Population Of Healthy Children Research Articles

Excessive laxity of connective tissue in constipated children

Excessive laxity of the connective tissue refers to a group of inherited abnormalities manifested by disturbances in the functioning of internal organs, including the gastrointestinal tract. Increased susceptibility to stretching of the distal part of the large intestine and abnormal colonic motor function could explain the predisposition to the development of functional constipation in some children. Our aim was to determine whether patients with functional constipation are more likely to be characterized by congenital laxity of connective tissue compared to the population of healthy children. Children diagnosed with functional constipation according to the Rome III criteria were prospectively enrolled in the study (study group, S) and compared to otherwise healthy children (control group, C). Excessive laxity of the connective tissue was evaluated using the Beighton Score (BS) and expressed as median and interquartile range (IQR). The study included 411 patients (median age 7.8 years, min 3 years, max 18 years; 49% male), comprising 211 patients in the S group and 200 children in the C group. The median BS in the S group was significantly higher than in the C group (median: 5 points [IQR: 1–4.5] vs 2 points [IQR: 3–7], respectively; p = 0.000). Furthermore, increased connective tissue laxity was observed more frequently in females (p < 0.05). Increased connective tissue laxity was more frequent in children with functional constipation, especially in girls. Excessive laxity of the connective tissue may be one of the etiological factors of functional constipation in children.

COVID-19: A New Horizon in Congenital Heart Diseases.

Objective: Previous studies have demonstrated that both children and adult patients with a history of congenital heart disease (CHD) are at high risk for coronavirus disease 2019 (COVID-19) infection. This study investigates the status of COVID-19 infection among children undergoing surgical repair within the past 2 years.Methods: All alive patients operated on in a tertiary referral center between March 2018 and March 2020 were recruited in the present study. Detailed demographics, past medical and surgical history, and physical examination were reviewed for each patient. During the COVID-19 pandemic, data regarding the patient's status were collected by telephone survey from April 15 to April 30, 2020.Results: A total number of 210 patients are analyzed in this study. Participants' median age was 21.59 months [interquartile range (IQR) = 12–54.67], and 125 (59.5%) were female. The median interval between surgery and COVID-19 assessment was 305 days (IQR = 215–400). In addition, 67 (32%) patients used angiotensin receptor blocker (ARB)/angiotensin-converting enzyme (ACE) inhibitor (spironolactone and/or captopril). Sixteen patients (7.6%) were symptomatic and had positive chest CT results and/or RT-PCR compared to the previously reported prevalence of COVID-19 among the pediatric population (2.4% of children with <18 years of age); the prevalence of COVID-19 among the patients operated on due to CHD in the present study was significantly higher (p = 0.00012). Two patients were admitted to the intensive care unit (ICU); one patient was discharged 2 weeks later with acceptable status, and one patient died 2 days after ICU admission due to cardiac and respiratory arrest and myocarditis. The complexity of the underlying cardiac disorders was not different between patients with low risk (p = 0.522), suspicious patients (p = 0.920), and patients positive for COVID-19 (p = 0.234). The ARB/ACE inhibitor consumption was not associated with the COVID-19 infection [p = 0.527, crude odds ratio (OR) = 1.407, 95% CI = 0.489–4.052].Conclusion: Children with a history of previous CHD surgery are more susceptible to infections, especially those infections with pulmonary involvements, as the lung involvement could cause worsening of the patient's condition by aggravating pulmonary hypertension. The results of the current study indicate that these patients are more prone to COVID-19 infection compared to the healthy children population.

