Guidelines for catheter intervention in coronary artery lesion in Kawasaki disease

The Research Committee of Ministry of Health, Labour and Welfare 'Study of treatment and long-term management in Kawasaki disease' reported the guidelines for catheter intervention in coronary artery lesion in Kawasaki disease in this paper. The contents include: (i) background and natural history of coronary artery lesion in Kawasaki disease; (ii) indication of catheter intervention; (iii) types of procedure, and their indication and care; (iv) institute and backup system; (v) the management after procedure, evaluation and follow up; and (vi) prospects, especially in relation to bypass surgery.     

Overweight and obesity prevalence in children and adolescents from a private school in Recife

OBJECTIVES: To determine the prevalence of overweight and obesity in students from a private school in Recife; compare the prevalence rates of overweight and obesity in boys and girls and in different age groups (children and adolescents) and verify the correlation between body mass index and triceps skinfold thickness in this population. METHODS: Cross-sectional study with 762 students (332 children and 430 adolescents) from a middle/upper class school in Recife, in 1999. Overweight was defined as body mass index equal or above the 85th percentile for age and gender. Obesity was defined as body mass index and triceps skinfold thickness equal or above the 85th percentile. RESULTS: The prevalence rates were 26.2% (95%CI = 23 to 29%) for overweight, and 8.5% (CI95% = 6.5 to 10.5%) for obesity. Overweight was more prevalent among children (34.3%) than among adolescents (20.0%) (P<0.001). Obesity was more frequent among children (14.2%) than among adolescents (4.2%) (P<0.001). The prevalence of overweight in boys (34.6%) was higher than in girls (20.6%) (P<0.001). The prevalence of obesity was also higher in boys (14.7%) than in girls (4.4%) (P<0.001). The correlation coefficient between body mass index and triceps skinfold thickness was equal to 0.64 (95%CI = 0.60 to 0.68). CONCLUSIONS: The prevalence of overweight in our study population was as high as that found in industrialized countries; obesity, however, was less frequent.     

Adolescent obesity, a need for greater awareness and improved treatment.

Obesity is arguably the most important medical problem in America today. About 25% of children are considered either overweight or obese, according to newly established national criteria. These teenagers are at significant risk for becoming obese adults, and adolescent obesity predisposes to a range of short- and long-term medical, and psychosocial problems. Despite the enormous medical and economic implications of obesity, effective prevention and treatment strategies are lacking. This review summarizes the epidemiology, evaluation, and management of adolescent obesity, focusing on promising treatment strategies for the future.     

Metabolic syndrome in children and adolescents with acute lymphoblastic leukemia after the completion of chemotherapy

The metabolic syndrome is a cluster of potent risk factors for cardiovascular diseases. To provide information on the late complications of chemotherapy for acute lymphoblastic leukemia (ALL), the authors prospectively studied the frequency of overweight, obesity, and metabolic syndrome in survivors of ALL in the initial years after the completion of therapy. Children and adolescents were classified as having the metabolic syndrome if they met three or more of the following criteria: hypertriglyceridemia, low levels of high-density lipoprotein (HDL), high fasting glucose, obesity, and hypertension. Obesity was defined on the basis of Body Mass Index (BMI) (kg/m2) standard deviation scores or z-scores. Cutoff points for triglycerides and HDL were taken from equivalent pediatric percentiles with the cutoff points proposed by the Adult Treatment Panel III (ATPIII). Hyperglycemia was defined using the ATPIII cutoff points. Elevated systolic or diastolic blood pressure was defined as a value greater than the 95th percentile for age, gender, and height. Fifty-two subjects (29 male and 23 female) with a median age of 15.2 years (range 6.1-22.6 years) were evaluated. Median interval since completion of therapy was 37 months (range 13-121 months). All of them had been treated according to the ALL-BFM 90 chemotherapy protocol and none had received cranial radiotherapy. Of the 52 subjects, 25 (48%) were overweight (BMI z-score >1.5) and 3 (5.76%) were obese (BMI z-score >2); among them, 1 was severely obese (BMI z-score >2.5). Three criteria for the metabolic syndrome (high triglyceride levels, glucose intolerance, and obesity) were fulfilled by three subjects (5.76%). Twenty-nine subjects (55.7%) had at least one risk factor for metabolic syndrome. Hyperglycemia and hypertension were infrequent. Prompt recognition of the risk factors for metabolic syndrome and intervention seem mandatory to ensure early prevention of cardiovascular disease in survivors of ALL.     

