Age Z-score Research Articles

Anastrozole improves height outcomes in growing children with congenital adrenal hyperplasia due to 21-OHD.

Hyperandrogenemia resulting in estrogen-mediated accelerated bone maturation and early growth plate fusion contributes to short stature in children with congenital adrenal hyperplasia (CAH) due to 21OHD. Aromatase inhibitors block androgen conversion to estrogen and have been used off-label in children with short stature to improve adult height. There are no adequately powered studies examining the use of aromatase inhibitors in children with CAH with advanced bone age and reduced predicted adult height. Records of CAH patients treated with anastrozole were reviewed. Z-scores of bone age, predicted adult height and height corrected for bone age were examined over an 8-year period. Outcome changes were analyzed using weighted mixed-effects models, adjusting for sex, diagnosis, age at diagnosis, and average hydrocortisone dose before and during treatment with anastrozole. In 60 patients (26 females, 52 classic, 8 non-classic) started on anastrozole therapy, the mean bone age Z-score decreased from 4.2 to 2.0 at 4 years and 1.3 at 6 years (both p <0.001); predicted adult height Z-score improved from -2.1 to -0.45 at 4 years and 0.18 at 6 years (both p <0.001); corrected height Z-scores improved from -1.7 to -0.33 at 4 years and 0.18 at 6 years (p <0.001). There was no significant difference in the average total daily hydrocortisone dose used before or during treatment. Anastrozole decreased the rate of bone maturation and led to improved height outcomes, indicating that anastrozole could have a role as an adjunct therapy in children with CAH and advanced bone age.

Prenatal exposure to neonicotinoid insecticides, fetal endocrine hormones and birth size: Findings from SMBCS

BackgroundNeonicotinoid insecticides (NNIs) were reported to be endocrine disruptors and cause adverse health effects in human. However, epidemiological evidence about the effect of prenatal NNIs exposure on birth outcome and hormones remains limited. ObjectivesThis study aimed to explore the effects of prenatal NNIs exposure on neonatal birth size and endocrine hormones, and assess the potential mediating role of hormones. MethodsThe study included 860 mother–child pairs from the Sheyang Mini Birth Cohort Study. 12 parent NNIs (p-NNIs) and 6 metabolites of NNIs (m-NNIs) were measured in maternal urine samples collected on their delivery days, and 5 thyroid hormones and 2 sex hormones were analyzed in cord serum. The concentrations of p-NNIs and its specific metabolite(s) were summed to characterize the role of each class of NNIs. Generalized linear model and weighted quantile sum regression were used to examine the impact of prenatal NNIs exposure on birth size and endocrine hormones, and potential mediating roles of hormones were further explored using mediation analysis. ResultsHigher detection frequencies of m-NNIs were observed than those in p-NNIs. A decrease in neonatal head circumference for gestation age z-score was associated with a 10-fold increase in 5-OH-IMI (β = -0.15, 95 %CI: −0.26, −0.03), ∑DIN (β = -0.22, 95 %CI: −0.40, −0.03), ∑IMI (β = -0.20, 95 %CI: −0.35, −0.06) and ∑NNIs (β = -0.23, 95 %CI: −0.42, −0.04). ∑IMI and ∑DIN were the major contributors to the significantly negative mixture effect and no sex-specific effect was observed. Negative associations were observed between ∑DIN and TT3 (β = -0.013, 95 %CI: −0.025, −0.002), ∑IMI and T (β = -0.035, 95 %CI: −0.065, −0.004), respectively. Furthermore, TT3 and T demonstrated 6.7 % and 6.1 % mediating effects on the negative association of prenatal ∑DIN and ∑IMI exposure with head circumference. ConclusionsOur findings suggested the potential endocrine disruptive properties of NNIs and their impacts on head circumference. Endocrine hormones may partly mediate these associations.

