Body Mass Index Z-score Research Articles

Salivary Physicochemical Parameters in Relation to Dental Caries and Adiposity Status.

The objective of this study was to investigate the correlations between salivary physicochemical parameters, adiposity, and caries indices in Hong Kong adolescents. A total of 921 adolescents aged 12-15 years from four randomly selected local secondary schools were invited to participate in this cross-sectional study. Dental examinations including the number of decayed, missing, and filled teeth (DMFT), salivary physicochemical parameters, and anthropometric measurements were performed. The Mann-Whitney U test was used to examine the differences in salivary parameters and adiposity indices between participants with different levels of caries experience. Correlations between adiposity indices, salivary parameters, and caries indices were examined using Spearman's correlation coefficients. The participation rate was 83.6%. After exclusion, data from 695 adolescents were analysed. Adolescents with high caries experience (DMFT ≥ Significant Caries Index [SiC Index]) had significantly higher weight-to-height ratio (W/H) and waist circumference (WC) z-scores and lower unstimulated and stimulated salivary flow rates and buffering capacity than those with DMFT < SiC Index. Except for body mass index z-score, the other adiposity indices were negatively correlated with at least one salivary physicochemical parameter (stimulated salivary flow rate or salivary buffering capacity) (rs ranged from -0.078 to -0.132). After adjusting for age and sex, decreased stimulated salivary flow rate was associated with higher body fat percentages, WC, and waist-to-height ratio z-scores, whereas low salivary buffering capacity was associated with higher W/H and WC z-scores. There is a potential link between adiposity indices and certain salivary physicochemical parameters that are implicated in the aetiology of dental caries.

Effectiveness of Universal Community Engagement Childhood Obesity Interventions at Improving Weight-Related and Behavioral Outcomes among Children and Adolescents: A Systematic Review and Meta-Analysis

Background: Universal community engagement interventions can address childhood obesity. Objectives: This review aimed to evaluate the effectiveness of these interventions in improving body mass index (BMI) (primary outcome) as well as dietary choices and activity levels (secondary outcomes) among children and adolescents. Methods: Eight electronic databases were searched from inception dates to January 2024. A meta-analysis was conducted using the random-effect model, when appropriate; otherwise, the findings were narratively synthesized. Heterogeneity was determined by the I2 statistics and Cochran’s Q chi-squared test. The Cochrane ROB tool and the GRADE approach were used to assess the quality appraisal at the study and outcome levels, respectively. Results: Twenty-two studies were included in this review. The results showed that these interventions had a limited effect in improving children’s standardized BMI (BMI-z) scores post-intervention. A meta-analysis on BMI-z scores showed that the intervention group had a statistically non-significantly lower BMI-z score than the control group (MD = −0.02, 95%CI = [−0.07, 0.03], Z = 0.83, p = 0.40) at immediate post-intervention. It was also reported that universal community engagement interventions had a limited effect in improving children’s dietary choices and activity levels. Only the meta-analysis on children’s daily sugar-sweetened beverage intake measured using continuous data reported a statistically significant small effect favoring the intervention group (SMD = −0.25, 95%CI = [−0.38, −0.13], Z = 3.98, p &lt; 0.0001) at immediate post-intervention. Conclusions: Universal community engagement interventions have the potential to address childhood obesity. Children and adolescents could benefit more from interventions that focus on implementing both environmental and behavioral changes, and interventions that include parental involvement.

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.

Feasibility and efficacy of adding high-intensity interval training to a multidisciplinary lifestyle intervention in children with obesity-a randomized controlled trial.

Multidisciplinary lifestyle interventions for children with obesity in Denmark often include recommendations regarding physical activity, but no structured exercise program. We hypothesized that adding high-intensity interval training (HIIT) to a multidisciplinary lifestyle intervention would improve BMI z-score (primary outcome), waist circumference, blood pressure, and health-related quality of life (HRQOL). This randomized controlled trial included 173 children and adolescents with obesity. Participants were allocated to 12-months lifestyle intervention (N = 83), or 12-month lifestyle intervention accompanied by a 12-week HIIT program (N = 90). HIIT consisted of three weekly sessions and included activities eliciting intensities >85% of maximal heart rate. Attendance rate for the 3-months HIIT intervention was 68.0 ± 23.2%. Dropout was lower in HIIT compared to control at three months (7.8% vs. 20.5%) and 12 months (26.5% vs 48.2%). Changes in BMI z-score did not differ between HIIT and control at 3 months (Mean Difference (MD): 0.01, 95% confidence interval (CI): -0.09; 0.12, P = 0.82) or 12 months (MD: 0.06, CI: -0.07;0.19, P = 0.34). Across randomization, BMI z-score was reduced by 0.11 (CI: 0.17; 0.06, P < 0.01) at 3 months and 0.20 (CI: 0.26;0.14, P < 0.01) at 12 months. At 3 months, HIIT experienced a greater increase in HRQOL of 2.73 (CI: 0.01;5.44, P = 0.05) in PedsQL Child total-score and 3.85 (CI: 0.96; 6.74, P < 0.01) in psychosocial health-score compared to control. At 12 months, PedsQL Child physical-score was reduced by 6.89 (CI: 10.97; 2.83, P < 0.01) in HIIT compared to control. No group differences or changes over time were found for waist circumference or blood pressure. Adding a 12-week HIIT program did not further augment the positive effects of a 12-month lifestyle intervention on BMI z-score. Adding HIIT improved HRQOL after 3 months, but reduced HRQOL at 12 months. Implementation of HIIT in community-based settings was feasible and showed positive effects on adherence to the lifestyle intervention.

Mediation of genetic susceptibility to obesity through eating behaviours in children.

