Adolescent obesity is associated with high ambulatory blood pressure and increased carotid intimal-medial thickness

OBJECTIVES: To investigate 24-hour ambulatory blood pressure, lipid profiles, and carotid artery intimal-medial thickness (IMT) in adolescents with and without obesity. STUDY DESIGN: Ambulatory blood pressure data from 93 consecutive adolescents referred to our hypertension center for possible hypertension were analyzed. Fasting serum glucose and lipid concentrations were measured in all subjects. Carotid artery IMT was also measured by B-mode ultrasound imaging in all patients. Obesity was defined as body mass index > or =95(th) percentile for age and sex. Twenty-two of the subjects were obese and 71 nonobese. RESULTS: Mean 24-hour, daytime, and nighttime systolic blood pressures were significantly higher in obese subjects compared with nonobese subjects (P < .002). Twenty-four-hour, daytime, and nighttime pulse pressures were also significantly higher in obese subjects (P < .001). The magnitude of systolic white coat effect was significantly higher in obese subjects (P < .006) and white coat hypertension was significantly more frequent in obese subjects (P < .0001). Obese subjects had higher triglycerides (P < .001) and lower HDL cholesterol (P < .01) than nonobese subjects. Finally, obese adolescents had thicker mean IMT of internal carotid arteries than nonobese adolescents (P < .005). CONCLUSIONS: Obese adolescents have higher ambulatory blood pressure and higher carotid artery IMT, possibly indicating an early course of obesity-related hypertension and carotid artery structural alterations.     

Low bone mineral density in small for gestational age infants: correlation with cord blood zinc concentrations.

Twenty eight term small for gestational age (SGA) infants and 18 term appropriate for gestational age (AGA) infants were studied prospectively to assess bone mineral density and cord serum zinc concentrations. Growth and nutritional status were evaluated, and bone mineral density was measured by dual energy x ray densitometry of the lumbar spine. Cord serum zinc, parathyroid hormone, osteocalcin, vitamin D metabolite and mineral concentrations were measured. Growth, nutritional status, and bone mineral density (mean (SD) 0.223 (0.032) vs 0.277 (0.032) g hydroxyapatite/cm2) were significantly low in SGA infants. Bone mineral density was linearly related to growth and nutritional measures. Cord serum zinc concentrations were in the normal range and similar in both groups (mean (SD) 13.86 (3.0) vs 13.43 (2.1) mumol/l). It is suggested that SGA infants may not be zinc deficient. Low bone mineral density could be caused by growth and nutritional status deficiencies, the mechanisms for which could be those that reduce nutrient substrate supply to the fetus.     

Effect of application pressure and gestational age on transfontanel pressure in healthy neonates

We developed and evaluated a transducer holder and calibrated, spring-loaded applicator for the Ladd intracranial pressure monitor. The transducer holder/applicator combination allows reproducibility of application pressure and assures coplanarity of the transducer and the skin of the anterior fontanel. Measured transfontanel pressure (TFP) increased with increasing application pressure. Mean TFP was 9.1 +/- (SD) 2.6 cm H2O with an application pressure of about 10 g/cm2 in a group of healthy preterm and term infants at 6 h postnatal age. Birth weight, gestational age and mode of delivery did not affect TFP, allowing use of a single normative value and set of confidence limits in all infants at 6 h of postnatal age.     

Changes in placental blood flow in the normal human fetus with gestational age

We assessed fetoplacental blood volume flow and placental resistance prospectively with Doppler sonography in 74 normal human fetuses of 19 to 42 wk gestation to determine the changes in placental perfusion with gestational age. Placental blood volume flow was assessed from the umbilical vein as the product of the mean flow velocity integral and the cross-sectional area of the umbilical vein. Placental resistance was assessed as the ratio of maximum systolic and minimum diastolic blood flow velocities from an umbilical artery. Umbilical vein blood volume flow increased exponentially (r = 0.86) with gestational age from 19 wk to term, and did not decrease in postdate fetuses. Umbilical vein blood volume flow increased linearly with fetal weight (r = 0.77), although volume flow per unit body weight changed little with gestational age. Umbilical artery velocity ratio decreased progressively, indicating diminishing placental resistance with gestational age, but did not correlate closely with umbilical vein blood volume flow. We submit that fetoplacental blood volume flow can be readily calculated directly from the umbilical vein with Doppler ultrasound and may provide a better index of placental perfusion than the umbilical artery velocity ratio.     

