Healthy Adolescent Population Research Articles

Determinants of malnutrition among adolescent females of age 15–19 years in an urban slum of Raipur city

ABSTRACT Context: Adolescent girls suffer the brunt of malnutrition due to increased nutritional needs to facilitate rapid growth spurt including menstruation and increased physical activity. This vulnerable group has low social power and is subjected to peer and social pressures related to body image and weight. All these factors along with the sociocultural milieu may lead to a spectrum of nutritional problems in them. Aims: To determine factors associated with malnourishment among adolescent females of age 15–19 years in an urban slum of Raipur City. Settings and Design: The study setting was the urban field practice area of the institute in Raipur. The study was an analytical cross-sectional study done from January 2022 to June 2023 among 401 adolescent girls of age 15–19 years. Methods and Material: The sampling was done using the consecutive sampling method. The study tools used were a semi-structured questionnaire on sociodemographic variables and details of the respondents, anthropometric measurements, dietary assessment using the 24-hour food recall method, and food consumption patterns using a food frequency questionnaire. Statistical Analysis Used: The Chi-square test of significance was applied to find the association between malnourishment with the input variables. For calculating the strength of the association, the odds ratio was estimated for those variables with P value < 0.2 in the Chi-square test, and later the odds ratio was adjusted for confounding with the same variables, using multivariable logistic regression. Results: According to BMI-for-age Z scores, 2% were severely thin (< −3 SD), 9.7% were thin (−3 to − 2 SD), 5% were overweight (1 to 2 SD), and 1.5% were obese (>2SD). While measuring the height-for-age Z scores, 5.5% had severe stunting and 21.9% had moderate stunting. Those respondents with educational status of high school or below [AOR 3.5 (1.8–6.8), P < 0.001] and those who did not consume a non-vegetarian diet [AOR 2.1 (1.1–4.1), P = 0.02] had significantly higher adjusted odds of being undernourished (severely thin or thin) as compared to those with educational status above high school and those who consumed a mixed diet, respectively. The respondents who are currently not going to school/college had significantly higher adjusted odds [AOR 2.2 (1.2–3.8), P = 0.007] of being stunted when compared to those who are attending school/college. Conclusions: The significant levels of malnutrition observed in this study among late adolescent girls aged 15–19 years—11.7% undernourishment, 6.5% overnourishment, and 27.4% stunting—highlight the concerning vulnerability of this population. The higher prevalence of stunting throws light onto the chronicity of malnutrition. As seen from the significant associations, proper education, and a mixed diet will help nurture a healthy female adolescent population.

Selected somatic parameters and body composition as predictors of cardiorespiratory fitness among Polish adolescents aged 11–14

The aim of the study was to verify whether selected somatic parameters and components of body composition were significant predictors of cardiorespiratory fitness (CRF) among a potentially healthy Polish population of adolescents aged 11–14 years. The cross-sectional study was conducted on a group of 375 subjects (164 girls, and 211 boys). A 20 m shuttle run test (20 m SRT) was used to assess CRF. The total number of rounds was taken into account. Basic somatic parameters were measured: body mass (BM), body height (BH), waist circumference (WC), hip circumference (HC), body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), and body composition components: body fat percentage (FM%), fat mass (FM kg), total body water (TBW), fat-free mass (FFM). Statistical analyses included basic statistical measures (mean and standard deviation) and Spearman rank correlation coefficient. Multiple linear regression analysis was performed to detect significant predictors of CRF. In each proposed model, the dependent variable was the number of rounds, and the independent variables were selected somatic parameters and components of body composition. More than half (65%) of the subjects had an average or lower level of CRF, and 35% of the population presented a good or above good level of CRF. The study showed a statistically significant negative correlation between BM, FM%, FM kg, HC, WC, BMI, WHR, WHtR and the number of laps in the total sample. The strongest correlation in the group of girls was noted for age (r = 0.34) and in the group of boys for FM% (r = -0.52\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$-0.52$$\\end{document}). Each regression model presented proved to be statistically significant, and the significant predictors of CRF in the group of girls were age (R2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$R^2$$\\end{document} = 16%) and FM% (R2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$R^2$$\\end{document} = 6%). In the group of boys, the significant predictors of CRF were WHtR (R2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$R^2$$\\end{document} = 8%) and age (R2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$R^2$$\\end{document} = 2%). Estimating body fat distribution is useful in assessing cardiorespiratory fitness, and this in turn indicates its usefulness in preventive screening of school-aged adolescents.

Lack of Association Between Depression and Subclinical Hypothyroidism in Adolescents Presenting for Routine Physical Examinations.

