Higher Body Mass Index Percentile Research Articles

Gingival crevicular fluid and salivary resistin and tumor necrosis factor-alpha levels in obese children with gingivitis.

This study aimed to evaluate the levels of resistin and tumor necrosis factor-alpha (TNF-α) in gingival crevicular fluid (GCF) and saliva of obese children with gingivitis. One-hundred and thirty children (65 obese and 65 normal weight; age range 8 to 12 years) were recruited for the study. The children were classified into four subgroups based on their body mass and periodontal status; 1) obese children with gingivitis (OG, n=33); 2) obese children with healthy periodontium (OH, n=32); 3) normal weight children with gingivitis (NWG, n=32); 4) normal weight children with healthy periodontium (NWH, n=33). Body mass index (BMI) percentile, probing pocket depth (PPD), gingival index (GI), and plaque index (PI) were recorded. Resistin and TNF-α were analyzed in GCF and saliva samples by ELISA. Obese children had higher BMI percentiles than normal weight children (p<0.0001). PPD, GI, PI, GCF volume, GCF, and salivary resistin and TNF-α levels were similar between obese and normal weight children (P>0.05). OG and NWG subgroups had significantly higher GI, PI, GCF volume, GCF resistin total amounts, and salivary resistin concentrations but lower GCF resistin and TNF-α concentrations than OH and NWH (P<0.0001 for all). GCF resistin total amounts were positively correlated with GI, PI, and GCF TNF-α total amounts (P<0.05). To our knowledge, this is the first study evaluated the levels of resistin in GCF and saliva of children. Obesity is not associated with GCF and salivary resistin and TNF-α levels in children in the presence of gingival inflammation.

O15 - Difference in Eating Patterns Between Children with Siblings and Without Siblings

Background (Background, Rationale, Prior Research, and/or Theory): Children without siblings (singletons) have higher rates of obesity than children with siblings (non-singletons). Early eating patterns predict child obesity, but have not been compared between these groups. Objective: The purpose of this study was to examine the differences in eating patterns between singleton and non-singleton children. Study Design, Setting, Participants, Intervention: Mothers of singleton children ages 5.0–7.9 years old and mothers of non-singleton children ages 5.0–7.9 years old with a sibling between the ages of 2.0–4.9 years old were recruited. Height, weight, and waist circumference (WC) of the 5.0-7.9-year-old child were objectively measured. Mothers reported child demographic characteristics and completed a three-day food/beverage diary for the child. Outcome Measures and Analysis: Body mass index (BMI) was calculated, and BMI and WC percentiles were calculated for age and sex. Healthy Eating Index 2010 (HEI score) was calculated for each day and averaged. Results: Seventy-two mother-child dyads (28 singletons and 44 non-singletons) participated. On average children were 5.7 ± 0.7 years old, 50% male, and predominantly white (65%). Singletons had a higher BMI percentile (73.7 ± 29.8) and WC percentile (67.2 ± 27.6) compared to non-singletons (53.2 ± 28.5, P = .01; 51.7 ± 24.2, P < .01). Singletons had a significantly lower HEI score (60.0 ± 13.4) compared to non-singletons (67.1 ± 13.4. P < .01). Singletons continued to have a lower HEI score on weekdays by 5.1 points (P = .01) and weekends by 11.1 points (P < .01), independent of age and sex. When comparing constituent factors of the HEI score, singleton children consumed less seafood/plant protein, sodium, and refined grains on weekdays than non-singletons. On weekends, singleton children had lower total vegetables, greens and beans, and seafood/plant protein consumption than non-singletons. Conclusions and Implications: In this sample, singletons had a higher BMI percentile and had lower HEI scores compared to non-singletons. Investigation into differences in singleton/non-singleton families, including family health behaviors, may support understanding of the mechanism. Funding: College of Allied Health Student Research and Creativity Grant, Department of Nutritional Sciences.

Feasibility of Ideal Cardiovascular Health Evaluation in a Pediatric Clinic Setting.