Obesity and associated cardiovascular risk factors in Iranian children: A cross-sectional study

BACKGROUND: Obesity is a growing public health problem in developing countries considering its association with cardiovascular risk factors. Relationship between childhood obesity and these risk factors has not been attested in the Iranian population before. The aim of the present study was to investigate frequency of cardiovascular risk factors and their association with severity of obesity in a sample of Iranian obese children. METHODS: A total of 13 086 children aged 7-12 years were screened and those with waist circumference = 90th percentile of their age were invited for further evaluations. Participants were divided into two groups of overweight or obese according to International Obesity Task Force criteria. Cardiovascular risk factors were defined as high fasting total cholesterol, high low density lipoprotein, low high density lipoprotein, high triglycerides, and systolic or diastolic hypertension. These factors were compared between obese and overweight children and their correlations with body mass index and other measures of obesity were tested. RESULTS: Of 532 children (274 boys, mean age 9.5 +/- 1.3) enrolled in the study, 194 were overweight and 338 were obese. Mean levels of triglyceride and Apo-lipoprotein B in obese children were significantly higher than overweight participants. A total of 81.9% of obese children and 75.4% of overweight children had at least one cardiovascular risk factor. There were significant correlations between body mass index and systolic blood pressure, diastolic blood pressure, serum triglyceride, and Apo-lipoprotein B levels (P values <0.01). CONCLUSION: The high prevalence of cardiovascular risk factors in overweight and obese children and positive correlation of these factors with severity of obesity emphasizes the need for prevention and control of childhood obesity from early stages.     

Intra-abdominal fat in obese children

We investigated the distribution of abdominal fat accumulation in obese children to know whether a clustering of coronary risk factors was demonstrated in visceral fat obesity as reported in adults. The relative indicator of intra-abdominal fat accumulation was obtained from computed tomography scans at the umbilicus level in 36 obese subjects (24 males, 12 females). There was no visceral fat obesity in this study by reported criteria. All metabolic variables except triglyceride did not correlate significantly with intra-abdominal fat accumulation. We conclude that visceral fat obesity is a rare status and has no close relationship to coronary risk factors in childhood.     

Prediction of obesity in children at 5 years: A cohort study

Objective: To examine determinants of moderate and severe obesity in children at 5 years of age.
Methodology: A prospective cohort of mothers were enrolled at first antenatal visit, and interviewed shortly after delivery, at 6 months and 5 years. Detailed health, psychological and social questionnaires were completed at each phase by mothers, and child health questionnaires at 6 months and 5 years. At 5 years 4062 children were assessed physically, the Peabody Picture Vocabulary Test administered and mothers completed a modified Child Behaviour Checklist. Moderate obesity was defined as BMI between 85th and 94th percentiles inclusively, and severe obesity as a BMI greater than the 94th percentile.
Results: Independent predictors of severe obesity at 5 years were birthweight, female gender, maternal BMI and paternal BMI. Moderate obesity at 5 years was predicted by birthweight, paternal BMI and sleeplessness at 6 months, while small for gestational age (SGA) status and feeding problems at 6 months were protective factors for moderate obesity. Obesity was not associated with problems of language comprehension or behaviour.
Conclusions: Findings of this study suggest that biological rather than psychosocial factors are the major determinants of obesity at 5 years.     

