Cook Criteria Research Articles

Serum vitamin D and metabolic risk factors in a group of Spanish schoolchildren

To analyze the vitamin D status and its relationship with metabolic syndrome (MS) risk factors in a group of Spanish schoolchildren. A group of 314 Spanish schoolchildren (8-13 years old) from A Coruna, Barcelona, Madrid, Seville and Valencia were studied. Anthropometric data on weight, height, waist and hip circumferences, and triceps skinfold, as well as blood pressure data were collected. Serum levels of glucose, triglycerides, HDL-c and 25-hydroxycholecalciferol (25 (OH) D) were assessed. Following Cook criterion, the following MS risk factors were defined: glucose ≥100 mg/dL; ≥P90 waist circumference; triglycerides> P90, HDL ≤P10; and sistolic and/or diastolic blood pressure > P90. Mean serum 25(OH)D were 23.0±8.6 ng/mL. Forty seven percent of children had hypovitaminosis (20- 30 ng/mL) and 35% had vitamin deficiency (<20 ng/mL). Compared to the first tertile, children in the second tertile have a lower risk of elevated triglycerides (OR = 0.50 [CI = 0.25 to 0.99]; those in the the third tertile had lower risk of high blood pressure and triglycerides (0.60 [CI = 0.42-0.86] and 0.50 [CI = 0.32 to 0.79], respectively). The prevalence of vitamin D deficiency is high in this group of Spanish schoolchildren. Low serum levels of vitamin D are associated with an increased risk of elevated triglycerides and blood pressure.

Effects of neonatal nutritional status on the risk for metabolic syndrome in Chilean obese children

Neonatal malnutrition defined by birth weight (BW) is a risk factor for obesity and cardio-metabolic diseases in adults. Neonatal ponderal index (NPI) may have better diagnostic value than BW to establish nutritional status. To determine the effect of neonatal nutritional status, established by the three NPI curves available in Chile, on the risk of Metabolic Syndrome (MS) in obese school children. A nested case/control study in a sample of 410 obese school children aged 10 to 16 years (57% males) was performed. The dichotomous response variable was the presence of MS defined as International Diabetes Federation (IDF) or Cook's criteria. The exposure variable was having NPI < percentile (p) 10. The frequency of MS was 36 and 39% according to the IDF and Cook criteria, respectively. The proportion of children with neonatal malnutrition exceeded 20%. A significantly increased risk for MS was only found when PNI was defined according to Lagos's Table and MS was defined using IDF criteria. Having a PNI > p90, however, showed a trend towards a reduced risk of MS, which only reached significance using Lagos's Table and Cook's Criteria. Neonatal malnutrition defined by NPI is common in obese school children. The condition of neonatal under nutrition defined as PNI < p10 may be a risk factor for developing MS. Instead, having a NPI > p90 could be protective.

What is the Risk of Metabolic Syndrome in Adolescents with Normal BMI who have Polycystic Ovary Syndrome?

ObjectiveThe purpose of this study is to evaluate the effect of polycystic ovarian syndrome (PCOS) on the prevalence of metabolic syndrome (MBS) in adolescent girls with normal BMI. Materials and MethodsOur study group consisted of 63 pubertal girls with a BMI less than 25 kg/m2 who were referred to our center with signs of hirsutism or oligomenorrhea. The diagnosis of PCOS was based on the recent ESHRE/ASRM proposal and required that all 3 of the Rotterdam criteria for diagnosing PCOS in adolescents be met. The control group consisted of 159 pubertal girls matched for age and BMI. Glucose, insulin, testosterone, and sex hormone-binding globulin, free testosterone and all lipid parameters measured. For to diagnose the cases with MBS, modified Cook criteria were used and cases who had at least 3 of 5 criteria's were diagnosed as MBS. ResultsGirls with PCOS had higher blood pressure parameters (systolic/diastolic) (P < .01), fasting insulin (P = .007), low-density lipoprotein (P = .017), triglyceride (P = .045), total (P < .001) and free testosterone (P = .001) levels compared to control group. There were more cases who had at least 1 Cook criterion in girls with PCOS compared to the control group but the difference was not significant. However, there were more cases who had MBS in girls with PCOS compared to the control group (P = .02). ConclusionMBS prevalence is higher in normal BMI adolescent girls with PCOS compared to age and BMI matched control group. So as clinicians, we must search for the MBS criteria's in girls with PCOS even if they have a normal BMI.