The feasibility of “point-of-care” screening for ideal cardiovascular health was explored in a pediatric specialty clinic setting. Children and adolescents aged 9–18 years (n=91) with treated and stabilized diseases were recruited at a pediatric endocrinology clinic. A table-top device was used to assay fingerstick samples for non-HDL cholesterol (non-HDL-C), which was used to divide participants into two groups based on the non-HDL-C threshold for comparison of the remaining metrics between groups. A significant number of children had low scores, and score frequency distribution was similar to larger retrospective studies, with few participants achieving none or all of the health metrics. Healthy diet was the metric least often achieved. Those with a non-HDL-C above the ideal threshold of 3.1 mmol/L (120 mg/dl) had a higher BMI percentile (p<0.01) and diastolic blood pressure percentile (p<0.05). We conclude that pediatric risk factor screening and scoring can be performed in a specialty clinic with meaningful cardiovascular health scores for patients and providers. Association of abnormal “point-of care” non-HDL-C levels with elevated BMI and blood pressure supports evidence for risk factor clustering and use of the ideal health construct in pediatric clinic settings.

Difference In Physical Activity Between Children Without Siblings And With Siblings

Children without siblings, singletons, have higher rates of obesity than children with siblings, non-singletons. Physical activity, such as increased moderate-to-vigorous physical activity (MVPA) and decreased sedentary behavior, can curb excess weight gain early in life. PURPOSE: The purpose of this study is to examine the differences in physical activity and sedentary behavior between singleton and non-singleton children. METHODS: Mothers of singleton children ages 5.0-7.9 years old and mothers of non-singleton children ages 5.0-7.9 years old with a sibling between the ages of 2.0-4.9 years old in their primary household were recruited. Height, weight, and waist circumference (WC) of child were objectively measured. Mothers reported demographic characteristics of the child and self, and completed a questionnaire on their physical activity. Children wore an accelerometer at the ankle for at least 5 full days while parents recorded daily activities and time spent in away from home care (such as child care or kindergarten). Body mass index (BMI) was calculated, and BMI and WC percentiles were calculated for age and sex. MVPA and sedentary behavior per hour were calculated using accelerometer cut points and total wear time. RESULTS:43 mother-child dyads (10 singletons and 33 non-singletons) participated. On average mothers were 34.7 years old, employed full time (69%), married (77%), and the child’s biological mothers (97%); while children were 5.81 years old and predominantly white (62%). Singletons had a higher BMI percentile (80.1±21.3) and waist circumference percentile (77.6±21.7) compared to non-singletons (55.7±29.0, p=0.02; 53.4±21.3, p<0.01). In individual models, singletons did not differ in time away from home care (p=0.60) or in their mother’s average MET minutes per week compared to non-singleton children (p=0.90). After adjusting for child BMI percentile and month of wear, singletons spent 2.96 less minutes per hour in MVPA (p<0.01) and 5.18 more minutes per hour in sedentary behavior compared to non-singletons (p=0.01). CONCLUSIONS: In this sample, singletons had a higher BMI percentile and were less active compared to non-singletons. Investigation into differences in singleton/ non-singleton families, including family health behaviors, may support understanding of the mechanism.

Doppler Echocardiography Assessment of Aortic Stiffness in Female Adolescents with Anorexia Nervosa

Anorexia nervosa (AN) is associated with abnormalities in biomarkers of cardiovascular risk. Arterial stiffness, as measured by pulse-wave velocity (PWV), is also a risk factor for cardiovascular disease. The aims of this study were to determine the stiffness of the aorta in female adolescents with AN and to determine if either the severity or the type of AN was associated with PWV. This was a retrospective case-control study. Adolescent patients with a clinical diagnosis of AN were included. Aortic diameter and pulse-wave transit time over a portion of the thoracic aorta were measured using Doppler echocardiography, and PWV was calculated. There were 94 female patients with AN and 60 adolescent female control subjects. There was no significant difference in age between patients with AN and control subjects (15.5±1.7 vs 15.1±2.6years, P=.220). Body mass index (16.0±2.4 vs 19.7±2.7kg/m2, P<.001) and body mass index percentile (9.4±15.6 vs 45.5±26.2, P<.001) were significantly lower for patients with AN than control subjects.PWV (443±106 vs 383±77cm/sec, P<.001) was significantly higher in patients with AN than control subjects. Similar differences from control subjects were found in patients with AN with both lower and higher body mass index percentiles and also in patients with AN with the restrictive or the binge-purge subtype. Female adolescents with AN have increased aortic stiffness compared with control subjects. This study suggests that patients with AN may be at increased risk for future cardiovascular disease. Future studies are required to determine the reversibility of these changes with weight restoration.

