Increase In Body Mass Index Percentile Research Articles

Association Between Age- and Sex-Specific Body Mass Index Percentile and Multiple Intubation Attempts: A Retrospective Cohort Analysis.

Obesity distorts airways and slightly complicates intubations in adults, but whether obesity complicates pediatric intubations remains unclear. We, therefore, tested the primary hypothesis that increasing age- and sex-specific body mass index (BMI) percentile is associated with difficult intubation, defined as >1 intubation attempt. We conducted a retrospective analysis of pediatric patients between 2 and 18 years of age who had noncardiac surgery with oral endotracheal intubation. We assessed the association between BMI percentile and difficult intubation, defined as >1 intubation attempt, using a confounder-adjusted multivariable logistic regression model. Secondarily, we assessed whether the main association depended on preoperative substantial airway abnormality status or age group. A total of 9339 patients were included in the analysis. Median [quartiles] age- and sex-specific BMI percentile was 70 [33, 93], and 492 (5.3%) patients had difficult intubation. There was no apparent association between age- and sex-specific BMI percentile and difficult intubation. The estimated odds ratio (OR) for having difficult intubation for a 10-unit increase in BMI percentile was 0.98 (95% confidence interval [CI], 0.95-1.005) and was consistent across the 3 age groups of early childhood, middle childhood, and early adolescence (interaction P = .53). Patients with preoperative substantial airway abnormalities had lower odds of difficult intubation per 10-unit increase in BMI percentile, with OR (95% CI) of 0.83 (0.70-0.98), P = .01. Age- and sex-specific BMI percentile was not associated with difficult intubation in children between 2 and 18 years of age. As in adults, obesity in children does not much complicate intubation.

Maternal prenatal cortisol trajectories predict accelerated growth in infancy

Higher maternal cortisol in pregnancy has been linked to childhood obesity. Much of the previous research has been limited in that cortisol in pregnancy is only measured at one time-point, precluding the ability to examine critical timing effects of prenatal maternal cortisol. To fill this gap, this longitudinal study measured maternal plasma cortisol at 15, 19, 25, and 31 weeks of pregnancy, and assessed infant body mass index percentile (BMIP)11Body mass index percentile. at birth, 3, 6, 12, and 24 months in 189 mother-infant pairs. Three distinct patterns of maternal cortisol in pregnancy (typical, steep, and flat trajectories) were identified using general growth mixture modeling (GGMM)22General growth mixture modeling. and then used to predict child growth patterns using multilevel modeling. Infants of mothers who had flat cortisol trajectories, characterized by relatively high cortisol in early gestation that plateaus by mid-gestation, experienced more rapid increases in BMIP from birth to 6 months, and had higher BMIPs at 3 and 6 months, than infants whose mothers had the typical slow cortisol rise over gestation, or steep (rapidly accelerating) trajectories. These results suggest that it is not just the total amount of maternal cortisol in pregnancy that shapes early infant growth, but instead the timing and trajectory of prenatal cortisol exposure. To better understand the early origins of obesity risk, future research is needed to investigate the factors that shape mothers’ prenatal cortisol trajectories.

211 Increasing body mass index percentile in cystic fibrosis clinic using novel algorithm

211 Increasing body mass index percentile in cystic fibrosis clinic using novel algorithm

High Prevalence and Lack of Parental Awareness of Pediatric Hypertension Among a Low-income Sample in Worcester, MA.

To identify frequency and correlates of hypertension in a low income, ethnically diverse, sample of children as well as to assess parental awareness of hypertension. This cross-sectional study included parent-child dyads (n = 228), from which physical measurements of the child, and parent reported survey measures were collected. Child's blood pressure percentile was determined via 2017 American Academy of Pediatrics (AAP) clinical practice guidelines and categorized as normal (< 90th percentile), elevated (≥ 90th percentile to < 95th percentile), or hypertensive (≥ 95th percentile). Bivariate multinomial logistic regression models assessed the relative risk ratio for potential correlates of blood pressure categorization and frequency distribution of parental awareness of blood pressure status was examined. Median child age was 8.1 years (IQR 6.5-9.9). Half were female, 61.8% were Latino and 15.8% were Non-Latino Black. Median body mass index (BMI) percentile was 83.6 (IQR 58.4-97.1) and 31.6% exceeded the 95th percentile. AAP criteria for hypertension and elevated blood pressure were met by 30.7% and 14.3% of children respectively. After full adjustment, the relative risk of categorization as hypertensive versus normal increased by a factor of 1.16 (95% CI 1.02-1.3) per 10-unit increase in BMI percentile, and 0.86 (95% CI 0.74-1.0) per one-year increase in age. Less than five parents (redacted due to low sample size) reported their child having a history of high blood pressure. In this low income, racially/ethnically diverse sample, we observed levels of hypertension and elevated blood pressure considerably higher than national estimates. However, in contrast, extremely low parental awareness was observed.