There are conflicting results in the existing studies regarding the association between depression and subclinical hypothyroidism in adolescents. Subclinical hypothyroidism is defined as elevated thyroid stimulating hormone (TSH) levels above the reference range without signs or symptoms of hypothyroidism. The focus of this study is to determine whether there is any association between depression and subclinical hypothyroidism, (as defined by the serum TSH levels) in a population of healthy adolescents. Quantitative-based cross-sectional study of a representative subset of the adolescent population. We carried out a cross-sectional study to determine the association between major depressive disorder (MDD) and subclinical hypothyroidism, in adolescents presenting for annual physical examinations during the peak period of the COVID-19 pandemic in the USA, a period deemed high for adolescent depression. All the adolescents were screened for depression by the PHQ-9 screening tool and had their TSH measured. Of the 304 subjects analyzed, 179 (58.88%) were minimally or not depressed according to the Patient Health Questionnaire (PHQ-9) screening tool (mean PHQ 1.80 ± 1.49). 70 (23.03%) had mild depression (mean PHQ 6.59 ± 1.46), 50 (16.45%) had moderate depression (mean PHQ 13.70 ± 2.75), and 5 (1.64%) had severe depression (mean PHQ 21.40 ± 1.67). Mean TSH values were 1.93 ± 0.99, 1.77 ± 1.05, 2.10 ± 0.98, and 1.57 ± 0.32 mIU/L, respectively in the four groups. All values were within the recommended range of 0.50 to 4.30 mIU/L, without statistically significant inter-group differences. We conclude that there is no statistically significant association between depression and subclinical hypothyroidism, in a population of adolescents presenting for physical examinations, and if the screening for depression by the PHQ-9 tool indicates depression, a screening TSH test for subclinical hypothyroidism is not justified.

Assessment of ISTH-BAT Scores in a Primary Care Clinic Population of Menstruating Adolescents

Background Accurate assessment of bleeding severity is critical for timely diagnosis and appropriate management of inherited bleeding disorders. To achieve standardized and reliable evaluation, the International Society on Thrombosis and Haemostasis (ISTH) developed the Bleeding Assessment Tool (BAT). The ISTH-BAT is a comprehensive questionnaire designed to systematically evaluate bleeding symptoms in both children and adults. A crucial aspect of utilizing the ISTH-BAT in clinical practice is determining the normal range of bleeding scores in the general population. Defining this baseline aids in distinguishing abnormal bleeding tendencies from variations within the healthy population. The ISTH-BAT Merging Project established a normal range of BAT scores for children age <18 years as 0-2 and for adult females age ≥18 years as 0-5. However, the normal range of BAT scores for adolescent females remains undetermined. This population is unique because they have undergone the bleeding challenge of menarche but are less likely to have experienced childbirth or multiple surgeries. Furthermore, while prior studies have shown age-related increases in BAT scores in individuals with von Willebrand Disease, there are limited data on the effect of aging on BAT scores in a healthy adolescent population. This study aims to determine the range of BAT scores in a diverse menstruating adolescent population, compare bleeding scores to published reference ranges from the ISTH-BAT Merging Project and assess potential age-related variations in BAT scores. Methods In an ongoing large population study, 10-20 year-old menstruating adolescents presenting for routine care are recruited from primary care clinics across Nationwide Children's Hospital (Columbus, OH, USA). Patients with a prior diagnosis of a bleeding disorder are excluded. The ISTH-BAT is administered by trained study personnel. Data analyses were completed using nonparametric methods such as Wilcoxon signed-rank or rank sum tests and Spearman's correlation. Means and 95% confidence intervals (CI) were calculated and compared to historical estimates. Results In a preliminary analysis of the first 150 participants, the median age was 15 years (IQR: 13-18). Participants represented a diverse range of backgrounds, with 69% of participants identifying as Black/African American, 19% as White, and 12% as other races. 94% identified as non-Hispanic, while 6% identified as Hispanic/Latino. The mean BAT score was 1.06 (95% CI: 0.87-1.25), with scores ranging from 0-5. The data exhibited a non-normal distribution, with most scores concentrated at 0 or 1, accounting for 72% of the dataset. The mean BAT score is significantly higher than the ISTH-BAT Merging Project pediatric mean score of 0.34 (p<0.0001), but not significantly different from the adult female mean of 1.28 (p=0.99). When analyzed by age group, participants aged 10-17 years had a mean BAT score of 0.96, significantly higher than the published pediatric mean (p<0.0001) but similar to the published adult mean (p=0.99). Similarly, participants aged 18-20 years had a mean BAT score of 1.33. To assess if BAT score increased with age, we compared participants aged 10-14 years to adolescents 15-20 years, and identified a small, but significant increase in mean BAT score with age (p=0.001). Participants aged 10-14 years had a mean score of 0.69 (95% CI: 0.45-0.94), falling between the published pediatric and adult means, with no significant difference from either one (p=0.003 and p=0.99, respectively) (Figure 1). However, participants aged 15-20 had a mean BAT score of 1.30 (95% CI: 1.03-1.56), which remained significantly higher than the published pediatric mean (p<0.0001) but still showed no significant difference from the published adult mean (p=0.81). There was a weak, but statistically significant positive correlation between age and bleeding score, indicating that as age increases, bleeding scores tend to rise (Spearman's correlation r s= 0.21, p=0.001) (Figure 2). Similarly, a weak positive relationship exists between years post-menarche and bleeding score (r s=0.23, p=0.005). Conclusion This study provides insight on ISTH-BAT scores in a population of healthy menstruating adolescent females, suggesting that after the onset of menstruation, the adult female bleeding score range may be more suitable for adolescents than the pediatric range.