Body Mass Index Affects Proximal Femoral but Not Acetabular Morphology in Adolescents Without Hip Pathology.

Increased mechanical load secondary to a large body mass index (BMI) may influence bone remodeling. The purpose of this study was to investigate whether BMI is associated with the morphology of the proximal part of the femur and the acetabulum in a cohort of adolescents without a history of hip disorders. We evaluated pelvic computed tomographic (CT) images in 128 adolescents with abdominal pain without a history of hip pathology. There were 44 male patients (34%) and the mean patient age (and standard deviation) was 15 ± 1.95 years. The alpha angle, head-neck offset, epiphysis tilt, epiphyseal angle, and epiphyseal extension were measured to assess femoral morphology. Measurements of acetabular morphology included lateral center-edge angle, acetabular Tönnis angle, and acetabular depth. BMI percentile, specific to age and sex according to Centers for Disease Control and Prevention growth charts, was recorded. BMI percentile was associated with all measurements of femoral morphology. Each 1-unit increase in BMI percentile was associated with a mean 0.15° increase in alpha angle (p < 0.001) and with a mean 0.03-mm decrease in femoral head-neck offset (p < 0.001). On average, a 1-unit increase in BMI percentile was associated with a 0.0006-unit decrease in epiphyseal extension (p = 0.03), a 0.10° increase in epiphyseal angle (p < 0.001), and a 0.06° decrease in tilt angle (p = 0.02; more posteriorly tilted epiphysis). There was no detected effect of BMI percentile on acetabular morphology including lateral center-edge angle (p = 0.33), Tönnis angle (p = 0.35), and acetabular depth (p = 0.88). Higher BMI percentile was associated with increased alpha angle, reduced head-neck offset and epiphyseal extension, and a more posteriorly tilted epiphysis with decreased tilt angle and increased epiphyseal angle. This morphology resembles a mild slipped capital femoral epiphysis deformity and may increase the shear stress across the growth plate, increasing the risk of slipped capital femoral epiphysis development in obese adolescents. BMI percentiles had no association with measurements of acetabular morphology. Further studies will help to clarify whether obese asymptomatic adolescents have higher prevalence of a subclinical slip deformity and whether this morphology increases the risk of slipped capital femoral epiphysis and femoroacetabular impingement development.

Serum Thyroid-Stimulating Hormone Levels and Body Mass Index Percentiles in Children with Primary Hypothyroidism on Levothyroxine Replacement.

Objective:To determine the association, if any, between thyroid-stimulating hormone (TSH) levels and body mass index (BMI) percentiles in children with primary hypothyroidism who are chemically euthyroid and on treatment with levothyroxine.Methods:This retrospective cross-sectional study consisted of a review of medical records from RUSH Medical Center and Stroger Hospital, Chicago, USA of children with primary hypothyroidism who were seen in the clinic from 2008 to 2014 and who were chemically euthyroid and on treatment with levothyroxine for at least 6 months. The patients were divided into two groups based on their TSH levels (0.34-<2.5 mIU/L and ≥2.5-5.6 mIU/L). The data were analyzed by Spearman rank correlation, linear regression, cross tabulation and chi-square, Mann-Whitney U test, and Kruskal-Wallis test.Results:One hundred and forty-six children were included, of which 26% were obese (BMI ≥95%), 21.9% overweight (BMI ≥85-<95%), and 52.1% of a healthy weight (BMI ≥5-<85%). There was a significant positive correlation between TSH and BMI percentiles (r=0.274, p=0.001) and a significant negative correlation between TSH and serum free T4 (r=-0.259, p=0.002). In the lower TSH group, 68.4% of the children had a healthy weight, while the percentage of obese children was 60.5% in the upper TSH group (p=0.012).Conclusion:In children diagnosed with primary hypothyroidism who are chemically euthyroid on treatment with levothyroxine, there is a positive association between higher TSH levels and higher BMI percentiles. However, it is difficult to establish if the higher TSH levels are a direct cause or a consequence of the obesity. Further studies are needed to establish causation beyond significant association.