Elective Sports Surgery Leads to Postoperative Weight Changes in Pediatric Patients

Background:Patients who undergo orthopaedic surgeries often have activity restrictions during postoperative recovery. It is unknown whether these extended periods of reduced activity lead to postoperative weight changes in pediatric patients.Purpose:The purpose of this study was to evaluate changes in body mass index (BMI) percentile in children and adolescents following primary sports surgeries.Methods:After institutional review board (IRB) approval was obtained, institutional records for utilized current procedural terminology (CPT) codes were used to identify patients who underwent elective sports surgery at a single pediatric orthopaedic institution between October 2016 and December 2018. Non-primary surgeries and patients without preoperative BMI measurements were excluded. Demographic characteristics, height, weight, and BMI at every follow-up visit within 30 months of surgery were collected. To account for expected growth with age, BMI percentiles were calculated. Statistical analysis of changes in BMI percentile at follow-up intervals of 3-7 months, 9-18 months, and 24-30 months after surgery was performed. Analyses were also performed based on preoperative BMI category (underweight, normal-weight, overweight, or obese, per Centers for Disease Control definitions) and upper- or lower-extremity surgery.Results:A total of 468 patients (50.4% female, average age 14.5 years) were available for study. Seven patients (1.5%) were underweight at the time of surgery, 262 normal-weight (56%), 87 overweight (18.6%), and 112 obese (23.9%). Sixty-nine surgeries were performed on the upper extremity, while 399 were on the lower extremity. While on average patients demonstrated a tendency to increase BMI percentile at each follow-up interval, these values did not reach significance. However, analysis by preoperative BMI category revealed that at 24-30 months after surgery, normal-weight patients had increased BMI percentile by 6.74 points (p = .041) compared to baseline, while overweight patients had decreased BMI percentile by 17.65 points (p = .020) (Table 1). By final follow-up, 32 of 262 initially normal-weight patients had increased their weight category to overweight or obese, while 40 patients who were initially overweight or obese had favorable decreases in weight category.Conclusion:Children and adolescents undergoing primary sports surgeries may experience postoperative changes in BMI percentile. Normal-weight patients tend to increase weight, while overweight patients may decrease weight over 2.5 years after surgery.Table 1.Change in BMI Percentile by Preoperative BMI Category

Impact of Tonsillectomy on Obesity in Pediatric Patients With Sleep-Disordered Breathing.

ObjectiveBoth tonsillar hypertrophy and obesity contribute to pediatric sleep-disordered breathing (SDB). Tonsillectomy addresses anatomical obstruction causing SDB; however, it may adversely affect the obesity profile postoperatively. Herein, we investigate posttonsillectomy body mass index (BMI) changes in pediatric patients.Study DesignRetrospective case series.SettingTertiary, pediatric urban academic center.MethodsAll patients undergoing tonsillectomy from January 1, 2016, to December 31, 2016, were included. Patients’ age, sex, surgical indication, and preoperative BMI were recorded. Postoperative BMI data were collected between March 1, 2016, and December 31, 2017. Statistical analysis was performed using a generalized regression model, using BMI percentile-for-age weight status.ResultsA total of 1153 patients were included (50% female), with age ranging from 2.0 to 19.5 years (mean [SD], 7.6 [4.0]). The majority (87.8%) had tonsillectomy for SDB. Of the cohort, 560 (48.6%) had available follow-up BMI data. The BMI percentile on the day of the surgery had a median of 65.8, and the BMI percentile on follow-up had a median of 76.4. The median time to follow-up was 197 days with a range of 50 to 605 days. Higher postoperative BMI percentile strongly correlated to higher preoperative BMI percentile (P < .001), as well as younger age (P < .001), male sex (P = .0005), and SDB as a surgical indication (P = .003).ConclusionWe observed a significant increase in BMI percentile following tonsillectomy, which accounted for a significantly higher proportion of the cohort being classified as overweight or obese postoperatively. These findings necessitate greater preoperative counseling, closer follow-up, and adjunctive measures for obesity management in pediatric patients undergoing tonsillectomy.