Prevalence of Polycystic Ovarian Syndrome in Girls with a History of Idiopathic Central Precocious Puberty

Introduction: The prevalence of polycystic ovarian syndrome (PCOS) in adolescent girls is between 1 and 4.3%. It remains controversial whether women with a history of idiopathic central precocious puberty (ICPP) are at increased risk for PCOS. Our objective was to assess the prevalence of PCOS in adolescents with a history of ICPP compared with healthy adolescents and the prevalence of PCOS among ICPP girls who have received or not gonadotropin-releasing hormone analogue (GnRHa) treatment. Methods: We assessed post-menarcheal girls with a history of ICPP. Girls were evaluated at gynecological age ≥2.5 years. Data collected were age at menarche, menstrual cycle characteristics, BMI, clinical hyperandrogenism (HA), total and free testosterone levels. PCOS diagnosis was defined by criteria for adolescents. Subjects were also analyzed regarding whether or not they had received GnRHa treatment. Results: Ninety-four subjects were assessed, and 63 had been treated with GnRHa. Menstrual disorders were found in 29%, clinical HA in 36%, and biochemical HA in 23%. Twelve percent met the diagnostic criteria for PCOS. There was no difference in BMI or in the incidence of menstrual dysfunction or hyperandrogenemia between treated and untreated patients. A higher proportion of clinical HA was found in untreated patients when compared to treated girls. The relative risk (RR) of developing PCOS in ICPP girls was 2.5 compared to a population of healthy adolescents. This RR was not higher in patients who received treatment with GnRHa than in those who did not. Conclusion: Adolescent girls with a history of ICPP have an increased risk of PCOS. This risk seems not to be related to GnRHa treatment.

Serum neurofilament light chain reference database for individual application in paediatric care: a retrospective modelling and validation study

Neurological conditions represent an important driver of paediatric disability burden worldwide. Measurement of serum neurofilament light chain (sNfL) concentrations, a specific marker of neuroaxonal injury, has the potential to contribute to the management of children with such conditions. In this context, the European Medicines Agency recently declared age-adjusted reference values for sNfL a top research priority. We aimed to establish an age-adjusted sNfL reference range database in a population of healthy children and adolescents, and to validate this database in paediatric patients with neurological conditions to affirm its clinical applicability. To generate a paediatric sNfL reference dataset, sNfL values were measured in a population of healthy children and adolescents (aged 0-22 years) from two large cohorts in Europe (the Coronavirus Antibodies in Kids from Bavaria study, Germany) and North America (a US Network of Paediatric Multiple Sclerosis Centers paediatric case-control cohort). Children with active or previous COVID-19 infection or SARS-CoV-2 antibody positivity at the time of sampling, or a history of primary systemic or neurological conditions were excluded. Linear models were used to restrospectively study the effect of age and weight on sNfL concentrations. We modelled the distribution of sNfL concentrations as a function of age-related physiological changes to derive reference percentile and Z score values via a generalised additive model for location, scale, and shape. The clinical utility of the new reference dataset was assessed in children and adolescents (aged 1-19 years) with neurological diseases (epilepsy, traumatic brain injury, bacterial CNS infections, paediatric-onset multiple sclerosis, and myelin oligodendrocyte glycoprotein antibody-associated disease) from the paediatric neuroimmunology clinic at the University of California San Francisco (San Francisco, CA, USA) and the Children's Hospital of the University of Regensburg (Regensburg, Germany). Samples from 2667 healthy children and adolescents (1336 [50·1%] girls and 1331 [49·9%] boys; median age 8·0 years [IQR 4·0-12·0]) were used to generate the reference database covering neonatal age to adolescence (target age range 0-20 years). In the healthy population, sNfL concentrations decreased with age by an estimated 6·8% per year until age 10·3 years (estimated multiplicative effect per 1 year increase 0·93 [95% CI 0·93-0·94], p<0·0001) and was mostly stable thereafter up to age 22 years (1·00 [0·52-1·94], p>0·99). Independent of age, the magnitude of the effect of weight on sNfL concentrations was marginal. Samples from 220 children with neurological conditions (134 [60·9%] girls and 86 [39·1%] boys; median age 14·7 years [IQR 10·8-16·5]) were used to validate the clinical utility of the reference Z scores. In this population, age-adjusted sNfL Z scores were higher than in the reference population of healthy children and adolescents (p<0·0001) with higher effect size metrics (Cohen's d=1·56) compared with the application of raw sNfL concentrations (d=1·28). The established normative sNfL values in children and adolescents provide a foundation for the clinical application of sNfL in the paediatric population. Compared with absolute sNfL values, the use of sNfL Z score was associated with higher effect size metrics and allowed for more accurate estimation of the extent of ongoing neuroaxonal damage in individual patients. Swiss National Science Foundation, US National Institutes of Health, and the National Multiple Sclerosis Society.