Prediabetes is associated with genetic variations in the gene encoding the Kir6.2 subunit of the pancreatic ATP-sensitive potassium channel (KCNJ11): A case-control study in a Han Chinese youth population.

The E23K variant of the potassium voltage-gated channel subfamily J member 11 (KCNJ11) gene has been reported to be associated with type 2 diabetes (T2D) in many populations. However, little is known about the role of E23K in the development of prediabetes in Chinese youth. To investigate the role of E23K in the development of prediabetes, 279 subjects with prediabetes and 240 normal controls (mean [± SD] age 18.1 ± 3.2 and 17.8 ± 4.3 years, respectively) were recruited to the study. Height, weight, and hip and waist circumferences were measured by trained physicians. Genotyping of KCNJ11 polymorphisms and clinical laboratory tests to determine cholesterol, triglyceride (TG), blood glucose, and insulin levels were performed. The carrier rate of K23 allele-containing genotypes was higher for prediabetic than control subjects (P = 0.005). Logistic regression analyses revealed that higher body mass index percentiles (P = 0.013), lower insulin levels at 30 min during an oral glucose tolerance test (P = 0.001), a higher ratio of total cholesterol: high-density lipoprotein cholesterol (P = 0.001), and a K allele-containing genotype (P = 0.019) are independent risk factors for prediabetes in Chinese Han youth. Furthermore, K23 allele-containing genotypes were associated with impaired indices of insulin secretion and β-cell function in female youth with prediabetes. These effects were not seen in male youth with prediabetes. The results confirm that the common E23K polymorphism of KCNJ11 carries a higher susceptibility to the development of prediabetes in the Chinese Han population. The results suggest that E23K may have a greater effect on the development of T2D in female Chinese youth.

Chronic Pain and Obesity Within a Pediatric Interdisciplinary Pain Clinic Setting: A Preliminary Examination of Current Relationships and Future Directions.

Pediatric obesity and chronic pain are 2 of the most significant public health crises affecting youth today. Despite the high number of youth experiencing both chronic pain and obesity, little research has been done examining their relationship. This study aims to both replicate and extend this research base. A retrospective chart review of 99 patients presenting for evaluation in a pediatric pain clinic was conducted. Demographic information, including patient weight status, and self-report measures completed by both patients and their parents, including the Pain Frequency-Severity-Duration scale, the Functional Disability Inventory, and the Pain Catastrophizing Scale were examined. Abdominal pain was the most frequently reported primary pain diagnosis category, with headache, diffuse musculoskeletal, localized musculoskeletal, and back pain categories reported from greatest to least frequency. Results show that 29% of our sample was obese. Age was related to weight status such that older children were more likely to have a higher body mass index. Among school-aged children, a higher body mass index percentile was associated with greater parent-reported pain catastrophizing. Obese youth had higher parent-reported Functional Disability Inventory scores than those in the normal weight group. Post hoc comparisons identified that this finding was only significant for girls. Further, obese youth were more likely to have a longer pain duration than those classified as normal weight. The results of this study add to the growing literature regarding the importance of taking weight status into account when intervening with youth with chronic pain.

Measuring Children's Physical Activity: Compliance Using Skin-Taped Accelerometers.

Accelerometer-based physical activity monitoring has become the method of choice in many large-scale physical activity (PA) studies. However, there is an ongoing debate regarding the placement of the device, the determination of device wear time, and how to solve a lack of participant compliance. The aim of this study was to assess the compliance of Axivity AX3 accelerometers taped directly to the skin of 9- to 13-yr-old children. Children in 46 school classes (53.4% girls, age 11.0 ± 1.0 yr, BMI 17.7 ± 2.8 kg·m) across Denmark wore two Axivity AX3 accelerometers, one taped on the thigh (n = 903) and one on the lower back (n = 856), for up to 10 consecutive days. Participants were instructed not to reattach an accelerometer should it fall off. Simple and multiple linear regressions were used to determine associations between accelerometer wear time and age, sex, BMI percentiles, and PA level. More than 65% had >7 d of uninterrupted, 24-h wear time for the thigh location and 59.5% for the lower back location. From multiple linear regressions, PA levels showed the strongest association with lower wear time (thigh: β = -0.231, R = 0.066; lower back: β = -0.454, R = 0.126). In addition, being a boy, being older (only for lower back), and having higher BMI percentile were associated with lower wear time. Using skin-taped Axivity accelerometers, we obtained 7 d of uninterrupted accelerometer data with 24-h wear time per day with a compliance rate of more than 65%. Thigh placement resulted in higher compliance than lower back placement. Achieving days with 24-h wear time reduces the need for arbitrary decisions regarding wear time validation and most likely improves the validity of daily life PA measurements.

