advance the development of more effective therapeutic strategies for congenital forms of bone fragility, as well as for common forms of age-related osteoporosis.
Collapse
Affiliation(s)
- Katharina Keupp
- Institute of Human Genetics, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, 50931 Cologne, Germany
| | - Filippo Beleggia
- Institute of Human Genetics, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, 50931 Cologne, Germany
| | - Hülya Kayserili
- Medical Genetics Department, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
| | - Aileen M. Barnes
- Bone and Extracellular Matrix Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Magdalena Steiner
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Oliver Semler
- Children’s Hospital, University of Cologne, 50931 Cologne, Germany
| | - Björn Fischer
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Gökhan Yigit
- Institute of Human Genetics, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, 50931 Cologne, Germany
| | - Claudia Y. Janda
- Department of Molecular and Cellular Physiology and Department of Structural Biology, Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jutta Becker
- Institute of Human Genetics, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Stefan Breer
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Umut Altunoglu
- Medical Genetics Department, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey
| | - Johannes Grünhagen
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Peter Krawitz
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Jochen Hecht
- Berlin-Brandenburg Centre for Regenerative Therapies, 13353 Berlin, Germany
| | - Thorsten Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Elena Makareeva
- Section on Physical Biochemistry, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ekkehart Lausch
- Division of Genetics, Children’s Hospital, University of Freiburg, 79106 Freiburg, Germany
| | - Tufan Cankaya
- Department of Medical Genetics, Dokuz Eylul University Medical Faculty, 35210 Izmir, Turkey
| | - José A. Caparrós-Martín
- Instituto de Investigaciones Biomédicas, Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pablo Lapunzina
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Genética Médica y Molecular, Instituto de Investigación Hospital Universitario La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain
| | - Samia Temtamy
- Human Genetics and Genome Research Division, National Research Centre, El-Buhouth Street, Dokki, 12311 Cairo, Egypt
| | - Mona Aglan
- Human Genetics and Genome Research Division, National Research Centre, El-Buhouth Street, Dokki, 12311 Cairo, Egypt
| | - Bernhard Zabel
- Division of Genetics, Children’s Hospital, University of Freiburg, 79106 Freiburg, Germany
| | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, University of Cologne, 50931 Cologne, Germany
| | | | - Sergey Leikin
- Section on Physical Biochemistry, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - K. Christopher Garcia
- Department of Molecular and Cellular Physiology and Department of Structural Biology, Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Christian Netzer
- Institute of Human Genetics, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Eckhard Schönau
- Children’s Hospital, University of Cologne, 50931 Cologne, Germany
| | - Victor L. Ruiz-Perez
- Instituto de Investigaciones Biomédicas, Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Stefan Mundlos
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Max Planck Institute for Molecular Genetics, 14195 Berlin, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Uwe Kornak
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Max Planck Institute for Molecular Genetics, 14195 Berlin, Germany
| | - Joan Marini
- Bone and Extracellular Matrix Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bernd Wollnik
- Institute of Human Genetics, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, 50931 Cologne, Germany
| |
Collapse
|
46
|
Schönau E. Kindliche Adipositas – Folgen für den Bewegungsapparat und Therapieansätze. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:528-31. [DOI: 10.1007/s00103-012-1634-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
47
|
Wirth F, Schempf G, Stein G, Wellmann K, Manthou M, Scholl C, Sidorenko M, Semler O, Eisel L, Harrach R, Angelova S, Jaminet P, Ankerne J, Ashrafi M, Ozsoy O, Ozsoy U, Schubert H, Abdulla D, Dunlop SA, Angelov DN, Irintchev A, Schönau E. Whole-Body Vibration Improves Functional Recovery in Spinal Cord Injured Rats. J Neurotrauma 2013; 30:453-68. [DOI: 10.1089/neu.2012.2653] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Felicitas Wirth
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Greta Schempf
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Gregor Stein
- Department of Orthopedics and Trauma Surgery, University of Cologne, Köln, Germany
| | | | - Marilena Manthou
- Department of Histology and Embryology, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Carolin Scholl
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Malina Sidorenko
- Department of Anatomy, Medical Faculty, University of Sofia, Sofia, Bulgaria
| | - Oliver Semler
- Department of Children's Hospital, University of Cologne, Köln, Germany
| | - Leonie Eisel
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Rachida Harrach
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Srebrina Angelova
- Jean-Uhrmacher Institute for ENT-Research, University of Cologne, Köln, Germany
| | - Patrick Jaminet
- Department of Hand, Plastic, and Reconstructive Surgery with Burn Unit, BG- Trauma Centre, University of Tuebingen, Tuebingen, Germany
| | - Janina Ankerne
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Mahak Ashrafi
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Ozlem Ozsoy
- Department of Physiology, Akdeniz University, Antalya, Turkey
| | - Umut Ozsoy
- Department of Physiology Anatomy, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Diana Abdulla
- Department of Anatomy I, University of Cologne, Köln, Germany
| | - Sarah A. Dunlop
- Experimental and Regenerative Neuroscience, School of Animal Biology, The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Andrey Irintchev
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Eckhard Schönau
- Department of Children's Hospital, University of Cologne, Köln, Germany
| |
Collapse
|
48
|
Langensiepen S, Semler O, Sobottke R, Fricke O, Franklin J, Schönau E, Eysel P. Measuring procedures to determine the Cobb angle in idiopathic scoliosis: a systematic review. Eur Spine J 2013; 22:2360-71. [PMID: 23443679 DOI: 10.1007/s00586-013-2693-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/18/2013] [Accepted: 01/25/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Scoliosis of the vertebral column can be assessed with the Cobb angle (Cobb 1948). This examination is performed manually by measuring the angle on radiographs and is considered the gold standard. However, studies evaluating the reproducibility of this procedure have shown high variability in intra- and inter-observer agreement. Because of technical advancements, interests in new procedures to determine the Cobb angle has been renewed. This review aims to systematically investigate the reproducibility of various new techniques to determine the Cobb angle in idiopathic scoliosis and to assess whether new technical procedures are reasonable alternatives when compared to manual measurement of the Cobb angle. METHOD Systematic review. Studies examining procedures used to determine the Cobb angle were selected. Two review authors independently selected studies for inclusion, extracted data and assessed risk of bias. Statistical results of reliability and agreement were summarised and described. RESULTS Eleven studies of new measuring procedures were included, all reporting the reproducibility. The new procedures can be divided into computer-assisted procedures, automatic procedures and smartphone apps. CONCLUSIONS All investigated measuring procedures showed high degrees of reliability. In general, digital procedures tend to be slightly better than manual ones. For all other measurement procedures (automatic or smartphone), results varied. Studies implementing vertebral pre-selection and observer training achieved better agreement.