P029 Home video sleep recording as a screening tool for paediatric obstructive sleep apnoea

Abstract Introduction Polysomnography (PSG) remains gold standard for assessment of paediatric OSA, despite limitations. Home-based video sleep recordings offer a promising screening tool that would be relatively simple and inexpensive but have been minimally investigated. This study aims to assess the ability of short home-based video sleep recordings to predict PSG-diagnosed OSA in a population of healthy children. Methods Healthy children aged 1–18 years undergoing PSG to assess for OSA were recruited. Those with comorbidities likely to cause/exacerbate OSA, aside from adenotonsillar hypertrophy and obesity, were excluded. Thirty-minute video recordings of sleep shortly after sleep onset capturing the face and exposed torso were obtained. A previously validated scoring system was modified to include six parameters: snore, inspiratory noise, respiratory events, respiratory effort, mouth breathing and neck extension. Results We report interim results of this ongoing study. Of the 51 children meeting inclusion criteria, videos for 44 (28M, mean (SD) age 8.58 (2.96) years) were deemed satisfactory and analysed. Four (9%) children had OAHI &amp;gt;5 episodes/h on PSG and median Total Video Score (TVS) was 0 (IQR 0–1). TVS and OAHI &amp;gt;5 episodes/h on PSG showed a statistically significant association (OR 2.782, p=0.006) with area under the curve of 0.847. TVS ≥4 showed sensitivity of 75% and specificity of 100% for OAHI &amp;gt;5 episodes/h. Discussion This video scoring system, when applied to short home-based video sleep recordings, showed acceptable diagnostic accuracy for PSG-diagnosed OSA. Full data analysis will further clarify the role of this modality as a screening tool for paediatric OSA.

Test of Motor Proficiency Second Edition (BOT-2) Short Form: A Systematic Review of Studies Conducted in Healthy Children.

Motor skill competence of children is one of the important predictors of health because if a child is physically active during early childhood, the possibility of occurrence of many chronic diseases in adulthood will be reduced. The aim of this study was to systematically review the studies conducted in healthy children using the shorter form of the Bruininks-Oseretsky (BOT-2) and to determine the applicability in cross-sectional studies and pre-post designs. The search and analysis of the studies were done in accordance with the PRISMA guidelines. An electronic databases search (Google Scholar, PubMed, Mendeley, Science Direct, and Scopus) yielded 250 relevant studies conducted from 2011 to 2020. A total of 21 studies were included in quantitative synthesis, with a total of 3893 participants, both male and female. Through this study, the BOT-2 test proved its broad applicability, so it can be concluded that this test can be used to improve motor proficiency in a healthy population of children. Hence, it is necessary to invest a lot of time during the implementation of various programs so that children would adequately develop their basic motor skills so they broaden their own repertoire of movements.

The 3 Minute Step Test is a validated field test to evaluate the functional exercise capacity in children aged 6 to 12

BackgroundField tests are useful to assess the functional exercise capacity. The 6minute walking test (6MWT) is the most common field test even if alternatives are needed. The main aim of the study was to verify if the 3minute step test (3MST) is a valid tool to measure the functional exercise capacity and can surrogate the 6MWT in healthy children from 6- to 12-years-old. MethodsThis randomized cross-over trial recruited 30 healthy children from 6 to 12 years. One 6MWT and two 3MST (3MST1 and 3MST2) were performed randomly on 3 consecutive days. The variables were the distance (6MWT), the number of steps (3MST) and the cardiorespiratory parameters. ResultsThe distance walked during 6MWT was very strongly correlated to the number of steps during the 3MST (3MST1: rho=0.833; P<0.001 and 3MST2: rho=0.868; P<0.001). Heart rate (HR) was lower than the theoretical maximal HR at the end of both tests. The change in HR and perceived fatigue were significantly higher after the 3MST. A learning effect was observed in the 3MST (+8 steps; P<0.001). ConclusionsThe 3MST is validated and can be a surrogate for the 6MWT in healthy children population between 6 and 12 years old. A training test is required in these children.

Adherence to Food-Based Dietary Guidelines: A Systemic Review of High-Income and Low- and Middle-Income Countries.

