Weight misperception and its barriers to keep health weight in Chinese children

Aims: To examine the prevalence rate of misperception, assess the relationship between weight perception and weight-related behaviors in Chinese children. Methods: A total of 2708 children aged 7–12 years from five public primary schools and their parents completed questionnaires assessing social demographic background, dietary and activity related factors. Weight and height were measured by trained investigators. The prevalence of misperception was defined by comparing calculated BMI and their perceived weight status. Log-binomial model yielded adjusted prevalence ratios (PRs) for each behavior by weight misperception in boys and girls separately. Results: Misperception was more prevalent in normal weight children 33.3% for girls and 40.5% for boys and boys were more likely to underestimate their weight status than girls. Associations were observed between misperceived thinness and eating before bed, want to eat seeing others eating, eating sugar and snacks frequently, monophagia and choosy in food both in girls and boys. And associations between misperceived fatness and depression and want to eat seeing others eating were found only in girls. Conclusions: Our findings underscore the importance of weight perception in shaping realistic body image among normal weight children. Education must be introduced to help children accurately look on their body shape.     

1型糖尿病对儿童认知功能的影响

目的：研究1型糖尿病患儿认知功能变化,并探讨其可能的影响因素。方法：选择年龄6~16岁且病程≥1年的32例1型糖尿病患儿为研究对象,采用中国韦氏儿童智力量表对其认知功能进行研究和分析,并应用多元回归分析法探讨认知功能的影响因素。同性别、同年龄健康儿童32例作为对照组。结果：糖尿病组言语智商显著低于对照组（97±15 vs 118±13,P＜0.01）,总智商亦显著低于对照组（99±15 vs 113±12,P＜0.01）。在分测验中,糖尿病组的言语量表中的知识、分类、领悟、算术、词汇量表分低于对照组,差异均有统计学意义（P＜0.01）。多元回归分析显示糖尿病儿童的糖化血红蛋白与总智商、言语智商及操作智商呈显著负相关（分别r=-5.64、-7.29、-3.00;均P＜0.05）。结论：1型糖尿病可能对患儿言语智商产生影响,进而影响患儿总智商水平。糖化血红蛋白可能为影响糖尿病患儿认知功能的独立危险因素。     

初发1型糖尿病患儿酮症酸中毒的调查

目的调查初发1型糖尿病患儿酮症酸中毒(DKA)的发生情况。方法以224例初发1型糖尿病患儿为研究对象,进行回顾性分析,分为DKA组和未合并DKA组,各112例。DKA组患儿根据年龄分为≥5岁组(65例)和5岁组(47例),并根据酸中毒情况分为轻度(26例)、中度(29例)、重度(57例)3组。分析DKA发生的影响因素以及不同年龄DKA患儿的临床及实验室特点。结果 224例初发1型糖尿病患儿中最常见的症状为多饮(86.2%)、多尿(78.6%)及体重下降(57.1%)。与未合并DKA患儿比较,DKA组5岁、低收入、父母教育程度高中及以下所占的比例均较高,随机血糖、Hb A1C水平较高,pH、HCO_3~-及C肽水平更低,差异均具有统计学意义(P0.05)。≥5岁组与5岁组的轻、中、重度DKA所占比例的差异无统计学意义(P0.05)。与5岁组相比,≥5岁组DKA患儿的症状持续时间较长,随机血糖较低,HbA1C、C肽水平较高,差异具有统计学意义(P0.05)。结论 1型糖尿病患儿DKA发生率高,DKA的发生与年龄、父母文化程度及家庭收入有关。     