Few studies have examined the putative mediating role of eating behaviours linking genetic susceptibility and body weight. The goal of this study was to investigate the extent to which two polygenic scores (PGSs) for body mass index (BMI), based on child and adult data, predicted BMI through over-eating and fussy eating across childhood. The study sample involved 692 participants from a birth cohort study. Height and weight were measured on six occasions between ages 6 and 13 years. Over-eating and fussy eating behaviours were assessed five times between ages 2 and 6 years. Longitudinal growth curve mediation analysis was used to estimate the contributions of the PGSs to BMI z-scores mediated by over-eating and fussy eating. Both PGSs predicted BMI z-scores (PGSchild: β = 0.26, 95% CI: 0.19-0.33; PGSadult: β = 0.34, 95% CI: 0.27-0.41). Over-eating significantly mediated these associations, but this mediation decreased over time from 6 years (PGSchild: 18.0%, 95% CI: 3.1-32.9, p-value = 0.018; PGSadult: 14.2%, 95% CI: 2.8-25.5, p-value = 0.014) to 13 years (PGSchild: 11.4%, 95% CI: -0.4-23.1, p-value = 0.057; PGSadult: 6.2%, 95% CI: 0.4-12.0, p-value = 0.037). Fussy eating did not show any mediation. Our results support the view that appetite is key to translating genetic susceptibility into changes in body weight.

Meet-in-metabonomics: Insights into associations between hair heavy metal and adverse child growth in e-waste recycling area

Heavy metal pollution from informal e-waste recycling may adversely affect child growth. However, the potential toxic mechanisms from a population perspective remain unknown. Herein, 18 hair heavy metals, urinary metabolomics, and three child growth indices [i.e., weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), and BMI Z-score (BMIZ)] were measured in children from e-waste recycling (ER, N = 426) and control areas (CR, N = 247). We examined longitudinal changes in heavy metal exposure and child growth after e-waste control to further elucidate causal relationships. Results showed that children in regulated ER site were still exposed to higher levels of several heavy metals and experienced poorer growth compared to those in control areas. Elevated exposure to heavy metals like tin, antimony, lead, cadmium, and cobalt correlated with poor child growth, particularly affecting girls and younger children. Tin, rather than traditionally concerning heavy metals, exhibited the most crucial role in driving the adverse effects of metal mixtures on child growth. Reducing heavy metal exposure through e-waste control could notably improve child growth, confirming the causal relationship between heavy metal exposure and poor child growth and underscoring the health benefits of e-waste regulation. Our research identified the roles of steroid biosynthesis, folate biosynthesis, amino acid metabolism, and purine metabolism in mediating the effects of metal exposure on child growth. Testosterone glucuronide, riboflavin, folic acid, xanthosine, and xanthine emerged as key mediators, potentially serving as metabolic signatures of heavy metal exposure. These findings illuminate the toxic mechanisms underlying poor child growth resulted from heavy metal exposure, offering important insights from a population-based perspective. In addition to lead and cadmium, monitoring and regulating tin and antimony are crucial to mitigate their negative impact on child growth in e-waste recycling areas.

Postoperative complications in the pediatric population. Malnutrition or phase angle? Which one do we use?

Malnutrition increases post-operative risks like infections and prolonged stays. Pediatric assessment challenges require using anthropometric measurements and phase angle, which reflects body cell mass and health outcomes. Phase angle varies by maturation stages, making it crucial for pre-surgical evaluations alongside BMI. This study aimed to determine the relationship between nutritional status, phase angle, and postoperative complications in pediatric patients who underwent surgery. Prospective study with patients aged 3-17 undergoing major non-ambulatory surgery. Anthropometric measurements (weight, height, BMI Z-scores) hand grip strength, dietary intake and body composition via bioimpedance to assess phase angle were recorded. Postoperative complications were monitored, including surgical site infections, morbidity (pneumonia, inotropic support, infections, thromboembolism), and mortality. Surgical risks and pre- and postoperative conditions were documented. After the application of the selection criteria, a total of 391 patients who underwent surgery were included; 60% (n = 235) were within the range of the preschool and school-age groups. During the follow-up period, 51 (13%) patients developed at least one postoperative complication, with surgical site infections being the most common. Moreover, as phase angle decreased, the length of stay (LOS) increased in all the participants. Among children aged ≤12 years old, malnutrition was a risk factor for complications [OR 3.86 (1.61-9.27 95%CI)], whereas among adolescents, phase angle served as a protective factor [OR 0.63 (0.42-0.94 95%CI)]. Significant associations were observed between nutritional status, by BMI z-score, and post-surgical complications in younger patients. Additionally, in adolescents, the phase angle emerged as a protective factor against these complications.

Effects of school closure on lifestyle behaviours and health outcomes in children during the COVID-19 pandemic in Chile: A time-matched analysis.

The COVID-19 pandemic led to school closures, potentially impairing children's behaviours and health. We aimed to explore the effects of school closure on lifestyle behaviours (dietary habits, physical activity) and health outcomes (adiposity, fitness, self-esteem, self-concept) in children. We measured 247 children before school closure (October-November 2019) and after school reopening (October-November 2021) (COVID-19 group). To distinguish the changes due to school closure from changes due to growth, we included 655 age-matched children with cross-sectional measurements in October-November 2019 (control group). The response of this group (i.e., differences between children with 2 years of difference) was considered the expected response to growth. Two-way ANOVA was used to test age-by-group interactions, indicating an effect of school closure. In 7-to-9-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.4 points), resulting in higher physical inactivity prevalence (by 19 percent points) at 9 years. This was accompanied by larger-than-expected increases in fat percentage (by 6.1 percent point). In 8-to-10-year-old children, the COVID-19 group had higher physical inactivity prevalence at 10 years (by 20 percent points). This was accompanied by larger-than-expected increases in fat percentage (by 8.3 percent points), z-score BMI (by 0.90 units), and waist circumference (by 6.1 cm). In 9-to-11-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.3 points) and increases in self-concept (by 0.2 points). The response in dietary habits, fitness, or self-esteem was not different between groups. Overall, school closure negatively impacted physical activity and adiposity, particularly in the youngest children.