Research comparing the adherence to food-based dietary guidelines (FBDGs) across countries with different socio-economic status is lacking, which may be a concern for developing nutrition policies. The aim was to report on the adherence to FBDGs in high-income (HIC) and low-and-middle-income countries (LMIC). A systematic review with searches in six databases was performed up to June 2020. English language articles were included if they investigated a population of healthy children and adults (7–65 years), using an observational or experimental design evaluating adherence to national FBDGs. Findings indicate that almost 40% of populations in both HIC and LMIC do not adhere to their national FBDGs. Fruit and vegetables (FV) were most adhered to and the prevalence of adhering FV guidelines was between 7% to 67.3%. HIC have higher consumption of discretionary foods, while results were mixed for LMIC. Grains and dairy were consumed below recommendations in both HIC and LMIC. Consumption of animal proteins (>30%), particularly red meat, exceeded the recommendations. Individuals from HIC and LMIC may be falling short of at least one dietary recommendation from their country’s guidelines. Future health policies, behavioral-change strategies, and dietary guidelines may consider these results in their development.

Prevalence of early childhood caries, risk factors and nutritional status among 3-5-year-old preschool children in Kisarawe, Tanzania.

Early childhood dental caries (ECC), a serious public health problem lacks information on the association between ECC, risk factors and nutritional status among children in Tanzania. Therefore, this study aimed to determine the prevalence of ECC, risk factors and nutritional status among 3-5-year-old preschool children and to assess its correlation with the form, visible plaque scores in upper anterior teeth, total sugar exposure, anthropometric measures, and socio demographic attributes. This cross-sectional study was conducted on 831 children registered in public preschools in Kisarawe District. Assessment of ECC used the WHO (2013) criteria and anthropometric measures used the WHO Child Growth Standards (2006). Structured questionnaires were completed by children's parents through an interview. Collected information on socio-demographic attributes including oral hygiene and sugar exposure to their children was analyzed. Only 459 children (55.2%) were recognized as caries-free. Dental caries experience in terms of decayed, missing and filled teeth (dmft) index was 2.51. Children with visible plaque were the majority (56.1%). The dmft score index was negatively and significantly associated with weight-for-age z-score [Coefficient: -0.11 (95% CI: -0.76, -0.11)] and positively significantly associated with visible plaque score index [Coefficient: 0.16 (95% CI: 0.18, 0.52)] and total sugar exposure [Coefficient: 0.19 (95% CI: 0.15, 0.38)] in the adjusted model. The prevalence of underweight was 4.2% [95% CI: (3.0-5.8)] and severe underweight was 0.2% [95% CI: (0.1-0.9)] while prevalence of stunting was 1.6% [95% CI: (0.9-2.7)] and severe stunting was 0.4% [95% CI: (0.1-1.1)]. This study demonstrated a significant negative relationship between ECC and children's anthropometric measures indicated by weight-for-age, and positive relationship with sugar exposure and poor oral hygiene indicated by visible plaque on upper anterior teeth. Controlling risk factors will reduce the occurrence of ECC thereby catering for a healthy population of well-nourished children.

Reference Cut-Offs to Define Low Serum Zinc Concentrations in 1-19 Year Old Indian Children and Adolescents