初发1型糖尿病儿童辅助性Th1细胞因子紊乱相关因素分析

目的：检测初发1型糖尿病患儿IL-1β、IL-12、IL-18、TNF-α等细胞因子水平,并分析其与感染、起病时间等临床指标相关性。方法：选择初发1型糖尿病患儿33例为病例组,依据外周血白细胞（WBC）水平将33例患儿分为WBC增高组和WBC正常组;另选取健康体检儿童27例为对照组。应用酶联免疫吸附法检测血清IL-1β、IL-12、IL-18、TNF-α等细胞因子水平;同时检测病例组患儿血气pH值、血糖、血乳酸、果糖胺、外周血白细胞及中性粒细胞等各临床指标水平。结果：病例组细胞因子 IL-12水平高于对照组（P＜0.001）。病例组IL-18水平与发病时间呈负相关（r=-0.413,P=0.015）;中性粒细胞与IL-1β水平呈正相关（r=0.413,P=0.023）;外周血WBC与IL-18水平亦呈正相关（r=0.352,P=0.038）。WBC增高组细胞因子IL-1β、IL-12、IL-18水平高于WBC正常组(均P＜0.05)。结论：1型糖尿病患儿存在Th1细胞分泌细胞因子紊乱,感染可进一步提高细胞因子的分泌水平,可能推动了早期糖尿病起病过程。     

Does epilepsy occur more frequently in children with Type 1 diabetes?

Aim: Hypoglycaemic seizures are common in children with diabetes and electroencephalogram abnormalities are well recognised in this patient group. Elevated antibodies to glutamic acid decarboxylase, a major auto‐antigen in Type 1 diabetes, are also implicated in a number of neurological disorders. Despite these associations, the question of whether children with diabetes are more prone to epilepsy, possibly as a result of lowered seizure threshold, has not been previously studied. We aimed to determine the prevalence and type of epilepsy in a large paediatric diabetes clinic. Methods: An audit by chart review was carried out at the Diabetes Clinic at the Royal Children's Hospital, Melbourne, Australia. Clinical, demographical, biochemical, EEG and neuro‐imaging data were recorded. Results: Of 1384 children and adolescents aged 0–19 years with Type 1 diabetes, we identified 12 with active epilepsy (prevalence of 8.7/1000), the majority of whom had idiopathic generalised epilepsy and benign focal epilepsy of childhood. These findings are similar to those in the general population. Conclusion: Childhood epilepsy is no more frequently encountered in children and adolescents with Type 1 diabetes than in the general paediatric population.     

1型糖尿病儿童甲状腺抗体的检测

目的：明确1型糖尿病（T1DM）儿童甲状腺抗体阳性的发生率及其相关因素。方法：回顾性分析我院2005年5月至2011年4月T1DM病例的临床资料,分析甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)与细胞因子IL-2、IL-4、IL-6、IL-10、TNF、IFN-γ和CD3+、CD4+、CD8+淋巴细胞的关系。结果：经筛选后共获得甲状腺双抗体资料完整的T1DM患儿186例,其中甲状腺双抗体正常143例,甲状腺抗体阳性43例（23.1％）,其中双抗体阳性21例。诊断为自身免疫性多腺体综合征3型变异型患儿18例（9.7%）。甲状腺抗体阳性组有糖尿病家族史的比例显著高于甲状腺抗体正常组（27.9% vs 14.7%,P＜0.05）。甲状腺抗体阳性组患儿年龄大于甲状腺抗体正常组（10.1±3.2岁vs 8.1±4.0岁,P＜0.05）。甲状腺抗体阳性组IL-2水平显著高于甲状腺抗体正常组（4.48 ±1.27 pg/mL vs 2.82 ±0.84 pg/mL,P＜0.05）,而其CD3+细胞比例低于甲状腺抗体正常组［（61±11)% vs (66±11）%, P＜0.05）］。结论：儿童T1DM甲状腺抗体阳性率增高可能与遗传背景和T细胞免疫功能紊乱,尤其是IL-2异常升高有关。     

Screen time is more strongly associated than physical activity with overweight and obesity in 9‐ to 16‐year‐old Australians

