Quelle méthode alternative à l'absorptiométrie biphotonique (DEXA) utiliser pour évaluer la composition corporelle des adolescents en surpoids ou obèses ?

CONTEXT: Professionals in charge of overweight and obese children and adolescents need a simple, reliable and precise method for assessing body composition. OBJECTIVES: To compare body composition as assessed by dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA) and the skinfold thickness (SFT) method in overweight and obese adolescents, and to establish and validate new predictive equations of body composition from BIA measurements using DXA as standard method. SUBJECTS AND METHODS: Body composition was assessed in 143 obese adolescents (Z-score = 3.2 +/- 1.4) aged 12 to 17 years by DXA, BIA (RJL System, Analycor and Analycor XF models) and SFT (Siri and Slaughter's equations). New prediction equations of fat mass (FM) as assessed by DXA were computed from BIA measurements in a calibration group, and validated in an homologous group of subjects. Results. - The Bland-Altman test showed that compared to DXA, BIA underestimated FM by 2.8 +/- 2.0 kg and 2.3 +/- 2.1 kg using the RJL System and Analycor impedancemeter, respectively (P < 0.001).With the Analycor XF model, FM was underestimated by 3.3 +/-2.6 kg in boys, and over-valued by 0.6 +/- 2.4 kg in girls. On the contrary, the predictive equation of Wabitsch et al. overvalued FM by 6.2 +/- 2.9 kg. The SFT method overvalued FM by 2.1 +/- 5.0 kg in boys and underestimated FM by 2.3 +/- 3.5 kg in girls using Slaughter et al. equation, while Siri's equation underestimated FM by 4.0 +/- 2.9 kg (P < 0.001). The alternative to the DXA method to assess FM was BIA with new prediction equations including gender, body weight, height(2)/resistance and reactance. CONCLUSION: DXA, BIA and the SFT method were not directly interchangeable. The SFT method was inadequate to assess body composition in overweight and obese adolescents. BIA and new prediction equations could be an alternative to the DXA method in overweight and obese adolescents.     

Validation of Bioelectric Impedance Analysis against Dual-Energy <Emphasis Type="Italic">X</Emphasis>-ray Absorptiometry for assessment of body composition in Indian children aged 5 to 18 years

Objective

To validate body composition measurements by Bioelectric Impedance Analysis (BIA) against Dual-Energy X-ray Absorptiometry (DXA) as the reference method in healthy children and adolescents.

Design

Cross-sectional

Setting

Schools in and around Pune city, India.

Participants

A random sample of 210 (114 boys, 96 girls) apparently healthy Indian children and adolescents (5–18 y).

Methods

Weight, height, Tanner stage (TS) were recorded. Body composition measures: fat-free mass (FFM), fat mass (FM), lean mass (LM), bone mineral content (BMC) and body fat percentage (%BF) were assessed by BIA and DXA on a single day. Agreement between the methods was estimated by Pearson’s correlation, and Bland and Altman analysis.

Main outcome measures

%BF, FM, FFM, LM, BMC.

Results

BIA underestimated %BF by 6.7 (3.7)% as compared to DXA. Mean FFM, BMC and LM by BIA were significantly higher than by DXA (P<0.001). These differences remained similar after adjusting for age, BMI and TS. Mean differences between FFM (?2.32 (1.39) kg), BMC (?0.18 (0.15) kg), and LM (?2.15 (1.34) kg) by DXA and BIA were significant (P<0.01). Correlations between BIA and DXA were 0.92 for %BF, 0.96 for LM and 0.98 for FFM and BMC. Both the methods were similar in identifying normal and overfat children as per their respective cut-offs.

Conclusion

BIA and DXA techniques are not interchangeable for assessment of body composition. However, BIA may be used in the field/clinical setting preferably with ethnicity specific references.

