Differences In Z-scores Research Articles

Overweight or obesity in children born after assisted reproductive technologies in Denmark: A population-based cohort study.

The association between assisted reproductive technologies (ARTs) and the body mass index (BMI) of children remains controversial. Confounding by morbidity and other factors associated with parental infertility may have biased studies comparing children born after ART with children born after no treatment. We investigated the associations between different fertility treatments and BMI in children at age 5 to 8 years, adjusting for and stratifying by causes of parental infertility. This Danish cohort study included 327,301 children born between 2007 and 2012 (51% males, median age at follow-up 7 years). Of these, 13,675 were born after ART, 7,728 were born after ovulation induction with or without intrauterine insemination [OI/IUI], and 305,898 were born after no fertility treatments. Using the International Obesity Task Force (IOTF) standards, we defined overweight (BMI ≥ IOTF-25) and obesity (BMI ≥ IOTF-30). We compared children born after ART versus OI/IUI; intracytoplasmic sperm injection (ICSI) versus conventional in vitro fertilization (IVF); and frozen-thawed versus fresh embryo transfer and estimated crude and adjusted prevalences of children with overweight or obesity at age 5 to 8 years, prevalence odds ratios (PORs), and differences in mean BMI z-scores. Adjustment was performed using stabilized inverse probability of treatment weights, including parity, year of conception, parental causes of infertility, age, educational level, comorbidities, maternal country of origin, BMI, and smoking as covariates. The crude prevalence of obesity was 1.9% in children born after ART, 2.0% in those born after OI/IUI, and 2.7% in those born after no fertility treatment. After adjustment, children born after ART and OI/IUI had the same prevalence of being overweight (11%; POR 1.00, 95% confidence interval [CI] 0.91 to 1.11; p = 0.95) or obese (1.9%; POR 1.01, 95% CI 0.79 to 1.29; p = 0.94). Comparison of ICSI with conventional IVF yielded similar pattern (POR 0.95, 95% CI 0.83 to 1.07; p = 0.39 for overweight and POR 1.16, 95% CI 0.84 to 1.61; p = 0.36 for obesity). Obesity was more prevalent after frozen-thawed (2.7%) than fresh embryo transfer (1.8%) (POR 1.54, 95% CI 1.09 to 2.17; p = 0.01). The associations between fertility treatments and BMI were only modestly different in subgroups defined by the cause of infertility. Study limitations include potential residual confounding, restriction to live births, and lack of detailed technical information about the IVF procedures. We found no association with BMI at age 5 to 8 years when comparing ART versus OI/IUI or when comparing ICSI versus conventional IVF. However, use of frozen-thawed embryo transfer was associated with a 1.5-fold increased risk of obesity compared to fresh embryo transfer. Despite an elevated relative risk, the absolute risk difference was low.

Is the awarding gap at UK medical schools influenced by ethnicity and medical school attended? A retrospective cohort study

ObjectivesTo better characterise the Awarding Gap (AG) between black, Asian and other minority ethnic (BAME) and white students in UK undergraduate medical education by examining how it affects eight minority...

Hyperprolactinemia Due to Prolactinoma has an Adverse Impact on Bone Health with Predominant Impact on Trabecular Bone: A Systematic Review and Meta-Analysis

Background: No meta-analysis has holistically analysed and summarized the effect of prolactin excess due to prolactinomas on bone mineral metabolism. We undertook this meta-analysis to address this knowledge-gap. Methods: Electronic databases were searched for studies having patients with hyperprolactinemia due to prolactinoma and the other being a matched control group. The primary outcome was to evaluate the differences in BMD Z-scores at different sites. The secondary outcomes of this study were to evaluate the alterations in bone mineral density, bone mineral content and the occurrence of fragility fractures. Results: Data from 4 studies involving 437 individuals was analysed to find out the impact of prolactinoma on bone mineral metabolism. Individuals with prolactinoma had significantly lower Z scores at the lumbar spine [MD -1.08 (95 % CI: -1.57 – -0.59); P < 0.0001; I2 = 54 % (moderate heterogeneity)] but not at the femur neck [MD -1.31 (95 % CI: -3.07 – 0.45); P = 0.15; I2 = 98 % (high heterogeneity)] as compared to controls. Trabecular thickness of the radius [MD -0.01 (95 % CI: -0.02 – -0.00); P = 0.0006], tibia [MD -0.01 (95 % CI: -0.02 – -0.00); P=0.03] and cortical thickness of the radius [MD -0.01 (95 % CI: -0.19 – -0.00); P = 0.04] was significantly lower in patients with prolactinoma as compared to controls. The occurrence of fractures was significantly higher in patients with prolactinoma as compared to controls [OR 3.21 (95 % CI: 1.64 – 6.26); P = 0.0006] Conclusion: Bone mass is adversely affected in patients with hyperprolactinemia due to prolactinoma with predominant effects on the trabecular bone.