Background: Both reduced moderate‐to‐vigorous physical activity (MVPA) and increased screen time have been implicated in the aetiology of childhood overweight/obesity. This study aimed to determine which behaviour had the stronger association with overweight/obesity. Method: 2200 randomly selected 9‐ to 16‐year‐old Australians provided four 24‐h use‐of‐time recalls. Participants were classified into weight status categories and as high or low physical active, and high or low screen time according to Australian guidelines (≥60 min MVPA; ≤120 min recreational screen time daily). Multivariate logistic regression was used to calculate the odds ratios (OR) for overweight/obesity for each screen time and MVPA category. Results: Increased likelihood of overweight or obese was often associated with high screen time (ORs, 2.13–2.55 for boys and 1.47–1.72 for girls), but only sometimes and less strongly associated with low MVPA (ORs, 0.49–2.55 for boys and 1.06–1.47 for girls). Analyses conducted for combined screen time and MVPA categories showed screen time to be a stronger indicator of weight status than physical activity, especially in boys. Conclusion: Overweight and obesity were more strongly associated with screen time than physical activity. Screen time may be an important target for interventions aimed at reducing childhood overweight and obesity.     

Pioglitazone as adjunctive therapy in adolescents with type 1 diabetes

OBJECTIVE: To determine whether the addition of the thiazoladinedione, pioglitazone, to standard therapy improves metabolic control in adolescents with type 1 diabetes (T1D) and clinical evidence of insulin resistance. STUDY DESIGN: Randomized, placebo-controlled 6-month 2-site trial of pioglitazone therapy in 35 adolescents with T1D, high insulin requirements (>0.9 U/kg/d), and suboptimal metabolic control (A1c 7.5%-11%), with the primary outcome of change in A1c. Secondary outcomes include change in insulin dose, body mass index (BMI), lipids, and waist and hip circumference. RESULTS: Metabolic control (A1c) was improved at 6 months in all subjects (P = .02). There was no significant difference between the pioglitazone and placebo treatment groups at 6 months in either change in A1c (-0.4% +/- 0.9% and -0.5% +/- 1.2%, respectively) or insulin dose. BMI SDS increased by 0.3 +/- 0.3 (kg/m(2)) in the pioglitazone group and remained unchanged in the placebo group (P = .01). There was no significant difference in change in any lipid parameters between the pioglitazone and placebo groups at 6 months. CONCLUSIONS: Adjunctive pioglitazone therapy was not effective in improving glycemic control in adolescents with T1D. Pioglitazone was associated with increased BMI.     

Insulin resistance in children and adolescents with type 1 diabetes mellitus: relation to obesity

BACKGROUND: Insulin resistance is well recognized both in type 1 diabetes mellitus (T1DM) and in obesity. Studies concerning the relation between insulin resistance and overweight in T1DM have not yet been carried out. METHODS: Degree of overweight [standard deviation score-body mass index (SDS-BMI)] and daily insulin doses per weight (ID/kg), per body surface (ID/m2), and per ideal body weight (ID/IW) were recorded in 4124 children aged between 5 and 20 yr with a duration of T1DM of 4-5 yr and an adequate metabolic control [hemoglobin A1c (HbA1c) <8.0%]. SDS-BMI was compared between insulin-resistant (ID/kg > or = 1.0) and insulin-sensitive (ID/kg <1.0) children. The ID/kg, ID/m2, and ID/IW were compared between obese (SDS-BMI >1.9) and non-obese children. Multivariate linear regression analysis was conducted for the dependent variables ID/kg, ID/m2, and ID/IW, including age, gender, SDS-BMI, and HbA1c as independent variables. RESULTS: The 882 insulin-resistant children did not differ significantly (p = 0.447) with respect to SDS-BMI (median +0.38) compared to the 3242 insulin-sensitive children (median SDS-BMI +0.42). The ID/kg was significantly (p = 0.031) lower in the obese children compared to the non-obese children (median 0.80 vs. 0.83), while ID/m2 (median 31.0 vs. 26.2) and ID/IW (median 1.17 vs. 0.85) were significantly (p < 0.001) increased in the obese children. In multivariate linear regression analysis, SDS-BMI was significantly (p < 0.001) associated with an increase in ID/m2 and ID/IW and a decrease in ID/kg. CONCLUSIONS: T1DM children with insulin resistance based on ID/kg are not more overweight than insulin-sensitive children with T1DM. ID/m2 and ID/IW seem to reflect a better tool than ID/kg to describe the influence of overweight on insulin resistance in T1DM.