Adiponectin,interleukin-6 and high-sensitivity C-reactive protein levels in overweight/obese Indian children

Objective

The aim of our study was to assess serum Adiponectin, Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) levels and their correlation with conventional risk factors for cardiovascular disease and diabetes in overweight/obese Indian children.

Methods

Body mass index (BMI), waist circumference, blood pressure, fasting serum adiponectin, IL-6, hsCRP, blood glucose, triglycerides, and total and high density lipoprotein cholesterol were measured in children aged 7–15 years with BMI >85th centile.

Results

84 overweight/obese children (48 boys) with mean (SD) age 10.2 (1.9) years were enrolled. Mean (SD) adiponectin, hsCRP and median (IQR) IL-6 levels were 6.0 (3.1) μg/mL, 3.4 (2.4) mg/L and 12.7 (5.0–90.0) pg/mL, respectively. Low adiponectin, high hsCRP and high IL-6 were noted in 16.5%, 49.4% and 54.4% participants, respectively. Adiponectin was inversely correlated with waist circumference, and IL-6 positively with BMI and blood glucose.

Conclusions

Inflammatory mediators, hsCRP and IL-6 were elevated in half of the overweight children. Adiponectin and IL-6 correlated well with traditional risk markers.

     

Exercise Capacity Assessment by the Modified Shuttle Walk Test and its Correlation with Biochemical Parameters in Obese Children and Adolescents

Objectives

To evaluate exercise capacity of obese children and adolescents compared with normal-weight individuals and to investigate possible correlations with blood biochemical parameters.

Methods

In this study, children and adolescents between 6 and 18 y were included and divided into control (eutrophic) and obese groups according to body mass index (BMI). Data were collected regarding demographic, anthropometric, waist circumference and exercise capacity through the Modified Shuttle Walk Test (MSWT). In the obese group, biochemical parameters in the blood (total cholesterol, HDL, LDL, triglycerides and glucose) were evaluated, and a physical activity questionnaire was applied.

Results

Seventy seven participants were included; 27 in the control group and 50 obese. There was no significant difference between the two groups regarding sample characteristics, except for body weight, BMI and waist circumference. Most obese children presented results of biochemical tests within the desirable limit, though none were considered active. There was a significant exercise capacity reduction (p?<?0.001) in the obese group compared to control subjects. Positive correlations were identified for the MSWT with age and height, and a negative correlation with BMI. However, there were no correlations with the biochemical parameters analyzed.

Conclusions

Obese children and adolescents have reduced exercise capacity when compared to normal individuals. The MSWT performance seems to have a negative association with BMI, but is not correlated with blood biochemical parameters.

     

Prevalence of metabolic syndrome in children aged 5-9 years from southwest colombia: a cross-sectional study

Background

Exploration of cardiometabolic alterations in the pre-adolescent stage is necessary to characterize possible patterns for matabolic syndrome (MetS) in the earliest stages of the life. However, defining specific cutoff points for metabolic and vascular markers represents a complex task in pre-adolescent populations. This study aimed to estimate the prevalence of MetS and its components in children aged 5-9 years old by using the MetS definition for adolescents with the lowest cut-off points, and evaluate its relationship with overweight and socio-demographic determinants.

Methods

A total of 494 children were evaluated. Multivariate models with filtered variables in preliminary univarite analyses were built to find predictive factors of MetS and its components.

Results

The prevalence of MetS was 8.7% in the studied children. Multivariate models showed that age, overweight and low socioeconomic stratum were associated with MetS; low high-density lipoprotein cholesterol was not significantly associated with any variable; high triglycerides were positively associated with age, overweight and inversely associated with kilocalories/day; female gender was the only variable significantly associated with high fasting glucose (inverse association); and age, gender and overweight were significant factors for increased waist circumference. In the case of high blood pressure, no variable was classified to the multivariate analysis.

Conclusion

This study showed disturbing figures regarding cardiometabolic risk in the children based on comparisons with studies in adolescents. Further studies are needed to confirm the utility of the de Ferranti Mets definition in children.

     

Body image and its relation with body mass index among Indian adolescents

Objective

To evaluate association of body mass index with perception and attitude towards bodyweight, shape and body image among adolescents.