7980 Physical Activity Attenuates the Association of Early Adolescent Adiposity with Later PCOS

Abstract Disclosure: R. Whooten: None. S. Rifas-Shiman: None. W. Perng: None. J. Chavarro: None. E. Oken: None. M. Hivert: None. Purpose: Adiposity is a risk factor for polycystic ovary syndrome (PCOS). Limited knowledge exists regarding modifiable behaviors, such as physical activity, during early-life may mitigate the association of adiposity with PCOS risk. We aimed to assess how moderate-vigorous physical activity (MVPA) may impact the association of adiposity in early adolescence with later report of adolescent PCOS. Methods: Within the Project Viva prospective cohort, we used multivariable logistic regression to assess the association of body mass index z-score (BMIz) at early adolescence (mean age 13.1 years) with mid-late adolescent PCOS (self-reported diagnosis or oligo-anovulation with clinical/biochemical hyperandrogenism at mean age 17.7 years). We stratified our analyses by actigraphy-assessed MVPA during early adolescence (≥30 versus &amp;lt;30 minutes/day). In multivariable models, we adjusted for maternal education and PCOS; and child race and ethnicity, dietary behaviors, actigraphy-assessed sleep duration, and self-reported screentime; and season of actigraphy assessment. Results: Among 341 female adolescents, n=47 (14%) met criteria for PCOS at mid-late adolescence. At early adolescence, mean (SD) BMIz was 0.32 (1.10) units and n=110 (32%) had ≥30 minutes/day MVPA. There was no difference in MVPA ≥30 minutes/day among those with versus without later PCOS (30% vs 33%, p=0.70). In unadjusted analyses, there was an association of early adolescent BMIz with mid-late adolescent PCOS (OR=1.93, 95%CI 1.39, 2.69 per unit increase in BMIz). In stratified analyses, the association of early adolescent adiposity with later PCOS was stronger in those with MVPA &amp;lt;30 minutes/day (OR=2.07, 95%CI 1.37, 3.11) than in those with MVPA ≥30 minutes/day (OR=1.72, 95%CI 0.97, 3.06). These findings persisted after adjusting for all covariates (overall: OR=1.72 95%CI 1.15, 2.56; MVPA &amp;lt;30 min/day: OR=2.01 95%CI 1.17, 3.45; MVPA ≥30 minutes/day: OR=1.36 95%CI 0.64, 2.91), however p-values for interaction terms were non-significant. Conclusion: Our findings suggest that maintaining ≥30 minutes MVPA daily during early adolescence may attenuate the association of adiposity with risk of PCOS by late adolescence. This has implications for the importance of promoting physical activity among at-risk individuals. Presentation: 6/2/2024

7519 Withdrawal of DCCR (Diazoxide Choline) Extended-Release Tablets Worsens Hyperphagia and Increases Weight and BMI in a 16-week Double-blind, Placebo-controlled, Randomized Withdrawal Period in Patients with Prader Willi Syndrome

Abstract Disclosure: E.F. Gevers: Advisory Board Member; Self; Pfizer, Inc., Soleno. Research Investigator; Self; Soleno Therapeutics, Inc.. Speaker; Self; Pfizer, Inc., Novo Nordisk, Soleno Therapeutics, Inc. J.L. Miller: Research Investigator; Self; Soleno Therapeutics, Inc. N.A. Bridges: Research Investigator; Self; Soleno Therapeutics, Inc. E.I. Felner: Research Investigator; Self; Soleno Therapeutics, Inc. P. Salehi: Research Investigator; Self; Soleno Therapeutics, Inc. D. Stevenson: Research Investigator; Self; Soleno Therapeutics, Inc. J. Yanovski: Research Investigator; Self; Soleno Therapeutics, Inc. L. Bird: Research Investigator; Self; Soleno Therapeutics, Inc. V. Kimonis: Research Investigator; Self; Soleno Therapeutics, Inc. A.H. Shoemaker: Research Investigator; Self; Soleno Therapeutics, Inc. K.S. Obrynba: Research Investigator; Self; Soleno Therapeutics, Inc. M. Lah: Research Investigator; Self; Soleno Therapeutics, Inc. E. Littlejohn: Research Investigator; Self; Soleno Therapeutics, Inc. N. Cowen: Employee; Self; Soleno Therapeutics, Inc.. Stock Owner; Self; Soleno Therapeutics, Inc. N. Cowen: Employee; Self; Soleno Therapeutics, Inc.. Stock Owner; Self; Soleno Therapeutics, Inc. K. Yen: Employee; Self; Soleno Therapeutics, Inc.. Stock Owner; Self; Soleno Therapeutics, Inc. S. Ballal: Employee; Self; Soleno Therapeutics, Inc.. Stock Owner; Self; Soleno Therapeutics, Inc. P. Hirano: Employee; Self; Soleno Therapeutics, Inc.. Stock Owner; Self; Soleno Therapeutics, Inc. M. Huang: Employee; Self; Soleno Therapeutics, Inc.. Stock Owner; Self; Soleno Therapeutics, Inc. A. Bhatnagar: Employee; Self; Soleno Therapeutics, Inc.. Stock Owner; Self; Soleno Therapeutics, Inc.. Background: Prader-Willi syndrome (PWS) is a rare genetic neurobehavioral-metabolic disease characterized by hyperphagia, endocrinopathies, weight gain, hypotonia, behavioral problems, and an increased risk of mortality and reduced life expectancy. There are currently no approved treatments for hyperphagia in PWS. Diazoxide choline extended-release (DCCR) is a novel, once daily oral therapy being developed for the treatment of PWS. Herein, we present results of the Randomized Withdrawal Period (RWP) of Clinical Study C602, a long-term treatment study of DCCR in people with PWS. Objectives and Methods: This was a 16-week multi-center, double-blind, placebo-controlled RWP that enrolled participants ≥4 years of age who were actively enrolled in the open label period of Clinical Study C602 and had received 2-4 years of DCCR treatment (target dose: ≥3.3 mg/kg; optimal range: 4.2-5.8 mg/kg) at the time of RWP entry. RWP-eligible participants were randomized 1:1 to continue DCCR or withdraw from DCCR and receive Placebo. The primary objective was to evaluate the effect of continued DCCR administration versus Placebo on hyperphagia based on the change in Hyperphagia Questionnaire for Clinical Trials (HQ-CT) Total Score from Baseline to Week 16. Additional endpoints included: the Clinical Global Impression of Severity (CGI-S) and Clinical Global Impression of Improvement (CGI-I) at Week 16; changes in body composition (weight, BMI, and BMI z-scores) at Week 16; and the safety profile of DCCR. Results: DCCR (n=38) and Placebo (n=39) groups were generally balanced for demographic and baseline characteristics. At Week 16, a statistically significant difference in change from baseline in HQ-CT Total Score was observed between DCCR and Placebo groups with HQ-CT Total Scores increasing markedly (indicating worsening hyperphagia) in the Placebo group compared to the DCCR group (LSMean difference [SE] -5.0 [1.57], p=0.002). CGI-S and CGI-I showed trends towards worsening in the Placebo group versus the DCCR group (p=0.079 and 0.092, respectively). The Placebo group also experienced significantly greater increases in weight, BMI, and BMI z-scores (p=0.035, 0.034, and 0.023, respectively) than the DCCR group. DCCR was well-tolerated, with no new or unexpected safety signals, and no serious adverse events or discontinuations due to adverse events in the DCCR group. Conclusions: In this 16-week RWP, the Placebo group experienced significant worsening in hyperphagia and increases in body weight, BMI, and BMI z-scores, along with worsening trends for the CGI-S and CGI-I, compared to the DCCR group. DCCR was well tolerated, with a safety profile that was consistent with prior experience. These data suggest treatment with DCCR may lead to clinical benefits in people with PWS by reducing hyperphagia and improving body composition. Presentation: 6/2/2024