Background: The quantification of population zinc (Zn) deficiency is based on serum zinc concentration (SZC) cut-offs, defined by International Zinc Nutrition Consultative Group (IZiNCG), derived from the 2·5th centile of age- and sex-specific SZC distributions from a high-income country. However, the SZC distributions, and its 2·5tthcentile cut-offs, can left-shift for a variety of reasons in lower middle-income countries (LMICs). The recent quality-controlled Indian Comprehensive National Nutrition Survey (CNNS) offered an opportunity to re-examine the SZC cut-offs in healthy 1–19-year-old children and adolescents and evaluate whether Zn deficiency was truly a public health problem in India. Methods: A healthy population (n=12473) of children was selected by including the highest 2 wealth quintiles, and excluding stunted, thin and obese children, and those with CRP >5mg/L, anemia, hypo-albuminemia, diabetes, recent diarrhea and a history of smoking. The 2·5th centile of the SZC distribution from this sample yielded the present cut-off to re-evaluate the prevalence of Zn deficiency against the IZiNCG cut-offs. Findings: The present study SZC cut-offs were significantly lower, by 10–18 µg/dL, than the IZiNCG cut-offs; more in adolescents. Thus, the prevalence of Zn deficiency in the entire CNNS sample, with the present cut-offs, was 2·7 to 5·5 times lower than with the IZiNCG cut-offs. No geographical state, nor any age group, showed Zn deficiency as a serious public health problem (≥20%). In contrast, with the IZiNCG cut-offs, between 9 to 27 states (depending on age group) had a serious public health problem with Zn deficiency. Interpretation: The present study reference SZC cut-offs for Zn deficiency are lower than the IZiNCG cut-offs, and since they were selected rigorously from a national sample, are more appropriate for use in India. A re-examination of the global applicability of IZiNCG recommended cut-offs to quantify Zn deficiency in other LMICs is required. Funding Source: CNNS is funded by The Mittal Foundation. However, there is no specific funding for this secondary analysis. Declaration of Interests: HSS designed the draft protocol of the CNNS with consultancy support from UNICEF, India. HSS, UK, and AVK were members of the Technical Advisory Committee of the CNNS, constituted by the Ministry of Health and Family Welfare of the Government of India, to oversee its conduct and analysis. HSS is a member of the WHO Nutrition Guidance Expert Advisory Subgroup on Diet and Health and Guideline Development Group on the use and interpretation of haemoglobin concentrations for assessing anaemia status in individuals and populations, member of the World Health Organization Nutrition Guidance Expert Advisory Subgroup on Diet and Health and Expert group on nutrient requirements: setting calcium, vitamin D and Zn nutrient intake values for children aged 0-4 years. He is also member of Expert Groups of the Ministry of Health and Family Welfare on Nutrition and Child Health. SD was involved in the CNNS study implementation. There were no other conflicts to declare. Ethics Approval Statement: The Population Council’s International Review Board (New York, USA) and the Ethics Committee of the Post Graduate Institute of Medical Education and Research (Chandigarh, India) gave ethical approval. Written consent from parent/caregiver for children under 10 years, consent of parent/caregiver as well as assent from adolescents (11-17 years) and written consent of adolescents above 17 years were obtained after due description of study details in local languages.

Viscoelasticity of children and adolescent brains through MR elastography

Magnetic Resonance Elastography (MRE) is an elasticity imaging technique that allows a safe, fast, and non-invasive evaluation of the mechanical properties of biological tissues in vivo. Since mechanical properties reflect a tissue's composition and arrangement, MRE is a powerful tool for the investigation of the microstructural changes that take place in the brain during childhood and adolescence. The goal of this study was to evaluate the viscoelastic properties of the brain in a population of healthy children and adolescents in order to identify potential age and sex dependencies. We hypothesize that because of myelination, age dependent changes in the mechanical properties of the brain will occur during childhood and adolescence. Our sample consisted of 26 healthy individuals (13 M, 13 F) with age that ranged from 7-17 years (mean: 11.9 years). We performed multifrequency MRE at 40, 60, and 80 Hz actuation frequencies to acquire the complex-valued shear modulus G = G′ + iG″ with the fundamental MRE parameters being the storage modulus (G′), the loss modulus (G″), and the magnitude of complex-valued shear modulus (|G|). We fitted a springpot model to these frequency-dependent MRE parameters in order to obtain the parameter α, which is related to tissue's microstructure, and the elasticity parameter k, which was converted to a shear modulus parameter (μ) through viscosity (η). We observed no statistically significant variation in the parameter μ, but a significant increase of the microstructural parameter α of the white matter with increasing age (p < 0.05). Therefore, our MRE results suggest that subtle microstructural changes such as neural tissue's enhanced alignment and geometrical reorganization during childhood and adolescence could result in significant biomechanical changes. In line with previously reported MRE data for adults, we also report significantly higher shear modulus (μ) for female brains when compared to males (p < 0.05). The data presented here can serve as a clinical baseline in the analysis of the pediatric and adolescent brain's viscoelasticity over this age span, as well as extending our understanding of the biomechanics of brain development.