Methods

This cross-sectional study was done on 1811 adolescents. Attitude towards body image was assessed by using a self-administered Multidimensional Body-Self Relations Questionnaire. Perceived body shape was measured using the Stunkard scale.

Results

Adolescents showed significant difference (P<0.005) in perceptions and behaviors related to appearance, fitness, health, body areas and weight across various body mass index and socioeconomic categories. Girls articulated significantly higher (P<0.005) body dissatisfaction than boys.

Conclusions

Attitudes and perceptions towards body image differ with sex, body mass index and socioeconomic class.

     

Prevalence of nonalcoholic fatty liver disease in normal-weight and overweight preadolescent children in Haryana,India

Objective

To document the prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic parameters among normalweight and overweight schoolchildren.

Design

Cross-sectional study.

Setting

Thirteen private schools in urban Faridabad, Haryana.

Participants

961 school children aged 5-10 years.

Methods

Ultrasound testing was done, and 215 with fatty liver on ultrasound underwent further clinical, biochemical and virological testing.

Outcome measures

Prevalence of fatty liver on ultrasound, and NAFLD and its association with biochemical abnormalities and demographic risk factors.

Results

On ultrasound, 215 (22.4%) children had fatty liver; 18.9% in normal-weight and 45.6% in overweight category. Presence and severity of fatty liver disease increased with body mass index (BMI) and age. Among the children with NAFLD, elevated SGOT and SGPT was observed in 21.5% and 10.4% children, respectively. Liver enzyme derangement was significantly higher in overweight children (27% vs 19.4% in normal-weight) and severity of fatty liver (28% vs 20% in mild fatty liver cases). Eleven (8.1%) children with NAFLD had metabolic syndrome. Higher BMI (OR 35.9), severe fatty liver disease (OR 1.7) and female sex (OR 1.9) had strong association with metabolic syndrome.

Conclusions

22.4% of normal-weight and overweight children aged 5-10 years had fatty liver. A high proportion (18.9%) of normal-weight children with fatty liver on ultrasound indicates the silent burden in the population.

     

Lean body mass and bone health in urban adolescents from northern India

Objective

To prepare percentile charts of lean body mass (LBM) among Indian urban children and adolescents; and to evaluate gender differences in LBM, and its relation with pubertal status.

Design

Secondary data analysis.

Setting

School in city of Delhi, India.

Participants

1403 apparently healthy children and adolescents (826 boys) with mean (SD) age 13.2 (2.7) years.

Outcome measures

Lean body mass assessed by dual energy absorptiometry.

Results

Total and regional lean mass were greater in older age groups in both sexes. LBM showed rising trends up to the age of 18 years in boys, whereas it plateaued after the age of 15 years in girls. The age-associated increase in LBM was significantly higher in boys (130%) compared to girls (83%) (P<0.001). Total and regional lean mass increased with progression of pubertal staging in both genders. During pubertal development, LBM almost doubled (100% increase) from stage-2 to stage-5 in boys, as opposed to a 73% rise in girls (P<0.001). Total and regional lean mass and Appendicular skeletal muscle mass index (ASMI) was positively correlated with age, body mass index (BMI), serum 25(OH)D, total fat mass, and bone mineral content (BMC). Relation between LBM and BMC remained significant even after adjusting for age, fat mass and various biochemical parameters.

Conclusion

Total and regional LBM rise with age and pubertal maturation in both genders, but more so in boys when compared to girls. LBM has direct bearing on BMC even after adjusting for age, fat mass and biochemical parameters.

     

A prospective study of homocysteine and its relation to body mass index and lipid profile in school children

Objective

To study the serum Homocysteine levels in children and its relation with body mass index (BMI), lipid profile and plasma glucose.

Methods

138 children (age 5–15 y) were enrolled and categorized into normal, overweight and obese group. Blood homocysteine, lipid profile and plasma glucose were estimated.

Results

Out of 138 children, 46 (33%) were normal, 40 (29%) were overweight and 52 (38%) were obese. Hyper-homocysteinemia was found in 34 (24.6%) of children. None of the normal children had hyperhomocysteinemia in contrast to 15 (37.5%) in overweight and 19 (36.5%) in obese group (P=0.001).The median homocysteine levels in obese and overweight children was significantly higher compared to normal children (P=0.001).There was a positive correlation between BMI and homocysteine levels. There was no significant correlation between lipid profile and plasma glucose with homocysteine levels.