Prevalence,risk factors,and consequences of overweight in children and adolescents who underwent renal transplantation – Short‐ and medium‐term analysis

To determine the prevalence and risk factors for (i) overweight/obesity and (ii) weight gain six months after transplantation and to study the effect of weight excess on graft function and survival. We performed a retrospective study of kidney transplanted children. Endpoints: (i) prevalence of overweight/obesity at sixth month, (ii) gaining 1.0 BMI SDS from one to six months. To study the effects of weight excess, graft function and survival at 36 months were the endpoints. The study included 197 individuals. At sixth month, 57/197 (29%) presented overweight/obesity, and the factors associated to this outcome were: (i) age at transplantation (OR = 3.04) and (ii) overweight/obesity in the first month (OR = 22.16). Groups presented no difference on graft function and survival at 36 months. From one to six months, 90/197 (46%) patients gained >1.0 BMI SDS. This outcome was associated with (i) female sex (OR = 2.50), (ii) steroids' pulses (OR = 2.98), (iii) steroids exposure (OR = 1.04), and (iv) living donor (OR = 2.69). The group that gained BMI presented a lower 36 months graft survival (86% vs. 98%, p < 0.001). Weight excess and gain after transplantation are frequent, particularly in younger female recipients and in those receiving high steroids exposure. The lower graft survival in patients with rapid weight gain deserves investigation.     

Assessment of individual changes in body fatness in boys during early pubertal period

BACKGROUND: In order to know whether the changes in indexes of overweight, body mass index (BMI; kg/m2) and percentage of overweight (POW) (%), really represent the tendency toward obesity, we examined longitudinal individual changes in these indexes, and the change in body composition in boys during early pubertal period. METHODS: The subjects were 50 school boys who lived in Shizuoka, Japan. Standing height and weight were measured, and BMI and POW were obtained. Body fat percentage (BF%), fat mass (FM) and lean body mass (LBM) were estimated by bioelectrical impedance method. The influence of predictive variables (LBM, FM) on the changes in BMI and POW was investigated by multiple regression analysis. We examined the 3-year changes in BMI, POW and predictive variables in each individual, from 9 to 12 years of age. RESULTS: The mean change of BMI was 1.7 +/- 0.3 (mean +/- SEM) kg/m2 and that of POW was 2.2 +/- 1.9%. The influence of predictive variables on the changes in BMI and POW was determined. The variance of the change in POW could be explained by that in FM (r(2) = 0.737, P < 0.0001), while the change in BMI was influenced by both LBM and FM (r2 = 0.891, P < 0.0001). CONCLUSIONS: Based on the definition of obesity, POW is the better index of body fatness to assess its individual change for boys during early pubertal period, because the index independent from the change in LBM is supposed to be the appropriate index for obesity in practical use.     

Recurrent abdominal pain in school children: effect of obesity and diet

AIMS: To study the epidemiology and some of the risk factors of childhood recurrent abdominal pain (RAP) in school age children. METHODS: We used a questionnaire concerning socioeconomic parameters, intensity, frequency, duration, nature of RAP and anthropometric measures. We used several criteria to identify RAP and the Wong-Baker FACES scale for pain intensity and calculated the gender/age-specific body mass index (BMI) Z-score using NCHS standards. Obesity was defined as a BMI>or=95th percentile for age and gender. RESULTS: A total of 925 children mean age of 9.5 years completed and returned the questionnaires. The prevalence of RAP was 24%; 22% among boys versus 26% among girls (p=0.28) and reached its peak among children aged 7-9 (29%) years. Children with BMI>or=95% percentile reported more RAP compared to those not obese (33.3% vs. 22.5%) (OR=1.8, p=0.01). There was an inverse correlation between fruit consumption and RAP prevalence with 20% among children reporting more than three serving of fruit per week compared to 40% of those who did not consume any fruits (p<0.002). Logistic regression analysis confirmed BMI>or=95th percentile and low consumption of fruits are significant risk factors for RAP. CONCLUSIONS: There is a significant association between RAP and obesity and both conditions are prevalent among children in this population. Understanding more about the co-morbidity between RAP and obesity could have important implications on RAP management and treatment.     

