High Blood Pressure in Obese and Nonobese Japanese Children: Blood Pressure Measurement is Necessary Even in Nonobese Japanese Children

Background

Although the prevalences of obesity and hypertension (HT) are increasing in children, there have been few epidemiological studies of HT in Japanese children. We evaluated the prevalences of HT and high-normal blood pressure (HNBP), and examined the relationship between blood pressure (BP) and body mass index (BMI), in Japanese children.

Methods

The subjects of this study were 2420 children living in the town of Ina, Saitama Prefecture, Japan during the period from 2006 through 2008. Body height, weight, and BP were measured. HT and HNBP were defined according to the HT criteria for Japanese children. Children with HNBP or HT were defined as having high blood pressure (HBP).

Results

The prevalences of HBP were 15.9% and 15.8% in fourth-grade boys and girls, respectively, and 11.1% and 10.8% in seventh-grade boys and girls, respectively. Irrespective of sex or grade level, a higher BMI was associated with a higher prevalence of HBP (P < 0.001). When compared with the <50th percentile BMI category, the crude odds ratios (ORs) were statistically significant for the 75th to 84th percentile category in fourth-grade boys (OR: 4.54, 95% CI: 2.36–8.76), the ≥95th percentile in fourth-grade girls (13.29, 5.93–29.77), the 85th to 94th percentile (3.16, 1.46–6.84) in seventh-grade boys, and the ≥95th percentile (7.96, 3.18–19.93) in seventh-grade girls.

Conclusions

BMI was associated with HBP in Japanese school children. In addition, some children in the lower BMI categories also had HBP.Key words: high blood pressure, children, BMI, hypertensive family history     

Diagnostic performance of visible severe wasting for identifying severe acute malnutrition in children admitted to hospital in Kenya

Objective

To determine the diagnostic value of visible severe wasting in identifying severe acute malnutrition at two public hospitals in Kenya.

Methods

This was a cross-sectional study of children aged 6 to 59.9 months admitted to one rural and one urban hospital. On admission, mid-upper arm circumference (MUAC), weight and height were measured and the presence of visible severe wasting was assessed. The diagnostic performance of visible severe wasting was evaluated against anthropometric criteria.

Findings

Of 11 166 children admitted, 563 (5%) had kwashiorkor and 1406 (12.5%) were severely wasted (MUAC < 11.5 cm). The combined sensitivity and specificity of visible severe wasting at the two hospitals, as assessed against a MUAC < 11.5 cm, were 54% (95% confidence interval, CI: 51–56) and 96% (95% CI: 96–97), respectively; at one hospital, its sensitivity and specificity against a weight-for-height z-score below −3 were 44.7% (95% CI: 42–48) and 96.5% (95% CI: 96–97), respectively. Severely wasted children who were correctly identified by visible severe wasting were consistently older, more severely wasted, more often having kwashiorkor, more often positive to the human immunodeficiency virus, ill for a longer period and at greater risk of death. Visible severe wasting had lower sensitivity for determining the risk of death than the anthropometric measures. There was no evidence to support measuring both MUAC and weight-for-height z-score.

Conclusion

Visible severe wasting failed to detect approximately half of the children admitted to hospital with severe acute malnutrition diagnosed anthropometrically. Routine screening by MUAC is quick, simple and inexpensive and should be part of the standard assessment of all paediatric hospital admissions in the study setting.     

Mothers Understand And Can do it (MUAC): a comparison of mothers and community health workers determining mid-upper arm circumference in 103 children aged from 6?months to 5?years

Background

Mid-upper arm circumference (MUAC) was recently endorsed and recommended for screening for acute malnutrition in the community. The objective of this study was to determine whether a colour-banded MUAC strap would allow minimally trained mothers to screen their own children for malnutrition, without locating the mid-point of the left upper arm by measurement, as currently recommended.

Methods

A non-randomised non-blinded evaluation of mothers’ performance when measuring MUAC after minimal training, compared with trained Community Health Workers (CHW) following current MUAC protocols. The study was conducted in 2 villages in Mirriah, Zinder region, Niger where mothers classified one of their children (n = 103) aged 6–59 months (the current age range for admission into community malnutrition programs) using the MUAC tape.