Fetal growth assessed via ultrasound in relation to maternal HIV infection status and antiretroviral regimens.

To evaluate effects of maternal HIV and antiretroviral treatment (ART) on intrauterine fetal growth. Prospective cohort studies of HIV and ZIKA infection among women living with HIV (WLHIV) and women not living with HIV (WNLHIV) conducted in Brazil and the US from 2016 to 2020. We evaluated fetal growth via repeated ultrasounds and calculated z scores for fetal growth measures using Intergrowth-21st standards among women with singleton pregnancies. Adjusted linear mixed models were fit for each fetal growth z score by HIV status. Among WLHIV, we compared fetal growth z scores by the most common maternal ART regimens, stratified by timing of ART initiation. We included 166 WLHIV and 705 WNLHIV; none had Zika infection. The z scores were similar for WLHIV and WNLHIV for femur length (latest third trimester median = 1.08) and estimated fetal weight (median ≈0.60); adjusted mean differences in fetal weight z scores by HIV status were less than 0.1 throughout gestation. Other fetal growth measurements were lower for WLHIV than WNLHIV early in gestation but increased more rapidly over gestation. Among WLHIV not on ART at conception, adjusted mean z scores were generally similar across regimens initiated during pregnancy but somewhat lower for atazanavir-based regimens for biparietal diameter compared with efavirenz-based or raltegravir-based regimens. Among WLHIV on ART at conception, mean z scores were similar across ART regimens. Within our cohorts, fetal growth was lower in WLHIV than WNLHIV early in gestation but similar by the end of gestation, which is reassuring. Among WLHIV, fetal growth measures were generally similar across ART regimens evaluated.

Afferent venous perfusion of fetal liver: umbilical and portal blood-flow volumes in fetuses born small-for-gestational age.

To quantify the dynamic changes in the afferent venous flow volume of the liver in low-risk pregnancies with fetuses born small-for-gestational age. This was a prospective study of low-risk singleton pregnancies with estimated fetal weight (EFW) and birth weight ≤ 10th centile attending for a routine second- or third-trimester ultrasound examination. Their umbilical and portal blood-flow volumes were compared with those of a control group of fetuses born appropriate-for-gestational age from which normal reference ranges were constructed. Absolute and Z-score differences between the groups were assessed. In total, 133 fetuses were included in the study group and 362 in the control group. The mean umbilical blood-flow volume in the study group, both absolute and normalized per kg of EFW, was below that of the appropriate-for-gestational-age fetuses for most of the period of pregnancy studied (overall mean Z-score, -0.82 and -0.84, respectively). In contrast, the mean portal blood-flow volume, per kg of EFW, showed the opposite trend (overall mean Z-score, +0.86), reaching its maximum level (+1.43) in the late third trimester. This resulted in a steep decrease in the mean placental-to-portal-blood-flow volume ratio, from 14.4 at 24 weeks of gestation (above the 60th centile) to 4.7 at 38 weeks of gestation (15th centile), corresponding to Z-scores of +0.4 and -1.02, respectively. In fetuses born small-for-gestational age, the ratio of blood-flow volume in the umbilical vein to that in the portal vein decreases consistently during pregnancy, and to a greater extent compared with those born appropriate-for-gestational age, reaching a lower nadir in the third trimester. This additional redistribution of liver perfusion affects negatively fetal growth even in low-risk pregnancy, and should be taken into account when planning delivery. We suggest considering liver venous perfusion as an ancillary tool for monitoring small-for-gestational-age pregnancies. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Abstract 11817: Calculating Aortic Root Z- Scores With Ideal Body Weight Reclassifies Risk in Overweight and Obese Patients