Association of choroidal structure and body mass index in an adult population.

To determine the relation of choroidal structural parameters and body mass index (BMI) in an adult population. About 144 eyes of 144 healthy individuals were incorporated. There were four groups according to BMI values: Group 1 (⩽18.5), group 2 (18.6-24.9), group 3 (25.0-29.9), and group 4 (30.0-34.9). The enhanced depth imaging optical coherence tomography images were binarized using Image-J software. Choroidal thickness (CT), circumscribed choroidal area (CCA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) were calculated. Mean subfoveal, nasal, and temporal CT were lower in group 4 rather than group 1 (p = 0.032, p = 0.001, and p < 0.001, respectively). Mean nasal and temporal CT also showed a decrease in group 4 as compared to group 2 (p = 0.04 and p = 0.039). Mean CCA and LA were decreased in group 4 in comparison to group 3 (p = 0.001 and p = 0.001), group 2 (p < 0.001 and p < 0.001), and group 1 (p = 0.001 and p < 0.001). Mean SA showed a decrease only in group 3 rather than group 2 (p = 0.021) and group 1 (p = 0.008). Mean CVI was decreased in group 3 and group 4 in comparison to group 1 (p < 0.001 and p < 0.001) and group 2 (p = 0.002 and p < 0.001). Increased BMI percentile was associated with a decrease in CT and structural parameters.

Prediction of Childhood Obesity from Nationwide Health Records

To evaluate body mass index (BMI) acceleration patterns in children and to develop a prediction model targeted to identify children at high risk for obesity before the critical time window in which the largest increase in BMI percentile occurs. We analyzed electronic health records of children from Israel's largest healthcare provider from 2002 to 2018. Data included demographics, anthropometric measurements, medications, diagnoses, and laboratory tests of children and their families. Obesity was defined as BMI ≥95th percentile for age and sex. To identify the time window in which the largest annual increases in BMI z score occurs during early childhood, we first analyzed childhood BMI acceleration patterns among 417 915 adolescents. Next, we devised a model targeted to identify children at high risk before this time window, predicting obesity at 5-6years of age based on data from the first 2years of life of 132 262 children. Retrospective BMI analysis revealed that among adolescents with obesity, the greatest acceleration in BMI z score occurred between 2 and 4years of age. Our model, validated temporally and geographically, accurately predicted obesity at 5-6years old (area under the receiver operating characteristic curve of 0.803). Discrimination results on subpopulations demonstrated its robustness across the pediatric population. The model's most influential predictors included anthropometric measurements of the child and family. Other impactful predictors included ancestry and pregnancy glucose. Rapid rise in the prevalence of childhood obesity warrant the development of better prevention strategies. Our model may allow an accurate identification of children at high risk of obesity.

Antihistamines Increase Body Mass Index Percentiles and Z-Scores in Hispanic Children.

The prevalence of childhood obesity has increased over the years in the United States and contributed to a rise in metabolic syndrome and non-alcoholic fatty liver disease (NAFLD). Animal studies suggested the role of histamine blockade on mesenteric lymphatics tone, contributing to weight gain and hepatic steatosis. This study aimed to investigate an association between antihistamines (AH) use in children and obesity. A single-center retrospective cohort study on children with a diagnosis of NAFLD, followed in the gastroenterology clinic, was performed between January 2018 and April 2019. The demographics, medications, and body mass index (BMI) were assessed. Participants were divided into an AH group with documented use and comparison group, antihistamine naïve. Of the 32 participants in the study, 13 used AH, and 19 did not. Antihistamine users had a mean increase in BMI percentile per year of 1.17 compared to a decrease of 0.06 in comparison group (p = 0.0008). AH usage correlated with a mean increase in BMI z-score of 0.23 per year, as opposed to a decrease by 0.012 in comparison group (p = 0.0016). No difference was found in triglycerides (TG), glucose, and liver enzymes. AH use increases BMI percentiles and z-scores over time and is associated with obesity in children.