     

Cross-calibration of multi-frequency bioelectrical impedance analysis with eight-point tactile electrodes and dual-energy X-ray absorptiometry for assessment of body composition in healthy children aged 6–18 years

Background:  In diagnosis and treatment of obesity, body composition analysis including percent body fat (%BF) is useful in the clinical setting. Because bioelectrical impedance analysis (BIA) could be used quickly, easily and was non-invasive in clinical setting, the purpose of the present study was to evaluate the usefulness of multi-frequency BIA with eight-point tactile electrodes (MF-BIA8; InBody 720, Biospace) compared with dual-energy X-ray absorptiometry (DXA) in healthy children and adolescents.
Methods:  A total of 166 children and adolescents under 18 (male, n  = 86; female, n  = 80) were recruited. Height, weight, body mass index (BMI) and Tanner stage were measured for each subject. The body composition such as fat-free mass (FFM), fat mass (FM), and %BF was measured on BIA and DXA and compared.
Results:  On linear regression analysis, DXA FFM = 1.006(BIA FFM) + 0.554, R ² = 0.99 and the standard error of the estimate (SEE) was 1.16 kg; DXA FM = 0.971(BIA FM) – 0.596, R ² = 0.93; SEE, 1.34 kg; and DXA %BF = 0.940(BIA %BF) – 1.026, R ² = 0.858; SEE, 3.03%. Limit of agreement in FFM, FM, and %BF was 0.7 ± 2.3 kg, −0.9 ± 2.9 kg and –2.2 ± 6.1%, respectively.
Conclusions:  Although the %BF was not interchangeable with DXA, MF-BIA8 (InBody 720; Biospace) could be used to measure body composition of children and adolescents in the clinical field because of its high precision.     

Estimation of body fatness by air displacement plethysmography in African American and white children

The purpose of this study was to determine the ability of air displacement plethysmography (ADP) to estimate body fatness in prepubertal and early pubertal African American and white children. One hundred nineteen nonoverweight and overweight boys (N = 56) and girls (N = 63), age (mean +/- SD) 9.8 +/- 1.7 y, body mass index 25.9 +/- 7.6 kg/m2 (range, 14.2-47.0 kg/m2), and mean percent body fat (%BF) by dual-energy x-ray absorptiometry (DXA) 39.2 +/- 11.7% (range, 12.2-57.5%), were studied. %BF by ADP was compared with DXA %BF estimates and with body fat by several field methods: skinfold thicknesses using the Slaughter et al. equations (Hum Biol 60: 709-723, 1988), bioelectrical impedance analysis (BIA) using the Houtkooper et al. equation (J Appl Physiol 72: 366-373, 1992), and a predictive equation using skinfold thicknesses, BIA, and weight (Goran et al.: Am J Clin Nutr 63: 299-305, 1996). All methods used to estimate %BF were significantly correlated with DXA (all p < 0.0001), with r2 ranging from 0.85 (skinfold measurements) to 0.95 (ADP). ADP using the Siri equation underestimated %BF by -1.9% (p < 0.001); the Bland-Altman limits of agreement (defined as +/-2 SD) were +/-7.4%. %BF by ADP-Siri underestimated %BF by DXA by 3.0% for girls (p < 0.001) and by 0.6% for boys (NS). Agreement between body fat estimation by ADP and DXA did not vary with age, race, or pubertal stage. Application of the age-adjusted Lohman model to ADP significantly increased the magnitude of the underestimation to -6.9% (p < 0.0001). Prediction of %BF by the Slaughter skinfold thickness equation showed no significant mean bias for the overall data, but significantly underestimated %BF in girls (-3.7%) while overestimating %BF in boys (+2.4%) with wide limits of agreement (+/-17.7%, p < 0.01 versus ADP). %BF by the Houtkooper BIA equation or Goran model underestimated %BF to a significantly greater degree than ADP (Houtkooper, -8.1%; Goran, -10.1%; both p < 0.0001 versus DXA or ADP). Determination of %BF from ADP using the Siri model slightly underestimates %BF as determined by DXA in girls, but appears to be superior to existing field methods both in accuracy and limits of agreement. Because of the ease with which it can be performed, ADP may prove useful for investigations of adiposity in children.     