The evolution of pre-operative SRS scores over time in patients with adolescent idiopathic scoliosis.

To determine if preoperative Health Related Quality of Life (HRQoL) has declined in the past two decades for patients with Adolescent Idiopathic Scoliosis (AIS), as measured by the Scoliosis Research Society (SRS) questionnaire. A retrospective review was conducted on AIS patients that underwent surgery at a single institution between 2002 and 2022. Patients were included if they completed an SRS questionnaire preoperatively. A multivariate linear regression was performed with the SRS domains as the dependent variables. The independent variables were surgery year, gender, race/ethnicity, BMI, Lenke type, and major Cobb angle. A second regression was performed where the SRS scores for AIS patients were dichotomized as being above or below normal based on a threshold set at two standard deviations below the mean SRS scores of a healthy adolescent population. The binary SRS scores were used as the outcome of interest in a second regression. A total of 1380 patients (79.2% female, mean age 14.9 ± 2.0years old) were included for analysis. Surgery year had a negative association with Pain (coefficient = -0.03, p < 0.0001), Activity (coefficient = -0.02, p < 0.0001), Mental Health (coefficient = -0.01, p < 0.0001), and Total score (coefficient = -0.01, p < 0.0001), indicating declining HRQoL over time. Similarly, AIS patients became more likely to fall below 2SD of the healthy adolescent means in Pain (OR: 1.061, p < 0.0001), Appearance (OR: 1.023, p = 0.0301), Activity (OR: 1.044, p = 0.0197), and Total score (OR: 1.06, p < 0.0001). Over the past two decades, patients with surgical AIS have experienced a significant decline in various HRQoL domains preoperatively.

White blood cells in a healthy adolescent population according to social and health characteristics

BackgroundThe immune system constitutes a sensory system both for heritable and non-heritable factors. Among the latter, social and environmental determinants of health may influence and shape the immune system in early life. To study the relationship between leukocytes and determinants of health in adolescence, we assessed total and differential white blood cells (WBC) according to social and environmental determinants of health in a healthy adolescent population. MethodsAs part of the population-based cohort Epidemiological Health Investigation of Teenagers in Porto (EPITeen), 1213 adolescents were evaluated at the age of 13. Total and differential WBC were evaluated through a venous blood sample using an automated blood counter (Sysmex®XE-5000, Hyogo, Japan). Sociodemographic, behavioral, and clinical data were collected through self-administered questionnaires. ResultsParticipants with better socioeconomic conditions (enrolled at private schools or higher parental education) had significantly lower total WBC levels, and the latter showed a lower percentage of neutrophils and higher percentage of lymphocytes. Those who practiced sports had significantly lower total WBC levels and neutrophil percentage, as well as a significantly higher percentage of eosinophils and lymphocytes. Adolescents with chronic disease, chronic medication, or allergic diseases had a significantly higher percentage of eosinophils and a lower percentage of monocytes. With increasing body mass index and systemic inflammation, we found a significant increase in total WBC levels. ConclusionWBC linked to different immune response patterns are associated with several social and environmental determinants of health in adolescence.