Prevalence of Optimal Metabolic Health in U.S. Adolescents, NHANES 2007-2016.

Background: While the overweight and obesity epidemic in the adolescent population is well described, a comprehensive evaluation of cardiometabolic health markers has not been reported. Our purpose was therefore to determine the prevalence of cardiometabolic risk factors among non-diabetic individuals 12 to19 years of age in the United States. Methods: We analyzed data from nationally representative samples of U.S. adolescents (NHANES, 2007-2016). Optimal cardiometabolic health was defined as an absence of risk factors, that is, at least normal values on each of the following 11 measures: body mass index (BMI) percentile, waist circumference percentile, blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, non-HDL cholesterol, triglycerides, fasting plasma glucose, alanine aminotransferase, and insulin resistance. Domain analyses were conducted with Rao-Scott chi-square tests of independence. Multivariable linear/logistic regressions examined sociodemographic associations with cardiometabolic health. Results: Less than a quarter of the population (22.0%; 95% CI; 19.4%-24.8%) was found to have no cardiometabolic risk factors. Among individuals with a normal BMI, 35.7% (95% CI; 31.6%-40.1%) had no cardiometabolic risk factors. Family poverty-to-income ratio was identified as an independent predictor of cardiometabolic health (P = 0.01). A consistent trend was present between increasing BMI percentile and number of cardiometabolic risk markers. Conclusions: The overall prevalence of U.S. adolescents with no cardiometabolic risk factors is less than 25%. Even among those without increased BMI, less than half meet all metabolic health criteria. In addition, socioeconomic disparities are predictors of metabolic health.

Association of meibomian gland architecture and body mass index in a pediatric population

PurposeTo determine if meibomian gland architecture in a pediatric population is impacted by body mass index (BMI). MethodsProspective evaluation of 175 eyes of 175 pediatric patients from two clinics. Demographic and clinical information were reviewed. Symptoms of dry eye were assessed with the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. Meibography was performed and grading of images was performed by a masked rater using a previously validated 5-point meiboscale (0–4) for gland atrophy and a 3-point score (0–2) for gland tortuosity. Results175 eyes of 175 participants aged 4–17 years (11.6 ± 3.7 years) were imaged. The mean meiboscore was 0.82 ± 0.94 (range 0–4) and the mean gland tortuosity score was 0.53 ± 0.70 (range 0–2). Ninety-six patients (56%) showed evidence of gland atrophy (meiboscore greater than 0) and the majority of patients (n=50, 29%) had a gland tortuosity score of 1. The mean BMI was 20.5 ± 4.86 kg/m2 with 39.4% of patients (n = 69) above the 85th percentile. BMI percentile was not found to be a significant predictor of a meiboscore greater than 0 (odds ratio (OR) 1.004 95% confidence interval (CI) (0.99–1.10, p = 0.41). However, BMI percentile was found to be a significant predictor of gland tortuosity score (OR 1.01 95% CI (1.00–1.02), p = 0.02). Patients with BMI percentiles between 41 and 60 were 3.79 times more likely to have a gland tortuosity score of greater than 0 than patients with BMI percentiles between 0 and 20 (OR 3.789 CI (1.17–12.24)). No significant associations were found between age, race, or sex and meiboscore or tortuosity. There was a trend towards reduction in lipid layer thickness with increasing BMI percentile (p = 0.028, r2 = 0.04). ConclusionIn this pediatric population, there was an association between meibomian gland tortuosity and higher percentiles of BMI. Future studies are needed to elucidate the pathogenesis of meibomian gland tortuosity and atrophy in pediatric patients.

Increased body mass index percentile is associated with decreased epiphyseal tubercle size in asymptomatic children and adolescents with healthy hips.