Body composition,as assessed by bioelectrical impedance spectroscopy and dual-energy X-ray absorptiometry,in a healthy paediatric population

The aim of this study was to determine the level of agreement between body composition measurements by dual-energy X-ray absorptiometry (DXA), single-frequency bioelectrical impedance analysis (BIA) and multifrequency bioelectrical impedance spectroscopy (BIS). Fat-free mass (FFM), body fat mass and body fatness (percentage fat) were measured by DXA, BIA and BIS in 61 healthy children (37M, 24F, aged 10.9-13.9 y). Estimates of FFM, body fat mass and body fatness were highly correlated (r = 0.73-0.96, p < 0.0001) between the different methods. However, a Bland-Altman comparison showed wide limits of agreement between the methods. The mean differences between methods for FFM ranged from -2.31 +/- 7.76 kg to 0.48 +/- 7.58 kg. Mean differences for body fat mass ranged from 0.16 +/- 5.06 kg to 2.95 +/- 5.65 kg and for body fatness from -2.3 +/- 7.8% to 0.8 +/- 9.3%. Calculations of body composition with BIS were not superior to BIA. However, BIA overestimated fat mass in lean, subjects and underestimated fat mass in overweight subjects more than BIS, compared with DXA. CONCLUSION: The methods used provided estimates of FFM, body fat mass and body fatness that were highly correlated in a population of healthy children. However, the large limits of agreement derived from the Bland-Altman procedure suggest that the methods should not be used interchangeably.     

Evaluation of the complementary feeding practices,dietary intake,and nutritional status of infants on a cow's milk protein elimination diet

ObjectiveTo evaluate the complementary feeding practices, food intake, and nutritional status of infants on a cow's milk protein elimination diet.MethodsA cross-sectional and observational study was conducted to compare infants aged 4–18 months who were on a cow's milk protein elimination diet with a control group of healthy infants without any dietary restrictions. General information on the child's health, demographic data, and food consumption were collected.ResultsThe study included 96 infants in the elimination diet group and 99 in the control group. In the elimination diet group, the median age (in months) of introduction of solid foods (5.0 × 4.0; p < 0.001) and water (5.5 × 4.0; p < 0.05) was later, consumption of soft drinks and industrialized cookies was less frequent (p < 0.05), and a lower index of complementary feeding inadequacies (2.75 × 3.50; p < 0.001) was observed. The elimination diet group presented lower individual values of Z scores for weight/age, weight/height, and body mass index/age, although they were fed with higher amounts of energy (117.4 × 81.3 kcal/kg of weight; p < 0.001) and macro-and micronutrients, except for vitamin A. In the elimination diet group, breast milk and its substitutes contributed to more than 67% of energy intake. Although calcium consumption was a deficit in 31.5% of the infants, none received supplementation.ConclusionInfants on an elimination diet presented more adequate complementary feeding practices and higher nutritional intake, despite lower body weight values.     

C-反应蛋白、血沉、乳酸脱氢酶及血清铁蛋白联合检测对儿童发热待查病因诊断价值的探讨

目的探讨C-反应蛋白(CRP)、红细胞沉降率(ESR)、乳酸脱氢酶(LDH)及血清铁蛋白(SF)联合检测对发热待查患儿病因诊断的临床应用价值。方法回顾性分析热程2周以上的发热待查住院患儿154例的临床资料,并根据出院诊断分为感染组(n=54)、风湿组(n=67)、恶性肿瘤组(简称为肿瘤组,n=33),对3组患儿血清CRP、ESR、LDH及SF 4项指标的均值进行比较,并通过ROC曲线分析其单独及联合检测对发热待查患儿病因的诊断价值。结果感染组、风湿组、肿瘤组3组患儿血清CRP和ESR均升高,其中风湿组升高最明显;血清LDH在肿瘤组升高最明显;SF在风湿组和肿瘤组均明显升高。LDH对风湿性疾病、CRP和ESR对恶性肿瘤诊断的ROC曲线下面积(AUC)0.7(P0.05)。CRP诊断感染和风湿性疾病的AUC分别为0.861、0.782;ESR诊断感染和风湿性疾病的AUC分别为0.770、0.743;LDH诊断感染和恶性肿瘤的AUC、灵敏度、特异度及约登指数均较低;SF诊断感染的AUC、灵敏度、约登指数均为最高,但特异度最低;SF诊断风湿性疾病的AUC、灵敏度、特异度、约登指数都较高;SF诊断恶性肿瘤的AUC较低。4项指标联合检测对诊断风湿性疾病和恶性肿瘤的AUC、灵敏度、特异度比单独检测时高。结论在发热待查患儿的病因诊断中,CRP、ESR、LDH及SF对初步诊断风湿性疾病有一定临床意义,对感染性疾病和恶性肿瘤的诊断和鉴别价值有限;4项指标联合检测对发热待查患儿的病因诊断价值优于单独检测。     