Physical Activity, Sleep, and BMI Percentile in Rural and Urban Ugandan Youth

BackgroundUganda is experiencing a dual burden of over- and undernutrition, with overweight prevalence increasing while underweight remains common. Potential weight-related factors, particularly physical activity, sleep, and rural/urban status, are not currently well understood or commonly assessed in Ugandan youth. ObjectiveThe purpose of this study was to pilot test a survey measuring weight-related factors in rural and urban Ugandan schoolchildren. MethodsA cross-sectional survey measured sociodemographics, physical activity, sleep patterns, and dietary factors in 148 rural and urban schoolchildren aged 11-16 in central Uganda. Height and weight were objectively measured. Rural and urban youth were compared on these factors using χ2 and t tests. Regression was used to identify correlates of higher body mass index (BMI) percentile in the full sample and nonstunted youth. FindingsYouth were on average 12.1 ± 1.1 years old; underweight (10%) was more common than overweight (1.4%). Self-reported sleep duration and subjective sleep quality did not differ by rural/urban residence. Rural children overall had higher BMI percentile and marginally higher stunting prevalence. In adjusted analyses in both the full and nonstunted samples, higher BMI percentile was related to living in a rural area, higher frequency of physical activity, and higher subjective sleep quality; it was negatively related to being active on weekends. In the full sample, higher BMI percentile was also related to female gender, whereas in nonstunted youth, higher BMI was related to age. BMI percentile was unrelated to sedentary time, performance of active chores and sports, and dietary factors. ConclusionsThis study is one of the first to pilot test a survey assessing weight-related factors, particularly physical activity and sleep, in Ugandan schoolchildren. BMI percentile was related to several sociodemographic, sleep, and physical activity factors among primarily normal-weight school children in Uganda, providing a basis for understanding weight status in the context of the nutrition transition.

Child body mass index, genotype and parenting in the prediction of restrictive feeding.

Restrictive feeding is implicated in pediatric obesity, and caregivers increase controlling feeding practices on the basis of higher child weight status. However, few studies have examined how child genetic and parenting characteristics together impact restrictive feeding. We examined whether child body mass index (BMI) status predicts caregiver use of restrictive feeding and if this association is moderated by (i) caregiver strategies to manage their children's distress and (ii) child variations in the catechol-O-methyltransferase (COMT) gene (Val158 Met, rs4680). Participants included 126 Caucasian children (50% girls) and their caregivers who were participating in a larger study in the USA. Caregivers reported on their feeding practices and responses to child distress when children were 2.5-3.5years of age. Child anthropometric measurements were also obtained. Restrictive feeding was assessed again 1-1.5years later. Genomic DNA was obtained from saliva samples, and COMT-rs4680 was genotyped using TaqMan® methodology. Child BMI percentile predicted subsequent caregiver restrictive feeding for children who were Met/Met and who had caregivers reporting higher use of negative responses to child distress. For Val carriers, BMI percentile predicted restrictive feeding when caregivers were below the mean on these responses. Caregivers are at risk for use of restrictive feeding practices when their children are at higher BMI percentiles, and this association increases when caregivers use more ineffective stress regulation practices and their children are homozygous for the Met allele. Prevention programmes might focus on parenting behaviours that foster emotion regulation and consider variation in child responses to parenting.

Body weight affects ω-3 polyunsaturated fatty acid (PUFA) accumulation in youth following supplementation in post-hoc analyses of a randomized controlled trial.