Conclusions

Serum homocysteine levels are significantly higher in both overweight and obese children compared to normal children.

     

Association between Anthropometric Indices,Body Composition and Bone Parameters in Thai Female Adolescents

Objective

To investigate correlations between anthropometrics and body composition with bone parameters of the whole-body and lumbar spine in non-obese and obese Thai female adolescents.

Methods

This study was performed in 135 female adolescents aged 15 to 18 y enrolled in secondary schools in southern Thailand. Subjects were grouped into non-obesity (underweight and normal-to-overweight) (BMI < 25) and obesity (BMI ≥ 25) groups. Anthropometric indices for obesity [body weight (BW), waist circumference (WC), and body mass index (BMI)] were recorded. Bone parameters (BMC, BMD, and Z-scores) of the whole-body and lumbar spine (L1-L4) and body composition (LBM, BFM, %fat, %lean, and %bone) were assessed by dual-energy X-ray absorptiometry (DXA). Correlations between anthropometrics, body composition, and bone parameters were evaluated and compared between subject groups.

Results

The obesity group had significantly higher means of whole-body BMD, BMC and Z-score than non-obese group (p < 0.05). BMI and BW were positively associated with BFM and %fat (p < 0.05) for non-obese subjects. Obese subjects had greater lumbar spine BMC compared to non-obese subjects. BFM was correlated with whole-body BMC in obese group. BW was a positive determinant of BMC at both sites in all subject groups, particularly for obese subjects; BW had positive associations with all bone parameters at the lumbar spine.

Conclusions

BW can be used as a determinant of all bone parameters at lumbar spine, and BFM had a positive effect on whole-body BMC in Thai obese female adolescent subjects.

     

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.

     

Prevalence of obesity in Italian adolescents: does the use of different growth charts make the difference?

Background

Since populations are becoming increasingly multi-ethnic, the use of local or international charts is a matter of debate. This study aimed to evaluate how the choice of cut-off thresholds affected prevalence of underweight (UW), overweight (OW), obesity (OB) in 1200 11–12-year Italian adolescents, and how their somatic growth depended on parental origin.

Methods

The height, weight and body mass index were expressed as standard deviation score (SDS) using Italian (ISPED-2006) and UK (UK-1990) charts. The classification of UW/OW/OB was computed with the IOTF international cut-offs, and thresholds were identified as centiles corresponding to BMI values of 18.5/25.0/30.0 kg/m² at 18-year in ISPED-2006 or UK-1990 references.

Results

About 30% participants had non-Italian parents, above all from North-Africa and Romania. Referring to the UK-1990 charts, all groups showed negative mean SDS for height, and positive SDS for weight and BMI. Referring to the ISPED-2006 charts, all mean SDS were negative. Percentage of UW individuals was higher in accordance with ISPED-2006 than with UK-1990 charts, whereas percentages of OW/OB were higher with UK-1990 than ISPED-2006 charts. The results obtained using IOFT cut-offs were similar to UK-1990 cut-offs. These results were due to the different shape of age-dependent cut-off centiles. Independently by the parental origin, the percentages of adolescents classified as OW/OB were closer to the expected values using the ISPED-2006 then the UK-1990 cut-offs. The results suggested the use of the Italian references for adolescents with immigrant parents.

Conclusion

The use of local charts seems more appropriate at least in Italian adolescents in the age range studied.

     

Laser Treatment of a Tracheal Inflammatory Myofibroblastic Tumor

Background

Inflammatory myofibroblastic tumors of the trachea are rare childhood quasi-neoplastic lesions.

Case characteristics

7-year-old boy with recurrent episodes of cough, breathing difficulty and wheeze, initially treated as asthma.

Intervention

CT chest and flexible bronchoscopy revealed a mass lesion of the trachea, which was excised by diode laser through the ventilating bronchoscope. Histopathology confirmed it as the inflammatory myofibroblastic tumor.

Message

Use of laser ensured complete endotracheal excision of the tumor.