Overweight/obesity in adolescents with phenylketonuria: protective and predisposing factors

ObjectiveTo estimate the prevalence and factors associated with overweight/obesity development in adolescents with early diagnosed phenylketonuria treated exclusively by diet.MethodologyIn this cross-sectional study anthropometric measurements, serum phenylalanine levels, and 10 metabolites associated with lipid and carbohydrate metabolism were analyzed in 101 adolescents aged 10–20 years. Adolescents were categorized into overweight/obesity and eutrophic/low body mass index groups. These patients were compared using Student's t-test, Pearson's chi-square test, Wald's chi-square test for multivariate analysis. Further, to verify whether the prevalence of overweight/obesity found in the study population was similar to that in the general population, the authors compared the nutritional status of 46 patients aged 13–17 years with that of healthy students of the same age from the National School Health Survey using the chi-square test for adherence. The significance threshold was p < 0.5.ResultsThe prevalence of overweight/obesity in adolescents was 27.7%. There was no difference in prevalence between sexes. Older age was a protective factor and Increased Homeostasis Model Assessment Insulin Resistance index and high phenylalanine and low-density lipoprotein cholesterol levels were predictive factors for overweight/obesity. The equality hypothesis was not rejected in the comparison of nutritional states of 46 patients aged 13–17 years and healthy students of the same age.ConclusionThe prevalence of overweight/obesity in phenylketonuria adolescents was similar to what is found in healthy adolescents.     

Bone mineral density,pulmonary function,chronological age,and age at diagnosis in children and adolescents with cystic fibrosis

ObjectiveTo assess bone mineral density in patients with cystic fibrosis (CF), and to correlate it with possible intervening variables.MethodsChildren and adolescents diagnosed with CF, aged 6 to 18 years, followed at the outpatient clinic were included in the study. First, demographic data were collected and, subsequently, patients underwent a spirometric test. All patients answered the Cystic Fibrosis Quality of Life Questionnaire (CFQ) and underwent the six-minute walk test (6MWT) and bone densitometry (DXA).ResultsA total of 25 CF patients were included, of which 56% were males. The mean age was 12.3±3.4 years; mean height was 149.2±14.4 cm; and mean weight was 44.4±13.9 kg. Most results on pulmonary function and bone mineral density (BMD) were within normal limits. The mean forced expiratory volume in one second (FEV) was 92.5±23.6 (% of predicted), mean forced vital capacity (FVC) was 104.4±21.3 (% of predicted), and1 mean BMD z-score was 0.1±1.0. BMD was moderately correlated with FEV (r = 0.43, p = 0.03) and FVC (r = 0.57, p = 0.003). Regarding chronological age and age at diagnosis, a moderate and inverse correlation was also found (r = ?0.55, p = 0.004; r = ?0.57, p = 0.003, respectively). However, no significant correlations were found with the data from CFQ, 6MWT, and body mass index.ConclusionMost patients had BMD within normal limits and presented a positive correlation with pulmonary function, as well as a negative correlation with chronological age and age at diagnosis.     