Results

Mothers’ had a sensitivity and specificity for classification of their child’s nutritional status of > 90% and > 80% respectively for global acute malnutrition (GAM, defined by a MUAC < 125 mm) and > 73% and > 98% for severe acute malnutrition (SAM, defined by a MUAC < 115 mm). The few children misclassified as not having SAM, were classified as having moderate acute malnutrition (MAM). The choice of arm did not influence the classification results; weighted Kappa of 0.88 for mothers and 0.91 for CHW represent almost perfect agreement. Errors occurred at the class boundaries and no gross errors were made.

Conclusions

Advanced SAM is associated with severe complications, which often require hospital admission or cause death. Mothers (with MUAC tapes costing $0.06) can screen their children frequently allowing early diagnosis and treatment thereby becoming the focal point in scaling-up community management of acute malnutrition.

Trial registration

The trial is registered with clinicaltrials.gov (Trial number {"type":"clinical-trial","attrs":{"text":"NCT01790815","term_id":"NCT01790815"}}NCT01790815)     

Severe malnutrition in children presenting to health facilities in an urban slum in Bangladesh

Setting:

An urban slum in Kamrangirchar, Bangladesh.

Objectives:

Among children aged 6–59 months seeking medical care from the two Médecins Sans Frontières-supported primary health centres, to determine 1) the prevalence of severe acute malnutrition (SAM) and severe chronic malnutrition (SCM), and 2) the extent of overlap between SAM and SCM.

Design:

In a retrospective record review, data were analysed from out-patient registers on age, sex, height, weight and mid-upper arm circumference (MUAC) of children attending for medical care from April to September 2011. SAM was defined as weight for height < −3 Z scores of the median and/or MUAC <115 mm. SCM was defined as height for age < −3 Z scores of the median. World Health Organization growth standards were used as reference.

Results:

Data were complete in the records of 7318 (98%) children, of whom 322 (4%) had SAM and 1698 (23%) had SCM. Among the 322 children with SAM, 162 (50%) also had SCM.

Conclusion:

In an urban Bangladesh slum, SAM and SCM co-exist, with a predominance of SCM. The current national guidelines for severe malnutrition, which focus on identification and management only for SAM, urgently need to be expanded to include SCM if substantial childhood morbidity and mortality are to be reduced.     

Trends in Measures of Childhood Obesity in Korea From 1998 to 2012

Background

During the last several decades, the number of children who are overweight or obese has reached alarming levels worldwide. The purpose of the present study was to examine trends in measures of childhood obesity among Korean children aged 2–19 from 1998 to 2012.

Methods

Height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated. Age-adjusted means of WC and BMI were compared between years. We used three international criteria (International Obesity Task Force [IOTF], World Health Organization [WHO], United States Centers for Disease Control and Prevention [CDC]) and a Korean national reference standard (Korea Centers for Disease Control and Prevention [KCDC]) to calculate age-standardized prevalence of childhood overweight and obesity.

Results

Despite differences in absolute prevalence of childhood overweight and obesity according to the four different criteria, the time trends of prevalence were generally similar across criteria. The prevalence of childhood overweight and obesity generally stabilized from 2001–2012 in both boys and girls. WC decreased from 2001–2012 in both boys and girls aged 2–19.

Conclusions

Further studies exploring the factors causing plateaued trends of childhood obesity measures are needed to implement effective policies for reducing the prevalence of childhood overweight and obesity.Key words: body mass index, waist circumference, obesity, child, trends, Korea     

The epidemiology of child homicides in South Africa

Objective

To describe age- and sex-specific rates of child homicide in South Africa.

Methods

A cross-sectional mortuary-based study was conducted in a national sample of 38 medicolegal laboratories operating in 2009. These were sampled in inverse proportion to the number that were operational in each of three strata defined by autopsy volume: < 500, 500–1499 or > 1499 annual autopsies. Child homicide data were collected from mortuary files, autopsy reports and police interviews. Cause of death, evidence of abuse and neglect or of sexual assault, perpetrator characteristics and circumstances surrounding the death were investigated.

Findings

An estimated 1018 (95% confidence interval, CI: 843–1187) child homicides occurred in 2009, for a rate of 5.5 (95% CI: 4.6–6.4) homicides per 100 000 children younger than 18 years. The homicide rate was much higher in boys (6.9 per 100 000; 95% CI: 5.6–8.3) than in girls (3.9 per 100 000; 95% CI: 3.2–4.7). Child abuse and neglect had preceded nearly half (44.5%) of all homicides, but three times more often among girls than among boys. In children aged 15 to 17 years, the homicide rate among boys (21.7 per 100 000; 95% CI: 14.2–29.2) was nearly five times higher than the homicide rate among girls (4.6 per 100 000; 95% CI: 2.4–6.8).