Consumption of sugar-sweetened beverages is associated with components of the metabolic syndrome in adolescents.

Sugar-sweetened beverages (SSBs) are the principle source of added sugar in diets. Cardiometabolic disturbances can occur from early childhood to adulthood. The aim of this cross-sectional study was to examine the gender-specific association of SSB intake with metabolic syndrome (MetS) and its components among adolescents in Taiwan. A total of 2727 adolescents aged 12 to 16 years randomly selected from three diverse economic areas in Southern Taiwan by using a multistage-sampling strategy participated in this study. Demographic, dietary, physical and anthropometric parameters were measured, and serum lipid profiles and glucose levels were determined. The International Diabetes Federation (IDF) specifies that MetS requires abdominal obesity and ≥2 abnormal components, and Cook criteria for MetS require ≥3 abnormal components. We applied survey-data modules to data analyses, and used multiple regression and logistic models to adjust for covariates. An increased SSB intake was linked to a greater waist circumference in both sexes and to systolic blood pressure in boys (P for trend: ≤0.043). Male moderate and high consuming SSB drinkers exhibited triglyceride levels that were 8.0 and 8.2 mg/dL significantly higher, respectively, than those of nondrinkers. Compared with nondrinkers, boys who consumed >500 mL/day (high quantity) of SSBs exhibited 10.3-fold (95% confidence intervals (CIs): 1.2-90.2) and 5.1-fold (95% CIs: 1.01-25.5) risks of contracting MetS, as defined by the IDF and Cook criteria for MetS, respectively. In girls, the risk estimates for the same comparison were not significant by the IDF criteria (6.5-fold risk, 95% CIs: 0.9-∞) or Cook criteria (5.9-fold risk, 95% CIs: 0.8-43.8) for MetS. High SSB consumption was also linked to 1.9-fold (95% CIs: 1.1-3.1) and 2.7-fold (95% CIs: 1.3-5.7) higher risks of being at a greater overall metabolic risk in girls and boys, respectively. In conclusion, a high SSB intake is associated with adolescent MetS among boys but not girls in Taiwan.

Gonadal dysfunction in morbidly obese adolescent girls

To describe gonadal dysfunction and evaluate polycystic ovary syndrome (PCOS) and its association with metabolic syndrome (MeS) among girls in a morbidly obese adolescent population. In a cross-sectional study of 174 girls, height, weight, waist circumference, Tanner stage, reproductive hormones, carbohydrate and lipid markers, drug use, and menstrual history were obtained at baseline. Exclusion criteria were menarcheal age <2 years, hormonal contraceptive or metformin use, Tanner stage <4, and incomplete data on PCOS or MeS classification. University medical center outpatient clinic. Ninety-eight girls ages 13-19.6 years, Tanner 5, average body mass index of 46.6 kg/m(2), menarche at 11.4 years, and average menarcheal age of 5 years. None. Polycystic ovary syndrome and MeS. Ninety-eight girls were divided into four groups: PCOS by National Institutes of Health criteria (PCOSN, n = 24), irregular menses only (n = 25), elevated T (≥55 ng/dL) only (n = 6), and obese controls (n = 43). Metabolic syndrome by modified Cook criteria affected 32 girls or 33% overall: 6 of 24 PCOSN, 7 of 25 irregular menses only, 4 of 6 elevated T only, and 15 of 43 obese controls. Polycystic ovary syndrome by National Institutes of Health criteria and its individual components were not associated with MeS after adjusting for body mass index. Unlike obese adults, PCOSN and its individual components were not associated with MeS in the untreated morbidly obese adolescent population.