Bioelectrical impedance for measuring percentage body fat in young persons with Down syndrome: validation with dual‐energy absorptiometry

Aim: Children with Down syndrome have an increased prevalence of obesity, although there is little work describing body composition in this population. The aims of this study were to accurately measure body fat in children with Down syndrome and to identify which existing algorithm best predicts percentage body fat in this population. Methods: Seventy children with Down syndrome had anthropometric, bioelectrical impedance analysis (BIA) and dual‐energy X‐ray absorptiometry (DXA) data collected to calculate percentage body fat (PBF). Pearson correlations were carried out to assess the relationships of various methods for measuring body fat and Bland–Altman plots to assess systematic error. Results: Mean PBF was 30.5% for girls and 22.5% for boys. A total of 38% of girls and 23% of boys were obese according to international criteria. PBF as determined by DXA correlated well with PBF by BIA in both girls and boys (r = 0.91 and 0.89, respectively, p < 0.001). Conclusion: There are high rates of obesity in children with Down syndrome. BIA can be used to accurately determine adiposity in this population. We recommend the use of the Schaeffer algorithm for calculation of PBF in children with Down syndrome.     

Measurement of body fat using leg to leg bioimpedance.

AIMS: (1) To validate a leg to leg bioimpedance analysis (BIA) device in the measurement of body composition in children by assessment of its agreement with dual energy x ray absorptiometry (DXA) and its repeatability. (2) To establish a reference range of percentage body fat in Hong Kong Chinese children. METHODS: Sequential BIA and DXA methods were used to determine body composition in 49 children aged 7-18 years; agreement between the two methods was calculated. Repeatability for the BIA method was established from duplicate measurements. Body composition was then determined by BIA in 1139 girls and 1243 boys aged 7-16 years, who were randomly sampled in eight local primary and secondary schools to establish reference ranges. RESULTS: The 95% limits of agreement between BIA and DXA methods were considered acceptable (-3.3 kg to -0.5 kg fat mass and -3.9 to 0.6% body fat). The percentage body fat increased with increasing age. Compared to the 1993 Hong Kong growth survey, these children had higher body mass index. Mean (SD) percentage body fat at 7 years of age was 17.2% (4.4%) and 14.0% (3.4%) respectively for boys and girls, which increased to 19.3% (4.8%) and 27.8% (6.3%) at age 16. CONCLUSION: Leg to leg BIA is a valid alternative method to DXA for the measurement of body fat. Provisional reference ranges for percentage body fat for Hong Kong Chinese children aged 7-16 years are provided.     

Comparison of bioelectrical impedance analysis and dual energy X-ray absorptiometry for assessment of body composition in children

BACKGROUND: There are a variety of methods for assessing body composition. Bioelectrical impedance analysis (BIA) is an easy and non-invasive technique, but has limitations in underweight and overweight subjects. Few reports have investigated the validity of BIA in children. In this report, the characteristics of BIA, especially in overweight and underweight children, are assessed and the results are compared with those of dual energy X-ray absorptiometry (DXA), as a reliable method for assessing body composition. METHODS: Determination of the fat-free mass (FFM), body fat content and percent body fat (%fat) was carried out using both BIA and DXA. The subjects (60 males and 44 females) were divided into five groups according to the percentage of ideal bodyweight (%IBW). Ten obese children, who were treated with exercise and a low-energy diet for 1 month, were also enrolled in this study. RESULTS: The %fat, FFM and body fat content showed a close correlation when measured by BIA and DXA with the correlation coefficients being 0.90, 0.95, and 0.95, respectively. In the underweight group, the %fat value determined by BIA tended to be greater than that determined by DXA, while in the overweight group, the BIA value was lower than the DXA value. The same trend was also seen in obese children before and after therapy with exercise and diet. CONCLUSION: Bioelectrical impedance analysis seems to be a reasonable method for daily clinical use, but attention should be paid to the interpretation of %fat values in underweight and overweight children.     