Introduction: Indexing transthoracic echocardiography (TTE) aortic root diameter (AoR diam) measurements using body surface area (BSA) is important in children and small adults in whom non-indexed values may under detect dilation. However, the commonly used formula for expected AoR diam uses actual body weight, which may bias results in obese adults as AoR diam does not increase with body weight. Z-scores compare a patient’s AoR diam relative to an age, size, and sex specific population mean such that z- score = (observed AoR diam - expected AoR diam) /0.261. A normal AoR diam z-score is -2 ≤ z-score ≤2. Hypothesis: We hypothesize that using ideal body weight (IBW) in place of actual weight when calculating z-score reclassifies a significant proportion of overweight and obese patients with z-score &lt; 2 to z-score ≥2. Methods: We performed a retrospective review of all patients with a TTE at Tufts Medical Center in 2022 and Ao root diam ≥ 4 cm. We excluded patients &lt; 20 years old and those with inadequate TTE images or missing aortic measurements. Expected AoR diam and z-scores were calculated using both actual weight and IBW. A z-score difference, z diff = z actual weight - z ideal weight , was calculated. Results: 485 patients met our study criteria with a subset of 352 patients with BMI ≥ 25. The z diff was significantly different from zero across all BMI groups (p = 0.0003) and in the subset with BMI ≥ 25 (p&lt;0.001). 17.9% of patients with BMI ≥ 25 with z actual weight &lt; 2 were reclassified to z ideal weight ≥ 2 (p&lt;0.001) compared with 2.2% of patients with BMI &lt; 25 (p&lt;0.001). Among AoR diam subgroups of 4 - 4.5 cm, &gt; 4.5 - 5 cm, and &gt; 5 cm, all reclassification occurred in the 4 - 4.5 cm group. Within the 4 - 4.5 cm group, 24.1% of patients with z actual weight &lt; 2 reclassified to z ideal weight ≥ 2. Conclusions: Compared to current methods using actual weight, the use of IBW to calculate Ao root z-scores reclassifies nearly 2 in 10 patients with BMI ≥ 25 to Ao root dilation. Among patients with Ao root diam of 4 - 4.5 cm, nearly 1 in 4 are reclassified as dilated by z-scores calculated with IBW. Such reclassification would impact clinical decisions about increased surveillance and/or treatment. Further studies are needed to determine the optimal approach to indexing Ao root size and the implications for management.

Food Insecurity and Pediatric Nonalcoholic Fatty Liver Disease Severity

ObjectiveTo determine the association between food insecurity and pediatric nonalcoholic fatty liver disease (NAFLD). MethodsCross-sectional study of patients < 21 years of age with histologically confirmed NAFLD. The Household Food Security Survey Module was administered to determine food insecurity status. Skin lipidomics were performed to explore pathophysiologic mechanisms. ResultsSeventy-three patients with histologically confirmed NAFLD completed the Household Food Security Survey Module. Of these, the majority were male (81%) and non-Hispanic (53%), with a mean age at biopsy of 13±3 years. Food insecurity was seen in 42% (n=31). Comparison of features between food insecure and food secure subgroups revealed no differences in sex, ethnicity, BMI z-score, aminotransferases, or histologic severity. However, children experiencing food insecurity presented on average two years before their food secure counterparts (12.3 ± 3.0 vs. 14.4 ± 3.6 years, p = 0.015). A subset of 31 patients provided skin samples. Skin lipidomics revealed that food insecurity was associated with down-regulated features from the lipoamino acid class of lipids, previously linked to inflammation and adipocyte differentiation. ConclusionsFood insecurity is highly prevalent in children with NAFLD and is associated with earlier presentation. Lipidomic analyses suggest a possible pathophysiologic link that warrants further exploration.

Clinical factors associated with need for neurosurgical care in young children with imaging for macrocephaly: a case control study

BackgroundMacrocephaly is present in 2.3% of children with important neurosurgical conditions in the differential diagnosis. The objective of this study was to identify clinical associations with actionable imaging findings among children with head imaging for macrocephaly.MethodsWe conducted a case-control study of head imaging studies ordered for macrocephaly among children 24 months and younger in a multistate children’s health system. Four neurosurgeons reviewed the images, determining cases to be a ‘concern’ if neurosurgical follow-up or intervention was indicated. Electronic health records were reviewed to collect patient-level data and to determine if surgery was performed. Controls were matched 3:1 to cases of ‘concern’ in a multivariate model using conditional logistic regression.ResultsIn the study sample (n = 1293), 46 (4%) were concern cases, with 15 (1%) requiring surgery. Significant clinical factors associated with neurosurgical concern were bulging fontanel [aOR 7.47, (95% CI: 2.28–24.44), P < 0.001], prematurity [aOR 21.26, (95% CI: 3.76–120.21), P < 0.001], any delay [aOR 2.67, (95% CI: 1.13–6.27), P = 0.03], and head-weight Z-score difference (W_diff, defined as the difference between the Z-scores of head circumference and weight) [aOR 1.70, (95% CI: 1.22–2.37), P = 0.002].ConclusionsHead imaging for macrocephaly identified few patients with findings of concern and fewer requiring surgery. A greater head-weight Z-score difference appears to represent a novel risk factor for neurosurgical follow-up or intervention.