Fine Tuning ECG Interpretation for Young Athletes: ECG Screening Using Z-score-based Analysis

BackgroundElectrocardiograms (ECGs) in athletes commonly reveal findings related to physiologic adaptations to exercise, that may be difficult to discern from true underlying cardiovascular abnormalities. North American and European societies have published consensus statements for normal, borderline, and abnormal ECG findings for athletes, but these criteria are not based on established correlation with disease states. Additionally, data comparing ECG findings in athletes to non-athlete control subjects are lacking. Our objective was to compare the ECGs of collegiate athletes and non-athlete controls using Z-scores for digital ECG variables to better identify significant differences between the groups and to evaluate the ECG variables in athletes falling outside the normal range.MethodsValues for 102 digital ECG variables on 7206 subjects aged 17–22 years, including 672 athletes, from Hawaii Pacific Health, University of Hawaii, and Rady Children’s Hospital San Diego were obtained through retrospective review. Age and sex-specific Z-scores for ECG variables were derived from normal subjects and used to assess the range of values for specific ECG variables in young athletes. Athletes with abnormal ECGs were referred to cardiology consultation and/or echocardiogram.ResultsAthletes had slower heart rate, longer PR interval, more rightward QRS axis, longer QRS duration but shorter QTc duration, larger amplitude and area of T waves, prevalent R’ waves in V1, and higher values of variables traditionally associated with left ventricular hypertrophy (LVH): amplitudes of S waves (leads V1-V2), Q waves (V6, III) and R waves (II, V5, V6). Z-scores of these ECG variables in 558 (83%) of the athletes fell within − 2.5 and 2.5 range derived from the normal population dataset, and 60 (8.9%) athletes had a Z-score outside the − 3 to 3 range. While 191 (28.4%) athletes met traditional voltage criteria for diagnosis of LVH on ECG, only 53 athletes (7.9%) had Z-scores outside the range of -2.5 to 2.5 for both S amplitude in leads V1-V2 and R amplitude in leads V5-6. Only one athlete was diagnosed with hypertrophic cardiomyopathy with a Z-score of R wave in V6 of 2.34 and T wave in V6 of -5.94.ConclusionThe use of Z-scores derived from a normal population may provide more precise screening to define cardiac abnormalities in young athletes and reduce unnecessary secondary testing, restrictions and concern.

Amygdala Subregion Volumes and Apportionment in Preadolescents - Associations with Age, Sex, and Body Mass Index.

The amygdala, a key limbic structure, plays a critical role in emotional, social, and appetitive behaviors that develop throughout adolescence. Composed of a heterogeneous group of nuclei, questions remain about potential differences in the maturation of its subregions during development. To characterize the associations between developmental variables and amygdala subregion volumes during preadolescence. Cross-sectional Adolescent Brain Cognitive Development SM (ABCD®) Study data was collected from 3,953 9- and 10-year-old children between September 1, 2016, and October 15, 2018. Data analysis was conducted between June 1, 2023, and July 30, 2024. Using the CIT168 Amygdala Atlas , nine amygdala subregion volumes were quantified from high-quality MRI scans. Linear mixed-effects models were used to examine the effects of age, sex, pubertal stage, and body mass index z-score (BMIz) on subregion volumes and their relative apportionment within the amygdala. The study population consisted of 3,953 preadolescents (mean [SD] age, 120 [7.41] months; 1,763 [44.6%] female; 57 [1.4%] Asian, 527 [13.3%] Black, 740 [18.7%] Hispanic, 2,279 [57.7%] white, and 350 [8.9%] from other racial/ethnic groups [identified by parents as American Indian/Native American, Alaska Native, Native Hawaiian, Guamanian, Samoan, other Pacific Islander, or other race]). Distinct associations were observed between age, sex, and BMIz and whole amygdala volume, subregion volumes, and subregion apportionment. Pubertal stage was not related to amygdala subregion volumes. Age was associated with near-global expansion of amygdala subregions during this developmental period. Female sex was linked to smaller volumes in most amygdala subregions, with larger relative apportionment in dorsal amygdala subregions and smaller apportionment in the basolateral ventral paralaminar subregion. Higher BMIz was associated with smaller volumes in large laterobasal subregions, with increased relative apportionment in smaller subregions. This cross-sectional study suggests that age, but not pubertal stage, is associated with near-global expansion of the amygdala at ages 9 and 10, while sex and BMIz are linked to distinct changes in amygdala subregions that explain observed differences in total volumes. These findings provide a foundational context for understanding how developmental variables influence amygdala structure in preadolescents, with implications for understanding future risk for brain disorders.

The role of structured exercise and loving touch stimulation (SETS) with length for age z-score (LAZ) and Osteocalcin (OCN) levels among stunting children

The role of structured exercise and loving touch stimulation (SETS) with length for age z-score (LAZ) and Osteocalcin (OCN) levels among stunting children

The natural course of bone mineral density in transgender youth before medical treatment; a cross sectional study.