Impact of a Strength Training Exercise Program on Body Composition and Cardiovascular Risk Factors in a Group of Obese Schoolchildren by Pubertal Stage

The purpose of this study was to evaluate the impact of a strength training exercise intervention on body composition and cardiovascular risk factors in obese children, by pubertal stage. The sample included 60 obese schoolchildren of both genders, aged 8 to 13 years, recruited from a school in the city of Santiago (Chile). The intervention included physical exercise (strength training 3 times per week), during 3 months. Multi-compartmental body composition was estimated using isotopic dilution, plethysmography, radiographic absorptiometry and 4C model as the gold standard. Presence of metabolic syndrome was diagnosed according to Cook criteria and cardiovascular risk factors were determined using anthropometric and biochemical indicators. We found differences in schoolchildren in pubertal stages III & IV. Compared to girls, boys showed significant reductions in body fat in kg and percentage (4-Component model) and isotopic dilution in kg (p < 0,05). Likewise, we observed an increase in the fat-free mass in kg, in the 4-Component Model (p < 0,01). In all groups, the prevalence of metabolic syndrome decreased from baseline to 3 months, but the reduction was significant only among boys of Tanner I & II (p = 0.03). Only this group showed a significant reduction in the prevalence of cardiovascular risk factors from baseline to 3 months (p = 0.02). This study provides evidence on the positive impact of a strength training physical exercise program on reductions of body fat, metabolic syndrome, and cardiovascular risk factors, supporting the use of exercise as a treatment for obesity and its comorbidities in schoolchildren.

Validity of Integrative Weaning Index of Discontinuation From Mechanical Ventilation in Iranian ICUs

Background: Today, usage of weaning index is a controversial issue. Proper use of these indexes is beneficial for prevention of the losses caused by weaning failure, rapid and reliable identification of patients who are potentially ready for spontaneous breathing and accelerating the weaning of mechanical ventilation. Objectives: This study is to determine the validity of integrative weaning index as a mechanical ventilation discontinuation predictor in patients hospitalized in the Iranian intensive care units. Patients and Methods: This scale was evaluated on 124 adult patients who were on mechanical ventilation for more than 24 hours, in two 24-hour phases, in six ICUs (Surgery-Trauma-Medical-Poisoning) of selected hospitals in Tehran, totaling 60 beds, by the researcher as a single blind test. Inclusion criteria were: Patient 18 to 80 years old, none of them suffering from neurological and neuromuscular diseases, none or a minimal dose of sedative drugs being used (15 - 18 points based on Palma and Cook criteria), non-addict or heavy smokers, not admitted in ICU-OH. The study was conducted from November 2011 to December 2012. The ventilators used were from Rafael brand. Results: There were 80 successful and 44 unsuccessful as well as 72 successful and 8 unsuccessful weaning cases in the first and second phase of the study, respectively. The area under the ROC curves for IWI was 0.967, with standard error of 0.020, 95% Confidence interval of 0.899 to 0.993 and Significance level of P = 0.001, SE = 94.59, SP = 66.67, PPV = 97.22, NPV = 50, DA = 92.5 and likelihood ratio of positive test being 2.84 besides the lowest likelihood ratio of negative test equal to 0.08), with Diagnostic odds ratio being 97% and Confidence interval of 0.82 to 0.97. Conclusions: Integrative weaning index has appropriate predictive validity for weaning patients from mechanical ventilation in Iranian intensive care units.

True-triaxial compressive strength of Maha Sarakham salt

True triaxial compressive strengths of the Maha Sarakham salt are experimentally determined by using a polyaxial load frame. The salt specimens with nominal dimensions of 5.4×5.4×10.8cm3 are loaded to failure with the minimum principal stress, σ3, varying from 0 to 7MPa, and the intermediate principal stress, σ2, varying from 0 to 80MPa. The major principal (axial) stress is increased at a rate of 0.5–1.0MPa/s until failure occurs. Based on the Coulomb criterion the internal friction angle determined from the triaxial loading condition (σ2=σ3) is 50°, and the cohesion is 5.0MPa. The elastic parameters of the salt tend to be independent of σ2 for the applied stress range. The effect of σ2 on the salt strength can be described best by the modified Wiebols and Cook criterion with a mean misfit of 3.5MPa. The (power law) Mogi criterion underestimates the salt strength, particularly under high σ3 values. The modified Lade and 3-D Hoek & Brown criteria overestimate the strength at all levels of σ3. The Coulomb and Hoek & Brown criteria cannot describe the salt strengths beyond the condition where σ2=σ3, as they cannot incorporate the effects of σ2. Both circumscribed and inscribed Drucker–Prager criteria severely underestimate σ1 at failure for all stress conditions, showing the largest mean misfit of 19.5MPa.