Effect of increased intracranial pressure on blood pressure, heart rate, respiration and catecholamine levels in neonatal and adult rabbits

The effect of increased intracranial pressure (ICP) on heart rate, respiratory rate and blood pressure was measured in 2-day-old and adult rabbits. Neonates and adults exhibited the Cushing reflex with hypertension, bradycardia and decreased respirations when exposed to elevated ICP. Adult animals had a lower threshold of response to elevated ICP, implying a more sensitive adrenergic response compared to neonates. Although control levels of epinephrine and norepinephrine were higher in neonates compared to adults, the ratio of maximum concentration during increased ICP to control concentration was higher in adults (27.0 for epinephrine and 25.2 for norepinephrine in adults: 3.5 for epinephrine and 2.93 for norepinephrine in neonates). Injection of epinephrine was used to induce a maximal sympathetic response in both groups of rabbits studied. In adults, the cardiovascular response was the same after injection of epinephrine or after increasing ICP. In neonates, the blood pressure rise after injection of epinephrine was significantly higher (p less than 0.05) than the blood pressure rise after increasing ICP. The results demonstrate an immature adrenomedullary axis in neonates who have higher resting levels of catecholamines with a relatively smaller increase in catecholamines in response to stress when compared to adults.     

Low birth weight for gestational age and subsequent male gonadal function

OBJECTIVE: To verify whether a reduced birth weight for gestational age was associated with a testicular dysfunction in postpubertal boys.Study design: Boys born small for gestational age (SGA) (n = 25) were compared to 24 born with an appropriate weight. All subjects were postpubertal (mean age 17.5 +/- 1.3 and 17.6 +/- 2.0 years, respectively). The following clinical and endocrinologic variables were evaluated: final height, target height, body mass index, testicular volume, follicle-stimulating hormone, luteinizing hormone, testosterone, and inhibin B. RESULTS: The SGA group had reduced testicular size (16.3 +/- 2.7 mL vs 22.8 +/- 3.2 mL; P <.0001) with a lower testosterone level (3.76 +/- 1.35 ng/mL vs 4.77 +/- 1.55 ng/mL; P <.05) and a higher LH value (4.41 +/- 1.61 IU/L vs 3.44 +/- 1.29 IU/L; P <.05). Among the SGA group, 54% had a mean testicular volume >2 SD below the control mean (ie, <16 mL) and in these subjects, the inhibin B level was low (143 +/- 46 pg/mL vs 229 +/- 76 pg/mL; P <.0001). SGA patients with smaller testes had lower final height relative to target height(P <.05 vs patients with larger testes) and for the SGA group, inhibin B correlated with testicular size (P <.0001). Positive correlations also were found between the reduction of final height relative to target height and testicular volume (P <.005) and inhibin B values (P <.05). CONCLUSIONS: SGA subjects have pituitary-gonadal axis function that tends toward hypogonadism. There is a disruption of the exocrine function in subjects with smaller testicular size who failed to show a complete height catch-up growth. This study supports a link between low birth weight and lower fertility in adult males.     

Microalbuminuria and abnormal ambulatory blood pressure in adolescents with type 2 diabetes mellitus

OBJECTIVE: To determine whether risk factors for cardiovascular disease and diabetic nephropathy, as evidenced by abnormalities of ambulatory blood pressure (ABP), dyslipidemia, and microalbuminuria (MA), are present in adolescents with type 2 diabetes mellitus (T2DM). STUDY DESIGN: We enrolled 26 minority adolescents recently diagnosed with T2DM and 13 obese control subjects without diabetes mellitus. ABP monitoring was performed, and a 24-hour urine, a fasting lipid profile, blood urea nitrogen, creatinine, homocysteine, and hemoglobin A 1 c levels were obtained. The patients with T2DM underwent echocardiograms. RESULTS: Forty percent of the patients with T2DM had MA (> or = 30 mg of microalbumin/day), compared with none of the control subjects ( P < .05). There were no significant differences between patients with T2DM who had MA and patients with T2DM who didn't have MA in demographics, characteristics, casual BP, echocardiographic findings, and hemoglobin A 1 c levels. Average daytime systolic BP was greater in patients with T2DM with MA than patients without MA (129 versus 121 mm Hg, P = .03) and compared with the control subjects (113 mm Hg, P = .01). Patients with MA had an average daytime systolic BP load that was higher than patients without MA (37.1 versus 5.1%, P = .008) and compared with the control subjects (2.6%, P < .001). CONCLUSION: As in adults, adolescents with T2DM exhibit abnormalities of ABP, dyslipidemia, and microalbuminuria.     