     

Early Neurodevelopmental Outcomes After Corrective Cardiac Surgery In Infants

Objective

To assess neurodevelopmental status in Indian infants undergoing corrective surgery for congenital heart disease (CHD) and to analyze factors associated with neurodevelopmental delay.

Design

Cross-sectional study.

Setting

Tertiary-care pediatric cardiology facility.

Participants

Consecutive infants undergoing corrective surgery for CHD (January 2013–December 2014). Palliative procedures, and patients with known genetic syndromes were excluded.

Main outcome measures

Neurodevelopmental evaluation 3 months, and one year after surgery using Developmental Assessment Scales for Indian Infants (DASII); scores were categorized as delayed if ≤70.

Results

Of the 162 children enrolled, delayed PDI and MDI scores were observed in 33.5% and 19.6% of patients at 3 months, respectively; this reduced to 14.5 % on 1-year follow-up. On multivariate analysis, delayed PDI outcome at one year was predicted by early term birth and one-year postoperative head circumference Z-score <–2. Delayed MDI was associated with higher mean perfusion pressure on cardiopulmonary bypass. Cardiac diagnosis and peri-operative factors did not impact neurodevelopmental outcomes.

Conclusions

Neurodevelopmental status is delayed in 14.5% of infants one year after corrective infant heart surgery.

     

Isolated Mediastinal Pseudocyst of the Pancreas

Background

Mediastinal pancreatic pseudocyst is a rare complication of pancreatitis.

Case characteristics

An 8-year-old boy with chest pain and shortness of breath. Computed tomography of chest showed a cystic mass in the mediastinum. The cyst aspirate revealed high amylase and lipase levels, suggestive of pancreatic pseudocyst.

Outcome

The patient gradually recovered after Roux-en-Y cystojejunostomy.

Message

Cystojejunostomy is a viable treatment option for mediastinal pancreatic pseudocyst, especially with failure of medical therapy.

     

Components of Metabolic syndrome at 22 years of age–Findings from Pune low birth weight study

Objective

To study the early markers of Metabolic syndrome in a cohort of low birth weight (LBW) children followed up since birth, at the age of 22 years.

Design

Prospective cohort study.

Setting

Tertiary-care hospital

Participants

Neonates weighing less than 2000 g discharged from a neonatal special care unit were followed up prospectively; 153 cases and 77 controls were assessed at 22 years of age.

Methods

Fasting, 30 minute and 120 minute glucose and insulin after a bolus of 75g of glucose was determined. Insulin resistance was calculated. A lipid profile was also done. Anthropometric measurements were taken and abdominal fat was determined by magnetic resonance imaging.

Main outcome

Prevalence of the five components of Metabolic Syndrome as described by the International Diabetic Federation (IDF).

Results

65.1% of the cohort was born small for gestational age. All three components of Metabolic syndrome were present in only three cases and none of the controls. However, two components were present in 25 (16.4%) cases and 5 (6%) controls (P=0.039). Cases in the lowest quartile of birthweight who became big at 22 years had significantly higher fasting insulin (P=0.001), Homeostatic Model Assessment–Insulin Resistance (Homa-IR) (P=0.001) and higher systolic blood pressure. Sum of skinfold thickness at 4 sites correlated significantly with fasting insulin and HOMA-IR, and was a stronger correlate compared to BMI, waist circumference and MRI fat. There was no difference in the biochemical parameters between appropriate for gestational age and small for gestational age infants.

Conclusion

Prevelence of three or more components of Metabolic syndrome was low in LBW children at 22 years, but of two components was high. Those ‘Small at birth and big at 22 years’ had high insulin resistance.

     

Coexisting Congenital Subglosso-palatal Membrane and Tongue Dermoid in a Neonate

Background

Neonatal respiratory distress due to coexisting subglosso-palatal membrane and tongue dermoid has not been reported yet.

Case characteristics

A newborn with respiratory distress having a membrane in the oral cavity. Excision of membrane revealed a tongue mass with cleft palate, obstructing the nasopharynx completely. Elective ventilation was followed by excision of mass.

Outcome

The child was cured with uneventful course at follow-up of six months.