Guidelines for suggested intake of ω-3 polyunsaturated fatty acids (PUFAs) are limited in youth and rely primarily on age. However, body weight varies considerably within age classifications. The current analyses examined effects of body weight and body mass index (BMI) on fatty acid accumulation in 64 youth (7–14 years) with a diagnosed mood disorder in a double-blind randomized-controlled trial (2000mg ω-3 supplements or a control capsule) across 12 weeks. Weight and height were measured at the first study visit and EPA and DHA levels were determined using fasting blood samples obtained at both the first and end-of-study visits. In the ω-3 supplementation group, higher baseline body weight predicted less plasma accumulation of both EPA [B = -0.047, (95% CI = -0.077; -0.017), β = -0.54, p = 0.003] and DHA [B = -0.02, (95% CI = -0.034; -0.007), β = -0.52, p = 0.004]. Similarly, higher BMI percentile as well as BMI category (underweight, normal weight, overweight/obese) predicted less accumulation of EPA and DHA (ps≤0.01). Adherence to supplementation was negatively correlated with BMI percentile [B = -0.002 (95% CI = -0.004; 0.00), β = -0.44, p = 0.019], but did not meaningfully affect observed associations. As intended, the control supplement exerted no significant effect on plasma levels of relevant fatty acids regardless of youth body parameters. These data show strong linear relationships of both absolute body weight and BMI percentile with ω-3 PUFA accumulation in youth. A dose-response effect was observed across the BMI spectrum. Given increasing variability in weight within BMI percentile ranges as youth age, dosing based on absolute weight should be considered. Moreover, effects of weight should be incorporated into statistical models in studies examining clinical effects of ω-3 PUFAs in youth as well as adults, as weight-related differences in effects may contribute meaningfully to inconsistencies in the current literature.Trial registration. WHO International Clinical Trial Registry Platform NCT01341925 and NCT01507753

Implementation of a School Nurse-led Intervention for Children With Severe Obesity in New York City Schools

PurposeThe Healthy Options and Physical Activity Program (HOP) is a school nurse-led intervention for children with severe obesity. HOP was developed by experts at the New York City Department of Health and Mental Hygiene and implemented in New York City schools beginning in 2012. The purpose of this study was to evaluate HOP implementation with the goal of informing HOP refinement and potential future HOP dissemination. Design and MethodsThis study entailed a retrospective analysis of secondary data. Analytic methods included descriptive statistics, Wilcoxon rank sum and Chi square tests, and multivariate logistic regression. ResultsDuring the 2012–2013 school year, 20,518 children were eligible for HOP. Of these, 1054 (5.1%) were enrolled in the program. On average, enrolled children attended one HOP session during the school year. Parent participation was low (3.2% of HOP sessions). Low nurse workload, low school poverty, higher grade level, higher BMI percentile, and chronic illness diagnosis were associated with student enrollment in HOP. ConclusionsAs currently delivered, HOP is not likely to be efficacious. Lessons learned from this evaluation are applicable to future nurse-led obesity interventions. Practice ImplicationsPrior to implementing a school nurse-led obesity intervention, nursing workload and available support must be carefully considered. Interventions should be designed to facilitate (and possibly require) parent involvement. Nurses who deliver obesity interventions may require additional training in obesity treatment. With attention to these lessons learned, evidence-based school nurse-led obesity interventions can be developed.

Serum polychlorinated biphenyls and their hydroxylated metabolites are associated with demographic and behavioral factors in children and mothers

Factors contributing to the inter-individual variation in body burden of polychlorinated biphenyls (PCBs) and their hydroxylated metabolites (OH-PCBs) have not been fully elucidated. We examined associations between total serum concentrations of 209 PCBs, 64 OH-PCBs, and frequently detected individual congeners with demographic characteristics (age, gender, ethnicity and community of residence), body mass index (BMI or BMI percentile), and breastfeeding history in children and their mothers from 83 U.S. households. There was a significant positive association between age and concentrations of total PCBs and OH-PCBs in mothers. Non-Hispanics had significantly higher concentrations of total PCBs in mothers and OH-PCBs in children than Hispanics. Concentrations of total PCBs were significantly lower in mothers who had longer breastfeeding duration. Living in the Columbus Junction, Iowa community as compared to East Chicago, Indiana was associated with higher total PCBs in children, probably attributable to higher exposures at school. Lower concentrations of OH-PCBs were significantly associated with a higher BMI percentile in children. Congener-specific associations were observed for 30 PCB and 12 OH-PCB congeners and followed comparable trends. To our knowledge, this is the first study to examine factors contributing to variations in serum concentrations of total 209 PCBs and total OH-PCBs in children, as well as to examine ethnic differences in OH-PCB levels. Results from this study revealed that demographic characteristics, body mass index and breastfeeding history are factors that should be considered for human exposure and risk assessment of PCBs and OH-PCBs.