Obesity in children and adolescents with acquired brain injury

OBJECTIVES: To measure the prevalence of obesity and to assess associated clinical factors in children and adolescents with acquired brain injury (ABI). STUDY DESIGN: This cross-sectional study included 88 subjects aged between 2.4-17.7 years attending the Brain Injury Clinic at a tertiary paediatric hospital. Body mass index (BMI) and BMI z-scores were calculated. Obesity and overweight were defined using the International Obesity Taskforce cut-points. Associations were examined between BMI z-scores and the following: ABI severity, mobility level, duration from injury and presence of radiological injury. RESULTS: The prevalence of obesity in this population (obese = 15%) was higher than those in Australian children and adolescents (1995 National Nutrition Survey) while the prevalence of overweight (19.3%) was comparable. There was a linear trend for the participants to have a higher BMI z-score with increasing level of mobility (F = 6.91, df 1.70, p = 0.011). CONCLUSION: There is no data about obesity in children and adolescents with ABI. The study with limited statistical power suggests that obesity is prevalent in this population and increases with increasing level of mobility. Further studies are required to address the issue of obesity and related complications in this population.     

Pulmonary dysfunction and sleep apnea in morbid obesity

The interplay between obesity and respiratory function has implications on lung functions, sleep disordered breathing and asthma. Severe obesity can restrict lung functions in childhood, but the extent of obstructive disease due to obesity in childhood is not clear. Obesity is clearly linked to the increased incidence of sleep disordered breathing in childhood. Most obese children with sleep disordered breathing have tonsillo-adenoidal hypertrophy contributing to sleep apnea. The presence of sleep apnea is a consideration in recommending bariatric surgery in the appropriate setting. Obese children with asthma tend to have more symptoms of asthma. Obese children, particularly girls, have a greater likelihood of developing asthma later in life. Further investigations of the various interactions between obesity and respiratory function are currently needed. Obesity is on the rise in US, reflected in the 3 times higher prevalence of overweight (body mass index > 95th percentile) in children 6 to 19 years of age (1). The prevalence of morbid or severe obesity, defined as a body mass index (BMI) of 40 or more in adults (2), has also increased from 2.9%, in the years 1988-1994, to 4.7% in the years 1999-2000 (3). In children, severe obesity has been defined as a BMI standard deviation score > 2.5 (4). The interactions between morbid obesity and the respiratory system have become more relevant today and can be broadly discussed in relation to lung functions and exercise capacity; sleep disordered breathing; and asthma.     

Association between obesity and asthma in Japanese preschool children

Obesity may increase the risk of subsequent asthma. We have previously reported that there is a clear association between obesity and asthma in Japanese school-aged children. To evaluate whether a similar association exists in younger children, a nationwide cross-sectional questionnaire-based survey was performed focusing on children aged 4-5 yr. A child who had experienced wheezing during the past 12 months and had ever been diagnosed with asthma by a physician was defined as having current asthma. Overweight and underweight were defined as BMI ≥90th percentile and ≤10th percentile, respectively, according to the reference values for Japanese children from 1978 to 1981. After excluding 2547 children because of incomplete data, 34,699 children were analyzed. Current asthma was significantly more prevalent in overweight children compared with underweight and normal weight children (13.2% for overweight vs. 10.5% for underweight and 11.1% for normal weight; both p < 0.001). Even after adjusting for other variables, such as gender, other coexisting allergic diseases, and parental history of asthma, there was an association between overweight and current asthma (adjusted odds ratio: 1.23, 95% CI: 1.10-1.38, p < 0.001). Even in preschool children, obesity is already associated with asthma, and there was no gender effect on this association. Physicians should consider the impact of obesity when managing asthma in younger children.     