Bone mineral density (BMD) Z-scores decrease during puberty suppression in transgender youth. Assessment of treatment impact has been based on the assumption that without intervention, BMD Z-scores remain stable. However, the natural course of BMD in this population is unknown. Retrospective cross-sectional study. Dual-energy X-ray absorptiometry scans prior to medical intervention were included from 333 individuals assigned male at birth (AMAB) and 556 individuals assigned female at birth (AFAB) aged 12-25 years. The relationship between age and BMD Z-scores of sex assigned at birth was analysed for the lumbar spine (LS), total hip (TH), femoral neck (FN), and total-body-less-head (TBLH), adjusted for height SDS, height-adjusted lean mass Z-score, and whole body percentage fat Z-score. In individuals AMAB, the BMD Z-score was negatively associated with age between 12 and 22 years: LS -0.13/year (95% confidence interval, CI -0.17; -0.10); TH -0.05/year (95% CI -0.08; -0.02); FN -0.06/year (95% CI -0.10; -0.03); and TBLH -0.12/year (95% CI -0.15; -0.09). Adjusting for height-adjusted lean mass Z-score attenuated the association at the LS and TBLH and eliminated the association at the TH and FN. BMD Z-scores and age were not associated between 22 and 25 years. In individuals AFAB, BMD Z-scores were only associated with age at the TBLH (-0.08/year, 95% CI -0.12; -0.04) between age 12 and 20 years. In individuals AMAB aged 12-22 years prior to any treatment, BMD Z-scores were inversely correlated with age. This could imply that BMD increases less in individuals AMAB than in the general population, and that changes in Z-score during puberty suppression and subsequent hormone supplementation are not necessarily due to treatment, but possibly related to lifestyle factors.

Relationship between paternal excessive weight and neonatal anthropometry in a clinical trial of nutritional counseling for pregnant women with overweight.

Human studies suggest that fathers with obesity influence infant growth and development. This study aimed to evaluate the relationship between paternal body mass index (BMI) and waist circumference (WC) with neonatal anthropometry and adiposity. This study is a cohort nested in a randomized controlled clinical trial of nutritional counseling for pregnant women with overweight. In total, 89 partner-pregnant woman-neonate triads were included. Paternal anthropometric measurements were taken at the time of the interview. Secondary data related to birth were obtained through access to the health information systems. Neonatal skinfold thickness was assessed and the adiposity was estimated using a predictive anthropometric model. Pearson's correlation and adjusted multivariate linear regression models were employed to evaluate the relationship between paternal BMI and WC with neonatal anthropometric measurements and adiposity. In total, 57.0% of the fathers presented a BMI ≥ 25 kg/m² and 14.6% a waist circumference ≥102 cm. The mean ± SD birth weight of the newborns (g) was 3357 ± 538. Paternal BMI and WC were inversely correlated with head circumference at birth [r = -0.31 (p = 0.004), r = -0.23 (p = 0.03), respectively]. Paternal BMI was also inversely correlated with the birth weight standardized by gestational age (z-score) [r = -0.23 (p = 0.03)]. In adjusted multivariate linear regression models, the paternal BMI (kg/m²) was inversely associated with the head circumference at birth (cm) [β = -0.07 (95% CI -0.15; -0.001) p = 0.04]. The data suggest that paternal excessive weight have a negative effect on fetal development, as assessed by anthropometric measurements. The inverse association between paternal BMI and the head circumference at birth was independent of confounders. Future studies with larger sample sizes are necessary to confirm or refute such hypotheses.

Prenatal and early life exposure to fine particulate matter and telomere length in early childhood

BackgroundTelomere length is a biomarker of molecular aging that may be impacted by air pollution exposure starting in utero. We aimed to examine the association between prenatal and early life exposure to fine particulate matter (PM2.5) and leukocyte telomere length (LTL) in children and explore sex differences. MethodsAnalyses included 384 mother–child pairs enrolled in the Programming Research in Obesity, Growth, and Environmental Stressors (PROGRESS) birth cohort in Mexico City. Exposure to PM2.5 was estimated at the residential level using a satellite based spatio-temporally resolved prediction model. Average relative LTL was measured in DNA isolated from blood collected at age 4–6 years using quantitative real-time polymerase chain reaction. Linear regression models were used to examine the association between average PM2.5 across pregnancy, individual trimesters, first postnatal year, and LTL. Models were adjusted for maternal age and education at enrollment, prenatal environmental tobacco smoke exposure, child sex, age, and body mass index z-score at LTL measurement. Effect modification by sex was investigated with interaction terms and stratification. ResultsIn trimester specific models, we found an association between 2nd trimester PM2.5 and elongated LTL (β: 4.34, 95%CI [0.42, 8.42], per 5 μg/m3 increase). There was suggestive effect modification by sex on average 2nd trimester PM2.5 with stronger associations seen in females compared to males (β: 7.12, [95%CI: 0.98, 13.6] and β: 1.43 [95%CI: −3.46, 6.57]) per 5 μg/m3 increase respectively. ConclusionSecond trimester PM2.5 levels were associated with changes in LTL in early childhood. Understanding temporal and sex differences in PM2.5 exposure may provide insights into telomere dynamics over early life.