Salivary concentrations of cytokines and other analytes in healthy children

BackgroundBlood has been the usual biological fluid for measuring analytes, but there is mounting evidence that saliva may be also useful for detecting cytokines in a noninvasive way. Thus, in this study we aimed to determine concentration of cytokines and other analytes in saliva from a population of healthy children. MethodsWe collected un-stimulated whole saliva samples from clinically healthy children, and concentration of 17 cytokines and 12 other analytes were measured in supernatants. All values were adjusted by albumin content and were log-transformed before multivariate statistical analysis. ResultsWe included 114 children (53.5% females) between 6.0 and 11.9 years old. The highest concentrations (medians, pg/µg albumin) were seen for visfatin (183.70) and adiponectin (162.26) and the lowest for IL-13 and IL-2 (~0.003). Albumin concentration was associated with age (rS = 0.39, p < 0.001). In the multivariate analysis, five analytes (C peptide, ghrelin, GLP-1, glucagon, leptin) inversely correlated with age and positively with height-for-age. Age was also positively associated with PAI-1, while height-for-age was also positively associated with insulin and visfatin. Finally, BMI-for-age had a positive correlation with GM-CSF and insulin. ConclusionsHerein, we provided concentration values for 29 analytes in saliva from healthy children that may be useful as preliminary reference framework in the clinical research setting.

Irisin Correlates Positively With BMD in a Cohort of Older Adult Patients and Downregulates the Senescent Marker p21 in Osteoblasts.

Irisin is a myokine produced by skeletal muscle during exercise in both mice and humans. We previously showed that irisin treatment ameliorates immobility-induced osteoporosis and muscular atrophy in mice. Data in humans showed a positive association between irisin and bone mineral density (BMD) in athletes and a population of healthy children. However, the role of this myokine regarding the state of muscle and bone in the same population remained to be determined. For this purpose, 62 patients (age 68.71 ± 12.31 years) undergoing total hip or knee replacement were recruited. Our results showed that irisin serum levels negatively correlated with age (R = -0.515; p = .000018) and positively correlated with femoral BMD (R = 0.619; p = .001) and vertebral BMD (R = 0.201; p = .0001). Irisin was also positively associated with Fndc5 mRNA in muscle biopsies (R = 0.248; p = .016), as well as with Osteocalcin (Ocn) mRNA in bone biopsies (R = 0.708; p = .006). In skeletal muscle, FNDC5 positive fibers positively correlate with BMD of total femur (R = 0.765; p = .0014) and BMD of femoral neck (R = 0.575; p = .031), Interestingly, by analyzing patients divided by their T-score, we found lower irisin levels (p = .0011) in patients with osteopenia/osteoporosis (OP) compared to healthy controls matched for age and sex. By analyzing the senescence marker p21, we found a significant increase of its mRNA expression in the bone biopsies of OP patients compared to control ones. Therefore, we investigated in vitro whether rec-irisin had a direct effect on this senescence marker, showing that p21 mRNA expression was significantly downregulated in osteoblasts by the treatment with irisin. Overall, these results indicate that higher irisin levels are associated with a lower rate of age-related osteoporosis and that irisin could be effective in delaying the osteoblast aging process, suggesting a potential senolytic action of this myokine. © 2020 American Society for Bone and Mineral Research (ASBMR).

Development of spirometric reference equations for children living at high altitude.

This study was aimed to provide locally derived spirometric equations from a population of healthy children residing in Bogota, Colombia, a high-altitude city. Healthy children aged more than 6years up to less than 18years underwent spirometry from January 2017 to January 2018, following the recommendations made by the American Thoracic Society/European Respiratory Society (ATS/ERS) Task Force. We performed stepwise multiple regression analyses to predict each spirometric parameter. We also performed extensive residual analyses comparing the measured values with those calculated with our new spirometric equations and with other commonly used equations. Predictive equations for each spirometric variable were derived from 326 spirometric tests (149 boys, 177 girls). Our newly derived spirometric equations provided the minimum of median of prediction error for almost all spirometric indices measured. We recommend the newly developed spirometric equations for assessing the ventilatory function of children living in Bogota, Colombia.