Guidelines for the treatment of Crohn''s disease in children

This paper shows guidelines for the treatment of Crohn's disease in children by the Working Group of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition (Chair: Yuichiro Yamashiro) and the Japanese Society for Pediatric Inflammatory Bowel Disease (Chair: Akio Kobayashi). The points in which these guidelines differ from those for adult patients are as follows. (i) Total enteral nutrition in the form of an elemental formula is indicated as primary therapy for children with Crohn's disease at onset as well as the active stage. Oral mesalazine is used together. (ii) Total parenteral nutrition (TPN) with oral mesalazine is required for children with serious illness. The use of a corticosteroid should be withheld for at least 1 week after TPN has been started. (iii) When TPN is not considered to be effective, additional corticosteroid is used. Full doses of corticosteroid should be used for at least 2 weeks after clinical improvement has been achieved, and then the dose of the corticosteroid should be tapered carefully. (iv) When surgery is indicated in pediatric patients with stricture or fistula formation and complicated by persistent growth failure despite medical therapy, the optimum time for surgery is thought to be before epiphyseal plates have been closed.     

The prevalence of obesity in Singapore primary school children

ABSTRACT. The purpose of this study is to survey the prevalence of obesity in Singapore primary school children from 1976 to 1980. The number of children screened comprised of 221,988 in primary I and 218,104 in primary VI. The male to female ratio was 1.04:1. Obesity is defined as body weight above 120% of Harvard standard weight for height. The overall prevalence rate was 3.51% with a significantly higher rate in boys (3.95%) than in girls (3.06%), p < 0.0001. This sex difference prevailed in both the primary I and primary VI group. Furthermore, primary VI students had a higher prevalence rate (4.29%) compared to the primary I students (2.75%) p < 0.0001. The prevalence rates were rising over the years with a rate of 5.33% in 1980 compared to that in 1976 (1.80%). Our observations suggest that the problem of obesity is an increasing one. The tendency to become obese increases with age and boys are more prone to obesity.     

Risk factors of obesity in preschool children in an urban area in China

To assess risk factors of childhood obesity, we carried out a case-control study in ten kindergartens in Changsha, the capital city in the Chinese province of Hunan, between July 1 and December 31, 2007. Height and weight measurements were obtained from annual physical examinations for children attending these kindergartens. Obesity was defined according to the International Obesity Task Force cutoff for body mass index (BMI). For each obese child, one child with normal BMI, matched by kindergarten class, sex, age (within 3 months), and height (within 3 cm) were chosen as controls. The parents of the study subjects were asked to complete a questionnaire about their children, including perinatal factors, infant feeding, and current lifestyle factors. Univariate analysis was performed first to compare the distribution of risk factors between cases and controls. Conditional logistic regression analysis was used to assess independent risk factors of childhood obesity. A total of 162 subjects (81 pairs of cases and controls) were included in the final analysis. The results showed that the adjusted odds ratios and 95% confidence intervals for childhood obesity were 8.88 (2.41-32.70), 5.23 (1.24-22.04), 10.96 (2.08-21.64), and 6.72 (1.55-29.12), respectively, for macrosomia, cesarean delivery, early solid foods initiation (<4 months), and fetal musical education. We conclude that macrosomia, cesarean delivery, early initiation of solid foods, and fetal musical education are associated with increased risk of obesity in preschool children in urban China.     