The role of glycemia in insulin resistance in youth with type 1 and type 2 diabetes.

Hyperglycemia has traditionally been considered a major contributor to insulin resistance (IR) in type 1 diabetes (T1D), yet studies examining the relationship between HbA1c and IR are conflicting. Glucose measures captured by continuous glucose monitoring (CGM) (eg, peak glucose, standard deviation, hypoglycemia) in youth have not been explored as predictors of insulin sensitivity (IS). Assess the relationship between IS and glycemia in youth with T1D and type 2 diabetes (T2D). Sedentary 12-19 year olds with diabetes had peripheral IS measured by hyperinsulinemic-euglycemic clamp. HbA1c and 3 days of CGM data were also collected. Spearman correlation coefficients were calculated to examine the association between variables. Participants included 100 youth with T1D [46% male, median body mass index (BMI) 74 percentile, HbA1c 8.5%] and 42 with T2D (26% male, BMI 99 percentile, HbA1c 6.9%). Nineteen with T1D and 13 with T2D also wore CGM. In T2D youth, higher HbA1c, average sensor glucose, area under the CGM curve, and metabolic syndrome characteristics correlated with lower IS. In T1D youth, higher BMI percentile, waist circumference, triglycerides, and LDL cholesterol, but not HbA1c, correlated with lower IS. Moreover, higher CGM overnight means glucose correlated with greater IS, and CGM hypoglycemia correlated with lower IS. Markers of metabolic syndrome and hyperglycemia predicted decreased IS in T2D youth. Paradoxically, hypoglycemia predicted decreased IS in T1D youth and hyperglycemia, particularly overnight, predicted improved IS. These preliminary results imply different mechanisms underlying IR in T1D vs T2D and suggest a role for non-insulin therapies in T1D to improve IR.

Frequency of overweight and obesity in children and adolescents with autism and attention deficit/hyperactivity disorder

ObjectiveTo assess the frequency of overweight and obesity in children and adolescents with autism spectrum disorder (ASD) and with attention deficit/hyperactivity disorder (ADHD) and their parents, in comparison with children and adolescents without developmental disorders. MethodsAnthropometric measures were obtained in 69 outpatients with ASD (8.4±4.2 years old), 23 with ADHD (8.5±2.4) and 19 controls without developmental disorders (8.6±2.9) between August and November 2014. Parents of patients with ASD and ADHD also had their anthropometric parameters taken. Overweight was defined as a percentile ≥85; obesity as a percentile ≥95; and underweight as a percentile ≤5. For adults, overweight was defined as a BMI between 25 and 30kg/m2 and obesity as a BMI higher than 30kg/m2. ResultsChildren and adolescents with ASD and ADHD had higher BMI percentile (p<0.01) and z-score (p<0.01) than controls, and increased frequency of overweight and obesity (p=0.04). Patients with ASD and ADHD did not differ between them in these variables, nor regarding abdominal circumference. Parents of children with ASD and ADHD did not differ between themselves. ConclusionsChildren and adolescents with ASD and ADHD are at a higher risk of overweight and obesity than children without developmental problems in the community.

Frequência de sobrepeso e obesidade em crianças e adolescentes com autismo e transtorno do déficit de atenção/hiperatividade

ObjectiveTo assess the frequency of overweight and obesity in children and adolescents with autism spectrum disorder (ASD) and with attention deficit/hyperactivity disorder (ADHD) and their parents, in comparison with children and adolescents without developmental disorders. MethodsAnthropometric measures were obtained in 69 outpatients with ASD (8.4±4.2 years old), 23 with ADHD (8.5±2.4) and 19 controls without developmental disorders (8.6±2.9) between August and November 2014. Parents of patients with ASD and ADHD also had their anthropometric parameters taken. Overweight was defined as a percentile ≥85; obesity as a percentile ≥95; and underweight as a percentile ≤5. For adults, overweight was defined as a BMI between 25 and 30kg/m2 and obesity as a BMI higher than 30kg/m2. ResultsChildren and adolescents with ASD and ADHD had higher BMI percentile (p<0.01) and z‐score (p<0.01) than controls, and increased frequency of overweight and obesity (p=0.04). Patients with ASD and ADHD did not differ between them in these variables, nor regarding abdominal circumference. Parents of children with ASD and ADHD did not differ between themselves. ConclusionsChildren and adolescents with ASD and ADHD are at a higher risk of overweight and obesity than children without developmental problems in the community.