Evaluation of lean body mass in obese children

Multiple skinfold anthropometry (MSA) and bioelectrical impedance analysis (BIA) are useful as clinically non-invasive, inexpensive and portable techniques, although it is not clear if they can be used interchangeably in the same patient to routinely assess her/his body composition. In order to compare BIA, MSA and DXA in the estimation of lean body mass (LBM) of a pediatric obese population, 103 obese [body mass index (BMI) > 97th percentile] children (median age: 11 years; range: 5.4–16.7 years) underwent nutritional evaluation. After an overnight fast, the subjects’ anthropometric measurements were performed by the same investigator: body weight (BW), height, skinfold thickness (four sites); fat body mass (FBM) using Brook or Durnin equations and dual X-ray absorptiometry (DXA). BIA was performed using a bioelectrical impedance analyzer (Analicor-Eugedia, 50 kHz) and Houtkooper’s equation to calculate LBM. Linear regression analysis was performed to evaluate the relationship between the prediction of LBM by MSA, DXA and BIA. The differences between the three techniques were analysed using Student’s t-test for paired observations and the Bland and Altmann method. A considerable lack of agreement was observed between DXA- and BIA-LBM (δ = −4.37 kg LBM; δ−2σ = −11.6 kg LBM; δ+2σ = +2.8 kg LBM); between DXA- and MSA-LBM (δ = −1.72 kg LBM; δ−2σ = −8.2 kg LBM; δ+2σ = +4.8 kg LBM) and between BIA- and MSA-LBM (δ = −2.65 kg LBM; δ−2σ = −10.5 kg LBM; δ+2σ = +5.2 kg LBM). Conclusion: In obese children, DXA, BIA and MSA should not be used interchangeably in the assessment of LBM because of an unacceptable lack of agreement between them. The discrepancies between methods increase with the degree of obesity.     

Limited sampling strategies for sirolimus after pediatric renal transplantation

Abstract: SRL has been increasingly used in renal transplantation, but limited sampling approaches for estimation of AUC remain elusive. A post‐hoc analysis of 94 PK profiles in 75 patients from four previous studies was performed to generate limited sampling approaches for approximation of AUC based on two to four time points for both BID and OD SRL dosing. AUC was calculated using the trapezoid rule. Stepwise linear regression was performed to generate an abbreviated AUC from the limited sampling approaches. For BID dosing, complete AUC had a strong correlation with the trough levels (r² = 0.882, p < 0.0001) and with C2 level (r² = 0.9025, p < 0.0001). A three‐point and a four‐point limited sampling approach showed improved agreement with complete AUC compared with single‐point sampling. A convenient and accurate (r² = 0.992) four‐point limited sampling approach reads: AUC = 10^(1.085 + 0.117 × log C0 + 0.164 × log C1?0.131 × log C2 + 0.823 × log C4). Similarly, complete AUC had a statistically significant correlation with the trough levels (r² = 0.549, p < 0.0001) and with C2 level (r² = 0.716, p < 0.0001) for OD dosing. The estimation of AUC for OD dosing was improved over single‐point sampling (r² = 0.951) using the formula: AUC = 10^(1.100 + 0.115 × log C0 + 0.803 × log C4). This study represented the first limited sampling approach for SRL. Further studies are required to determine the optimal SRL target AUC.     

Idiopathic musculoskeletal pain,musculoskeletal pain syndromes,and use of electronic devices in adolescents with asthma

ObjectiveTo evaluate idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with asthma and healthy controls.MethodsCross-sectional study was conducted on 150 asthmatic adolescents and 300 controls. Adolescents completed a self-administered questionnaire regarding painful symptoms, use of electronic devices, and physical activity. Seven musculoskeletal pain syndromes were evaluated, and Asthma Control Test (ACT) was assessed.ResultsMusculoskeletal pain (42% vs. 61%, p = 0.0002) and musculoskeletal pain syndromes (2.7% vs. 15.7%, p = 0.0006) were significantly lower in asthmatic adolescents than in controls. The frequency of pain in the hands and wrists was reduced in asthmatic than in controls (12.6% vs. 31.1%, p = 0.004), in addition to cell phone use (80% vs. 93%, p < 0.0001), simultaneous use of at least two electronic media (47% vs. 91%, p < 0.0001), myofascial syndrome (0% vs. 7.1%, p = 0.043), and tendinitis (0% vs. 9.2%, p = 0.008). Logistic regression analysis, including asthma with musculoskeletal pain as the dependent variable, and female sex, ACT > 20, simultaneous use of at least two electronic devices, cell phone use, and weekends and weekdays of cell phone use, as independent variables, showed that female sex (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.929–6.316; p = 0.0009) and ACT ≥ 20 (OR, 0.194; 95% CI, 0.039–0.967; p = 0.045) were associated with asthma and musculoskeletal pain (Nagelkerke R² = 0.206).ConclusionsMusculoskeletal pain and musculoskeletal pain syndromes were lower in adolescents with asthma. Female sex was associated with musculoskeletal pain in asthmatic, whereas patients with asthma symptoms and well-controlled disease reported a lower prevalence of musculoskeletal pain.     