7190 Serum uric acid and serum uric acid-to-creatinine ratio and its association with metabolic syndrome in Korean adolescents: the nation-wide population-based study

Abstract Disclosure: S. Jung: None. J. Kim: None. S. Kim: None. Backgrounds: As the prevalence of obesity and metabolic syndrome (MetS) among the pediatric population continues to rise, it is crucial to identify the factors associated with cardiometabolic risk factors (CMRFs) to prevent the future development of diabetes and cardiovascular disease. Elevated serum uric acid (SUA) and SUA-to-creatine ratio (SUA/Cr) levels are associated with MetS, CMRFs, and non-alcoholic fatty liver disease (NAFLD) in adults. However, studies on the usefulness of SUA or SUA/Cr to predict MetS in adolescents were sparse. The aim of this study is to investigate the association between SUA or SUA/Cr level and MetS and CMRFs among Korean adolescents. Material/Methods: Data collected from the Korea National Health and Nutrition Examination Survey between 2016 and 2021, which was nationally representative cross-sectional data, were used. A total of 2,218 subjects (1,185 males, 54.0%) aged 13-18 years were included in this study. They were classified into tertiles of SUA or SUA/Cr levels (T1, lower tertile; T2, mid-tertile; and T3, upper tertile) according to sex. The prevalence of MetS and CMRFs, including alanine aminotransferase (ALT), was compared by tertiles of SUA. Results: The mean SUA and SUA/Cr was higher in males than females (6.37 ± 0.04 mg/dL and 4.66 ± 0.06 mg/dL, P &amp;lt; 0.001 for SUA; 7.90 ± 0.07 mg/dL and 7.30 ± 0.06 mg/dL, P &amp;lt; 0.001 for SUA/Cr). Z-scores of body mass index, waist circumference, waist-height ratio, levels of total cholesterol, triglyceride, and ALT were significantly higher in T3 of SUA and SUA/Cr in both sexes, while high-density lipoprotein cholesterol (HDL-C) was lower. In T3 of SUA and SUA/Cr, the prevalence and odds ratio (95% confidence interval) increased significantly in abdominal obesity [34.5%, 5.5 (4.0, 7.7) vs. 31.3%, 5.3 (3.7, 7.6)], elevated blood pressure [19.5%, 2.1 (1.5, 2.9) vs. 16.3% 1.6 (1.1, 2.2)], elevated triglyceride [29.5%, 2.1 (1.5, 2.8) vs. 27.9%, 2.1 (1.6, 2.8)], low HDL-C [22.5%, 3.4 (2.4, 5.0) vs. 20.2%, 2.6 (1.8, 3.9)], elevated ALT [31.5%, 5.7 (3.8, 8.6) vs. 19.1% 4.9 (3.2, 7.6)], obesity [33.6%, 7.6 (5.2, 11.2) vs. 25.9%, 6.0 (3.9, 9.1)] and MetS [13.7%, 7.4 (4.3, 13.0) vs. 10.8%, 6.8 (3.9, 9.1)], compared with T1 of SUA and SUA/Cr, respectively. In the receiver operating characteristic curve analysis, the area under the curve of predicting MetS was 0.681 for males and 0.823 for females using SUA and 0.653 for males and 0.840 for females using SUA/Cr. The proportion of participants with ≥ 3 CMRFs was 2.1% in T1, 3.5% in T2, and 13.7% in T3 in SUA (P &amp;lt; 0.001) and 2.1% in T1, 5.8% in T2, and 10.8% in T3 in SUA/Cr (P &amp;lt; 0.001). Conclusions: In this nationwide cross-sectional study, SUA and SUA/Cr levels are associated with MetS, its components, and the marker of NAFLD in Korean adolescents. SUA and SUA/Cr seem to be more specific in diagnosing MetS in female adolescents. Both SUA and SUA/Cr could be used as important markers to predict MetS in adolescents. Presentation: 6/1/2024