Physicians' attitude toward identification and management of childhood obesity in Israel

Obesity is a serious health problem, and is becoming increasingly common in affluent societies. In 1998, an Expert Committee published guidelines regarding obesity evaluation and treatment. The purpose of this study was to assess the attitude of primary care physicians in Israel toward diagnosis and treatment of childhood obesity, as related to the recommended guidelines. Primary physicians caring for children and adolescents were asked to complete an anonymous questionnaire including personal and professional details, methods of diagnosis, documentation and treatment of childhood obesity, and familiarity with and implementation of the Expert Committee recommendations. One hundred forty-four physicians, treating approximately 100,000 children monthly, completed the questionnaire. Ninety-four percent were considered to have diagnosed obesity properly. Furthermore, only 19% reported weighing all children examined, while 99% of the physicians suggested some treatment for obesity. The most frequent recommendations for managing obesity were referral to a dietitian (92%), physical exercise (85%), and group treatment (27%). The majority of physicians (78%) were not familiar with the new Expert Committee recommendations regarding obesity treatment. This study suggests that the majority of primary physicians diagnose obesity properly and recommend accepted modalities to manage obesity. A comprehensive program to prevent and treat obesity is recommended to improve the health status of the population.     

Television viewing and its effect on physical health of schoolage children

Obesity is an increasing health problem all over the world. In addition to genetic and many environmental factors, television is also thought to be a risk factor. This study examined the effects of television viewing on obesity and other physical complaints among Turkish children. From two different socioeconomic class primary schools, 886 second- and third-grade children were visited at their schools, and their weight, height and triceps skin fold thickness (TST) were measured and body mass index (BMI) calculated. Television viewing behavior of the children, parental weight and height, and physical complaints of children were investigated by a questionnaire sent to parents. A subgroup of children was also called to the hospital, and their blood lipid profile and visual acuity were measured. According to the questionnaires, children were found to watch television 2.1 +/- 1.2 hours/day (hr/d) during the weekdays, 3.4 +/- 2.1 hr/d at the weekend and 2.5 +/- 1.3 hr/d generally. Children were also grouped according to the amount of time they watch television. Group 1 (n = 298) children watched television less than 2 hr/d, Group 2 (n = 323) watched 2-4 hr/d, and Group 3 (n = 68) more than 4 hr/d. The prevalence of obesity was 10.9% according to BMI, 11.8% according to TST and 6.4% according to both criteria. Obese girls were found to watch television longer than their peers (2.9 +/- 1.2 hr/d vs 2.3 +/- 1.3 hr/d, respectively, p = 0.034), but no other relation was found between television viewing and obesity. Headache, back pain, eye symptoms and sleep problems were found to be more often among children who watched television longer (p < 0.05). It was concluded that television viewing is related to many physical complaints, which may have lifelong consequences (obesity). Thus, pediatricians should give appropriate guidance to families about television habits and health consequences.     

Breast-feeding and overweight in Singapore school children

Background:  Studies from developed Western countries have shown inconsistent associations between breast-feeding and overweight/obesity in children and adolescents. Few data are available from Asian populations. The purpose of the present study was therefore to evaluate the association between breast-feeding and overweight/obesity in a study of 10–12-year-old children in Singapore.
Methods:  A total of 797 school children (49% girls, 76% Chinese) who participated in the Singapore Cohort Study of the Risk Factors for Myopia (SCORM) were examined. Overweight/obesity ( n  = 179) was defined as age–sex-specific body mass index (BMI) cut-offs corresponding to BMI of 25 kg/m² for overweight and 30 kg/m² for obesity at age 18 based on the International Obesity Task Force (IOTF) reference.
Results:  The prevalence of overweight/obesity was 22.5%. Overall, breast-feeding was not found to be associated with overweight/obesity. After adjusting for potential confounders, the multivariable odds ratio (95% confidence interval) of overweight/obesity was 1.14 (0.80–1.63) for ever breast-fed compared with never breast-fed, 1.00 (0.57–1.72) for breast-fed for >3 months compared to ≤3 months and 0.79 (0.47–1.34) for exclusive/mostly breast-fed compared to partly breast-fed.
Conclusions:  No significant associations were detected among breast-feeding, its type, and duration with overweight/obesity in this Asian cohort of 10–12-year-old children.