Reproducibility of macular retinal nerve fiber layer and ganglion cell layer thickness measurements in a healthy pediatric population.

To evaluate the reproducibility of Spectralis spectral domain-OCT segmented ganglion cell layer (GCL) and macular retinal nerve fiber layer (mRNFL) measurements in a healthy children population. An observational, cross-sectional study was carried out on 79 children to measure the intraobserver reproducibility and the repeatability between a novel and an experienced operator of the segmented macular GCL and mRNFL. Interobserver and intraobserver reproducibility were defined by the intraclass correlation coefficient (ICC) and coefficients of variation (COV). Kruskal-Wallis test was used to determine statistical significance in the COV of three age groups children (younger than 6 years, between 6 and 12, and older than 12 years old). The results from the intraoperator GCL thickness analysis were highly reproducible (COV < 6%) and reliable (ICCs > 0.81). When the measurements were compared between a novel and an experienced examiner lower ICCs and higher COV were found. COVs ranged from 1.85% (total volume area) to 5.57% at the central ETDRS subfield while the ICC vary from 0.632 (outer inferior) to 0.832 (inner inferior). The repeatability and reproducibility of the mRNFL thickness were lower, with ICCs ranging from 0.428 to 0.872 in the interobserver analysis and from 0.897 to 0.346 in the interobserver one. In the present study, we establish substantial reliability of the GCL thickness in children with Spectralis® SD-OCT in all the sectors, albeit lower than the reported in the literature with other SD-OCTs and in adults. The reproducibility and repeatability of the mRNFL were significantly lower. We were unable to find consistent statistical significant differences between the COV of the three age groups.

Pediatric nomograms for left ventricle biplane 2D volumes in healthy Caucasian children.

Left ventricular (LV) volumes are basic parameters used to estimate ventricular size and function; however, normal values are not available in children. The aim of our study is to provide normal values for LV volumes (measured with the biplane Simpson method) in healthy children. We prospectively studied1320 healthy Caucasian Italian children (age 0days-17years, 49.4% female). Echocardiographic measurements on LV volumes were performed. Age, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. Models with exponential (ln[y]=a+b*ln[x]) equations resulted in the best fit for LV volumes. The association with BSA was found to be stronger than the association of HR and age. Thus BSA was used for normalization of our data. Predicted values and Z-score boundaries by BSA are provided. We report normal values for 2D biplane LV volumes in a population of healthy children. These data cover a gap in current pediatric echocardiographic nomograms and may serve as baseline for evaluation of children with cardiac defects characterized by LV dilatation or hypoplasia.

Targeted Dietary Supplementation Improves Mental Performance in Children

BackgroundSaffron (Crocus sativus) dried flower stigma is the world’s most expensive spice and has been used in traditional medicine for alleviating depression, stress, anxiety, and insomnia. Saffron stigma contains more than 160 bioactive compounds including lepticrosalides (safranal, crocin, crocetin, picrocrocin) and numerous flavonoids and terpenes that have been associated with relaxation, positive mood, and mental &amp; physical balance. At least seven controlled clinical trials have shown the antidepressant activity of saffron.ObjectiveBuilding on the well‐described “mood” benefits of saffron, our objective was to assess the benefits of saffron stigma combined with complementary brain‐supporting spices (Holy Basil, Rosemary, Clove, and Oregano) on measures of mental focus and mental performance in healthy children who had not been diagnosed with either depression or ADHD.MethodsTen healthy children (ages 6–12 years of age) participated in this study. We used the validated NICHQ Vanderbilt Assessment Scales (National Institute for Children’s Health Quality) that are routinely used by healthcare professionals to help diagnose ADHD in children 6–12 years and are part of the American Academy of Pediatrics (AAP) Resource Toolkit for Clinicians Caring for Children with ADHD (3rd edition, 2019). Parents administered the NICHQ survey before and after 30‐days of supplementation with a multi‐nutrient blend intended to improve mental focus, mood, and stress resilience (Kid’s Mood+; Amare Global). The NICHQ assessment scales have 2 components: Symptom Assessment (in 5 areas: inattention, hyperactivity, defiance, conduct, and anxiety/depression) and Performance Assessment (including school performance on reading, writing, and math; as well as social relationship performance with parents, siblings, and peers including on organized teams).ResultsFollowing 30‐days of supplementation, we found dramatic improvements on assessments of both Symptoms (e.g. focus, attention, mood, listening, tension, and irritation) and Performance (e.g. overall school work, math, reading, writing, and social relationships). All participants (10/10) demonstrated benefits in response to supplementation, with average Symptom scores 29% lower (23.4 pre versus 16.6 post) and Performance scores improved 18% (2.24 pre versus 1.83 post).ConclusionsPrevious human trials in children and teenagers have shown equivalence of saffron to fluoxetine (Prozac) for depression and methylphenidate (Ritalin) for ADHD. This is the first study in a population of normal healthy (“non‐diagnosed”) children showing improvements in not just mental focus attributes, but also mental performance (academically and socially) subsequent to targeted supplementation. This study provides compelling evidence for safe and effective natural approaches as potential first‐line therapy for improving focus, mood, and mental performance in children.Support or Funding InformationThis trial was supported by Amare Global