Influence of sex and gestational age on cord blood IgE

Cord blood IgE (CB-IgE) is widely used as a screening parameter for atopy. Therefore it is necessary to define the normal values accurately. In this study influence of sex and gestational age on CB-IgE is evaluated. 5,305 cord blood samples were analysed. Boys had a higher CB-IgE than girls (p less than 0.001). Using a cut-off value for normal of 2.4 micrograms/l, boys had significantly more abnormal values than girls (p = 0.0475). Using a lower cut-off value (2.16, 1.92, 1.68 micrograms/l) the difference became more significant (p = 0.0029, p = 0.0036 and p = 0.0019 respectively). Gestational age (in the range from 34-42 weeks of gestation) had no influence on the absolute CB-IgE concentration nor on the number of abnormal values. From this study we may conclude that, when CB-IgE is used in prediction and prevention programs for atopic disease, the sex of the newborn should be taken into consideration when evaluating the results, in particular when the cut-off limit is lowered. No correction needs to be made for gestational age if the baby is born after the 34th week of gestation.     

Household factors and gestational age predict diet quality of pregnant women

Adequate diet during pregnancy has positive effects on the mother and pregnancy outcome. Assessment of diet quality during pregnancy is particularly important in areas where household food security is suboptimal, to enable appropriate targeting and intervention. This study assessed diet quality and identified predicting factors among pregnant women in northern Ghana. A cross‐sectional study involving 403 pregnant women was conducted in May 2018. Pregnant women attending antenatal care clinics (ANC) were selected using simple random sampling technique. We assessed socio‐demographic characteristics, 24‐h recall and household food security. The minimum dietary diversity for women (MDD‐W) was used as a proxy measure for diet quality based on Food and Agricultural Organization (FAO) guidelines. Logistic regression models were fitted to determine the predictors of diet quality. The mean dietary diversity score (DDS) of 10 food groups was 4.4 ± 1.1 (95% CI: 4.3–4.5). Logistic regression showed that women of high educational level (adjusted odds ratio [AOR] = 2.42; 95% confidence interval [CI] [1.21–4.84]; P = 0.01), women of high household wealth index (AOR = 1.78; 95% CI [1.14–2.77]; P = 0.01], none/mild household hunger (AOR = 2.71; 95% CI [1.26–5.82]; P = 0.01), medium household size (6–15 members) (AOR = 1.66; 95% CI [1.04–2.66]; P = 0.03) and women of gestational age 20–35 weeks (AOR = 1.89; 95% CI [1.05–3.40]; P = 0.03) were more likely to have quality diets after adjusting for potential confounding variables. Diet quality among pregnant women was low and was predicted by educational level, household wealth, gestational age and food security. Women education and improvements in household food security could impact diets of pregnant women in northern Ghana.     

Intracranial pressure monitoring associated with increased mortality in pediatric brain injuries

Utilization of ICP monitors for pediatric patients is low and varies between centers. We hypothesized that in more severely injured patients (GCS 3–4), there would be a decreased mortality associated with invasive monitoring devices. The pediatric Trauma Quality Improvement Program (TQIP) was queried for patients aged ≤ 16 years meeting criteria for invasive monitors. Our primary outcome was mortality. Patients with ICP monitoring were compared to those without. A logistic regression was used to examine the risk of mortality. Of 3,808 patients, 685 (18.0%) underwent ICP monitoring. ICP monitors were associated with increased risk of mortality (OR 1.82, CI 1.36–2.44, p < 0.001). A secondary analysis including type of invasive ICP monitor and dividing GCS into 3 categories revealed both intraventricular drain (OR 1.89, CI 1.3–2.7, p = 0.001) and intraparenchymal pressure monitor (OR 1.86, CI 1.32–2.6, p < 0.001) to be independently associated with an increased likelihood of mortality regardless of GCS, while intraparenchymal oxygen monitoring was not (OR 0.47, CI 0.11–2.05, p = 0.316). The strongest effect was seen in those patients with a GCS of 5–6. ICP monitors are an independent risk factor for mortality, particularly with intraventricular drains and intraparenchymal monitors in patients with a GCS 5–6.     