Lipid profiles in children with and without asthma: Interaction of asthma and obesity on hyperlipidemia

AimsThe joint effect of obesity and asthma on hyperlipidemia has never been explored. We aim to examine (1) the association of dyslipidemia and asthma, (2) the interaction effect of asthma and obesity on hyperlipidemia, and (3) whether a gender difference existed in the above relationships. MethodsBetween 2009 and 2010, 10- to 15-year-old children were recruited from 7 schools and 2 hospitals in Northern Taiwan. The population consisted of 237 asthmatic children and 225 non-asthmatic controls, and was further divided into four groups: non-obese controls, obese controls, non-obese asthmatics, and obese asthmatics. Measurements included anthropometric measures and blood samples for analysis of metabolic factors. The Cook's criteria were used to define childhood metabolic syndrome. General linear models were used to analyze how lipid profiles were associated with obesity and asthma. ResultsTotal cholesterol and low density lipoprotein cholesterol levels increased progressively in the group order obese asthmatics>non-obese asthmatics>obese controls>non-obese controls. In boys, low density lipoprotein cholesterol levels were significantly higher in obese asthmatics compared to obese non-asthmatics, with a mean difference of 6.2mmol/L in the general linear model. We also discovered a significant interactive effect of obesity and asthma on hyperlipidemia in boys (p for interaction=0.03). ConclusionsAsthma was associated with higher low density lipoprotein cholesterol levels and this association was amplified in overweight and obese subjects. A gender difference was observed in the joint effect of obesity and asthma on hyperlipidemia.

중학생의 비만율 변화 및 대사증후군 발생 위험요소와의 상관관계

본 연구는 최근 울산 지역 중학생의 비만율 변화와 대사증후군 발생위험 요소들의 상관관계를 파악하여 학교건강증진사업의 기초자료를 제공하기 위하여 수행되었다. 연구를 위하여 2007년부터 2011년까지 '인구보건복지협회 울산지회'에서 실시한 울산시 관내 중학교 2학년생에 대한 건강검진에 참여한 58,298명의 자료를 수집 분석하였다. 울산지역 중학교 2학년생의 비만율의 변화는 조사 대상 전체와 여학생에 있어서는 2007년부터 2010년까지 줄고 있다가 2011년 다시 증가하였다. 남학생은 2008년에 비만율이 가장 높았고 2010년에 가장 낮았다. 모든 연도에서 남학생에서 여학생보다 과체중과 비만 유병률이 모두 통계적으로 유의하게 높았다. 혈압 항목을 제외한 4개 항목 만으로서의 판정에서 전체 학생의 대사증후군 유병률은 0.58%였으며 저체중군은 0%, 정상군은 0.01%, 과체중군은 0.31%, 비만군에서는 4.53%로 비만도가 증가할수록 대사증후군 유병률은 급격히 증가하였다. 전체 학생 중 대사증후군 진단항목별 유병률은 고중성지방혈증이 36.58%로 가장 높았고 다음이 저HDL 6.47%, 복부비만 3.72%, 고혈당 0.47% 순으로 나타났다. 비만군의 경우 대사증후군 진단항목 모두에 있어 타군에 비해 통계적으로 유의하게 높았다(P<0.05). 본 연구에서 나타난 2007년부터의 비만율의 감소추세를 이어가기 위해서는 학교에서 학생들을 대상으로 보다 다양한 비만예방 프로그램을 개발하여 지속적으로 실시해 나가는 것이 필요하다고 생각된다. 2011년의 비만도 증가에 대한 추가적인 원인 분석이 이루어진다면 보다 체계적인 학교보건정책 수립에 도움이 될 것이다. The purpose of this study was to provide fundamental materials for improving school health promotion programs by investigating the relationships between the change in obesity rate and risk factors of metabolic syndrome among middle school students in Ulsan. We analyzed the routine health check-up data in 58,298 2nd-year middle school students in Ulsan, which conducted by the Planned Population Federation of Korea from 2007 to 2011. The overall and girls obesity rates gradually decreased throughout the first four years but increased again in 2011. The boys obesity rates were highest in 2008 and lowest in 2010. Throughout the research years, the incidence rates of over-weight and obesity were statistically significantly higher in boys compared to girls(P<0.05). Prevalence rates of the metabolic syndrome, assessed with the modified Cook criteria except high blood pressure, were 0.58%, 0%, 0.01%, 0.31% and 4.53%, respectively in total, low, normal, over-weight, and obese groups. It indicates that the prevalence of metabolic syndrome is increasing and directly related to the obesity rate among adolescents. Hypertriglyceridemia was the most common component (36.58%) of the metabolic syndrome among the middles school students followed by low HDL cholesterol (6.47%), abdominal obesity (3.72%), and high blood sugar (0.47%). Prevalence of the various components of the metabolic syndrome were significantly higher in the obese group compared to other groups. In this study we observed the decrease in obesity rates between 2007 and 2010, and developing obesity prevention programs is essential in order to maintain the trend. Additional study should be necessary to find the cause of increase of obesity rate in 2011 and so to create more effective school health promotion programmes.