Whole Blood Expression Levels of Long Noncoding RNAs: HOTAIRM1, GAS5, MZF1-AS1, and OIP5-AS1 as Biomarkers in Adolescents with Obesity-Related Asthma

Asthma is a heterogeneous entity encompassing distinct endotypes and varying phenotypes, characterized by common clinical manifestations, such as shortness of breath, wheezing, and variable airflow obstruction. Two major asthma endotypes based on molecular patterns are described: type 2 endotype (allergic-asthma) and T2 low endotype (obesity-related asthma). Long noncoding RNAs (lncRNAs) are transcripts of more than 200 nucleotides in length, currently involved in many diverse biological functions, such as chromatin remodeling, gene transcription, protein transport, and microRNA processing. Despite the efforts to accurately classify and discriminate all the asthma endotypes and phenotypes, if long noncoding RNAs could play a role as biomarkers in allergic asthmatic and adolescent obesity-related asthma, adolescents remain unknown. To compare expression levels of lncRNAs: HOTAIRM1, OIP5-AS1, MZF1-AS1, and GAS5 from whole blood of Healthy Adolescents (HA), Obese adolescents (O), allergic asthmatic adolescents (AA) and Obesity-related asthma adolescents (OA). We measured and compared expression levels from the whole blood of the groups mentioned above through RT-q-PCR. We found differentially expressed levels of these lncRNAs between the groups of interest. In addition, we found a discriminative value of previously mentioned lncRNAs between studied groups. Finally, we generated an interaction network through bioinformatics. Expression levels of OIP5-AS1, MZF1-AS1, HOTAIRM1, and GAS5 in whole blood from the healthy adolescent population, obese adolescents, allergic asthma adolescents, and obesity-related asthma adolescents are differently expressed. Moreover, these lncRNAs could act as molecular biomarkers that help to discriminate between all studied groups, probably through molecular mechanisms with several genes and miRNAs implicated.

Creatine supplementation in the pediatric and adolescent athlete-- A literature review

BackgroundAn increase in intra-muscular creatine through supplementation has been proposed as a strategy for improving muscle performance and recovery, with studies showing some benefit for adult athletes who rely on short, explosive movements. We reviewed and summarized the current literature on creatine supplementation in a pediatric and adolescent population. MethodsThe databases PubMed and EMBASE were queried to identity articles related to the use of creatine supplementation in a healthy pediatric and adolescent population according to the guidelines established by PRISMA. The abstracts of all articles were reviewed to determine relevancy, with those meeting the pre-defined criteria included in the final review. ResultsA combined total of 9393 articles were identified. Following application of filters and review of abstracts, 13 articles were found to meet criteria and were included in the final review. There was a total of 268 subjects across all studies, with mean age ranging from 11.5 to 18.2 years. More than 75% of the studies were randomized-controlled trials, and 85% involved either soccer players or swimmers. The overall quality of the studies was poor, and there were no consistent findings regarding creatine supplementation and improvements in athletic performance. No studies were designed to address the topic of safety. ConclusionsThere is a gap in the study of the safety and efficacy of creatine supplementation in adolescents. Additional studies are needed to evaluate the effects of alterations in muscle composition on the growth, development, and performance of the developing athlete. Orthopedic providers should counsel their pediatric and adolescent patients on the current limitations in trying to assess the true risk and benefit of creatine supplementation for the aspiring athlete. Level of evidenceReview, III.

DTI assessment of the maturing growth plate of the knee in adolescents and young adults

PurposeTo assess the growth plates of the knee in a healthy population of young adults and adolescents using DTI, and to correlate the findings with chronological age and skeletal maturation. MethodsA prospective, cross-sectional study to assess the tibial and femoral growth plates with DTI in 155 healthy volunteers aged between 14.0 and 21 years old. Echo-planar DTI with 15 directions and b value of 0 and 600 s/mm2 was performed on a 3 T whole-body scanner. ResultsA relationship was observed between chronological age and most DTI metrics (fractional anisotropy, mean diffusivity, and radial diffusivity), tract length and volume. (No significant relationship could be seen for axonal diffusivity and tract length.) Subdivision according to skeletal maturation showed the greatest tract lengths and volumes seen in stage 4b and not 4a. The intra-observer agreement was significant (P = 0.01) for all the measured variables, but agreement varied (femur 0.53 – 0.98; tibia 0.58 – 0.98). Spearman’s correlation showed a significant correlation for age (P = 0.05; P = 0.01) as well as for the fractional anisotropy value within all variables in both femur and tibia. Tract number and volume had a similar correlation with most variables, especially the DTI metrics, and would seem to be interchangeable. ConclusionThe current study indicates that DTI metrics could be a tool to assess the skeletal maturation process of the growth plate and its activity. Tractography seems promising to assess the activity of the growth plate in a younger population but must be used with caution in the more mature growth plate.