PurposeTo investigate whether body mass index (BMI) percentile impacts the morphology of the capital femoral epiphysis in children and adolescents without hip disorders.MethodsWe assessed 68 subjects with healthy hips who underwent a pelvic CT for evaluation of appendicitis. There were 32 male patients (47%) and the mean age was 11.6 years (sd 2.3). The BMI (k/m2) was calculated for sex- and age-related percentiles according to the Centers for Disease Control and Prevention growth charts. CT images were segmented, and the epiphysis and metaphysis were reformatted using 3D software. We measured the epiphyseal tubercle (height, width and length), the metaphyseal fossa (depth, width and length) and the peripheral cupping of the epiphysis. All measurements were normalized to the diameter of the epiphysis. Pearson’s correlation analysis was used to assess the correlations between the variables measured and BMI percentile adjusted for age.ResultsFollowing adjustment to age, increased BMI correlated to decreased tubercle height (r =-0.34; 95% confidence interval (CI) -0.53 to -0.11; p = 0.005), decreased tubercle length (r = -0.32; 95%CI -0.52 to -0.09; p = 0.008) and decreased tubercle width (r = -0.3; 95% CI -0.5 to -0.07; p = 0.01). There was no correlation between BMI and metaphyseal fossa and epiphyseal cupping measurements.ConclusionThe association between increased BMI percentile and decreased epiphyseal tubercle size, without changes of the metaphyseal fossa and peripheral cupping suggests another morphological change of the femur that may be associated with decreased growth plate resistance to shear stress. Further study is necessary to investigate whether the epiphyseal tubercle size plays a role in the pathogenesis of slipped capital femoral epiphysis in obese children and adolescents.Level of EvidenceLevel IV

Effect of body mass index percentile on skeletal maturation of cervical vertebrae and hand-wrist and dental maturation

Objective: The aim of this study was to evaluate the relationship between age- and gender-specific body mass index (BMI) percentile and skeletal and dental maturation in Turkish adolescents.Materials and methods: A sample of 429 patients (171 males, 258 females aged between 7 and 17 years) was selected. Skeletal maturation was identified in the hand-wrist radiography by Björk, Grave and Brown (BGB), and the cervical vertebrae maturation (CVM) method defined by Hassel and Farman in lateral cephalometric radiography. Dental maturation was determined by the Demirjian method. BMI was calculated by reference curves used for Turkish children. A regression model was used for the relationship between BMI percentile and skeletal and dental maturation.Results: There was no significant correlation between BMI and skeletal maturation of cervical vertebrae and dental maturation. A one-percentile increase in BMI percentile accelerates the increase of period (likelihood of being post-pubertal period) to 1.016 times (p < .05). Skeletal maturation of hand-wrist and cervical vertebrae and dental maturation were more prominent in females compared to males (p < .05). Males and females were not statistically significantly different in BMI percentile (p = .52).Conclusions: BMI may be considered before deciding to estimate the skeletal and dental maturation in an individual by the relevant methods.

Obesity Is Associated With Increased Thoracic Kyphosis in Adolescent Idiopathic Scoliosis Patients and Nonscoliotic Adolescents

Study DesignRetrospective comparative cohort study. ObjectiveTo compare radiographic parameters between adolescents with a greater body mass index (BMI) percentile to underweight individuals. Summary of Background DataIncreased BMI percentile has been associated with increased complications after surgical correction of adolescent idiopathic scoliosis (AIS). However, association between BMI percentile and preoperative sagittal plane alignment has not been evaluated. The purpose of this study was to evaluate the effect of BMI percentile on sagittal alignment in AIS patients compared with nonscoliotic adolescents. MethodsPosterior-anterior and lateral spinal radiographs of 1,551 AIS patients with a thoracic major curve (Lenke 1–4) and 70 nonscoliotic adolescent patients were compared. BMI percentile was determined based on age and sex, and patients were divided into four categories: underweight (<5th percentile), normal-weight (5th–85th percentile), overweight (85th–95th percentile), and obese (≥95th percentile). ResultsCoronal plane deformity magnitude was not significantly different between the 4 categories of AIS patients (p = .51). Increased BMI percentile was associated with increased thoracic kyphosis globally (T2–T12: p < .005) as well as segmentally (T2–T5: p < .001; T5–T12: p < .001) in patients with AIS. This was also true in obese adolescents without spinal deformity (p < .04). Lumbar lordosis, pelvic incidence, and pelvic tilt were not significantly different between AIS patients in the four BMI percentile categories (p > .07). Pelvic incidence was significantly greater in AIS patients compared with nonscoliotic adolescents (54 ± 13 vs. 46 ± 11; p = .01). ConclusionIncreased BMI percentile is associated with increased thoracic kyphosis in AIS patients and nonscoliotic adolescents. Excess weight may reduce anterior vertebral growth. AIS patients have an increased pelvic incidence compared with nonscoliotic adolescents; however, this variable is not influenced by body mass. These relationships should be taken into account when planning sagittal plane deformity correction or considering neuro axis disorders (also associated with increased kyphosis) in patients with scoliosis. Level of EvidenceLevel II.