6448 Metabolic Profile and Adipose Tissue Distribution of Young Individuals with Turner Syndrome

Abstract Disclosure: V.M. Thomas: None. P.F. Backeljauw: Consulting Fee; Self; Novo Nordisk, Ascendis, Biomarin, Cavalry Biosciences, Upsher-Smith Laboratories, Tolmar. Speaker; Self; BioMarin, Ascendis.. A. Shah: None. I. Gutmark-Little: Research Investigator; Self; Novo Nordisk, Ascendis, OPKO. Introduction: Turner syndrome (TS) is the most common sex chromosome abnormality in females. Incidence of type 2 diabetes mellitus, hypertension, and dyslipidemia is high in TS. Current practice is to employ BMI as a proxy for adiposity. However, BMI is not an optimal tool due to the short stature observed in TS. Alternate methods such as the dual-energy x-ray absorptiometry (DXA) scan and bioelectrical impedance (BI) may provide more information about body composition. Objectives: The objective of this study is to assess alternative outpatient methods for body composition assessment, including adiposity in pediatric patients with TS. The secondary goal is to characterize the metabolic profile of pediatric subjects with TS compared to obese (BMI ≥95 th%ile) and lean controls (BMI: 5-85th%ile). Methods: This is a cross-sectional study. TS patients are on ≥50mcg transdermal estradiol equivalent replacement OR are self-menstruating. BI, DXA, metabolic markers, interleukin-6 (IL-6) &amp; C-reactive protein (CRP) were obtained in all 3 groups. Statistical analysis was conducted using SPSS software. Results: We present preliminary data on 15 TS, 12 obese, and 15 lean youth, aged 13-19 years. TS youth averages: Age 16.5±1.3 years; BMI 29.3±8.5 kg/m2 (z-score: 1.21±1.27). DXA visceral adiposity (DXA VA): 392±257 g; BI visceral fat (BI VF): 1300±750 cm². Elevated LDL-C&amp;gt;100 mg/dL was noted in n=5 (102-166). Elevated AST &amp;/or ALT &amp;gt;40 unit/L were found in 6 TS. 6 TS had elevated BI VF and DXA VA (&amp;gt;250g) with BMI z-score &amp;lt;2.0. Increased CRP &amp;/or IL-6 levels were noted in 4 TS (BMI z-score: 1.29-2.54), all of whom had primary ovarian failure. These 4 also had increased DXA VA (358-887 g), and BI VF (1500-2500 cm²) compared to the rest of the group. Obese youth averages: Age 16.7±1.83 years; BMI 38 kg/m2 (z-score: 2.26±0.3); DXA VA 674±226 g; BI VF 2300±390 cm². LDL-C&amp;gt;100 mg/dL noted in n=5 (102-121). AST&amp;ALT&amp;lt;35 units/L for all. Increased CRP &amp;/or IL-6 were noted in 4 study subjects (DXA VA: 474-718 g). All 4 had normal A1c, lipid, and liver profiles. Lean youth averages: Age 16.4±2.4 years, BMI 21.6 kg/m2 (z-score: 0.32±0.7); DXA VA 162±68 g; BI VF: 580±370 cm². LDL-C &amp;gt;100 mg/dL noted in n=3 (106-120); 1 subject had increased AST&amp;ALT &amp;gt;40 unit/L. All others had AST &amp; ALT&amp;lt;26 units/L. Elevated CRP/IL-6 was noted in 4 subjects, 1 of whom had increased DXA VA (367g). All subjects had normal HgA1c (≤5.6). Total mass, lean mass, and fat % from DXA and BI were compared (correlation analysis) for each subject and showed agreement throughout. Conclusion: Based on these preliminary data, BI may be a convenient and noninvasive tool to assess adiposity in the outpatient setting in TS. BI and DXA both detected increased visceral fat in TS subjects with normal BMI. BI could potentially identify TS individuals at risk for metabolic dysfunction. Further studies on larger patient numbers will be needed to confirm these preliminary findings. Presentation: 6/2/2024

7978 Metabolic Outcomes in Transgender Youth Receiving Affirming Hormonal Therapy

Abstract Disclosure: M. Salama: None. R. Basmaci: None. T. Rajjo: None. O. Chuzhyk: None. A.N. Lteif: None. A. Al Nofal: None. Objective: Heightened societal acceptance of transgender youth and increased awareness of their unmet medical needs have led to a rise in referrals for hormonal therapy. There is limited literature available on the metabolic outcomes of hormone therapy on transgender youth. We investigated how the different metabolic markers of cardiovascular disease change after the initiation of gender-affirming hormonal therapy in transgender adolescents. Methods: A Retrospective, observational cohort study based on chart review of all children with gender dysphoria (under 18 years of age) who were evaluated in the Pediatric Endocrinology Clinic in a tertiary care center between January 2015 and December 2022. Children's demographic information, baseline weight, height, BMI, hematocrit, lipid profile, ALT, prolactin, and HbA1C levels were obtained before and after the initiation of gender-affirming hormonal therapy. The Wilcoxon signed-rank test was employed for paired analysis, while the chi-square test was used as appropriate. Results: We identified 106 transgender youth who were included in the analysis, with a median age at the start of hormonal therapy of 16 years (IQR: 15-17); comprising 68 trans-males (64%) and 38 trans-females (36%). The median treatment duration was 34 months (IQR: 18-54). Among trans-males, ALT levels increased post-treatment (mean difference 6.851 U/L, p &amp;lt; 0.001), as did BMI Z scores (mean difference 0.257, p &amp;lt; 0.001) and LDL-C (mean difference 12.734 mg/dl, p = 0.002), triglycerides (mean difference 10.18 mg/dl, p = 0.009), non-HDL-C (mean difference 12.8 mg/dl, p = 0.002), and total cholesterol (mean difference 10.18 mg/dl, p = 0.02). No significant differences were observed in HbA1C and HDL-C post-treatment. Among transfemales, BMI Z-scores were higher post-treatment (mean difference 0.27, p = 0.007), with increased total cholesterol (mean difference 19.88 mg/dl, p = 0.008), LDL-C (mean difference 12.6 mg/dl, p = 0.02), and HDL-C (mean difference 11.38 mg/dl, p &amp;lt; 0.001). Other variables did not significantly differ pre-and post-treatment. Ten transfemales with measured prolactin levels pre- and post-treatment showed no statistically significant differences. Conclusion: This pilot study revealed increased BMI Z scores following the commencement of hormone therapy in both trans-male and trans-female youths. Moreover, masculinizing treatment led to increased ALT levels. Furthermore, the cardiometabolic profile exhibited diverse alterations, particularly higher LDL-C levels in both cohorts. These findings underscore the necessity for close monitoring of these parameters during the treatment of transgender youth. Larger prospective randomized controlled trials are essential to comprehensively assess the impact of gender-affirming therapy on transgender youth. Presentation: 6/2/2024