Increased serum carboxylesterase-1 levels are associated with metabolic dysfunction associated steatotic liver disease and metabolic syndrome in children with obesity

BackgroundCarboxylesterase 1(CES1) is expressed mainly in the liver and adipose tissue and is highly hypothesized to play an essential role in metabolism. Our study aimed to investigate the association between CES1 and metabolic syndrome (MetS) and metabolic dysfunction associated steatotic liver disease (MASLD) in children with obesity in China.MethodsThis study included 72 children with obesity aged 6-13years (including 25(35%) diagnosed as MetS and 36(50%) diagnosed as MASLD). All subjects were measured in anthropometry, serum level of biochemical parameters related to obesity, circumstance levels of insulin-like growth factor1, adipokines (adiponectin, leptin and growth differentiation factor 15) and CES1.ResultsHigher serum CES1 level were found in the MetS group (P = 0.004) and the MASLD group (P < 0.001) of children with obesity. Serum CES1 levels were positively correlated with alanine aminotransferase, aspartate aminotransferase, triglyceride, cholesterol, low-density lipoprotein cholesterol, GDF15, Leptin and negatively correlated with high-density lipoprotein cholesterol, adiponectin and IGF1. We also found a multivariable logistic regression analysis of MASLD and MetS predicted by CES1 significantly (MASLD P < 0.01, MetS P < 0.05). The combination of CES1, sex, age and BMI Z-score showed a sensitivity and specificity of 92.7% for the identification of MASLD and 78.6% for the identification of MetS. The cutoff for CES1 of MASLD is 56.30 ng/mL and of MetS is 97.79 ng/mL.ConclusionsCES1 is associated with an increasing risk of MetS and MASLD and can be established as a biomarker for metabolic syndrome and MASLD of children with obesity.

O107 A LONGITUDINAL STUDY ON THE IMPACT OF CHILDHOOD ELEVATED BLOOD PRESSURE ON TARGET ORGAN HEALTH IN ADOLESCENCE: THE EXAMIN YOUTH SA STUDY

Background and objective: Primary hypertension in children is becoming a global threat for the growing economic burden of hypertension management in adulthood and sustainable healthcare. We determined the associations of adolescent blood pressure (BP) with target organ damage markers (carotid intima-media thickness (CIMT) and left ventricular mass index (ilVM)) over a four year period, stratified by childhood BP status at baseline. Methods: We included 421 Black and 307 White South African adolescents (mean age: 11.04 years) with complete follow-up data for BP, CIMT and iLVM. Standard anthropometric measures and basic demographic information were collected. Results: Children were stratified by baseline BP status, i.e., normotensive; n=454 (57.5% Black and 57.7% female) and elevated BP; n=274 (58.4% Black and 52.2% female), with comparable proportions of ethnicity (p=0.81) and sex (p=0.15). Systolic BP (by 6mmHg; p&lt;0.001), diastolic BP (by 3mmHg; p&lt;0.001) and perfusion pressure (by 4mmHg; p&lt;0.001) as well as sex-specific body mass index for age z-scores (BAZ; p&lt;0.001) were all higher in the elevated BP compared to normotensive group. Groups were comparable for age (p=0.78), CIMT (p=0.28) and iLVM (p=0.64). In partial regression analysis (adjusting for ethnicity, sex, follow-up age and BAZ), systolic BP correlated positively with CIMT (r=0.125; p=0.041) and iLVM (r=0.184; p=0.002) in the elevated BP group only. Backward multiple adjusted linear regression analysis (adjustment for perfusion pressure at baseline, age, sex, ethnicity and BAZ) showed adverse associations of systolic BP with CIMT (β=0.126; p=0.046) and iLVM (β=0.199; p=0.001), and diastolic BP with iLVM (β=0.130; p=0.002), only in children with elevated BP at baseline. Conclusion: Elevated BP in early childhood contributes to the long-term impact on target organ health during adolescence independent of sex and ethnicity, while the association of BP with iLVM seems to be moderated by excess adiposity.