Influencia étnica en la prevalencia de síndrome metabólico en población pediátrica obesa

IntroductionObesity in children is becoming more prevalent. Obesity and type 2 diabetes is higher in the Latin American immigrant population. ObjectiveTo analyze the influence of ethnicity on the prevalence of metabolic syndrome (MS) and its components in an obese pediatric population. Patients and methodsA retrospective study of 616 obese children and adolescents (BMI ≥2 SD [Hernández 88-04]), was conducted on 142 Latin American children and 474 Caucasians, which compared the prevalence of metabolic syndrome and its components according to modified Cook criteria (2003): obesity+2 or more of the following components: HDL-cholesterol <40mg/dl, triglycerides >110mg/dl, systolic and/or diastolic blood pressure >p90 (Task Force 2004), and impaired glucose metabolism (ADA 2011). Hepatic function, family history of MS, HbA1c, insulin resistance (HOMA) and BMI evolution at one year of treatment with changes in lifestyle (diet and exercise) were also assessed. ResultsAlmost one-third (30.5%) of Latin American children had MS compared to 15.5% of Caucasians (OR=2.4 [CI 95%: 1.5-3.8]), P<.005] and OR=2.5 adjusting for sex, SD-BMI and puberty. Latin American children also had a higher insulin resistance (58.6% vs 42.8%, P<.005) and a worse outcome after one year of treatment. ConclusionThere is a higher prevalence of MS in our Latin American obese pediatric population with poor adherence to the measures of change in lifestyle, making these patients a group with potentially increased risks of cardiovascular disease in adulthood

Catastrophe Theory Analysis on Asymmetric Mining Pillar Dynamic Failure

Based on the simplified analytic model of asymmetric mining rock beam-pillar system, the catastrophe model of dynamic failure of the rock beam-pillar system in asymmetric mining has been established by way of the differential form of total potential function deduced by law of conservation of energy. Analysis and illustration show it is consistent in discriminating the system stability by energy importing rate J—presenting the descending or increasing tendency. Outside or suroundings imports energy into rock beam-pillar system when J&gt; 0; and the system exports energy to outside or surroundings when J&lt;0.J=0 is the critical condition of system destabilization,which implicates Cook stiffness criterion and is a dynamic generalization of Cook criterion in the form of energy.