Conclusion

South Africa’s child homicide rate is more than twice the global estimate. Since a background of child abuse and neglect is common, improvement of parenting skills should be part of primary prevention efforts.     

Use of Upper-Arm Anthropometry as Measure of Body-Composition and Nutritional Assessment in Children and Adolescents (6–20 Years) of Assam,Northeast India

Background

Upper-arm muscle area (UMA), upper-arm fat area (UFA), arm-fat index (AFI), upper-arm fat estimate (UFE) and upper-arm muscle estimate (UME) was introduced for the assessment of body-composition. This cross-sectional study assessed age-sex specific upper-arm composition and nutritional status among children and adolescents.

Methods

The present cross-sectional study was conducted among 1545 (770 boys; 775 girls) Sonowal Kacharis of Dibrugarh District, Assam, Northeast-India, using multi-stage stratified random sampling method. The anthropometric measurements of height, weight, triceps and mid-upper-arm circumference were recorded. The upper-arm composition was assessed using standard equations. Nutritional status was assessed using standard classification of upper-arm muscle-area by height (UAMAH) and thinness (low BMI-for-age).

Results

Age and sex-specific muscularity were found significantly greater among boys than girls (p<0.01), while adiposity was significantly greater among girls (p<0.01), particularly when they approached to puberty. The overall prevalence of low and below-average UAMAH was found to be 16.38% and 22.65% respectively. The overall prevalence of thinness was 23.69% (26.36% boys, 21.03% girls) (p>0.05).

Conclusion

Body-composition and nutritional status of these children and adolescents were found markedly unsatisfactory using upper-arm composition, UAMAH and thinness. The combination of upper-arm composition and conventional anthropometric measures appear to be useful for body-composition and nutritional status assessment.     

Multilevel Longitudinal Analysis of Sex Differences in Height Gain and Growth Rate Changes in Japanese School-Aged Children

Background

Determining standard pubertal growth patterns using longitudinal anthropometric measures is important in growth assessment. We used an appropriate repeated-measurements method to identify height growth patterns in Japanese school-aged girls and boys.

Methods

The participants were children born during the period from 1991 through 1999 who had entered the first grade of elementary school in the Enzan district in Koshu City, Japan. This study was part of the Project Koshu cohort study. Height was measured annually in April from the first grade of elementary school (age, 6–7 years) to the third grade of junior middle school (age, 14–15 years). Height gain and growth rate trajectories in boys and girls were constructed using multilevel analysis.

Results

In total, 1984 children (1036 boys and 948 girls) were included in this study. Height in boys and girls was similar at age 6.5 to 9.5 years. Girls subsequently grew faster and were taller than boys at age 10.5 to 11.5 years. Starting at age 12.5 years, male height caught up and exceeded female height. Height gain trajectories showed that annual height gain among girls increased slowly and peaked during age 9.5 to 11.5 years, while male height gains declined slightly at first and peaked at age 11.5 to 12.5 years. Sex differences in height gains were significant during the period from age 7.5 to 14.5 years (P < 0.0001). Growth rate and height gain trajectories were similar between sexes.

Conclusions

Sex differences in growth trajectory were significant, and female height gain peaked approximately 2 years earlier than male height gain.Key words: growth pattern, sex, puberty, height gain, growth rate     

Prevalence of Head Lice Infestation and Its Associated Factors among Primary School Students in Iran: A Systematic Review and Meta-analysis

Objectives

Head lice infestation is one of the most important health problems, generally involving children aged 5–13 years. This study aims to estimate the prevalence of head lice infestation and its associated factors among primary school children using systematic review and meta-analysis methods.

Methods

Different national and international databases were searched for selecting the relevant studies using appropriate keywords, Medical Subject Heading terms, and references. Relevant studies with acceptable quality for meta-analysis were selected having excluded duplicate and irrelevant articles, quality assessment, and application of inclusion/exclusion criteria. With calculating standard errors according to binomial distribution and also considering the Cochrane''s Q test as well as I-squared index for heterogeneity, pediculosis prevalence rate was estimated using Stata SE V.11 software.