Glycated albumin may have a complementary role to glycated hemoglobin in glucose monitoring in childhood acute leukemia.

Glycated hemoglobin (HbA1c) as a glycemic index may have limited value in pediatric patients with acute leukemia as they often present with anemia and/or pancytopenia. To address this issue, we evaluated the usefulness of glycated albumin (GA) as a glycemic monitoring index in pediatric patients with acute leukemia. Medical records of 25 patients with type 2 diabetes mellitus (T2DM), 63 patients with acute leukemia, and 115 healthy children from Seoul St. Mary's Hospital, The Catholic University of Korea, were retrospectively investigated for serum GA, HbA1c, and fasting blood glucose (FBG) levels, along with demographic data. GA, HbA1c, and FBG levels did not differ between the control and acute leukemia groups. In the T2DM group, positive correlations were observed among GA, HbA1c, and FBG (P<0.01). Although GA level was not associated with the HbA1c level in the control group, GA and HbA1c levels showed a positive correlation in the acute leukemia group (P=0.045). Regression analysis revealed GA and HbA1c levels to be positively correlated in the acute leukemia and T2DM groups even after adjusting for age, sex, and body mass index z-score (P=0.007, P<0.01). GA may be a useful complementary parameter to HbA1c for glycemic monitoring in pediatric patients with acute leukemia, similar to its use in patients with T2DM.

Evaluation of Nutritional Status using Head Circumference among Bhil, Dhodia and Kinnaura tribal Preschool Children, India

Background: Undernutrition is a major problem in developing countries, especially among tribal pre-school children. Many studies have been undertaken on preschool tribal children in different parts of India, but by considering different ecological zones, no previous studies have been taken into account for determining nutritional status using head circumference. Head circumference for age Z-score (HCAZ) is also a useful index for determining the nutritional status of pre-school children. Objectives: The aim of the study is to assess the nutritional status based on head circumference of preschool children of the Bhil, Dhodia and Kinnaura tribes. Methods: The present study was undertaken among 509 boys and 476 girls. Among which, 168 boys and 185 girls belonged to the Bhil tribe from Barmer district, 164 boys and 142 girls belonged to the Dhodia tribe from Valsad district, and 177 boys and 149 girls belonged to the Kinnaura tribe from Kinnaur district. WHO Child Growth Standards (2007) were utilized to determine Z-scores for head circumference for age (HCAZ). The standard formula was used to compute HCAZ: Z-score= (X- Median value of WHO 2007)/ standard deviation, WHO (2007). Moderately undernourished: &lt;-2SD and severely undernourished: &lt;-3SD were considered following the WHO standard (2007). Results: From this study, it was found that among Bhil preschool children, 28.3% of boys and girls are undernourished, 33.6% of boys and 31.3% of girls are suffering from malnutrition among Dhodia boys, and 13.5% of boys and 17.2% of girls are undernourished among Kinnaura tribe. Conclusion: Regular intervention programmes need to be done by the authority to spread awareness among the people of these tribal communities so that the health condition of preschool children improves.

Zinc and Growth with Picky Eating in a Jordan Pediatric Clinic: An Observational Study

Background: Picky eating is a common feeding disorder in early childhood, characterized by a refusal to eat familiar foods or try new ones. This disorder can lead to nutritional deficiencies as well as impacting growth and development. The study aimed to determine whether picky eating is related to low serum zinc levels and growth in southern Jordan. Methods: Data collection was based on history taking and the physical examination of all examined patients at the pediatric clinic of Al-Karak Teaching Hospital. The collected data included hair loss, other signs of zinc deficiency, weight for age (Z-score), income category of the family, and the presence of underlying diseases. Blood levels of zinc, vitamin D, ferritin and hemoglobin were determined, and the results were analyzed statistically using ANOVA and t-tests. Results: An association was found between low serum zinc levels and low weight for age Z-scores, confirming the relationship between zinc deficiency and underlying general nutritional deficiencies, such as celiac disease and acrodermatitis enteropathica, which were rare (4 out of 118 studied cases); however, these patients had severely low serum zinc levels compared to the nutritional causes. On the other hand, the income category of the patient’s family could not reliably predict low serum zinc levels. Conclusion: Picky eating is associated with lower weight for age, hemoglobin levels, and vitamin D levels, thereby suggesting that picky eating can lead to a wide range of nutritional deficiencies beyond just zinc deficiency.

