Ratio of waist circumference to chest circumference is inversely associated with lung function in Chinese children and adolescents

Background and objective: In White children, waist circumference (WC) is positively correlated with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV₁). Because fat distribution differs among different races, the relationship between WC and lung function in Asian children may differ from that in White children. The present study aimed to examine the effect of WC on ventilatory function in Chinese children. Methods: A cross‐sectional study was performed on 1572 healthy subjects aged 9–18 years. Height, weight, chest circumference (CC), WC and lung function (FVC, FEV₁, peak expiratory flow (PEF) and maximal mid‐expiratory flow (MMEF)) were measured. To avoid the problem of colinearity, a model that combined CC and WC as the waist‐to‐chest ratio (WCR) was used. The relative contributions of WCR and body mass index (BMI) to spirometric parameters were determined by linear regression analysis. Results: WCR was inversely associated with all spirometric parameters. On average, each 0.01 increase in WCR was associated with decreases of 8.14 mL for FVC, 9.36 mL for FEV₁, 6.54% for FEV₁/FVC, 19.81 mL/s for PEF and 17.25 mL/s for MMEF. BMI was positively associated with all spirometric parameters except FEV₁/FVC. These results suggest that WC was inversely associated with lung function parameters. Conclusions: Inverse associations were identified between WCR, as well as WC, and lung function in a population of Chinese children. The underlying mechanisms need to be further explored.     

A comparison between the early and mid-term results of surgical as opposed to percutaneous closure of defects in the oval fossa in children aged less than 6 years

OBJECTIVES: To compare surgical as opposed to percutaneous interventional closure of isolated atrial septal defects in the oval fossa in terms of hospital stay, efficacy, and complications, and to study the respective role of the two techniques in current practice. METHODS: Between January 1998 and April 2004, 126 out of 1210 patients treated at our institution for closure of an isolated defect in the oval fossa were aged less than 6 years. The mean age of these 126 patients at procedure was 4.2 plus or minus 1 year. The ratio of females to males was 74 to 52. RESULTS: Of the patients, 62% were treated successfully using a percutaneous approach. The groups treated surgically or percutaneously did not differ for age, gender, or indications for treatment. No deaths occurred. The rates of total and major complications were higher in the group undergoing surgical closure, at 34% versus 9%, p less than 0.0001, and 10.5% versus 1%, p equal to 0.01, respectively. Embolisation of the device requiring subsequent surgery occurred in 1% of patients. The stay in hospital was shorter in those closed percutaneously, at 3.2 plus or minus 0.9 days versus 6.8 plus or minus 2.8 days, p equal to 0.0001. During a mean follow-up of 3.4 plus or minus 1.9 years, no major complications occurred in either group, and symptoms improved significantly in both groups. Additional sequels occurred in 2 patients who had major complications subsequent to surgical closure. CONCLUSIONS: Even in young children, it is both feasible and safe to close defects in the oval fossa percutaneously. Compared to surgical closure, the transcatheter approach allows a shorter stay in hospital, and has a lower rate of complications. Early and mid-term follow-up has confirmed the safety and efficacy of both techniques.     

A simple and sensitive method in using the ratios of cholesteryl ester molecular species as indexes of oxidative stress in plasma and lipoprotein fractions.

To develop a simpler method for lipid peroxidation which may replace the classic gold standard of measuring the loss of polyunsaturated fatty acids, we investigated the use of ratios of molecular species of neutral lipids (MSNL) separated by gas chromatography in a single step. We sub-fractionated lipoproteins and subjected each to oxidation. Among different combinations of ratios of MSNL, we found that the ratios of cholesteryl esters (CE) containing C20/C16 (R1) and C18/C16 (R2) decreased most rapidly with increasing Cu2+ concentration and with increasing oxidation time, for all lipoproteins. We suggest that these two CE ratios can be used as oxidative indexes for all lipoproteins and thus for intact plasma. Experimental evidence showed that the oxidative index of whole plasma is the weighted average index of its lipoproteins. This method was validated with thiobarbituric acid method. Normal healthy asymptomatic males had R1 value 0.496 +/- 0.130, and R2 4.674 +/- 0.848, and females had R1 0.535 +/- 0.117 and R2 4.569 +/- 0.733 with no significant gender differences. Both ratios showed low variabilities within each individual. The method was tested to be feasible in monitoring vitamin E supplementation study. This CE-ratio method is concentration independent. It is simple, rapid, and highly reproducible, and, suitable for screening plasma on large scale.     