Comparison between broad-band ultrasound attenuation of the calcaneum and total body bone mineral density in children

We measured broad-band ultrasound attenuation (BUA) in the calcaneum using the prototype Paediatric Contact Ultrasound Bone Analyser (CUBA) and total body bone mineral density (TBBMD) using dual-energy X-ray absorptiometry (DXA) (Hologic QDR-1000W) in 58, 7 17-year-old healthy children and adolescents. Calcaneal BUA was significantly related to TBBMD ( r = 0.74, p < 0.001), and both the calcaneal BUA and TBBMD were significantly correlated with age and body weight. We conclude that calcaneal BUA reflects bone mineral density (BMD) in healthy children and adolescents; however, BMD measured by CUBA appears to be less sensitive than that measured by DXA. Since BUA reflects structural properties of bone, as well as density, it may complement radiological techniques of bone density measurement in the assessment of paediatric conditions associated with fracture risk.     

Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy

ObjectiveTo evaluate musculoskeletal involvement and autoantibodies in pediatric leprosy patients.Methods50 leprosy patients and 47 healthy children and adolescents were assessed according to musculoskeletal manifestations (arthralgia, arthritis, and myalgia), musculoskeletal pain syndromes (juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, and tendinitis), and a panel of autoantibodies and cryoglobulins. Health assessment scores and treatment were performed in leprosy patients.ResultsAt least one musculoskeletal manifestation was observed in 14% of leprosy patients and in none of the controls. Five leprosy patients had asymmetric polyarthritis of small hands joints. Nerve function impairment was observed in 22% of leprosy patients, type 1 leprosy reaction in 18%, and silent neuropathy in 16%. None of the patients and controls presented musculoskeletal pain syndromes, and the frequencies of all antibodies and cyoglobulins were similar in both groups (p > 0.05). Further analysis of leprosy patients demonstrated that the frequencies of nerve function impairment, type 1 leprosy reaction, and silent neuropathy were significantly observed in patients with versus without musculoskeletal manifestations (p = 0.0036, p = 0.0001, and p = 0.309, respectively), as well as multibacillary subtypes in leprosy (86% vs. 42%, p = 0.045). The median of physicians’ visual analog scale (VAS), patients’ VAS, pain VAS, and Childhood Health Assessment Questionnaire (CHAQ) were significantly higher in leprosy patients with musculoskeletal manifestations (p = 0.0001, p = 0.002, p = 0002, and p = 0.001, respectively).ConclusionsThis was the first study to identify musculoskeletal manifestations associated with nerve dysfunction in pediatric leprosy patients. Hansen's disease should be included in the differential diagnosis of asymmetric arthritis, especially in endemic regions.     

补体C3对儿童脓毒症患者预后的预测价值

目的 分析补体C3在脓毒症患儿中的变化情况及其与脓毒症病情严重程度的关系,探讨补体C3对脓毒症患儿死亡的预测价值。方法 回顾性收集2019年11月—2021年9月湖南省儿童医院重症医学科收治的529例脓毒症患儿为研究对象。按诊断脓毒症后28 d预后情况分为存活组(n=471)和死亡组(n=58);按入院诊断脓毒症24h内补体C3的中位数(0.77g/L)分为C3正常组(n=273)和C3降低组(n=256)。比较各组间的临床及实验室指标差异,分析补体C3对脓毒症患儿死亡的预测价值。结果 死亡组补体C3水平较存活组明显降低(P<0.05)。多因素logistic回归分析显示,儿童快速序贯器官衰竭评分(pediatric Sequential Organ Failure Assessment,p-SOFA)得分高和补体C3低与脓毒症患儿死亡密切相关(P<0.05)。受试者操作特征曲线分析显示,p-SOFA与补体C3的联合预测模型曲线下面积为0.852,高于p-SOFA、补体C3单项指标的预测价值(P<0.05)。结论 补体C3可作为脓毒症患儿病情严重程度及预后的评价指标;...     