Results

Forty studies met the inclusion criteria of this review and entered into the meta-analysis including 200,306 individuals. Using a random effect model, the prevalence (95% confidence interval) of head lice infestation among primary school children was estimated as 1.6% (1.2–2.05), 8.8% (7.6–9.9), and 7.4% (6.6–8.2) for boys, girls, and all the students, respectively. The infestation rate was found to be associated with low educational level of parents, long hair, family size, mother''s job (housewife), father''s job (worker/unemployed), using a common comb, lack of bathrooms in the house, and a low frequency of bathing.

Conclusion

This meta-analysis revealed that the prevalence of head lice infestation among Iranian primary school children is relatively high with more prevalence among girls. We also found that economic, social, cultural, behavioral, and hygienic factors are associated with this infestation.     

Association between Lead and Cadmium and Reproductive Hormones in Peripubertal U.S. Girls

Background

Lead (Pb) and cadmium (Cd) are known reproductive toxicants thought to disrupt hormone production throughout sensitive developmental windows, although this has not been previously examined in nationally representative peripubertal children.

Objectives

We examined the association between blood Pb and urinary Cd concentrations and the reproductive hormones inhibin B and luteinizing hormone (LH) in girls 6–11 years of age who participated in the cross-sectional Third National Health and Nutrition Examination Survey (NHANES III) (1988–1994).

Methods

Pb (micrograms per deciliter) was measured in whole blood, and Cd was measured in urine (nanograms per milliliter). Inhibin B (picograms per milliliter) and LH (milli–International units per milliliter) were measured in residual sera for 705 girls. Survey logistic regression was used to estimate associations with pubertal onset based on inhibin B concentration > 35 pg/mL or LH concentration > 0.4 mIU/mL, and multinomial logistic regression was used to estimate the association between Pb and increasing categories of hormone concentrations.

Results

High Pb (≥ 5 μg/dL) was inversely associated with inhibin B > 35 pg/mL [odds ratio (OR) = 0.26; 95% confidence interval (CI), 0.11–0.60; compared with Pb < 1 μg/dL]. At 10 and 11 years of age, girls with low Pb (< 1 μg/dL) had significantly higher inhibin B than did girls with moderate (1–4.99 μg/dL) or high Pb (≥ 5 μg/dL). In the subsample of 260 girls with levels of inhibin B above the level of detection and using survey regression modeling, inhibin B levels were lower among girls with both high Pb and high Cd (β = −0.52; 95% CI, −0.09 to −1.04) than among girls with high Pb alone (β = −0.35; 95% CI, −0.13 to −0.57), relative to girls with low Pb and low Cd.

Conclusions

Higher Pb was inversely associated with inhibin B, a marker of follicular development, and estimated effects suggestive of pubertal delays appeared to be stronger in the context of higher Cd concentrations. These data underscore the importance of Pb and Cd as reproductive toxicants for young girls.     

Predictors of Serum Dioxins and PCBs among Peripubertal Russian Boys

Background

Although sources and routes of exposure to dioxins and polychlorinated biphenyls (PCBs) have been studied, information regarding exposure among children is limited. Breast-feeding and diet are two important contributors to early life exposure. To further understand other significant contributors to childhood exposure, we studied a cohort of children from a city with high environmental dioxin levels.

Objectives

We investigated predictors of serum concentrations of polychlorinated dibenzo-p-dioxins (PCDDs)/polychlorinated dibenzofurans (PCDFs)/co-planar PCBs (C-PCBs), toxic equivalents (TEQs), and PCBs among 8- to 9-year-old boys in Chapaevsk, Russia.

Methods

We used general linear regression models to explore associations of log₁₀-transformed serum concentrations of PCDDs/PCDFs/C-PCBs, TEQs, and PCBs at study entry with anthropometric, demographic, geographic, and dietary factors in 482 boys in Chapaevsk, Russia.

Results

The median (25th, 75th percentile) concentration for total 2005 TEQs was 21.1 pg/g lipid (14.4, 33.2). Boys who were older, consumed local foods, were breast-fed longer, and whose mothers were employed at the Khimprom chemical plant (where chlorinated chemicals were produced) or gardened locally had significantly higher serum dioxins and PCBs, whereas boys with higher body mass index or more educated parents had significantly lower serum dioxins and PCBs. Boys who lived < 2 km from Khimprom had higher total TEQs (picograms per gram lipid) [adjusted mean = 30.6; 95% confidence interval (CI), 26.8–35.0] than boys who lived > 5 km away (adjusted mean = 18.8; 95% CI, 17.2–20.6).