Methodological approach to the assessment of the obesogenic environment in children and adolescents: A review of the literature

AimsChildhood and adolescent obesity has been defined as a planetary epidemic by WHO “globesity”. The obesogenic environment, defined as a life environment promoting a high-energy intake and a sedentary lifestyle, significantly contributes to the genesis and the diffusion of the globesity. In the last decades, several authors and working groups tried to develop methodological instruments in order to guarantee a reliable analysis of an obesogenic environment. Their efforts have led to the production of a relatively large number of questionnaires with different characteristics. The general aim of these questionnaires is to identify the factors that significantly contribute to the creation of an obesogenic environment around children and adolescents. As a result of this work, a number of studies were carried out using such questionnaires. Aim of this review is to evaluate ad hoc questionnaires useful to identify and analyze obesogenic environment.Data synthesisThe search was carried out in February–March 2017 using the PubMed-Medline and Scopus databases (time interval: the last 10 years). After the selection and verification phases, a total of 14 studies were selected and therefore included in the present review.ConclusionsThe questionnaires constructed and validated to analyze multiple constitutive elements of an obesogenic environment at the same time are complex and must be administered by qualified and trained staff. On the other hand, when two or more questionnaires are used to analyze different factors, the questionnaires used are generally shorter, self-administered, and generally easier to understand and interpret.     

Cardiorespiratory fitness relates more strongly than physical activity to cardiovascular disease risk factors in healthy children and adolescents: the European Youth Heart Study.

BACKGROUND: Physical activity and cardiorespiratory fitness are closely related to health variables in adults, especially those considered to be among risk factors for cardiovascular diseases. The possible tracking of cardiovascular disease risk factors from childhood to adulthood makes it important to increase our understanding of the complex relationships between physical activity, cardiorespiratory fitness and cardiovascular risk factors early in life. DESIGN: A cross-sectional, school-based study on healthy children and adolescents, aged 9-10 years (295 girls, 295 boys) and 15-16 years (302 girls, 233 boys) was performed during a school year in Sweden and Estonia, as part of the European Youth Heart Study. METHODS: Total physical activity, and minutes spent in inactivity and activity of moderate or higher intensity were measured by accelerometry. A maximal ergometer bike test was used for estimation of cardiorespiratory fitness. The risk factors included blood pressure and fasting blood levels of insulin, glucose, triglycerides, total cholesterol and high-density lipoprotein cholesterol. RESULTS: Canonical correlations between physical activity and cardiorespiratory fitness versus cardiovascular disease risk factors showed significant associations in both age and sex groups (rc=0.46-0.61, P<0.0001). The cardiorespiratory fitness was found to be the strongest contributor to these relationships. In girls high values of the physical activity variables were also associated with a favourable cardiovascular profile. CONCLUSIONS: Cardiorespiratory fitness relates more strongly to cardiovascular risk factors than components of objectively measured physical activity in children and adolescents. Physical activity becomes more important in the 15-year-old adolescents, indicating that these modifiable lifestyle factors increase in importance with age.     

Evaluation of adrenal function using the human corticotrophin-releasing hormone test, low dose Synacthen test and 9am cortisol level in children and adolescents with central adrenal insufficiency