7135 Changes in 11-oxygenated androgens in healthy prepubertal children from ages 4, 6, to 8 years: a prospective cohort study

Abstract Disclosure: Y. Lee: None. K. Lee: None. J. Kim: None. Y. Lim: None. J.I. Kim: None. B. Kim: None. Y. Hong: None. J. Song: None. C. Shin: None. Y. Lee: None. Background: 11-oxygenated androgens (11-oxyandrogens) have been recognized for their important role in adrenarche or androgen excess conditions. However, the trajectory during childhood remains understudied. Herein, we examined the longitudinal changes in 11-oxyandrogens among healthy prepubertal children. Methods: In an ongoing prospective cohort study, 172 prepubertal children with available blood samples at the ages of 4, 6, and 8 years were included. Serum concentrations of 14 adrenal androgens and precursors, including dehydroepiandrosterone (DHEA), DHEA-sulfate (DHEAS), androstenedione (A4), testosterone (T), 11β-hydroxyandrostenedione (11OHA4), 11-ketoandrostenedione (11KA4), 11β-hydroxytestosterone (11OHT), and 11-ketotestosterone (11KT) were assessed using liquid chromatography-tandem mass spectrometry. Repeated measures ANOVA was used to analyze the changes in adrenal androgens across age groups. Linear mixed model analysis was used to evaluate factors associated with adrenal hormone levels during 4 to 8 years of age. Results: Among 172 prepubertal children (107 boys, 65 girls), 11OHA4 was the predominant 11-oxyandrogen, exceeding concentrations of DHEA or A4. Serum 11KT level was higher than testosterone level from 6 years of age. Across age 4, 6, and 8 years, 11-oxyandrogens showed an increasing trend. Trajectories of 11OHA4, 11KA4, and 11KT significantly differed by sex (p for interaction &amp;lt; 0.05). Serum levels of 11OHA4 and 11KT consistently increased from 4, 6, to 8 years in both sexes, while 11OHT increased during 6-8 years (p &amp;lt; 0.05 for all). Serum 11KA4 levels increased during 4-6 years in boys and 6-8 years in girls (p &amp;lt; 0.05 for all). Girls showed higher levels of 11OHA4, 11KA4 at 4 years, 11OHT at 6 years, and 11KT at 4 and 6 years. Regarding classic adrenal androgens, DHEA, DHEAS, and A4 also exhibited increases in different patterns between sexes (p for interaction &amp;lt; 0.05) during 4-8 years. Girls had higher serum DHEA and A4 levels at 4 and 6 years, and DHEAS levels at 4 years (p &amp;lt; 0.05 for all). In boys, lower gestational age, lower birth weight z-score, and higher body mass index (BMI) z-score were correlated with elevated levels of DHEA and DHEA-S. Additionally, a higher BMI z-score was associated with increased levels of A4, 11OHT, and 11KT (p &amp;lt; 0.05 for all, multivariable models). In girls, a higher BMI z-score was linked to elevated DHEA levels, while a higher birth weight z-score was associated with increased A4 levels (p &amp;lt; 0.05 for all, multivariable models). Conclusion: In prepubertal children, 11-oxyandrogens showed increasing patterns similar to classic androgens, with sex-differences. Some 11-oxyandrogens were more predominant than classic androgens. This study suggests the importance of 11-oxyandrogens as biomarkers for zona reticularis development and adrenarche in prepubertal children. Presentation: 6/3/2024

7669 Higher Serum Uric Acid Levels Are Associated With a Deleterious Metabolic and Inflammatory Profile in Brazilian Adolescents: An Exploratory Cross-Sectional Analysis

Abstract Disclosure: F.Q. Iorra: None. M.P. Guahnon: None. P.G. Rodrigues: None. A.T. Barcelos: None. F.V. Cureau: None. M. Drehmer: None. B.D. Schaan: None. Introduction: The association of high serum uric acid (sUA) with metabolic syndrome (MetS) and its components have been widely studied, but there are still gaps in how this breakdown product of purine metabolism might refine cardiovascular risk assessment and correlate with other cardiovascular disease biomarkers, especially in children and adolescents. Objective: To evaluate if sUA is associated with metabolic syndrome components and inflammatory markers in Brazilian adolescents. Methods: For this cross-sectional study, 786 individuals aged 12 to 17 years old, previously enrolled in the Study of Cardiovascular Risk in Adolescents (ERICA) - a Brazilian nationwide school based study, and who were from the city of Porto Alegre, had their sUA measured from blood samples that were stored in a biorepository. Anthropometric, biochemical and blood pressure data were collected. MetS diagnosis was based on the International Diabetes Federation age-specific criteria (2005), and insulin resistance was assessed by the HOMA-IR. In accordance with a non-parametric distribution, sUA was divided into quartiles (3.7 mg/dL, 4.4 mg/dL, 5.3 mg/dL for the 25th, 50th, and 75th percentiles, respectively) for the analysis. A linear regression model and a Poisson regression model with robust error variance were used, both adjusted for age, sex and skin color. Results: Participants were 14.8 ± 1.5 years-old, predominantly women (61.7%), self-identified as white skin color (72%) and eutrophic (66.9%). Through the linear regression model, significant positive associations were found between high sUA levels and body mass index Z-score, waist circumference, systolic and diastolic blood pressure, total cholesterol, triglycerides, HOMA-IR and C-reactive protein, and significant negative associations were observed for HDL cholesterol and adiponectin. No association was found between sUA and glucose or HbA1c. We also computed a metabolic risk score as the mean Z score of waist circumference, systolic blood pressure, HDL cholesterol (negative Z score), triglycerides and glucose, which was positive related to sUA (β ± SE = 0.13 ± 0.02; p &amp;lt; 0.001). Finally, the Poisson regression model was applied to estimate the prevalence ratios (PR) for MetS and its components, between adolescents with sUA in the 4th quartile to those in the 1st quartile. An association was observed for MetS (PR 6.37, 95% CI 1.39 - 29.21, p 0.017), high waist circumference (PR 4.61, 95% CI 2.55 - 8.36, p &amp;lt; 0.001) and increased triglycerides (PR 4.76, 95% CI 1.47 - 15.44, p 0.009). Conclusion: High sUA levels were associated with a worse metabolic and inflammatory profile, as well as a greater prevalence of MetS and some of its components in adolescents. Therefore, uric acid should be considered as a potential additional marker of cardiovascular risk in this population. Support: CNPq, CAPES, FIPE, FAPERGS. Presentation: 6/1/2024