Durability of Aortic Homografts in Pulmonary Atresia and Major Aortopulmonary Collateral Arteries.

Objectives: It is well-known that right ventricle-to-pulmonary artery homograft conduit durability is worse for smaller conduits and smaller/younger patients. However, there is limited literature on age and conduit-size specific outcomes, or on the role of conduit oversizing. Methods: Patients diagnosed with tetralogy of Fallot and major aortopulmonary collateral arteries undergoing right ventricular outflow tract (RVOT) reconstruction with a valved aortic homograft conduit from November 2001 through March 2023, at our institution were included. Conduits were grouped and evaluated by diameter, diameter Z-score, and patient age at implant. The primary time-related outcome was freedom from RVOT reintervention. Factors associated with freedom from time-related outcomes were assessed with univariable Cox regression analysis. Results: A total of 863 RVOT conduits were implanted in 722 patients. On multivariable analysis, younger age, male sex, Alagille syndrome, smaller diameter of the conduit, and smaller Z-score were associated with shorter freedom from reintervention. Among patients with smaller diameter conduits, larger Z-scores were associated with longer freedom from conduit reintervention (P < .001). Transcatheter interventions were commonly used to extend conduit lifespan across ages and conduit sizes. Conclusions: Larger conduit diameter, older age, and higher conduit Z-score were associated with longer freedom from reintervention in patients undergoing RVOT reconstruction in this cohort. Oversizing of conduits, even beyond a Z-score of 4, is generally appropriate.

Systematic review of randomised controlled clinical trials examining effectiveness of contingent financial rewards for smoking cessation during pregnancy: intention-to-treat and causal effects on birthweight.

Objective: To examine birth weight change caused by adding financial rewards for smoking cessation compared to no rewards for pregnant women. To estimate the average expected birth weight change for those who quit because of rewards. This study updates a previous systematic review and refocuses the outcome from smoking cessation to birth weight.Eligibility Criteria: Trials with an experimental design allowing treatment effects to be attributed to rewards were included. Trials involving non-pregnant participants, or with no report of magnitude, treatment duration, timing or where most rewards were contingent on another behaviour (e.g., treatment attendance) were excluded.Information sources: Medline, PsycInfo, Embase, Cochrane (Central Register of Controlled Trials, Tobacco Addiction Group Specialised Register and Database of Systematic Reviews), and PubMed searched to 5th December 2023.Risk of bias: Risk of bias and certainty of evidence used Cochrane 'Risk of bias 2' and GRADE assessments.Synthesis of results: Primary analysis estimated Intention-To-Treat (ITT) mean birthweight difference when randomised to offer of rewards versus control. Within-trial estimates and standard errors were derived from mean, standard deviation, and sample size data provided, or from publications. Pooled ITT estimates used common (fixed) and random effects models. Secondary analyses used trial team supplied data to derive Complier Average Causal Effect (CACE) estimate of smoking cessation on birth weight, and a standard error. Estimates were pooled using common and random effects models. Similar analyses were applied to low birth weight (<2500g), birth weight for gestational age z-scores, and small for gestational age (<10 th percentile). Included studies: Primary analysis included 8 trials (2351 participants) from the UK (2 trials, 1475 participants); France (1 trial, 407 participants), and the US (6 trials, 469 participants). Secondary analysis included 7 trials as data retrieval from one US trial (51 participants) was not possible.Synthesis of results: Primary ITT analysis (2351 participants) estimated a mean 46.3g (95% CI: 0.0 to 92.6) birth weight increase when offered financial rewards for smoking cessation. Secondary CACE analysis (2239 participants) estimated a mean 206.0g (95% CI: -69.1 to 481.1) increase for smokers who quit because of rewards. There was no effect on low birth weight (<2500g), or birth weight adjusted for gestational age, though less babies were born small for gestational age, particularly if cessation was because of rewards (CACE risk difference -17.7%; 95% CI: -34.9% to -0.4%). Limitation of evidence: Sample size led to imprecision - maximum 2351 participants. A single trial of 3712 participants would give 80% power at 5% significance to show a 46g increase from 3.1kg to 3.146kg with 0.5kg standard deviation in both groups. Consistency - trials where smoking cessation increased (7 of 8) all showed a mean birth weight increase. In one trial smoking cessation fell as did birth weight. Bias is unlikely as 3 of 4 trials with no birth weight data showed increased cessation consistent with higher mean birth weight. Interpretation: Trials of contingent financial rewards for smoking cessation have previously been shown to more than double pregnancy quit rates. We have uncovered a significant (46g) population level increase in mean birth weight, driven by a clinically important mean increase (206g) for those who quit because of financial rewards associated with a reduction in Small for Gestational Age births. Funding: Review update - The U.S. National Institute of Health, National Institute of General Medical Sciences Center of Biomedical Research Excellence Award P30GM149331. Data retrieval, synthesis and analysis - Scottish Cot Death Trust.Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024494262.