Timing of Cognitive Test Score Decline Prior to Incident Dementia Diagnosis in Blacks and Whites: The Atherosclerosis Risk in Communities Neurocognitive Study

Introduction: Commonly occurring dementias include those of Alzheimer’s, vascular, and mixtures of these and other pathologies. They are believed to evolve over many years, but that time interval has been difficult to establish. Our objective was to determine how many years in advance of a dementia diagnosis cognitive scores begin to change. Methods: 14,086 dementia-free ARIC participants underwent a cognitive exam at baseline visit 2 (1990–1992, mean age 57 ± 5.72), and 11,244 at visit 4 (1996–1998), 5,640 at visit 5 (2011–2013), and 3,574 at visit 6 (2016–2017) with surveillance for dementias of all-causes combined. Within 5-year intervals after each visit, we compared performance on the Delayed Word Recall Test (DWRT), the Digit Symbol Substitution Test (DSST), the Word Fluency Test (WFT), and the combined mean of three cognitive tests at baseline in participants who were diagnosed with dementia within each interval versus those who survived the interval without a dementia diagnosis. Z-scores were adjusted for demographics and education in separate regression models for each visit. We plotted adjusted z-score means by time interval following each visit. Results: During follow-up 3,334, 2,821, 1,218, and 329 dementia cases were ascertained after visits 2, 4, 5, and 6, respectively. Adjusted DWRT z-scores were significantly lower 20–25 years before dementia than those who did not experience dementia within 25 years. DSST z-scores were significantly lower at 25–30 years and 3-test combination z-scores were significantly lower as early as 30–31 years before onset. The difference between dementia and non-dementia group in the visit 2 3-test combination z-score was −0.20 at 30–31 years prior to dementia diagnosis. As expected, differences between the dementia and non-dementia groups increased closer to the time of dementia occurrence, up to their widest point at 0–5 years prior to dementia diagnosis. The difference between dementia and non-dementia groups in the visit 2 3-test combination z-score at 0–5 years was −0.90. WFT z-score differences were smaller than for the DSST or DWRT and began later. Patterns were similar in Black and White participants. Conclusion: DWRT, DSST, and combined 3-test z-scores were significantly lower more than 20 years prior to diagnosis in the dementia group versus the non-dementia group. Findings contribute to our knowledge of the long prodromal period in Blacks and Whites.

23 Cognitive Reserve Moderates Cognitive Functioning in Late-Life Depression

Objective:The concept of cognitive reserve (CR) explains why individuals with higher education, intelligence, or occupational attainment exhibit less severe cognitive changes in the presence of age-related or neurodegenerative pathology. CR may be a useful construct in understanding the cognitive performance of patients with late life depression (LLD), a cohort who are twice as likely to later receive a clinical diagnosis of dementia. It follows that depressed older adults with low CR may be at greater risk of cognitive decline compared to non-depressed older adults matched for CR. However, the literature on CR and LLD is limited to cross-sectional studies with mixed findings as to whether proxies of CR moderate cognitive outcomes in LLD. For example, both higher and lower education levels in LLD are associated with greater cognitive impairment in LLD compared to similarly educated non-depressed older adults. Longitudinal studies may help disentangle the association between CR and cognitive outcomes in LLD. The current study investigated the interaction between proxies of CR (e.g., education) and depression status on cognitive functioning over three years. We hypothesized that depressed older adults with low CR would demonstrate greater cognitive impairment and decline compared to depressed elders with high CR and non-depressed older adults with comparable CR.Participants and Methods:Older adults with LLD and non-depressed older adults age 59+ participated. All participants were free of dementia at baseline. We divided both patients and non-depressed participants into low (&lt;16) and high (&gt;=16) education groups based upon the median years of education (16) of the entire sample. All participants underwent detailed neuropsychological testing. Composite measures of episodic memory (CERAD Wordlist and recall, LM I and LM II, BVRT), processing speed-executive functioning (SDMT and Trail Making Part B), working memory (forward, reverse, ascending Digit Span), and verbal fluency (Animal Naming and COWA) were calculated based on the non-depressed older adults.Results:The baseline sample included 210 non-depressed older adults and 465 older adults with major depression (LLD). 150 non-depressed older adults and 235 LLD patients provided three-year follow-up data. Separate ANOVAs revealed a statistically significant interaction between education and depression status at baseline on the composite score of executive functioning F (1, 668) = 8.74, p &lt;.003. Consistent with our hypothesis, LLD with low education performed significantly worse compared to non-depressed with low education (z-score difference -1.35) and this effect was significantly greater than the difference between LLD patients and non-depressed with high education (z-score difference -0.36). No other interactions were found at baseline. Longitudinal analyses also revealed significant interactions between education and depression on memory over time, although sensitivity analyses did not suggest findings consistent with our hypothesis.Conclusions:Cognitive reserve contribute to group differences between LLD and non-depressed older adults in cognitive performance but may not alter cognitive trajectories over time. Future studies should further explore structural and functional brain changes associated with CR in LLD.