9193 Higher Serum Uric Acid Levels Are Associated With a Deleterious Metabolic and Inflammatory Profile in Brazilian Adolescents: An Exploratory Cross-Sectional Analysis

Abstract Disclosure: F.Q. Iorra: None. M.P. Guahnon: None. P.G. Rodrigues: None. A.T. Barcelos: None. F.V. Cureau: None. M. Drehmer: None. B.D. Schaan: None. Introduction: The association of high serum uric acid (sUA) with metabolic syndrome (MetS) and its components have been widely studied, but there are still gaps in how this breakdown product of purine metabolism might refine cardiovascular risk assessment and correlate with other cardiovascular disease biomarkers, especially in children and adolescents. Objective: To evaluate if sUA is associated with metabolic syndrome components and inflammatory markers in Brazilian adolescents. Methods: For this cross-sectional study, 786 individuals aged 12 to 17 years old, previously enrolled in the Study of Cardiovascular Risk in Adolescents (ERICA) - a Brazilian nationwide school based study, and who were from the city of Porto Alegre, had their sUA measured from blood samples that were stored in a biorepository. Anthropometric, biochemical and blood pressure data were collected. MetS diagnosis was based on the International Diabetes Federation age-specific criteria (2005), and insulin resistance was assessed by the HOMA-IR. In accordance with a non-parametric distribution, sUA was divided into quartiles (3.7 mg/dL, 4.4 mg/dL, 5.3 mg/dL for the 25th, 50th, and 75th percentiles, respectively) for the analysis. A linear regression model and a Poisson regression model with robust error variance were used, both adjusted for age, sex and skin color. Results: Participants were 14.8 ± 1.5 years-old, predominantly women (61.7%), self-identified as white skin color (72%) and eutrophic (66.9%). Through the linear regression model, significant positive associations were found between high sUA levels and body mass index Z-score, waist circumference, systolic and diastolic blood pressure, total cholesterol, triglycerides, HOMA-IR and C-reactive protein, and significant negative associations were observed for HDL cholesterol and adiponectin. No association was found between sUA and glucose or HbA1c. We also computed a metabolic risk score as the mean Z score of waist circumference, systolic blood pressure, HDL cholesterol (negative Z score), triglycerides and glucose, which was positive related to sUA (β ± SE = 0.13 ± 0.02; p &amp;lt; 0.001). Finally, the Poisson regression model was applied to estimate the prevalence ratios (PR) for MetS and its components, between adolescents with sUA in the 4th quartile to those in the 1st quartile. An association was observed for MetS (PR 6.37, 95% CI 1.39 - 29.21, p 0.017), high waist circumference (PR 4.61, 95% CI 2.55 - 8.36, p &amp;lt; 0.001) and increased triglycerides (PR 4.76, 95% CI 1.47 - 15.44, p 0.009). Conclusion: High sUA levels were associated with a worse metabolic and inflammatory profile, as well as a greater prevalence of MetS and some of its components in adolescents. Therefore, uric acid should be considered as a potential additional marker of cardiovascular risk in this population. Support: CNPq, CAPES, FIPE, FAPERGS. Presentation: 6/1/2024

6471 Adult Height in Male Survivors of Childhood Cancer Treated with Aromatase Inhibitors and Growth Hormone

Abstract Disclosure: N.I. Pollock: None. M. Song: None. A. Wolf: None. Y. Li: None. C. Hawkes: None. N. Motamedi: None. M.R. Denburg: None. S. Mostoufi-Moab: None. Title: Adult Height in Male Survivors of Childhood Cancer Treated with Aromatase Inhibitors and Growth Hormone Objectives: Aromatase inhibitor (AI) therapy in combination with growth hormone (GH), or as monotherapy, may have a role in improving height outcomes in male pediatric patients with GH deficiency (GHD). The effectiveness of AI therapy in the childhood cancer survivors is not known. In this retrospective study, we assess adult height (AH) in childhood cancer survivors treated with AI combined with GH therapy compared to those treated with GH alone. Methods: This was a single center retrospective cohort study of male survivors of childhood cancer treated with GH for diagnosis of GHD between 2007 and 2023. We compared AH outcomes in males treated with GH alone or in combination with off-label use of AI. Demographic and clinical characteristics, including anthropometric measurements, endocrinopathies, and cancer history, were obtained from the medical record. AH was noted as height documented at fusion of growth plates or following 18 years of age. Differences in demographic, clinical, and treatment characteristics were assessed using univariate tests of association. Multivariable regression with stepwise selection was used to examine risk factors associated with AH. All statistical analyses were performed using Stata 18.0. Results: Ninety-two patients were included; 70 were treated with GH monotherapy and 22 with combination AI/GH. Median age at AI initiation was 13.6 years (IQR 12.3-14.3) versus 11.2 years (IQR 8.6-12.9) for GH (unpaired t-test p-value &amp;lt;0.01; 95% CI -4.01, -1.91). A greater proportion of patients in the AI/GH group had been treated with stem cell transplantation, abdominal radiation, total body irradiation, and cis-retinoic acid (Fisher’s exact p-value &amp;lt;0.01). There was no statistically significant difference in AH or AH Z-score between treatment groups, with the median AH Z-score in the AI/GH group -1.95 (IQR -3.11, -0.75) versus -1.39 (IQR -2.65, 0.11) in the GH group. In multivariable linear regression, history of radiation to the spine (β= -5.9, 95% CI -11.2, -0.6), height Z-score (β= 0.3, 95% CI 0.11, 0.46), BMI Z-score (β= 3.2, 95% CI 0.95, 5.5), and advanced bone age at GH or AI treatment initiation (β= -10.1, 95% CI -17.3, -2.9) were significantly associated with AH. Conclusions: Adjunctive treatment with AI and GH was not associated with increased AH outcomes in male survivors of childhood cancer compared to GH monotherapy. Future work is needed to determine optimal adjunctive medical therapy to maximize FAH impacted by cancer therapy for this patient population. Presentation: 6/3/2024