Background The insulin tolerance test (ITT) has become less popular in paediatrics because of the risks associated with hypoglycaemia. Human corticotrophin‐releasing hormone (hCRH) test results correlate with the ITT and may be an acceptable method to test for central adrenal insufficiency (CAI). Simpler tests, such as the low dose Synacthen test (LDST) and 9am cortisol, have also been proposed. Objective To compare the ability of the hCRH test, LDST, 9am cortisol level and 24‐h cortisol profiles to diagnose CAI in a paediatric population. Design and setting A cross‐sectional study in a tertiary paediatric endocrine clinic. Participants Thirty‐one children and adolescents (aged 2·3–18·3 years) with CAI risk factors had an hCRH test, LDST, 9am cortisol and 24‐h cortisol profile performed. Results Of 23 patients with confirmed CAI (hCRH peak cortisol < 400 nmol/), 19 failed the LDST (peak cortisol < 267 nmol/l, i.e. 10th percentile for controls). Nineteen would have failed based on the 10th percentile cut point for 9am cortisol (< 140 nmol/l). Using receiver operating characteristic (ROC) curve coordinates, a 9am cortisol < 108 nmol/l was sensitive (83%) and specific (99%) for CAI. The 9am cortisol levels measured on two occasions were repeatable (94%) and correlated (r = 0·83, P = 0·01). All eight adrenally sufficient patients (hCRH peak cortisol ≥ 400 nmol/l) passed the LDST. Seven had normal 9am cortisol (≥ 140 nmol/l). The 24‐h cortisol area under the curve (AUC) for these patients was within the 10th–90th percentiles for control subjects’ AUC. The peak cortisol to hCRH and LDST were correlated (r = 0·88, P = 0·01), with no difference between the peaks (mean difference –5·3 nmol/l, P = 0·69). Conclusions In children with CAI risk factors, the diagnosis can be made if unstressed 9am cortisol is < 108 nmol/l. As cortisol levels > 381 nmol/l are highly suggestive of normal hypothalamic–pituitary–adrenal (HPA) function, stimulation testing need only be performed if 9am cortisol is 108–381 nmol/l. The LDST should be interpreted cautiously because mild CAI may be missed. When stimulation results are marginal, 24‐h cortisol profiles can provide reassurance of normal cortisol status.     

A comparison of the molecular clock of hepatitis C virus in the United States and Japan predicts that hepatocellular carcinoma incidence in the United States will increase over the next two decades

The prevalence of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) is considerably lower in the U.S. than in Japan. To elucidate this difference, we determined the time origin of the HCV epidemic in each country by using molecularly clocked long-term serial samples obtained from HCV carriers of genotypes 1a and 1b. The molecular clock estimated that HCV genotype 1 first appeared in Japan in around 1882, whereas emergence in the U.S. was delayed until around 1910. In addition, by statistical analysis using coalescent theory, the major spread time for HCV infection in Japan occurred in the 1930s, whereas widespread dissemination of HCV in the U.S. occurred in the 1960s. These estimates of viral spread time are consistent with epidemiologic observations and predict that the burden of HCC in the U.S. will increase in the next two to three decades, possibly to equal that currently experienced in Japan.     

Immunizing children to protect against the increasing risk of hepatitis A in adolescents and young adults in South Korea

We evaluated the CR326F strain (VAQTA) derived hepatitis A vaccine in Korean children and adolescents >2 years of age to consider a future immunization program. In our study, the pediatric two-dose regimen of VAQTA was found to be generally well tolerated and resulted in 100% (95% CI 94.8, 100.0) seroconversion after 2 doses. Immunizing children with the HAV vaccine routinely should be considered in South Korea, particularly in areas where recent outbreaks have occurred.     

Environmental and intrinsic factors shaping gut microbiota composition and diversity and its relation to metabolic health in children and early adolescents: A population-based study

ABSTRACT

Background

Gut microbiota, by influencing multiple metabolic processes in the host, is an important determinant of human health and disease. However, gut dysbiosis associated with metabolic complications shows inconsistent patterns. This is likely driven by factors shaping gut microbial composition that have largely been under-evaluated, at a population level, in school-age children, especially from developing countries.     

A new approach to assessing the health benefit from obesity interventions in children and adolescents: the assessing cost-effectiveness in obesity project