Nitrous oxide for the treatment of complex regional pain syndrome: a randomized blinded trial

IntroductionComplex Regional Pain Syndrome (CRPS) is a debilitating neuropathic condition often refractory to conventional treatments. N-methyl-D-aspartate (NMDA) receptor antagonists have a well-established role in the development and modulation of chronic...

Growth hormone use in pediatric inflammatory bowel disease.

Impaired linear growth is a known complication of pediatric inflammatory bowel disease (IBD), but theuse of growth hormone (GH) in this population is not well-described. The primary aim of this study is to determine whether growth hormone use in pediatric IBD leads to improved height outcomes. This was a retrospective chart review of patients with IBD aged 0-21 years followed at a single center between 2018 and 2021 treated with at least 1 year of GH. Records collected included demographics, IBD phenotype, IBD disease activity scores, medications, weight z-score, height z-score, bone age, and details of GH therapy including testing for GH deficiency. The primary outcome measure was change in height z-score after 1 year of GH treatment. Forty-six patients were identified and 18 were excluded. Of the 28 patients included (7 female; 25.0 %), 26 (92.9 %) had a diagnosis of Crohn's disease (CD) and 2 (7.1 %) had ulcerative colitis (UC). The mean (SD) age at GH initiation was 9.6 (3.4) years. Among all participants, there was a significant mean difference in height z-score from baseline to 1 year on therapy (-2.25 vs.-1.50, respectively; difference, 0.75; 95 % CI, 0.56 to 0.94; p<0.001). Among the 19 subjects thatcompleted GH therapy there was a significant mean difference between baseline and final height z-scores (-2.41vs.-0.77, respectively; difference, 1.64; 95 % CI, 1.30 to 1.98; p<0.001). GH use was associated with improved height outcomes. The pediatric IBD patients in this cohort had significant improvements in height z-scores both after one year on therapy and at completion of GH therapy.

THU180 Evaluation Of Factors Affecting Changes In Body Mass Index In Childhood Brain Tumor Survivors

Abstract Disclosure: D. Chatila: None. L.A. DiMeglio: None. D. Runco: None. N.G. Haddad: None. Introduction Excessive weight gain in childhood brain tumor (CBT) survivors has been documented. We characterized changes in body mass index (BMI) in CBT survivors and studied possible risk factors for excessive weight gain. Objectives 1) Compare BMI z-score at CBT diagnosis to that at time of last clinical follow up, and 2) Correlate BMI and BMI z-score changes with age at diagnosis; tumor location; treatment including radiation therapy (RT), chemotherapy (CT), or both; presence of endocrinopathies. Methods Following IRB approval, we conducted a retrospective chart review of children with CBTs diagnosed between 2005 and 2017. We excluded children with craniopharyngiomas due to their known high risk of obesity. Results 311 patients (177 female) were identified (median age at diagnosis 6y [range 0-18 y], median follow-up duration 6y [range 1-15 y]. Gliomas were the most common CBT type (69%) then medulloblastomas (18%) and germinomas (6%). 77 (25%) of CBTs were suprasellar. 137 patients received RT, 167 had CT, 110 had both, 7 had only surgery. 95 (30%) of children were ultimately diagnosed with a concomitant endocrinopathy. Baseline BMI and BMI z-scores (18.6 ± 4.8; 0.45 ± 1.52) correlated with mean BMI and BMI z-scores at last follow up [22.5 ± 6.4 (r=0.15, p=0.005); 0.67 ± 1.26, (r=0.11, p=0.048)]. BMI z-scores increased significantly over time. Age at diagnosis was not correlated with change in BMI or BMI z-scores. There were no differences in BMI z-scores at last follow-up or change in BMI z-scores between patients who had suprasellar tumors vs those with other tumor locations (BMI z-scores 0.94 ± 1.53 vs 0.60 ± 1.17, p=0.06; change in BMI z-score 0.36 ± 1.95 vs 0.18 ± 1.84, p=0.47). However, patients with a suprasellar tumor location had a lower mean age at diagnosis (5.6 ± 4.2 years vs 7.2 ± 4.2 years p=0.01). There were no differences in BMI z-scores at last follow-up or change in BMI z-score by type of treatment (CT, RT, or surgery alone) nor were there differences in BMI z-scores at last follow-up or change in BMI z-score between patients who did and did not have endocrinopathies (BMI z-score 0.61 ± 1.29 vs 0.70 ± 1.25, p=0.57; change in BMI z-score 0.03 ± 1.95 vs -0.33 ± 1.817, p=0.11) although children with endocrinopathies were older at CBT diagnosis (8.1 ± 4.9 years vs 6.3 ± 4.5 years, p=0.002) and had a longer duration of follow up than patients without endocrinopathies (7.5 ± 3.4 vs 5.7± 3.0 years, p&amp;lt; 0.001). Conclusions In CBT survivors, BMI z-scores increased over time however this change did not correlate with age at diagnosis of CBT, tumor location, type of intervention received, or presence of endocrinopathies. Future studies are needed to evaluate additional risk factors underlying increases in BMI. Presentation: Thursday, June 15, 2023