Higher circulating plasma polychlorinated biphenyls (PCBs) in fit and lean children: The European youth heart study

BackgroundLipophilic compounds such as polychlorinated biphenyls (PCBs) are primarily stored in adipose tissue, but exercise-induced lipolysis is able to release PCBs from the adipose tissue into the circulation. The plasma concentration, distribution and metabolism of PCBs can thus vary much among individuals due to inter-human variations in lifestyle behavior and pharmacokinetics. ObjectivesWe examined the observational relationship of circulating plasma PCB concentrations with cardiorespiratory fitness, engagement in vigorous physical activity and fat mass in a healthy Danish child population. MethodsData on ∑PCB (PCB138, PCB153 and PCB180), cardiorespiratory fitness, skinfold thickness and objectively measured physical activity of 509 children derived from the Danish sub-study of The European Youth Heart Study. ResultsHigher fitness and greater leanness were associated with elevated plasma ∑PCB in both boys and girls. The associations were independent of each other and persisted after controlling for socio-economic status and duration of breastfeeding. We observed an almost three-fold increase in plasma ∑PCB level in the most fit/least fat children relative to the least fit/most fat children. The association between fatness and ∑PCB was strongest for boys as girls, and especially pubertal girls, displayed lower decrease in plasma ∑PCB with higher fat mass. DiscussionOur findings suggest that increased lipolysis stimulates the release of PCBs into the vasculature. The consequence is higher plasma levels of PCB in very fit and lean subjects. This scenario is likely to cause negative confounding in epidemiological observations of PCB and cardio-metabolic health. At the same time adipose tissue may play a dual role in promoting adverse health and providing a relatively safe place to store PCB.

P1542 Reference values for multilayer longitudinal strain in children: preliminary findings from healthy individuals