Prevalence of metabolic syndrome in children and adolescents who consult with obesity

The higher prevalence of childhood obesity has led to search for metabolic syndrome (MS) in this age group. To study the prevalence of MS in obese children and adolescents. Cross sectional study of 255 obese children and adolescents aged 11.3 ± 2.4 years, 45% males, 60% pubertal, with a body mass index (BMI) z score of 2.7 ± 0.6, who were evaluated for obesity. MS was defined as the presence of at least three of the following criteria, according to Ferranti: fasting glucose (FG) ≥ 100 mg/dl, triglycerides (TG) ≥ 100 mg/dl, HDL < 50 mg/dl, waist circumference (WC) > percentile (p) 75 and blood pressure (BP) > p90. Patients were also classified using Cook criteria: FG ≥ 100 mg/dl, TG ≥ 110 mg/dl, HDL < 40 mg/dl, WC > p 90, BP > p 90. MS was observed in 45 and 22.7% of patients, according to Ferranti and Cook definitions, respectively. WC was the most frequent criteria and glucose was the most uncommon. Males had higher body mass index, WC and TG levels than females. According to Ferranti and Cook definitions, MS prevalence was 53.5 and 28% in males and 37.6 and l8.4% in females (p < 0.05). Fifty and 26.1% of pubertal patients exhibited MS vs 36.9 and 17.5% in pre-pubertal subjects (p < 0.05) using Ferranti and Cook criteria, respectively. The frequency of MS increased along with a higher BMI. MS is a prevalent condition in obese children and adolescents, especially in males and pubertal children. It is necessary to have a better and universal definition for MS in pediatrics including all ages, in order to be focused in obesity prevention and treatment.

Prevalence of the metabolic syndrome using ATP-derived definitions and its relation to insulin-resistance in a cohort of Italian outpatient children

To analyze the prevalence of the metabolic syndrome (MetS) defined by three sets of Adult Treatment Panel III (ATPIII)-derived criteria, and the ability of each definition to identify insulin-resistance (IR) in a wide cohort of outpatient children. Seven hundred and twenty-four children consecutively observed in the Outpatient Pediatric Clinic of Pozzuoli Hospital during the period 2004-2009 were included in the study. Diagnosis of the MetS was made using three definitions: Cook, Jolliffe (which adopt age- and gender-specific cut-points) and de Ferranti. Insulin sensitivity was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR). IR was defined by the 90th percentile of HOMA-IR in healthy non-obese Italian children grouped by gender and Tanner stage. The ability of each definition to identify IR was evaluated in terms of sensitivity and specificity. The prevalence of the MetS in the overall cohort was 11, 12 and 24% using Cook, Jolliffe and de Ferranti criteria, respectively. Sensitivity and specificity in relation to IR were 19 and 94% with Cook criteria, 21 and 92% with Jolliffe criteria, and 39 and 84% with de Ferranti criteria. The prevalence of the MetS in children increases with increasing body weight. Among the three definitions analyzed, de Ferranti identifies a larger number of children with the MetS. The prediction of IR is weak with all definitions; on the contrary, the absence of MetS identifies fairly well children with low degree of IR.

Preclinical manifestations of organ damage associated with the metabolic syndrome and its factors in outpatient children

Background To evaluate whether the pediatric metabolic syndrome (MetS) or its factors are useful to detect subclinical abnormalities of cardiac, liver, and glomerular damage in an outpatient population. Methods The population study included 799 children (age 10 ± 3 years, mean ± SD), 24% of whom were normalweight, 25% overweight, and 51% obese. Alanine-aminotransferase (ALT) levels, estimated glomerular filtration rate (eGFR) and HOMA-IR were analyzed in all children. Microalbuminuria (MA) and left ventricular (LV) geometry and function were evaluated in 501 and 247 children, respectively. MetS was defined using Cook's criteria. Results MetS was diagnosed in 131 children (16%). Children with MetS+ and MetS− were similar for age, gender and Tanner stage distribution. Children with MetS+ showed higher ALT levels (31 ± 19 vs 21 ± 11 IU/L, p < 0.0001), LV mass (39 ± 10 vs 34 ± 10 g/h 2.7, p < 0.001) and relative wall thickness (0.37 ± 0.06 vs 0.35 ± 0.05, p < 0.01) than MetS−. The two groups were similar for MA and eGFR. At multiple logistic regression analysis, children MetS+ showed a higher risk (OR, 95% Cl) adjusted for confounding factors, of high ALT levels (1.71, 1.12–2.59, p = 0.012) and concentric LV hypertrophy (2.17, 1.01–4.66, p = 0.047) than children MetS−. The risk of preclinical liver and cardiac damage associated with the MetS phenotype was not higher than predicted by its single components. Conclusions Children with MetS show a 2-fold greater risk of having high ALT levels and concentric LV hypertrophy. However, the risk of subclinical manifestations of liver and cardiac damage can be predicted equally well by the single components of the syndrome.