Healthy fitness zone prevalence and age-specific fitness profile of young people in seven European countries in 2022: The EUFITMOS project.

Physical fitness is a health marker in youth and is associated with current and future health. Present the healthy fitness zone (HFZ) prevalence and age-specific fitness profile of young people from seven European countries. This study used data from the European Fitness Monitoring System project. The sample comprised 4965 (51.4% boys) youths aged 9 to 18 years. Fitness data were collected by physical education teachers using field-based tests. Raw data from the fitness tests were used to calculate the prevalence and 95% confidence intervals (CI) of participants in the HFZ. The overall prevalence of boys and girls in the HFZ for all tests was 16.6% (95% CI = 14.7, 18.1) and 14.9% (95% CI = 13.2, 16.6), respectively. Boys have a mainly positive HFZ profiles, except for the 9-year-olds in the sit and reach (z-score difference = -1.20) and the 20 m run for boys 13-18-year-olds (z-score difference range: -0.09 to -0.01). Girls have worse HFZ profiles than boys, being out of the HFZ in several tests. Furthermore, a decreasing trend in z-score difference from the HFZ with age was observed in VO2 peak for boys and girls and sit and reach for girls. Notwithstanding, several country-related, sex and age differences were observed. Boys presented mostly healthy age-specific fitness profiles in several fitness tests and ages. These differences should be considered when promoting youth's health through physical activity and fitness, as different fitness levels may require different approaches to implementing health-enhancing physical activity policies.

Rapid increase in the body mass index of very preterm infants is a risk factor for iron deficiency during infancy

Iron deficiency (ID) in very preterm infants born at 28–32 weeks of gestational age (GA) can lower mental and motor test scores. This study aimed to determine whether the rapid growth of very preterm infants might be associated with ID. Among 134 very preterm born between January 2014 and December 2020 at Jeonbuk National University Hospital and discharged home, 93 were included in this study. Rapid BMI increase (RBI) was defined as a z-score difference of > 1 standard deviation between birth and 8 months. ID occurred in 23 of 93 (24.7%) infants at 8 months of corrected age (CA). ID was more common in the RBI group (50%) than in the non-RBI group (18.7%). In the multivariate logistic regression corrected for GA, infants small for gestational age (SGA) (odds ratio [OR] 6.06, 95% confidence interval [CI] 1.34–30.21) and RBI by z-score (OR 4.26, 95% CI 1.28–14.65) were identified as independent risk factors for ID at 8 months of CA. Conclusively, both SGA and RBI in the early life of very preterm were risk factors for ID at 8 months of CA.

Adaptation of the International Fitness Scale and Self-Perceived Health-Related Physical Fitness Questionnaire into Turkish.