Plasma lipid metabolites are associated with gestational age but not bronchopulmonary dysplasia

Aim: To test the hypothesis that plasma lipid metabolite levels in premature infants are associated with the development of bronchopulmonary dysplasia (BPD). The studies also tested a secondary hypothesis that plasma lipid metabolite levels were correlated with gestational age. Methods: Infants born <32 weeks’ gestation were enrolled during the first 72 h of life. Plasma samples were obtained and lipid levels were measured by LC‐MS/MS. Clinical data were collected to determine infant outcomes and BPD diagnosis. Results: Following adjustment for confounders, lipid levels were not associated with BPD; however, levels of specific lipid metabolites were correlated with gestational age. Conclusion: Immature lipid metabolism pathways in premature infants may contribute to the pathogenesis of BPD and other diseases.     

Infant locomotive development and its association with adult blood pressure

Evidence from animal models suggests that locomotion and blood pressure share common neurophysiological regulatory systems. As a result of this common regulation, we hypothesized that the development of locomotion in human infants would be associated with blood pressure levels in adulthood. The study sample comprised 4,347 individuals with measures of locomotive and non-locomotive neuromotor development in infancy and adult blood pressure levels within a longitudinal birth cohort study, the Northern Finland Birth Cohort 1966. Later development in all three stages of locomotive development during infancy was associated with higher systolic and diastolic blood pressure levels at age 31. For age of walking without support, 0.34 (95 % CI 0.07 to 0.60)-mm Hg higher SBP and 0.38 (95 % CI 0.15 to 0.62)-mm Hg higher DBP were estimated for each month of later achievement (P?=?0.012 for SBP; P?=?0.001 for DBP). No association was identified for non-locomotive neuromotor development. Conclusion: These results highlight the positive sequelae of advanced locomotive development during infancy, suggesting that the common regulatory systems between locomotion and blood pressure may influence the development of raised blood pressure over time.     

Foetal haemoglobin concentration in cord blood in relation to gestational age

Summary Eighty newborns of various birth weights and gestational age ranging from 28 to 45 weeks were studied. There were 26 preterm, 41 term and 13 post-term infants. The average values of total and foetal haemoglobin in males and females were studied and there was no significant difference in the two sexes. Total haemoglobin tended to rise with advancing gestation. On the contrary, foetal haemoglobin showed a gradual fall with advancing gestational age. Correlation between gestational age and birth weight and foetal haemoglobin could not be established. Foetal haemoglobin in preterm, term and post-term newborns was 83.93, 68.59 and 60.03% respectively. It was concluded that foetal haemoglobin can be used as one of the indices for determining the maturity. From the Department of Paediatrics, M.G.M. Medical College, Indore.     

Prepubertal stature and blood pressure in early old age

AIMS—To test the hypothesis that childhood growth rate is a marker for formation of control mechanisms that influence blood pressure in early old age.METHODS—Data are from a sample of 149 (74 male) members of Sir John Boyd Orr''s survey of British families conducted between 1937 and 1939. Measured heights were collected between ages 5 and 8 years, and in early old age between 1997 and 1998. Multiple linear regression investigated the relations of blood pressure with age and sex standardised childhood height with adjustment for potential confounding factors, including adult height. Inclusion of both childhood and adult heights in the same model was used to estimate growth, as measures of childhood height are relative to adult height.RESULTS—Mean blood pressures in early old age for those in the shortest childhood height fifth were 167.8 and 76.3 mm Hg for systolic blood pressure and pulse pressure, respectively. For the tallest fifth they were 150.8 and 63.7 mm Hg, respectively. After adjustment for potential confounding factors including adult height, the mean increase for the shortest childhood height fifth compared with the tallest was 28.5 mm Hg for systolic pressure (p = 0.015) and 22.8 mm Hg (p = 0.010) for pulse pressure. The relations of blood pressure with adult height were not statistically significant in the adjusted models.CONCLUSION—Prepubertal growth rate is associated with the formation of mechanisms associated with the control of blood pressure in later life.