Message

Co-existing congenital anomalies causing airway obstruction may be missed in presence of subglosso-palatal membrane.

     

Incomplete Miller—Fisher syndrome with advanced stage Burkitt lymphoma

Background

Lymphoma-associated incomplete Miller-Fisher syndrome is very rare.

Case Characteristics

An 11-year-old boy who initially presented with headache, left ptosis, diplopia and weakness. Neurologic examination indicated left sided ptosis with ophthalmoplegia.

Observations

Cerebral imaging and cerebrospinal fluid examinations were normal. Magnetic resonance imaging of the abdomen showed a mass lesion in the ileal loops. A bone marrow biopsy showed infiltration by Burkitt’s lymphoma.

Message

Burkitt lymphoma may present with incomplete Miller Fisher syndrome.

     

Hypertension and prehypertension among adolescents in secondary schools in Enugu,South East Nigeria

Background

Hypertension is a prevalent cardiovascular disease risk factor among blacks and adolescent hypertension can progress into adulthood.

Objective

To determine the prevalence of hypertension and prehypertension among secondary school adolescents in Enugu South East Nigeria.

Methodology

A study of 2694 adolescents aged 10-18 years in Enugu metropolis was carried out. Socio-demographic profile anthropometric and blood pressure readings were obtained. Derived measurements such as Prehypertension, hypertension and BMI were obtained.

Results

The results showed that the mean systolic blood pressure and diastolic blood pressure for males were 106.66+ 11.80 mmHg and 70.25 + 7.34 mmHg respectively. The mean SBP and DBP for females were 109.83+ 11.66 mmHg and 72.23 + 8.26 mmHg respectively (p < 0.01). Blood pressure was found to increase with age. Prevalence of hypertension and prehypertension was 5.4% and 17.3% respectively with a higher rate in females (6.9%) than males (3.8%). Prevalence of prehypertension among males and females were 14.3% and 20.1% respectively. The prevalence of obesity was 1.9%.

Conclusion

Modifiable risk factors exist among adolescents. Early lifestyle modification and a strengthened school health are recommended.

     

Pediatric rhabdomyosarcoma in India: A single-center experience

Objective

Analyze the profile and outcome of children with rhabdomyosarcoma from a pediatric-oncology unit.

Design

Retrospective analysis of case records over 23 years (1990–2012).

Setting

Government-run, tertiary-care, university hospital in Northern India.

Participants

159 children (<12-years) with a diagnosis of rhabdomyosarcoma were enrolled. The median age was 4 years; 13% were infants.

Main outcome measure

Five-year event free survival.

Results

The median symptom interval was 2-months. Head and neck region was the most frequent site (44%), followed by tumors in the extremity (15.7%). The majority (67%) of the tumors were located at ‘unfavorable’ sites; 68% were >5 cm in size. The most frequent (58%) pathological subtype was embryonal. Treatment was based on the ‘Intergroup Rhabdomyosarcoma Study (IRS) Group’ risk-stratification. 33% were ‘low-risk’ children, 11% were ‘high-risk’. Treatment-refusal (18%) and abandonment (33%) were major impediments. The median ± SE five-year event free survival of those taking treatment was 43.6 ± 6%.

Conclusions

Large sized tumors, tumors at unfavorable locations, and treatment refusal/abandonment contributed to inferior outcome in children with rhabdomyosarcoma.

     

Metabolische Prägung durch frühkindliche Ernährung: Schützt Stillen gegen Adipositas?

Background

Metabolic imprinting during early life may have long-term effects on development and health. Recent findings show that breastfeeding may reduce the risk of overweight and obesity in later life.

Method

Results of epidemiological studies and proposed biological mechanisms were evaluated.

Results

The results of several cross-sectional studies and two prospective longitudinal studies clearly show that breastfed infants have a lower risk of later overweight and obesity than infants who are never breastfed. The hypothesis that the reduced risk for obesity may be conferred by the characteristics of breastmilk is supported by the observation of a dose-response relationship and plausible biological arguments.

Conclusions

The probable early imprinting of the risk for obesity in later life opens up new opportunities for prevention. Prospective and interventional studies are necessary to confirm that there is a causal connection between breastfeeding and obesity and to identify the underlying biological mechanisms.