This study aims to investigate the Turkish validity and reliability of the International Fitness Scale (IFIS) and the Self-Perceived Health-Related Physical Fitness Questionnaire for Children (SPHQ-C) aged 10-17. The measurement tools were translated into Turkish by two independent researchers and back-translated. Then, the content validity was established with a group of 13 individuals (Sample 1) who presented to the sports medicine clinic. The pilot application phase was initiated. A sample of 372 individuals (Sample 2) studying in the provincial center was selected for piloting the measurement tools with the ALPHA-FIT Test Battery. The test-retest application of the measurement tools with a 15-day interval was carried out with 207 individuals (Sample 3) not included in Sample 2. The authors calculated that the content validity ratio values for the items in the IFIS ranged from 0.85 to 1.00, with a content validity index of 0.94 for the scale. In the SPHQ-C, these values were found to be between 0.92 and 1.00, with a content validity index of 0.99. According to the Z-score difference analysis for both measurement tools, the construct validity of all items was achieved (p < 0.05). In the Bland-Altman plot test conducted for the IFIS-TR, the mean difference was calculated as 0.11, the standard deviation of the differences was 1.57, and the p-value was determined as 0.31. For the SPHQ-C-TR, the mean difference was -0.15, the standard deviation of the differences was 1.95, and the p-value was determined as 0.26. The Kappa coefficients for the items of the IFIS-TR ranged from 0.45 to 0.52, while for the SPHQ-C-TR, the Kappa coefficients ranged from 0.47 to 0.75. Confirmatory factor analysis conducted on Sample 2 confirmed model fit indices with covariance among some items of the measurement tools (IFIS-TR: e1-e3; SPHQ-C-TR: e1-e2, e1-e3, e2-e3, e3-e4, e6-e7, e8-e9). The IFIS and SPHQ-C measurement tools have been adapted into Turkish, and their validity and reliability have been established.

Longitudinal Child Growth Patterns in Twins and Singletons in the Upstate KIDS Cohort

To investigate childhood growth patterns in twins and to determine whether they show the same signs of excess growth as singletons born small-for-gestational age (SGA), which may confer future cardiometabolic risk. In the Upstate KIDS cohort of infants delivered from 2008 through 2010, we compared height, weight, and body mass index (BMI) z-scores at 0-3 and 7-9years of age, as well as risk of rapid weight gain (RWG) in infancy and overweight/obesity beginning at 2years, among appropriate-for-gestational age (AGA) twins (n=1121), AGA singletons (n=2684), and two groups of SGA twins: uncertain SGA twins (<10th percentile for birthweight by a singleton reference but >10th% by a population-based twin birthweight reference; n=319) and true SGA twins (<10th% by a population-based twin reference; n=144). Compared with AGA twins, both SGA twin groups had lower weight and BMI z-scores at both time points. By 7-9years, both groups caught up in height with AGA twins. Compared with AGA singletons, z-score differences decreased between 0-3 and 7-9years for uncertain SGA and true SGA twins, though true SGA twins had the lowest z-scores for all measures. During infancy, twins were more likely to display RWG compared with AGA singletons (RR=2.06 to 2.67), which may reflect normal catch-up growth, as no twin group had higher prevalence of overweight/obesity at either time point. Though twins had lower height, weight, and BMI z-scores at birth and into toddlerhood, differences were reduced by 7-9years, with no evidence of pathological growth and no group of twins showing elevated risk of overweight/obesity.

Alcohol exposure before and during pregnancy is associated with reduced fetal growth: the Safe Passage Study

BackgroundPrenatal alcohol exposure (PAE) is a worldwide public health concern. While PAE is known to be associated with low birth weight, little is known about timing and quantity of PAE on fetal growth. This study investigated the association between periconceptional and prenatal alcohol exposure and longitudinal fetal growth, focusing on timing and quantity in a high exposure cohort.MethodsThe Safe Passage Study was a prospective cohort study, including 1698 pregnant women. Two-dimensional transabdominal ultrasound examinations were performed to measure fetal femur length, abdominal and head circumference, and biparietal diameter, at three time points during pregnancy. Estimated fetal weight and Z-scores of all parameters were calculated. Trimester-specific alcohol exposure was assessed using the Timeline Followback method. To investigate the associations of specific timing of PAE and fetal growth, two models were built. One with alcohol exposure as accumulative parameter over the course of pregnancy and one trimester specific model, in which PAE was separately analyzed. Linear mixed models adjusted for potential confounders were applied with repeated assessments of both alcohol exposure and fetal growth outcomes.ResultsThis study demonstrated that periconceptional and prenatal alcohol exposure were associated with reduced fetal growth. Effect sizes are displayed as estimated differences (ED) in Z-score and corresponding 95% confidence intervals (95% CIs). When investigated as accumulative parameter, PAE was related to a smaller femur length (ED30; − 0.13 (95% CI; − 0.22; − 0.04), ED36; − 0.14 (95% CI; − 0.25; − 0.04)) and a smaller abdominal circumference (ED36; − 0.09 (95% CI; − 0.18; − 0.01)). Periconceptional alcohol exposure was associated with a smaller abdominal circumference (ED30; − 0.14 (95% CI; − 0.25; − 0.02), ED36; − 0.22 (95% CI; − 0.37; − 0.06)) and a smaller estimated fetal weight (ED36; − 0.22 (95% CI; − 0.38; − 0.05)). Second trimester alcohol exposure was associated with a smaller abdominal circumference (ED30; − 0.49 (95% CI; − 0.86; − 0.12), ED36; − 0.70 (95% CI; − 1.22; − 0.17)) and estimated fetal weight (ED30; − 0.54 (95% CI; − 0.94; − 0.14), ED36; − 0.69 (95% CI; − 1.25; − 0.14)). No additional association of binge drinking was found besides the already observed association of PAE and fetal growth.ConclusionsThis study demonstrated that PAE negatively affects fetal growth, in particular when exposed during the periconception period or in second trimester. Our results indicate that potential negative consequences of PAE are detectable already before birth. Therefore, healthcare providers should actively address and discourage alcohol use during pregnancy.