Emotion Identification in Preschool and Early Adolescent Body Mass Index: Exploring the Roles of Depressive Symptoms and Peer Relations.

The ability to identify and label emotions may represent an early-life risk factor that relates to excess weight gain during childhood. The current study investigates the relationships between preschool emotion identification and early adolescent body mass index (BMI), as well as the mediating role of two variables: depressive symptoms and peer relations. In a longitudinal study, preschoolers completed an emotion identification task, and parents completed psychiatric assessments and a peer-relations questionnaire about their child. BMI percentile was measured at later time points in early adolescence. Poor emotion identification during preschool predicted increases in BMI percentile over time, with greater deficits in emotion identification ability relating to steeper increases in BMI percentile across early adolescence. Peer relations in preschool partially mediated the relationship between preschool emotion identification ability and adolescent BMI. This study provides novel information about potential targets for early interventions in the service of obesity prevention.

Correlation of HOMA-IR with BMI-for-age percentile in children and adolescents from the Soconusco region of Chiapas, Mexico

Introduction: Insulin resistance (IR) is a major risk factor for developing diabetes mellitus type 2 and cardiovascular diseases. In pediatrics, morbidity and mortality associated with these diseases highlights the diagnostic importance of IR for primary care.Objective: To determine Homeostatic Model Assessment Insulin Resistance (HOMA-IR) values and their correlation with BMI-for-age percentile in children and adolescents of the Soconusco region of Chiapas, Mexico.Materials and methods: Cross-sectional study. Overweight and obesity prevalence was determined based on the Body Mass Index (BMI) percentile of 112 children (5-19 years old). Glucose and fasting insulin values were quantified and used for estimation of HOMA-IR.Results: The combined prevalence of obesity and overweight was 66%, with insulin (p=0.010) and HOMA-IR (p=0.015) values higher than those of the normal weight group. The HOMA-IR values correlated positively with age (r=0.636), weight (r=0.569), height (r=0.578) and BMI percentile (r=0.198).Conclusions: In the study population, HOMA-IR has a moderately significant correlation with an increase in BMI percentile.

Weighing in on asthma: Insights on BMI, magnesium, and hospitalizations from the Ohio Pediatric Asthma Repository

Objective: Little is known about weight status and its effects on clinical course during hospitalization for asthma exacerbation. We sought to evaluate associations between weight status, specifically body mass index (BMI), with inpatient clinical course and clinical history.Methods: We retrospectively analyzed data from 2012 to 2013 on children hospitalized for asthma exacerbation in a state-wide longitudinal cohort, the Ohio Pediatric Asthma Repository. We examined BMI continuously (z scores) and categorically, comparing overweight and obese (Ov/Ob) to non-overweight and non-obese (nOv/nOb) children. We used linear mixed models controlling for site effects to determine if BMI was related to length of stay, as determined by physiologic readiness for discharge (PRD), defined as time to albuterol spaced every 4 h, need for nonstandard care or clinical history.Results: Across six hospitals, 874 children were included in analyses. BMI was positively associated with PRD (p=.008) but this increase was unlikely to be clinically significant. Ov/Ob children were more likely than nOv/nOb to require nonstandard care with repeat magnesium dosing in intensive care after dosing in the emergency department (OR = 3.23, 95%CI 1.39–7.78). Hospitalization in the year prior to enrollment was positively associated with BMI percentile (73.3 vs. 66.0, p=.028). Sleep disordered breathing was also associated with higher BMI percentile (78.2 vs. 65.9; p=.0013).Conclusions: Ov/Ob children had similar PRD to nOv/nOb children and were prone to repeat magnesium dosing. Previous hospitalization for exacerbation was positively associated with increasing BMI percentile. Additional research should investigate differential magnesium use by weight status, quantifying risks and benefits.