Effect of skipping on body mass index, waist to hip ratio and muscle strength in overweight adolescent girls

Overweight problems in adolescents tend to increase, with obese nutritional status prevalence for Indonesian teenagers in group aged–13-15 and 16-18 years respectively 11,2% and 9,5%. This study aimed to analyze the effect of skip training on the body mass index for age z-score (BAZ), waist-to-hip ratio (WHR), and muscle strength in overweight adolescent girls. The method of this research was a quasi-experimental design using a subject study of 28 female students, which were divided into two groups: those age between 15-18 years old. The research was conducted at Senior High School 1 West Sumatra and Batipuh from October to December 2023. The skipping group received 4-8 minutes of exercise 3 times per week for 8 weeks of intervention. The statistical analysis employed a paired t-test and simple regression linear test. The results of this study revealed that skipping intervention had a significant effect on the reduction of BAZ (p&lt;0,05; R2=0,286) and WHR (p&lt;0,05; R2=0,174) in the skipping group compared to the control group. There was no significant difference in the muscle strength between the skipping and control groups (p&gt;0,05; R2=0,049). In conclusion, skipping for a duration of 4-8 minutes conducted three times a week for 8 weeks, which reduced the value of BAZ and WHR in adolescent girls.

Cross-Sectional Assessment of Nutritional Status, Dietary Intake, and Physical Activity Levels in Children (6-9 Years) in Valencia (Spain) Using Nutrimetry.

The aims of this research were to evaluate the current nutritional status, dietary intake, and level of physical activity and assess the need for intervention. This was a cross-sectional study with 2724 participating children aged 6-9 years old. Nutritional status was assessed using nutrimetry, dietary intake with a 3-day food-recall questionnaire and physical activity with an ad hoc questionnaire. The nutricode with the highest prevalence was healthy weight/normal stature, with 51.3% of the sample. For the BMI for age Z-score, those in the overweight/obesity category represented 37.5% of the sample, while the thinness category included 7.6%. Intake of calories, proteins, sugar, lipids, SFA, MUFA, and cholesterol were significantly higher than recommended. The thinness groups consumed a significantly higher amount of excess calories while the overweight/obesity groups had the lowest mean excess calorie intake. Children in the thinness category presented the highest rates at both ends of the spectrum for sedentary activities. This study showed the high prevalence of malnutrition in schoolchildren. The results for the risk of thinness and overweight/obesity according to individual nutrient intake should be carefully interpreted. Lifestyle is a fundamental aspect to consider when combating malnutrition, especially at the level of dietary and physical activity habits, to combine various methods of intervention to improve nutritional status.

Effects of prenatal small-quantity lipid-based nutrient supplements on pregnancy, birth, and infant outcomes: a systematic review and meta-analysis of individual participant data from randomized controlled trials in low- and middle-income countries