Site specific differences in vBMD and geometry in postmenopausal women with primary hyperparathyroidism.

Primary Hyperparathyroidism (PHPT) is associated with catabolic effects at both trabecular and cortical bone. Mechanical loading is one of the most important natural anabolic stimuli for bone at all ages. The present study was designed to assess the impact of PHPT on vBMD and bone geometry using peripheral quantitative computed tomography (pQCT) at the radius and tibia, sites with similar structural characteristics, but subject to different loading conditions. We evaluated the impact of PHPT on bone, by comparing the z-scores of volumetric Bone Mineral Density (vBMD) and indices of bone geometry simultaneously at the tibia and the radius by pQCT, skeletal sites with similar structure, but subject to different loading conditions. Forty-one postmenopausal women with PHPT and 79 controls, comprised the study group. At both trabecular and cortical sites, vBMD and bone geometry indices were significantly lower in patients compared with controls. In patients with PHPT, apart from a lower z-score for total vBMD (p = 0.01) at the radius, there was no other difference between the radius and the tibia at the trabecular sites. On the contrary, at cortical sites, the z-scores of cortical bone mineral content (p = 0.02), cortical vBMD (p = 0.01) and cortical cross-sectional area (p = 0.05) were significantly lower at the radius compared with the tibia, indicating that cortical bone at the weight bearing tibia might be less affected by the catabolic actions of continuous parathyroid hormone (PTH) exposure. PTH levels were positively associated with the difference in z-scores of cort BMD (r = 0.439, p < 0.01) indicating that in more severe cases, as expressed by higher PTH levels, the deleterious effects at the non-weight bearing radius might be accentuated. We found that in postmenopausal women with PHPT, both trabecular and cortical bone are adversely affected. However, at the weight bearing tibia as compared with the radius, the deleterious effects, especially on cortical bone, seem to be attenuated. NCT05426512, 21/06/2022, "retrospectively registered".

Oscillometry and spirometry are not interchangeable when assessing the bronchodilator response in children and young adults born preterm.

The European Respiratory Society Oscillometry Taskforce identified that clinical correlates of bronchodilator responses are needed to advance oscillometry in clinical practice. The understanding of bronchodilator-induced oscillometry changes in preterm lung disease is poor. Here we describe a comparison of bronchodilator assessments performed using oscillometry and spirometry in a population born very preterm and explore the relationship between bronchodilator-induced changes in respiratory function and clinical outcomes. Participants aged 6-23 born ≤32 (N = 288; 132 with bronchopulmonary dysplasia) and ≥37 weeks' gestation (N = 76, term-born controls) performed spirometry and oscillometry. A significant bronchodilator response (BDR) to 400 μg salbutamol was classified according to published criteria. A BDR was identified in 30.9% (n = 85) of preterm-born individuals via spirometry and/or oscillometry, with poor agreement between spirometry and oscillometry definitions (k = 0.26; 95% confidence interval [CI] 0.18-0.40, p < .001). Those born preterm with a BDR by oscillometry but not spirometry had increased wheeze (33% vs. 11%, p = .010) and baseline resistance (Rrs5 z-score mean difference (MD) = 0.86, 95% CI 0.07-1.65, p = .025), but similar baseline spirometry to the group without a BDR (forced expiratory volume in 1 s [FEV1 ] z-score MD = -0.01, 95% CI -0.66 to 0.68, p > .999). Oscillometry was more feasible than spirometry (95% success rate vs. 85% (FEV1 ), 69% (forced vital capacity) success rate, p < .001), however being born preterm did not affect test feasibility. In the preterm population, oscillometry is a feasible and clinically useful supportive test to assess the airway response to inhaled salbutamol. Changes measured by oscillometry reflect related but distinct physiological changes to those measured by spirometry, and thus these tests should not be used interchangeably.