Asthma-associated comorbidities in children with and without secondhand smoke exposure

BackgroundSecondhand smoke (SHS) exposure is known to trigger asthma, but asthma disease severity and comorbidities in children exposed to SHS are not very well quantified. ObjectiveTo identify comorbidities and understand health care usage in children with asthma exposed to SHS (cases) compared with children with asthma but without SHS exposure (controls). MethodsA retrospective nested matched case-and-control study was conducted with children 5 to 18 years old who were enrolled in the Pediatric Asthma Management Program. Pulmonary function testing (spirometry, methacholine challenges, and exhaled nitric oxide) and body mass index were reviewed. Influenza vaccination rates, oral steroid usage, emergency department visits, and hospitalizations were assessed. Network analysis of the 2 groups also was conducted to evaluate for any associations between the variables. ResultsCases had significantly higher body mass index percentiles (>75%, odds ratio [OR] 1.64, 95% confidence interval [CI] 1.22–2.2, P = .001). Cases were less likely to have had a methacholine challenge (OR 0.49, 95% CI 0.36–0.68, P < .001) and an exhaled nitric oxide (OR 0.6, 95% CI 0.37–0.97, P = .04) performed than controls. The ratio of forced expiration volume in 1 second to forced vital capacity and forced expiration volume in 1 second were lower in cases than in controls (P < .05). Cases were less likely to have received an influenza vaccination (OR 0.61, 95% CI 0.45–0.82, P = .001) than controls. Unsupervised multivariable network analysis suggested a lack of discrete and unique subgroups between cases and controls. ConclusionChildren with asthma exposed to SHS are more likely to have comorbid conditions such as obesity, more severe asthma, and less health care usage than those not exposed to SHS. Smoking cessation interventions and addressing health disparities could be crucial in this vulnerable population.

Rate of Uptake of Ivacaftor Use after FDA Approval among Patients Enrolled in the United States Cystic Fibrosis Foundation Patient Registry

Chronic cystic fibrosis (CF) therapies have variable rates of prescribed use, and therapies are rarely prescribed to more than 80% of eligible patients. Ivacaftor was approved in the United States in January 2012 for patients ages 6 years and older with a G551D mutation in their CF gene. To examine the rate of uptake and patterns of documented ivacaftor use among U.S. patients with CF during the first year after approval, to compare eligible patients with and without reported use, and to describe characteristics of early adopters of ivacaftor use. A cross-sectional study of patients in the U.S. Cystic Fibrosis Foundation Patient Registry in 2012 with at least one encounter in which ivacaftor use was documented. Ivacaftor-eligible patients were defined as any individual 6 years of age or older with a G551D mutation. We performed bivariate and multivariate regression analyses, stratified by age group, to compare clinical and demographic characteristics of (1) eligible patients with and without documented ivacaftor use in 2012 and (2) early (February-June) versus late (July-December) adopters in 2012. A total of 1,087 patients with CF with G551D mutations were in the U.S. Cystic Fibrosis Foundation Patient Registry in 2012. By June 2012, 64% of eligible patients had documented ivacaftor use, which increased to 81% by the end of 2012. Among eligible patients younger than 18 years of age, 85% were prescribed ivacaftor, with significantly lower odds among those with higher BMI percentile, fewer clinical encounters in 2011, and later age at diagnosis. Among eligible patients age 18 years or older, 79% were prescribed ivacaftor, with significantly lower odds in nonwhite patients and those with later age at diagnosis. Documented prescriptions of ivacaftor also varied by state of residence, with a range of 42-100% of eligible patients across states. The only association with early adoption of ivacaftor in 2012 was a decreased likelihood in adults with fewer than four encounters in 2011. Uptake of ivacaftor use among eligible patients in the United States was rapid, with the majority of use initiated within 4 months of regulatory approval. Differences in ivacaftor prescriptions appear to be related to patient age, older age at diagnosis, and less frequent clinical encounters. Nutritional status also appears to play a role in children, and race seems to have an association in adults.