7063 Serum Alkaline Phosphatase Level as a Marker for Progressive Central Precocious Puberty

Abstract Disclosure: V.M. Figueredo: None. T. Seeherunvong: None. Background: Precocious puberty is typically associated with a speed up in growth, risk of premature growth plate closure and reduced adult height. Serum alkaline phosphatase (ALP) is a biochemical indicator of bone turnover and studies have shown greater serum ALP levels in pubertal individuals compared to prepubertal controls. We examined serum ALP levels among children with various form of early puberty. We investigated whether serum ALP levels were significantly different between children with premature thelarche or premature adrenarche compared to those with central precocious puberty (CPP). Methods: We conducted a retrospective chart review of patients with early pubertal development attending a pediatric endocrinology clinic between 2017 and 2023. Information on height, weight, serum ALP levels and bone age was obtained. Patients were considered to have CPP based on the results on a GnRH test. Patients with diagnosis of premature adrenarche or premature thelarche were included as controls. This study was approved by Institutional Review Board (IRB). Analysis of data was performed using IBM SPSS Statistics version 29.0.1.0 (171). Results: Among 72 patients included in the study, 22 patients had progressive CPP whereas 50 patients had premature adrenarche or premature thelarche. The prevalence of abnormally elevated serum ALP levels was greater among patients with CPP (22.7%) than among patients with premature adrenarche or premature thelarche (6%). Using logistic binomial regression analysis, serum ALP levels were significantly elevated (p=0.042) in subjects with progressive CPP compared to patients with premature adrenarche or premature thelarche. Both groups had similar BMI values. BMI z-scores and advanced bone age were positively correlated. BMI (p=0.08) and advanced bone age were not significantly different (p=0.12) in the group with CPP compared with the group comprising patients with either premature adrenarche or premature thelarche. Conclusion: These findings suggest that serum ALP levels are helpful as a tool to help distinguish CPP from premature adrenarche or premature thelarche in the evaluation of patients with initial early pubertal development. Presentation: 6/1/2024

6962 Natural History of Menstrual Pain and Associated Risk Factors in Early Adolescence

Abstract Disclosure: M. Sofia: None. R. Modarelli: None. S. Molsberry: None. S. Denslow: None. D. Zaccaro: None. C. Kamoun: None. N.D. Shaw: None. Background: Primary dysmenorrhea (PD), or menstrual pain of uterine origin without pelvic pathology, affects up to 93% of adolescents and is a leading cause of school and work absenteeism. The theory that PD only occurs when progesterone levels fall in the late-luteal phase, triggering production of uterine prostaglandins, has dominated the literature. However, recent studies identifying PD among girls with anovulatory cycles cast doubt on this theory. We took advantage of an ongoing longitudinal study of healthy early post-menarchal girls to test the hypothesis that ovulation is associated with increased PD and to explore other participant factors associated with PD. Methods: Participants contributed daily urine samples to measure Cr-corrected LH, estrone conjugates, and pregnanediol-3-glucuronide [PdG], completed menstrual diaries, and reported dysmenorrhea symptoms using the 24-item Menstrual Symptom Questionnaire (MSQ) approximately biannually. A cycle was defined as ovulatory if peak PdG &amp;gt;2500 ng/mg Cr. Scores were natural log-transformed and modeled to assess associations with gynecologic age, ovulation, anxiety, depression, and physical activity exposures using generalized estimating equations with a normal distribution and autoregressive covariance structure. Models were adjusted for age at menarche, baseline BMI Z-score, race, ethnicity, maternal age at menarche, parental education and employment, and gynecologic age (ovulation models only). Results: The 43 participants were 12.38 ± 1.06 years old (mean ± SD) with a gynecologic age of 2.99 ± 2.22 months. The majority were non-Hispanic White and of normal weight. Average maternal age at menarche was 12.64 ± 1.09 years. Among parents of participants, most were both at least college-educated and nearly 50% were both employed. Participants completed 155 MSQs (1-9/participant). Dysmenorrhea scores increased over time (scores 1.14x higher for every 1-year increase in gynecologic age, p&amp;lt;0.001). Dysmenorrhea scores were 1.12x higher (p=0.03) if the preceding cycle was ovulatory vs. anovulatory and 1.11x higher if all cycles in the preceding 6 months were ovulatory vs all anovulatory (p=0.11). Gynecologic age remained significant in models with ovulation-based exposures, and maternal age at menarche was inversely associated with dysmenorrhea score (beta -0.08, p=0.04) in the model with gynecologic age as the exposure. Conclusion: In early-postmenarchal girls, dysmenorrhea scores were higher when associated with ovulatory cycles but also increased over time independent of ovulatory status, suggesting a pathophysiologic role for progesterone and other unknown factors. There was no association between age at menarche, BMI, race/ethnicity, and dysmenorrhea scores whereas maternal age at menarche was inversely associated with dysmenorrhea scores. Presentation: 6/1/2024

Feasibility of a culturally adapted technology-delivered, family-based childhood obesity intervention for Latino/Hispanic families in rural Nebraska: the Hispanic Family Connections study protocol

IntroductionAddressing childhood obesity risk factors like home environment, parental roles, excess weight, physical activity and healthy eating among Latino/Hispanic (L/H) families living in rural communities is an important priority. However,...