High Prevalence of Metabolic Syndrome Traits in Children with Acute Lymphoblastic Leukemia Entering Maintenance Therapy.

Abstract 4114The metabolic syndrome, which includes obesity, hypertension, dyslipidemia, and insulin resistance, has been reported to occur in excess among long term survivors of pediatric acute lymphoblastic leukemia (ALL). Among known risk factors are exposure to corticosteroids and cranial radiotherapy. However, at what point along the trajectory of therapy that the metabolic abnormalities develop is unclear. Twenty-two consecutively enrolled patients with pre-B or T cell ALL treated on or according to Children's Oncology Group protocols at Vanderbilt Children's Hospital were evaluated for components of the metabolic syndrome at the start of maintenance chemotherapy. The overall prevalence of metabolic syndrome traits in this cohort was high, with 19 (86%) subjects exhibiting at least 1 component of the metabolic syndrome. Of those, 4 (21%) met full criteria for metabolic syndrome (demonstrating at least 3/5 components) (Table 1). Dyslipidemia was common with 11/22 (50%) having a fasting HDL ≤ 40mg/dl [median= 35mg/dl; 1st/3rd quartiles (29, 38)] and 8/22 (36%) having fasting triglycerides >110 mg/dl [median=165mg/dl; (129, 340)]. Patients with ALL NCI high risk classification had higher fasting triglycerides (p<0.01) and lower HDL (p=0.02) versus those who were classified as standard risk. Hypertriglyceridemia, but not HDL, was correlated with increased patient age (Spearman's ρ=0.45; p=0.03); neither was associated with sex or other components of the metabolic syndrome. Obesity was noted in 6/22 patients (27%) with BMI ≥ 90th percentile, controlled for age and sex. Hypertension was also frequent, observed in 11/22 (50%) subjects. Elevated systolic blood pressure correlated with decreasing age (ρ=-0.45, p=0.03) but not with other components of the metabolic syndrome. Only 1 subject had fasting hyperglycemia. Fasting leptin levels [median=2.6μg/ml (0.9, 4.4)] were significantly correlated with the BMI z-score (ρ=0.44, p=0.05) but did not significantly correlate with other components of the metabolic syndrome. Fasting adiponectin levels [median=21 μg/ml; (13, 25)] did not significantly correlate with any of the components of the metabolic syndrome. No subject had growth hormone deficiency. In summary, although the sample size was small, components of the metabolic syndrome were common at the start of maintenance chemotherapy, prior to significant further exposure to corticosteroids. Dyslipidemia was particularly common, and routine screening may be considered as there is the potential for successful intervention. The patients in this cohort are currently being followed longitudinally during maintenance chemotherapy to assess for changes in metabolic abnormalities with ongoing leukemia therapy, particularly corticosteroids. Determining the nature and onset of metabolic abnormalities can further inform future interventions to prevent or mitigate the abnormalities which, if untreated, may lead to long-term chronic health conditions that may increase cardiovascular risk.Table 1Characteristics of subjects meeting at least 3 of 5 criteria for the metabolic syndrome (Cook Criteria*)Subjects1234Age (years)148166GenderFemaleMaleMaleMaleALL Risk ClassificationHighHighHighStandardBMI Z-Score at Diagnosis2.152.082.39-0.16BMI Z-Score at Start of Maintenance2.242.232.68-0.08Fasting Triglycerides (mg/dl)352288153336Fasting HDL (mg/dl)27363518Systolic BP Z-Score-0.132.440.700.77Diastolic BP Z-Score0.821.761.341.44Fasting Glucose (mg/dl)73758678Fasting Leptin (μg/ml)40.219.445.71.4Fasting Adiponectin (μg/ml)27101121IGF-1 (ng/ml)21128815341*Cook et al. Arch Pediatr Adolesc Med 2003 Disclosures:No relevant conflicts of interest to declare.