Collapse
Affiliation(s)
- S Langensiepen
- Unireha, Paediatric Rehabilitation, University of Cologne, Lindenburger Allee 44, 50931, Cologne, Germany,
| | | | | | | | | | | | | |
Collapse
|
49
|
Weber T, Beijer Å, Rosenberger A, Mulder E, Yang P, Schönau E, Bloch W, Rittweger J. Vascular adaptations induced by 6 weeks WBV resistance exercise training. Clin Physiol Funct Imaging 2012; 33:92-100. [PMID: 23383686 DOI: 10.1111/j.1475-097x.2012.01166.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/13/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of whole-body vibration (WBV) upon the cardiovascular system is receiving increasing attention. Despite numerous studies addressing the acute cardiovascular effects of WBV training, very little is known regarding long-term adaptations in healthy humans. METHODS A 6-week training study, with a 70 days follow-up was designed to compare resistive exercise with or without super-imposed whole-body vibrations. Arterial diameter, intima media thickness and flow-mediated dilation (FMD) were assessed by ultrasonography in the superficial femoral artery (SFA), the brachial (BA) and the carotid arteries (CA). RESULTS SFA resting diameter was increased from 6·22 mm (SD = 0·69 mm) at baseline to 6·52 mm (SD = 0·74 mm) at the end of the training period (P = 0·03) with no difference between groups (P = 0·48). Arterial wall thickness was significantly reduced by 4·3% (SD = 11%) in the CA only (P = 0·04). FMD was not affected by any of the interventions and in any of the investigated arteries. CONCLUSION To the best of our knowledge, this has been the first study to show that the superposition of vibration upon conventional resistance exercise does not have a specific effect upon long-term vascular adaptation in asymptomatic humans. Our findings seem to be at variance with the findings observed in a bed-rest setting. One possible explanation could be that the independently saturable effects of flow-mediated versus acceleration-related endothelial shear stresses on arterial structure and function differ between ambulatory and bed-rest conditions.
Collapse
Affiliation(s)
- Tobias Weber
- Department of Space Physiology, German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Kühn T, Kroke A, Remer T, Schönau E, Buyken AE. Is breastfeeding related to bone properties? A longitudinal analysis of associations between breastfeeding duration and pQCT parameters in children and adolescents. Matern Child Nutr 2012; 10:642-9. [PMID: 22909290 DOI: 10.1111/j.1740-8709.2012.00443.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Nutritive and bioactive components of human milk could be involved in programming metabolic systems that affect bone growth throughout the life course. Bone properties in childhood and adolescence might differ, depending on breastfeeding duration. Thus, breastfeeding could be a relevant factor in the context of primary osteoporosis prevention. The prospective association between breastfeeding duration and bone properties was investigated using the data of 284 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Breastfeeding duration was assessed during infancy. Bone properties were measured by peripheral quantitative computed tomography (pQCT) at ages 5-23 years. Cortical volumetric bone mineral density, cortical bone mineral content, strength strain index, total cross-sectional area of the bone and cross-sectional area of the cortical bone were determined at the 65% site of the radius. Linear regression analyses were performed to check for differences in pQCT parameters of subjects who had not or shortly been breastfed (0-16 weeks) and subjects who had been breastfed for a long duration (≥17 weeks). Multivariable models adjusted for age, gender, forearm length, muscle cross-sectional area, body mass index standard deviation score (SDS), height SDS and socio-economic status did not yield associations between breastfeeding duration and pQCT parameters. These findings suggest neither protective nor adverse effects of prolonged breastfeeding on bone health in childhood and adolescence. Influences of early nutrition on bone growth might be overridden by current effects of mechanical loads on bone physiology.
Collapse
Affiliation(s)
- Tilman Kühn
- Department of Nutritional, Food and Consumer Sciences, University of Applied Sciences Fulda, Fulda, Germany; Department of Cancer Epidemiology, German Cancer Research Center - DKFZ, Heidelberg, Germany
| | | | | | | | | |
Collapse
|