OBJECTIVE: To report on a new modelling approach developed for the assessing cost-effectiveness in obesity (ACE-Obesity) project and the likely population health benefit and strength of evidence for 13 potential obesity prevention interventions in children and adolescents in Australia. METHODS: We used the best available evidence, including evidence from non-traditional epidemiological study designs, to determine the health benefits as body mass index (BMI) units saved and disability-adjusted life years (DALYs) saved. We developed new methods to model the impact of behaviours on BMI post-intervention where this was not measured and the impacts on DALYs over the child's lifetime (on the assumption that changes in BMI were maintained into adulthood). A working group of stakeholders provided input into decisions on the selection of interventions, the assumptions for modelling and the strength of the evidence. RESULTS: The likely health benefit varied considerably, as did the strength of the evidence from which that health benefit was calculated. The greatest health benefit is likely to be achieved by the 'Reduction of TV advertising of high fat and/or high sugar foods and drinks to children', 'Laparoscopic adjustable gastric banding' and the 'multi-faceted school-based programme with an active physical education component' interventions. CONCLUSIONS: The use of consistent methods and common health outcome measures enables valid comparison of the potential impact of interventions, but comparisons must take into account the strength of the evidence used. Other considerations, including cost-effectiveness and acceptability to stakeholders, will be presented in future ACE-Obesity papers. Information gaps identified include the need for new and more effective initiatives for the prevention of overweight and obesity and for better evaluations of public health interventions.     

A province-based study using sampling method to investigate the prevalence of cystic echinococcosis among primary school children in Manisa, Turkey

A province-based field study using a portable ultrasound scanner (US) was performed for the first time using sampling method to investigate the prevalence of cystic echinococcosis (CE) in primary school children in Manisa, Turkey. A total of 6093 children from 37 primary schools was selected as the representative sample of the total number of 166,766 primary school children, and examined by the US. Prevalence was found to be 0.15%, as nine children were diagnosed with CE, seven new and two previously operated. A questionnaire applied to the children revealed no significant relationship between the risk factors and the infection (P > 0.05). In conclusion, it would be advisable to repeat the study at the same schools in eight years’ time, in order to evaluate the efficacy of the control programs, since nearly all students involved in this study will have graduated by then. Besides, it is recommended to choose a sampling group to find the prevalence of an infection in a defined region.     

A population study to define the incidence and survival of multiple myeloma in a National Health Service Region in UK

Epidemiology data on multiple myeloma (MM) occurrence and outcome is inconsistent whilst a major limitation of randomized controlled trials is selection bias. We present a population-based analysis of patients diagnosed with MM in the South Thames area, which comprises 5.4 million adult inhabitants. A total of 855 cases of MM were ascertained between 1999 and 2000 in a collaborative project involving haematologists and the Thames Cancer Registry. The age-standardized rate was 3.29 per 100 000 and 4.82 cases per 100 000 (World Standard and European Population respectively). The median age was 73 years. The median survival for the whole group was 24 months whist it was 42 and 18 months in those aged less than 65 years and greater than 65 years respectively (P < 0.001). This population study has shown a higher incidence than previously reported in the UK and Europe and provides a benchmark for future studies. If survival is to be improved, future clinical trials and health care planning should consider patients over 65 years of age.     

A pilot study to determine association of parental metabolic syndrome with development of metabolic risk in Indian children,adolescents and youth with Type-1 diabetes

Background and aimsPrevalence of metabolic syndrome (MS) is increasing in children with type-1 diabetes (T1D). Genetic and environmental factors shared among family members are considered significant risk factors. We conducted this study to assess the association of parental MS with development of metabolic risk (MR) in patients with T1D.MethodThis cross-sectional study included 29 patients with T1D along with their parents (29 triads). Demographic data, anthropometry, blood pressure, biochemical measurements and body composition measurements were performed using standard protocols. Insulin resistance was calculated using estimated glucose disposal rate (eGDR) in patients and using HOMA-IR in their parents. MS was diagnosed using International Diabetes Federation Consensus Definition, 2017.ResultsOf total study participants, 44.8% patients with T1D had MR while 25.3% of parents had MS. Low HDL was identified as the most common component of MS. 64.3% patients with T1D, who had parents with MS, had MR. The odds ratio (OR) for development of MR in patients with T1D with parents affected by MS was 4.9 (95% confidence interval 1.0–24.1) while relative risk (RR) was 2.4 (95% confidence interval 0.9–6.1). MR in patients with T1D was found to have a strong correlation with parental MS and also with development of double diabetes (DD).ConclusionIn conclusion, parental MS increases the risk of development of metabolic abnormalities in patients with T1D. Thus, positive family history may serve as a useful indicator for targeted screening to detect DD.