Conclusions

Our findings suggest that there are specific local sources of dioxin and PCB exposure among children in Chapaevsk including maternal gardening, consumption of locally grown food, and residential proximity to the Khimprom plant.     

Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil

OBJECTIVE

To analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil.

METHODS

Data were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model.

RESULTS

A sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting.

CONCLUSIONS

Socioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition.     

Drinking-Water Herbicide Exposure in Indiana and Prevalence of Small-for-Gestational-Age and Preterm Delivery

Background

Atrazine and other corn herbicides are routinely detected in drinking water. Two studies on potential association of atrazine with small-for-gestational-age (SGA) and preterm birth prevalence found inconsistent results. Moreover, these studies did not control for individual-level potential confounders.

Objectives

Our retrospective cohort study evaluated whether atrazine in drinking water is associated with increased prevalence of SGA and preterm birth.

Methods

We developed atrazine concentration time series for 19 water systems in Indiana from 1993 to 2007 and selected all births (n = 24,154) based on geocoded mother’s residences. Log-binomial models were used to estimate prevalence ratios (PRs) for SGA and preterm delivery in relation to atrazine concentrations during various periods of the pregnancy. Models controlled for maternal demographic characteristics, prenatal care and reproductive history, and behavioral risk factors (smoking, drinking, drug use).

Results

Atrazine in drinking water during the third trimester and the entire pregnancy was associated with a significant increase in the prevalence of SGA. Atrazine in drinking water > 0.1 μg/L during the third trimester resulted in a 17–19% increase in the prevalence of SGA compared with the control group (< 0.1 μg/L). Mean atrazine concentrations over the entire pregnancy > 0.644 μg/L were associated with higher SGA prevalence than in the control group (adjusted PR = 1.14; 95% confidence interval, 1.03–1.24). No significant association was found for preterm delivery.

Conclusions

We found that atrazine, and perhaps other co-occurring herbicides in drinking water, is associated with an increased prevalence of SGA, but not preterm delivery.     

The relationship between distorted body image and lifestyle among Japanese adolescents: a population-based study

Background

Distorted body image plays a significant role in the development of obesity, eating problems, and eating disorders. The aim of this study was to investigate the relationship between distorted body image and lifestyle among Japanese adolescent boys and girls.

Methods

Subjects were 1731 seventh graders (age 12–13 years) from the Ina-town’s junior high schools, Japan, from 2005–2009. The height and weight of each subject were measured. Childhood underweight, overweight, and obesity were defined using the body mass index cutoff points proposed by the International Obesity Task Force. Information regarding the self-perceived weight status and lifestyles (exercise, snacking after dinner, breakfast, wakeup time, bedtime) of each subject was collected using a self-administered questionnaire. Self-perceived weight status was categorized into three groups (thin, normal, or heavy), and compared with the subjects’ actual weight status. Body image perception was categorized into the following three groups: an underestimated own weight status group (underestimated group), a correct own weight status group (correct group) and an overestimated own weight status group (overestimated group).

Results

The proportion of boys in the underestimated group was higher than that of girls, while the opposite was true for the overestimated group (P < 0.001). There were no statistically significant differences in lifestyle between the underestimated group and the correct group regardless of sex. In contrast, there were statistically significant differences between the overestimated group and the correct group in the lifestyle factors of exercise among boys and snacking after dinner among girls. The adjusted odds ratio (OR) in boys who exercised daily significantly decreased (OR: 0.35, 95 % CI: 0.16–0.77), while a significantly increased OR was observed in girls who snacked after dinner (OR: 1.53, 95 % CI: 1.07–2.19).

Conclusion

Adolescent boys tended to underestimate their body weight, whereas adolescent girls were likely to overestimate their body weight. Furthermore, lifestyle factors associated with distorted body image differed by sex, with exercise affecting body image perception among boys and snacking after dinner affecting body image perception among girls. Thus, lifestyle may lead to distorted body image among adolescents.     

Does the 65 cm height cut-off as age proxy exclude children eligible for nutritional assessment in Bangladesh?

Setting:

Kamrangirchar slum, Dhaka, Bangladesh.

Objective:

During nutritional surveys and in circumstances when it is difficult to ascertain children’s age, length/height cut-offs are used as proxy for age to sample children aged 6–59 months. In a context of prevalent stunting, using data from primary health care centres where age and height parameters were well-recorded, we assessed the proportion of children aged between 6 and 59 months who would be excluded from nutritional assessment using a height cut-off of 65 cm as a proxy for age ≥6 months.