Early markers for atherosclerosis and metabolic syndrome in children

The high prevalence of obesity in children favors the appearance of metabolic syndrome (MS), increasing their cardiovascular risk. To evaluate components of MS in children and to correlate them with surrogate markers of atherosclerosis and subclinical inflammation. We studied 209 children aged 11.5 +/- 2 years (50% girls, 30% prepuberal). Fifty percent had normal weight, 18% were overweight, 29% were obese and 3% were undernourished. A fasting blood sample was obtained to measure lipid levels, glucose, insulin, adiponectin and ultrasensitive C-reactive protein (usCRP). Subclinical atherosclerosis was evaluated using flow mediated dilatation of brachial artery (FMD) and carotid intima-media thickness (IMT). For diagnosis of MS we adapted Cook's criteria. Five percent of all children and 18% of those with overweight had MS. Children with more components had significantly higher fasting insulin and Homeostasis Model Assessment (HOMA) values. Clustering of MS components was also associated to higher values of usCRP and non significantly to lower adiponectin levels. We did not find differences in FMD. In obese children there was a tendency towards a higher IMT with clustering of MS components, although not significant. Children with overweight presented a higher risk of a clustering of MS components, which was also associated with insulin resistance and increase in ultrasensitive C reactive protein.

Detecting multiple confounders

This paper proposes an approach for detecting multiple confounders which combines the advantages of two causal models, the potential outcome model and the causal diagram. The approach need not use a complete causal diagram as long as it is known that a known covariate set Z contains the parent set of the exposure E. On the other hand, whether a covariate is or not a confounder may depend on its categorization. We introduce uniform non-confounding which implies non-confounding in any subpopulation defined by the interval of a covariate (or any pooled level for a discrete covariate). We show that the conditions in Miettinen and Cook's criteria for non-confounding also imply uniform non-confounding. Further we present an algorithm for deleting non-confounders from the potential confounder set Z , which extends Greenland et al.'s [1999a. Causal diagrams for epidemiologic research. Epidemiology 10, 37–48] approach by splitting Z into a series of potential confounder subsets. We also discuss conditions for non-confounding bias in the subpopulations in which we are interested, where the subpopulations may be defined by non-confounders.

On the influence of fracture criterion in projectile impact of steel plates

Perforation tests presented in a previous study on 12-mm-thick circular high-strength steel plates are numerically evaluated using the non-linear finite element code LS-DYNA. In the present study, the influence of fracture criterion in numerical simulations of the perforation process has been studied for three different steel alloys. The five-parameter Johnson–Cook fracture criterion, which is calibrated based on several relatively simple tensile tests, is found to give both qualitatively and quantitatively good results for this kind of impact problem. However, this study will also show that a one-parameter fracture criterion where only one simple material test is required for calibration, is found to give similar results as the Johnson–Cook criterion. The study indicates that the ballistic limit can be quantitatively well predicted independent of the chosen fracture criterion, but qualitatively some differences are seen during the perforation process.

Criteria for Confounders in Epidemiological Studies

SummaryThe paper addresses a formal definition of a confounder based on the qualitative definition that is commonly used in standard epidemiology text-books. To derive the criterion for a factor to be a confounder given by Miettinen and Cook and to clarify inconsistency between various criteria for a confounder, we introduce the concepts of an irrelevant factor, an occasional confounder and a uniformly irrelevant factor. We discuss criteria for checking these and show that Miettinen and Cook's criterion can also be applied to occasional confounders. Moreover, we consider situations with multiple potential confounders, and we obtain two necessary conditions that are satisfied by each confounder set. None of the definitions and results presented in this paper require the ignorability and sufficient control confounding assumptions which are commonly employed in observational and epidemiological studies.