Normative values for hand grip and pinch strength for 6 to 18 year-olds in Saudi Arabia

BackgroundNormative values for hand grip and pinch strength among children in Saudi Arabia has not been well established. Therefore, the main aim of this study is to establish normative values for hand grip and pinch strength in children aged 6 to 18 years in Saudi Arabia.MethodsA cross-sectional study was conducted from different 5 regions in Saudi Arabia. Participants between the age of 6 years and 18 years old were recruited through different primary and secondary schools in Saudi Arabia. Data for age, gender, Body Mass Index, and preferred hand were collected. Hand grip strength was measured using digital hand dynamometer and the tip pinch, palmar pinch, and key pinch strength were measured using the hydraulic pinch gauge.ResultsA total of 616 participants included in this study (318 boys and 298 girls). Participants were stratified into 5 chronological age groups of 6–7 years, 8–9, 10–11, 12–13, 14–15, 16–17, and 18 years. The results showed an overall trend of increasing hand grip strength and pinch strength with age regardless of hand preference. Boys had significantly higher grip strength than girls in all age groups (P < 0.05).ConclusionThis study established normative values for hand grip and pinch strength in the healthy Saudi pediatric and adolescent population, using boys and girls aged 6 to 18. The outcomes of this study also demonstrated that gender, age, and hand preference can all have an impact on how strong a handgrip develops.

PS-P13-11: ASSOCIATION BETWEEN SPOT URINE SODIUM-TO-POTASSIUM RATIO AND BLOOD PRESSURE IN HEALTHY ADOLESCENTS: THE WAKAYAMA STUDY

Objective: Spot urine sodium to potassium ratio (Na/K) is a simple measure of sodium loading and has been shown to be associated with blood pressure (BP) levels. This study aimed to evaluate the association between spot urine Na/K and BP in a cross sectional sample of healthy adolescent population. Design and method: The study participants consisted of 457 healthy adolescents (217 males and 240 females) aged 12 to 15 years (mean age: 13.9 years). Brachial arterial BP was measured in the supine position using digital BP monitor with an appropriate cuff size. Urinary Na, K, and creatinine levels were measured using spot urine specimens collected in the early morning of the sampling day. Results: The spot urine Na/K levels of participants was 4.99 ± 2.76 (Na, 148.1 ± 58.4 mEq/L; K, 36.1 ± 18.7 mEq/L), and there was no significant difference between males and females. When the participants were stratified based on the quartiles of urinary Na/K distribution (&lt; 2.95, 2.95 to 4.54, 4.55 to 6.59, &gt; = 6.6), systolic and diastolic BP gradually increased with an increase in Na/K levels (systolic BP, 106.1, 106.9, 108.2, and 111.5 mmHg, P for trend &lt; 0.001; diastolic BP, 62.0, 62.4, 63.1, 64.3 mmHg, P for trend = 0.022). The Na/K was more closely associated with BP than urinary Na and K levels, as well as daily salt intake estimated from urinary Na. In multiple regression analysis, Na/K was significantly associated with systolic BP (β; = 0.144, P &lt; 0.001) and diastolic BP (β; = 0.114, P = 0.015), independent of potential confounding factors. The BP of the subgroup with high Na/K (&gt; = 6.6) and high salt intake (&gt; = 8.5 g/day) was significantly higher than that of those with only high salt intake (systolic BP, 115.0 mmHg vs. 109.1 mmHg, P &lt; 0.001; diastolic BP, 66.0 mmHg vs. 62.5 mmHg, P = 0.017). Conclusions: High Na/K levels is associated with elevated BP in healthy adolescents, and Na/K may be useful in assessing the effect of salt loading on BP than Na excretion alone.

The contribution of self-concept to sleep quality in adolescents: A cross-sectional study

ABSTRACT Self-concept has been associated with health-related behaviors and emotional self-regulation, which can improve sleep. However, its involvement in sleep quality in a healthy adolescent population has been little studied. This study evaluated the association between self-concept and sleep quality in adolescents adjusting for sleep/wake habits. The cross-sectional study included 1,751 adolescents, 54% females, with an age of M = 16.76 ± 1.04 years. The information was collected through an electronic survey that contained the Patient Health Questionnaire, Sleep Habits Questionnaire, Pittsburgh Sleep Quality Index, and Self-Concept Scale. A significant association between self-concept, adjustment for adolescents´ characteristics and sleep/wake habits was observed (R 2 = .17, F = 26.61, p < .001). That is, in addition to the adolescent habits, self-concept also contributed to the explanation of sleep/wake habits. These results reinforce the idea that the self-concept can be an essential factor that contributes to better sleep quality, despite the habits of adolescents.