BackgroundUndernutrition during pregnancy increases the risk of giving birth to a small vulnerable newborn. Small-quantity lipid-based nutrient supplements (SQ-LNSs) contain both macro- and micronutrients and can help prevent multiple nutritional deficiencies. ObjectivesWe examined the effects of SQ-LNSs provided during pregnancy compared with 1) iron and folic acid or standard of care (IFA/SOC) or 2) multiple micronutrient supplements (MMSs) and identified characteristics that modified the estimates of effects of SQ-LNSs on birth outcomes. MethodsWe conducted a 2-stage meta-analysis of individual participant data from 4 randomized controlled trials of SQ-LNSs provided during pregnancy (n = 5273). We generated study-specific and subgroup estimates of SQ-LNS compared with IFA/SOC or MMS and pooled the estimates. In sensitivity analyses, we examined whether the results differed depending on methods for gestational age dating, birth anthropometry, or study design. ResultsSQ-LNSs (compared with IFA/SOC) increased birth weight [mean difference: +49 g; 95% confidence interval (CI): 26, 71 g] and all birth anthropometric z-scores (+0.10–0.13 standard deviation); they reduced risk of low birth weight by 11%, newborn stunting by 17%, newborn wasting by 11%, and small head size by 15%. Only 2 trials compared SQ-LNSs and MMSs; P values for birth outcomes were >0.10 except for head circumference (e.g., z-score for gestational age: +0.11; 95% CI: −0.01, 0.23). Effect estimates for SQ-LNSs compared with IFA/SOC were greater among female infants and, for certain outcomes, among mothers with body mass index <20 kg/m2, inflammation, malaria, or household food insecurity. Effect estimates for SQ-LNSs compared with MMSs were greater for certain outcomes among female infants, first-born infants, and mothers <25 y. ConclusionsSQ-LNSs had positive impacts on multiple outcomes compared to IFA/SOC, but further research directly comparing SQ-LNSs and MMSs is needed. Targeting SQ-LNSs to vulnerable subgroups may be worth considering. Clinical Trial RegistryThis study was registered at PROSPERO as CRD42021283391.

Longitudinal study of birthweight, blood pressure, and markers of arterial stiffness in children age six among the TIDES cohort.

Although some studies have observed an association between birthweight and cardiovascular disease in adulthood, fewer have investigated whether birthweight is linked to cardiovascular health in early childhood. This study assesses the association between birthweight and cardiovascular outcomes in children 6 years of age. Birthweight, blood pressure (BP), and markers of arterial stiffness in children, including brachial artery distensibility and carotid-femoral pulse wave velocity (cfPWV), were obtained from 324 participants in The Infant Development and the Environment Study, a prospective multisite pregnancy cohort. Birthweight was converted into sex-specific birthweight-for-gestational-age (bw/ga) z -scores based on the INTERGROWTH-21st standard. Following 2017 American Academy of Pediatrics guidelines, SBP and DBP were transformed into sex, age, and height-specific z -scores. Associations between birthweight and cardiovascular outcomes were assessed using nested multivariable linear regression models among the overall and sex-stratified samples. Among the overall sample, bw/ga z -score was positively associated with cfPWV [b = 0.11 m/s, 95% confidence interval (CI): 0.01 m/s, 0.21 m/s] in crude and adjusted models. No associations between birthweight and cardiovascular outcomes were detected among the sex-stratified analyses. Overall, birthweight was not related to cardiovascular outcomes in children 6 years old. However, infants born with a higher birthweight may be at risk for higher cfPWV in childhood. Early intervention in pregnant people at risk of delivering high birthweight infants may be warranted if results are replicated.

The Effect of Baby-Led Weaning and Traditional Complementary Feeding Trainings on Baby Development: Study Protocol

Aim: In this study, it was aimed to evaluate the risks of self-feeding, transition to early solids and home meals, choking, anemia and obesity in 6-and 12-month-old infants who were introduced to complementary feeding with the trainings of traditional complementary feeding (TCF) and baby-led weaning (BLW) methods. Material and Method: This study is an experimental and randomized controlled study conducted to examine the effect of the trainings of the TCF and BLW methods on the transition to complementary feeding. The population of the study consisted of 73 infants aged 4 and 5 months who 62 were assigned to intervention groups by stratified randomization method. The study was conducted according to the CONSORT-2010 checklist. Five complementary feeding modular trainings with 8 sessions, appropriate for the age of the baby in months, were carried out in both intervention groups. In both groups, the trainings were maintained until the baby was 4 months to 12 months old. The outcomes consisted of height, weight gain, LAZ (Length for age z-score), WAZ (Weight for age z-score), and WLZ (Weight for length z-score) scores at 12 months, iron intake, hemoglobin, hematocrit, and ferritin levels, micronutrients, choking risk, growth retardation, transition time to solid foods, family meals and self-feeding, behaviors of transition to complementary feeding and developmental assessment parameters. Practice Implications: This study, the trainings given are expected to give an idea about the extent to which they affect the infant's body weight, growth and development, iron and micronutrient intake, obesity, choking and growth retardation risks..