Impact of continuous low-dose antibiotic prophylaxis on growth in children with vesicoureteral reflux

Continuous antibiotic prophylaxis (CAP) is a mainstay of treatment for children with vesicoureteral reflux (VUR). There has been an increasing focus on the effect of antibiotics on gut microbiota and subsequent repercussions on growth. Continuous antibiotic prophylaxis is generally considered safe; however, its impact on growth in children with VUR remains unknown. This objective of this study was to determine whether CAP altered height, weight, or body mass index (BMI) in children with VUR. Children diagnosed with primary VUR were identified. Demographics including weight and height percentiles, BMI and BMI percentiles, age, gender, antibiotic class, prior antibiotic use, urinary tract infectionhistory, and breakthrough infections were tested in univariate and multivariate analyses. Primary outcome was change in BMIas well as weight, height, and BMI percentiles. One hundred eighty patients (146 girls, 34 boys) were prescribed CAP at mean age of 29.2±26.2 months. Mean follow-up on CAP was 4.1±3.3 years, with median follow-up of 3.08 years. Mean increase in weight percentile was 1.49 (2.02 males, 1.37 females; P=0.46). Mean decrease in height percentile was -4.44 (-2.18 males, -4.95 females; P=0.51). Age at diagnosis (P=0.004) and history of prior treatment courses of antibiotics (P=0.007) were associated with a significant BMI increase (Fig.1). Body mass index percentile increased from 58.4 to 66.5; however, this increase was only significant in children aged above 1 year(P<0.0001). Of note, children above 1 year of age were significantly more likely to have a history of prior treatment courses of antibiotics (58% vs32%; P<0.0001), and when controlling for prior antibiotic use, the increase in BMI percentile in those over 1 year of age did not reach significance. The use of antibiotics has been associated with alterations in pediatric growth parameters in both animal models and clinical studies. However, little information exists on the impact of prophylactic-dosed antibiotics on growth. While this study is limited by the retrospective analysis and small sample size, it was found that the use of CAP did impact growth parameters, with a stronger effect seen in children who had received prior treatment courses of antibiotics before the infection leading to the initiation of CAP. Continuous antibiotic prophylaxis was correlated with significant increase in BMI in children with prior antibiotic usage and a significant increase in BMI percentile in children aged above 1 year. Continuous antibiotic prophylaxis was also associated with decreased height percentiles, particularly in patients aged less than 1 year, though it did not reach statistical significance. Further analysis is needed to investigate whether these effects on weight, height, and BMI are persistent and clinically significant.

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.

Weight gain and hypertension at three years of age and older in extremely low birth weight infants

To determine the prevalence and weight gain as a risk factor of hypertension (HTN) at three years of age and older among extremely low birth weight (ELBW) infants. Retrospective cohort study of all ELBW infants born and followed up at our institution over 15 years. 204 infants were followed up for [median (inter-quartile range)] 10.2 years (6.9-13.0). Their birth weight and gestational age were (mean±standard deviation) 758±149 g and 26.4±2.1 weeks respectively. At 3 years of age and older, the prevalence of HTN was 7.3% (15/204), and the prevalence of obesity was 13.2% (27/204). Obesity was more prevalent in children with than without HTN [33% (5/15) vs. 12% (22/189); p = 0.01]. In a regression analysis, body mass index (BMI) percentile at 3 years of age and older (p = 0.04) and increase in weight Z scores since birth (p = 0.008) were associated with a higher systolic blood pressure (SBP; R = 0.386, p < 0.001). Obesity is prevalent in ELBW infants at three years of age and older, and it is significantly associated with hypertension. An increase in BMI percentile at ≥3 years of age, and the rate of weight gain since birth among ELBW infants are associated with an increase in SBP.