Translation and transcultural validation of the Dutch hospital for special surgery paediatric functional activity brief scale (HSS Pedi-FABS)

BackgroundThere is a need for a validated simple Dutch paediatric activity scale. The purpose was to translate and transculturally validate the Dutch Hospital for Special Surgery Paediatric Functional Activity Brief Scale (HSS Pedi-FABS) questionnaire in healthy children and adolescents.MethodsThe original HSS Pedi-FABS was translated forward and backward and was transculturally adapted after performing a pilot study among children and professionals. The final version of the Dutch HSS Pedi-FABS was validated in healthy children and adolescents aged 10 to 18 years old. Children who had any condition or injury limiting their normal physical activity were excluded. The interval between the first questionnaire T0 (HSS Pedi-FABS, Physical Activity Questionnaire for children or adolescents (PAQ-C/A) and Tegner activity scale) and the second questionnaire T1 (HSS Pedi-FABS) was 2 weeks. Construct validity, interpretability and reliability were evaluated. Content validity was evaluated through cognitive interviews among a smaller group of children and through a questionnaire among professionals.ResultsTo evaluate content validity, 9 children and adolescents were interviewed, and 30 professionals were consulted. Content validity among professionals showed a relevance of less than 85% for most items on construct. However, content validity among children was good with a 92% score for item relevance. Readability was scored at a reading level of 11- to 12-year-olds. The validation group consisted of 110 healthy children and adolescents (mean age of 13.9 years ±2.6). Construct validity was considered good as 8 out of 10 hypotheses were confirmed. The Dutch HSS Pedi-FABS showed no floor or ceiling effect. Analysis of the internal consistency in the validation group resulted in a Cronbach’s alpha of 0.82. Test-retest reliability was evaluated among 69 children and adolescents and revealed an Intraclass Correlation Coefficient (ICC) of 0.76.ConclusionThe Dutch HSS Pedi-FABS showed good psychometric properties in a healthy Dutch paediatric and adolescent population. Limitations of the current Dutch HSS Pedi-FABS are content validity on construct of items reported by professionals.

Measurement properties of the six-minute pegboard and ring test (6PBRT) in healthy adolescents

ObjectivesTo investigate the cardiorespiratory responses to the 6-min pegboard and ring test (6PBRT) and to assess its reproducibility in healthy adolescents. MethodsIt was a cross-sectional study with 52 healthy adolescents (11–18 years old of both genders). The 6PBRT was performed twice on two different days by the same examiner. Intra-rater reliability, percentage of the minimal difference chance (MDC%) and agreement of the number of moving rings were analyzed. Also, cardiopulmonary parameters were collected before and after tests. ResultsIntraclass correlation coefficient (ICC) for the number of rings moved was 0.87 (95%CI 0.69–0.93). The mean number of moved rings during the second test was higher. The MDC% with a 95 % confidence interval was greater than acceptable values. Bland-Altman analysis did not show agreement between measurements (bias = 30.1); with upper and lower limits of agreement of −67.8 to 127.9, respectively. There was a significant increase in dyspnea, fatigue and HR values at the end of the tests (p < 0.0001). In both tests, participants reached HR equivalent to 48 % of the maximum predicted. ConclusionTogether, the results suggest that the 6PBRT is not a reliable measure for a population of healthy adolescents, which indicates the necessity to perform more than one test. The 6PBRT is suggested to be a submaximal test for this population.

Mental Health in New Mothers: A Randomised Controlled Study into the Effects of Dietary Flavonoids on Mood and Perceived Quality of Life.

The postnatal period is a significant period of physical, physiological and psychological change for mothers, rendering them particularly vulnerable to changes in mood or disorders such as postnatal depression (PND). Previous interventions with foods high in flavonoids have demonstrated beneficial acute and chronic mood effects in healthy child, adolescent and adult populations. It is unclear whether mood effects persist in populations who are potentially at-risk of developing mood disorders, such as postnatal mothers. This exploratory study investigated the effects of a 2-week daily dietary flavonoid intervention on mood (PANAS-NOW), anxiety (STAI), depressive symptoms (PHQ-8) and perceived quality of life (WHOQOL-BREF) in forty-one new mothers in the 0–12-month postnatal period, before and after flavonoid intervention. Mothers either added high flavonoid foods to their daily diet, or did not include additions following a randomised, between-groups, controlled design. Significant effects were observed in the flavonoid group with mothers reporting lower state anxiety and higher perceived quality of physical health at the 2-week timepoint. These findings suggest that regular dietary consumption of flavonoids may benefit mothers’ anxiety and perceived quality of life in the postnatal period. Replication of these results may indicate the potential for dietary flavonoids to promote healthy mood regulation in mothers or prevent the onset or severity of symptoms in postnatal psychological disorders, both of which would be beneficial for women’s health services and public mental health.