Design:

This was a secondary data analysis of primary health centre data.

Results:

A total of 2060 children were included in the analysis, with a median age of 24 months and a median height of 78 cm (SD 12.1, range 50–109 cm). There were 240 (12%, 95%CI 10–13) children aged between 6 and 29 months, with a height <65 cm. The majority (59%) of these children were females; 97.5% were aged 6–17 months.

Conclusion:

In an urban slum setting in Bangladesh, the use of the current height cut-off as a proxy for age excludes vulnerable children from nutritional assessment and could also lead to underestimation of the prevalence of malnutrition in nutritional surveys.     

Annals Journal Club: Prognosis of Abdominal Pain in Children in Primary Care—A Prospective Cohort Study

PURPOSE

Abdominal pain is a common complaint in children. Because few data exist on its natural history, we wanted to investigate the prognosis of abdominal pain in children in general practice.

METHODS

In a prospective cohort study of children (aged 4 to 17 years) complaining of abdominal pain, follow-up was at 3, 6, 9, and 12 months using standardized questionnaires. The primary outcome measure was chronic abdominal pain: abdominal pain at least 1 time a month during at least 3 consecutive months that had an impact on daily activities. Prevalence, incidence, and duration of chronic abdominal pain were assessed.

RESULTS

Three hundred five children (116 boys, 189 girls), with a median age of 7.8 years (interquartile range [IQR] = 5.7–10.5 years) were included. Chronic abdominal pain was present in 142 (46.6%) children at an initial visit to the primary care physician for this complaint. During follow-up, 78.7% fulfilled the criteria for chronic abdominal pain at 1 or more follow-up points. Among 163 children at risk for developing chronic abdominal pain, the cumulative incidence of chronic abdominal pain was 60.1% (95% CI, 52.1%–67.7%) and was higher in girls than in boys (RR = 1.23; 95% CI, 0.94–1.61). Median duration of abdominal pain was 7.5 months (IQR = 4.5–12.0 months). Children aged 10 to 17 years had the longest duration of abdominal pain (median = 9.0 months; IQR = 7.5–12.4 months). Children with symptoms of irritable bowel syndrome seemed to have a less favorable prognosis compared with children with symptoms of functional dyspepsia or functional abdominal pain.

CONCLUSIONS

The presence and development of chronic abdominal pain is common and of long duration among children consulting in primary care for abdominal pain. These poor outcome data warrant follow-up.     

Gestational Weight Gain and Overweight in Children Aged 3–6 Years

Objective

To determine whether gestational weight gain (GWG) was associated with increased odds of childhood overweight after accounting for pre-pregnancy BMI.

Methods

In a prospective cohort study based on a premarital and perinatal health care system in China, data of 100 612 mother-child pairs were obtained. The main exposure was GWG as both a continuous and categorical variable. The outcome measure was overweight, defined by age- and sex-specific cutoff values for body mass index (BMI) in children aged 3–6 years.

Results

A 1-kg increase in maternal GWG was associated with an increase of 0.009 (95% confidence interval [CI]: 0.007–0.010, P < 0.001) in children’s mean BMI; in the subgroup of pre-pregnancy overweight/obese mothers, the increase in children’s BMI was 0.028 (95% CI, 0.017–0.039, P < 0.001). Excessive GWG played an important role in childhood overweight when adequate GWG was used as the reference, with an odds ratio (OR) of 1.21 (95% CI, 1.12–1.29). The risk was highest (OR 2.22; 95% CI, 1.79–2.76) in the children of mothers who were overweight/obese before pregnancy and gained excessive weight during pregnancy.

Conclusions

Greater maternal GWG was associated with greater offspring BMI, and the risk of overweight was doubled in children whose mothers were overweight/obese before pregnancy and gained excessive weight during pregnancy. As a result, maintenance of appropriate weight gain during pregnancy and prophylaxis of maternal overweight/obesity before pregnancy should be a strategy for preventing childhood overweight/obesity.Key words: cohort study, gestational weight gain, childhood overweight, birth weight, maternal pre-pregnancy BMI     

Effects of Outdoor and Indoor Air Pollution on Respiratory Health of Chinese Children from 50 Kindergartens

Background

Concentrations of ambient air pollution and pollutants in China have changed considerably during the last decade. However, few studies have evaluated the effects of current ambient air pollution on the health of kindergarten children.