Ocena stanu odżywienia i składu ciała pacjentów z mukowiscydozą

IntroductionCystic fibrosis (CF) is a chroni? multiorgan disease inherited in an autosomal recessive manner. It is mainly characterized by respiratory failure and maldigestion. The exocrine insufficiency of pancreas manifests itself in steatorrhea and leads to malnutrition and growth retardation.AimThe airm of this study was to evaluate retrospectively the physical development and the body composition of patients with CF using noninvasive methods: anthropometric traits and densitometry.Material and methodsThe examined group comprised 25 patients with cystic fibrosis (17 girls, 8 boys) aged from 15-months to 18-years-old (mean age 10 years, SD ± 67 months). Basic anthropometric traits were measured and 3 skin-folds, Mid Arm Fat Area (MAFA) also Mid Arm Muscle Area (MAMA) and Body Mass lndex were calculated. By using dual-energy X-ray absorptiometry (DXA) the Lean Body Mass (LBM) as well as bon? minera? content of total skeleton and lean body mass ratio (TBBMC/LBM) were calculated. 23 healthy children (17 boys, 6 girls) were the control group. Data standardization was mad? by using computer programme ‘gimAntropometry’. For the statistical calculations nonparametric tests were used which are available in the STATISTICA application.Results40% of patients with CF were below the 10 centile for body weight (4.34% in control's group, p=0.003). The skinfold thickness of triceps in 52% of children was below norm (vs 8.69%). Lowered index (TBBMC/LBM) was in 31% of patients with CF. The values of MAMA and LBM were reduced in respectively 31.8% and 42.1% patients with cystic fibrosis (p=0.02; p=0.001). The obtained results pointed the delayed height age in relation to calendar age in both groups, however, it was significantly bigger in CF group. Within MAFA, chest circumference and other skinfolds there was no statistic difference.ConclusionsThe deficiency of body weight, height and reduced skinfold thickness of triceps confirmed a problem of malnutrition in the disease unit. The non-invasive methods of assessment of physical development allow to estimate the progress of disease and the presumptive modification of dietary treatment.     

Excess adiposity and low physical fitness hamper Supine-to-Stand test performance among sedentary adolescents

ObjectiveThe aim of this study was to analyze the relationship between body adiposity and physical fitness with performance in the Supine-to-Stand test (STS-test) in sedentary adolescents.MethodsSixty-two adolescents, of both sexes, between 10 and 16 years old, participated in the study. Body mass (BM), height, waist circumference (WC), fat mass (FM), fat-free mass (FFM), right and left handgrip strength (HGS-right, HGS-left), abdominal resistance (ABDO), flexibility (FLEX), and cardiorespiratory fitness (VO_2peak) were measured. Body mass index (BMI), z-score BMI (BMI-z), tri-ponderal mass index (TMI) and waist-to-height ratio (WHtR) were calculated. The STS-test was applied to evaluate the STS-MC by the movement patterns in the execution of the test. The STS-time in seconds (s) was categorized into terciles: fast (FG < 2.0 s), intermediate (IG = 2.0–2.6 s) and slow (SG > 2.6 s). One-way ANOVA, Chi-square, Spearman's correlation coefficient as well as non-parametric tests were used, with significance p ≤ 0.05.ResultsThe SG presented higher BMI, BMI-z, TMI, WHtR, FM, %FM, as well as lower averages for %FFM, HGS-right, HGS-left, FLEX, ABDO, VO_2peak, VO_2peak relative to BM (VO_2peakBM) in relation to GF. The BMI, BMI-z, TMI, WC, WHtR and FM showed moderate and direct correlations with STS-time and inverse with STS-MC (p < 0.01). HGS-right, HGS-left, ABDO, and VO_2peakBM showed moderate and an inverse correlation with STS-time (p < 0.05). The VO_2peakBM was moderate and with direct correlations to STS-MC (p < 0.01).ConclusionIt is concluded that excess fat and low physical fitness hamper STS-test performance. Therefore, the STS-test can be used for screening students to assess MC.