1104-P: Normative Fasting C-Peptide Values in Adolescents in the National Health and Nutrition Examination Surveys (NHANES)

Background: C-peptide values are used for evaluation of residual β-cell function as well as endpoints in clinical trials. Therefore, it is crucial to have normative standards as a reference. This study aims to report normative fasting C-peptide values and variations across demographics in healthy adolescents included in the NHANES dataset. Materials and Methods: In this analysis, we used fasting C-peptide data (n=2063) from the 1999-2004 NHANES dataset for participants ages 12 to &amp;lt; 18 yrs old. Results: The mean ± SE age of participants was 14.99 ± 0.06; 992 were females and 1071 were males. The majority (&amp;gt;80%) of females and males had a BMI percentile (%ile) &amp;lt;85%. Among males, geometric mean C-peptide levels increased from 0.52 nmol/L at age 12, to 0.66 nmol/L at age 15 yrs. Mean values decreased slightly at age 16 and increased back to 0.66 nmol/L at age 17 yrs. Among females, C-peptide levels fluctuated around a geometric mean of 0.67 nmol/L and age did not have a significant effect on C-peptide (p=0.15). Females had significantly higher mean log-transformed C-peptide concentrations than males (p&amp;lt;0.0001) after adjusting for age, race, and BMI %ile category. After adjusting for age and BMI %ile category, we found that in males, non-Hispanic blacks had significantly lower C-peptide levels than non-Hispanic whites (p=0.0026), Mexican Americans (p&amp;lt;0.0001) and other races including multiracial (p=0.0186). Similarly, in females, non-Hispanic blacks had significantly lower concentrations than non-Hispanic whites (p=0.0093), Mexican Americans (p&amp;lt;0.0001), and other Hispanics (p=0.0187). BMI %ile category was positively correlated with C-peptide levels in both males and females after adjusting for age and race. Conclusions: Here we describe normative fasting C-peptide in a healthy adolescent population. These data will provide novel information which can be used in assessing residual β-cell function and response to intervention therapy. Disclosure P. Y. Soni: None. Y. Wang: None. G. J. Eckert: None. H. M. Ismail: None.

Caffeinated energy drinks in the Canadian context: health risk assessment with a focus on cardiovascular effects.

In Canada, caffeinated energy drinks (CEDs) currently sold under Temporary Marketing Authorizations must meet strict eligibility criteria. These criteria, which include compositional and labelling requirements, were developed based on the outcome of a health risk assessment conducted by Health Canada (HC) in 2013. HC updated its assessment by reviewing new information with the focus on potential cardiovascular effects associated with the consumption of CEDs available for sale in Canada. Due to limited data on CED consumption among Canadians to derive accurate exposure information, the composition of a typical CED was characterized to assess the potential effects of single ingredients and synergistic interactions between ingredients on the cardiovascular system. Surveillance data on potential adverse effects related to CED consumption was also analyzed. After extensive review, HC's updated assessment confirms the current risk management approach for CEDs is health protective for Canadian consumers, including the potential for cardiovascular effects. The available evidence supports that moderate consumption (up to 500mL per day) of a typical CED authorized for sale in Canada is safe for the general population of healthy adults and adolescents. It also re-confirms that vulnerable sub-populations (i.e., children, pregnant and/or breastfeeding women, and caffeine-sensitive individuals) should not consume CEDs. Novelty: Consumption up to 500 mL per day of a typical CED is not associated with an increased risk of cardiovascular effects. Children, pregnant and/or breastfeeding women, and caffeine-sensitive individuals should not consume CEDs.

Non-invasive left ventricular myocardial work indices in healthy adolescents at rest.

Global myocardial work (GMW) provides a metric of left ventricular (LV) function and energy consumption. Its non-invasive assessment by echocardiography correlates with invasive measures and normal values have been reported in healthy adults. We aimed to establish normal values in a healthy adolescent population. Fifty-two healthy adolescents (mean age = 14.5 ± 2.0 years, range 11-19 years, 62% male) with normal echocardiograms were included. Brachial cuff blood pressure was obtained immediately following apical imaging in the supine position. Post-processing of echocardiograms for speckle tracking strain measurement and derivation of global myocardial work indices from LV pressure-strain loops was performed. The mean global work index (GWI) was 1802.0 ± 264.4 mmHg% with mean global work efficiency of 95.5 ± 1.1%. The mean global constructive work (GCW) was 2054.5 ± 297.3 mmHg%, and the mean global wasted work 83.8 ± 28.1 mmHg%. On multivariable analysis, there were significant associations between both GWI and GCW with systolic blood pressure (β coefficient = 0.57, p < 0.001; β coefficient = 0.67, p < 0.001 respectively) and LV global longitudinal strain (GLS) (β coefficient = - 0.56, p < 0.001; β coefficient = - 0.52, p < 0.001 respectively). There were no associations with any of the work indices with age, sex, body surface area, heart rate or LV ejection fraction. This study provides echocardiographic reference ranges for non-invasive indices of GMW in normal adolescents.