Methods

We studied 6730 Chinese children (age, 3–7 years) from 50 kindergartens in 7 cities of Northeast China in 2009. Parents or guardians completed questionnaires that asked about the children’s histories of respiratory symptoms and risk factors. Three-year concentrations of particles with an aerodynamic diameter ≤10 µm (PM₁₀), sulfur dioxide (SO₂), and nitrogen dioxides (NO₂) were calculated at monitoring stations in 25 study districts. A 2-stage regression approach was used in data analyses.

Results

The prevalence of respiratory symptoms was higher among children living near a busy road, those living near chimneys or a factory, those having a coal-burning device, those living with smokers, and those living in a home that had been recently renovated. Among girls, PM₁₀ was associated with persistent cough (odds ratio [OR]_PM10 = 1.44; 95% CI, 1.18–1.77), persistent phlegm (OR_PM10 = 1.36; 95% CI, 1.02–1.81), and wheezing (OR_PM10 = 1.31; 95% CI, 1.04–1.65). NO₂ concentration was associated with increased prevalence of allergic rhinitis (OR = 1.96; 95% CI, 1.27–3.02) among girls. In contrast, associations of respiratory symptoms with concentrations of PM₁₀, SO₂, and NO₂ were not statistically significant among boys.

Conclusions

Air pollution is particularly important in the development of respiratory morbidity among children. Girls may be more susceptible than boys to air pollution.Key words: air pollution, children, respiratory diseases, China     

Family History of Hypertension and the Risk of Overweight in Japanese Children: Results From the Toyama Birth Cohort Study

Background

Family history can be a useful screening tool in the assessment and management of the risk for noncommunicable disease. However, no data have yet been reported on family history of hypertension and its effect on children’s overweight.

Methods

A total of 7249 Japanese children enrolled in the Toyama Birth Cohort Study were followed until 2002 (mean age: 12.3 years). Family history of hypertension was ascertained by asking children’s parents whether children’s biological parents or grandparents had doctor-diagnosed hypertension. Child overweight was defined according to international criteria for age- and sex-specific body mass index.

Results

The prevalence of child overweight at age 12 was 21.7% for males and 15.9% for females. After adjusting for family structure, parental employment status, and lifestyle factors, we found that a maternal family history of hypertension was positively associated with the risk of child overweight at age 12 (adjusted odds ratio [OR] 1.21, 95% confidence interval [CI] 1.04–1.39). The adjusted OR increased from 1.16 (95% CI 0.99–1.35) to 1.42 (95% CI 1.04–1.92) to 4.75 (95% CI 1.35–16.69) as the number of family members with hypertension increased from 1 to 2 to 3, respectively. There was no significant difference in the prevalence of overweight between children with a paternal family history of hypertension and those without.

Conclusions

A maternal family history of hypertension was positively associated with the risk of overweight in children at age 12.Key words: family history, hypertension, overweight, the Toyama study     

Beyond drugs: tuberculosis patients in Bangladesh need nutritional support during convalescence

Settings:

All sputum microscopy laboratories under the BRAC Tuberculosis Programme in Dhaka City.

Objectives:

To study the nutritional status of tuberculosis (TB) patients attending microscopy laboratories during convalescence following DOTS.

Design:

The study included 1068 TB patients registered for treatment at 10 laboratories from May 2010 to December 2011, and 910 healthy neighbourhood controls. Weight (in kg), height (in cm) and mid-upper arm circumference (MUAC; in cm) were measured before, at 2 months and immediately after completion of treatment. Body mass index (BMI) < 18.5 kg/m² and MUAC < 22.0 cm were taken as cut-offs for defining malnourishment.

Results:

Two thirds of the patients (67%) had a low BMI (<18.5 kg/m²) before treatment, compared to only 23% among the healthy controls. At the end of treatment, 50% of the patients still had a low BMI, including 12% who had severe malnourishment (BMI ≤ 16 kg/m²). MUAC < 22.0 cm was higher among patients before (42%), at 2 months (39%) and immediately after completion of treatment (34%) compared to the control group (9%).

Conclusions:

Malnutrition is a serious problem among TB patients in peri-urban areas of Dhaka City. Under the circumstances, additional nutritional supplements, combined with education on nutrition, are expected to contribute to rapid and sustained recovery during DOTS-based treatment.