Abstract BACKGROUND Strain echocardiography is a reliable echocardiographic modality to measure myocardial mechanical deformation and evaluate regional and global myocardial systolic function, and has been demonstrated to be a useful tool for the evaluation of cardiac function in children with acquired and congenital heart diseases. Recent advancements in echocardiographic technology allow to analyze myocardial strain in multiple layers. To our knowledge, there are no published reference values for echocardiographic multilayer-specific strain measurement. AIM OF THE STUDY Aim of our study was to establish normal reference values for left ventricular (LV) and right ventricular (RV) longitudinal strain (LS) in a wide population of Italian children and to provide normal reference values of layer-specific LS in a healthy pediatric population. METHODS AND RESULT At present we have analyzed data from two-hundred (target: n = 500) healthy, consecutive subjects (age &amp;lt;18 years, mean age 7.5 ± 4yrs; range from 1 month to 17,5 years). All subjects underwent a clinical cardiological evaluation including ECG and physical examination. Subsequently, a complete echo Doppler examination including LS evaluation using speckle-tracking echocardiography was performed. Individuals were excluded if any significant abnormality was found at echocardiography (e.g. valvular regurgitation more than trivial, any structural abnormalities including small ASDs or VSDs; patients with isolated PFO were included). Subendocardial, midwall, subepicardial LS, and strain gradient (LSsubepi - LSsubendo) were also determined. LS% analysis was considered acceptable if missing data were present in no more than one segment per echocardiographic view, according to current consensus. Echocardiographic yield for LS analysis was 98.5 % for 4-chamber views, 82.5% for 2-chamber views and 84.5% for 3-chamber views. Accordingly Global Longitudinal Strain (GLS) was available overall in 82% of the population analyzed so far (n= 164 children) on all layers, with a total of 8,872 echocardiographic available segments analyzed. Normal distribution was found for global subendocardial, midwall and subepicardial LS. As displayed in figure 1 (panels A-B-C), means ± SD were -20.8 ± 1.9% for LSsubendo, -19.2 ± 1.8% for LSsubepi and -19.9 ± 1.8% for LSmidwall. Accordingly higher value (95ile) for normal LS were -17.9%, -16.4% and -17.1% for LSsubepi, LSsubendo and LSmidwall, respectively. A significant subepicardial to subendocardial gradient was found in all children with higher absolute values found at the endocardial level, with a mean difference of 1.6 ± 0.9% (Panel D). CONCLUSIONS We provide preliminary data on 200 children to establish normal reference values for echocardiographic multilayer-specific strain measurement in a wide population of healthy italian children. Abstract P1542 Figure.

The relationship of obesity with lifestyle and dietary exposure to endocrine-disrupting chemicals

Phytoestrogens are natural components of plants, including numerous foods that form part of the habitual diet of humans and animals. They have similar estrogenic effects to those of synthetic endocrine disrupters such as monomers of plastic materials, e.g., polycarbonates and epoxy resins. The most frequently used monomer is bisphenol A (BPA), which has been found to migrate from drink and food packaging, plastic baby bottles, and the coating of cans. Numerous studies have associated exposure to endocrine disrupters with obesity, classifying them as obesogens. The objectives of this study were to estimate the dietary exposure to phytoestrogens and BPA in a group of Spanish schoolchildren and to estimate their potential obesogenic effects. The diet of this population of healthy Spanish children was estimated to have a mean total estrogenic capacity of 5.10−12 M eq.E2 (5 pmol/day). The effects of this additional estrogenic burden are highly controversial, and no definitive conclusion has been reached. Thus, some authors consider exposure to these substances with estrogenic activity to be positive at certain stages of life, whereas others regard it as posing a risk at any age. In the present population of children, the likelihood of normal weight versus obesity was significantly related to the total proliferative effect (OR = 0.51, p = 0.026) as well as to the energy expenditure on physical activity, with lesser activity implying a greater risk of obesity (OR = 13.54, p = 0.001). Further research is warranted on the obesogenic effects of exposure to endocrine disruptors present in foods.

Age-specific and sex-specific reference intervals for non-fasting lipids and apolipoproteins in 7260 healthy Chinese children and adolescents measured with an Olympus AU5400 analyser: a cross-sectional study

AimsEthnic, demographic, lifestyle, genetic and environmental factors influence lipids and apolipoproteins. The aim of this study was to establish age-specific and gender-specific reference intervals for non-fasting lipids and apolipoproteins in...

Diet Quality in Relation to Fat, Lean, and Bone Mass in Children: A Population-based Study (P18-105-19)

ObjectivesNutrition in early life is considered a crucial modifiable determinant of growth and development. Still, whether overall diet quality in childhood is related to body composition and bone health remains unclear. We aimed to examine associations of overall diet quality with detailed measures of fat, lean, and bone mass in childhood. MethodsWe included 3991 children from a large population-based prospective cohort in the Netherlands. Dietary intake was assessed using a food-frequency questionnaire at their age of 8 years, and a diet quality score (0–10) was calculated, measuring adherence to age-specific dietary guidelines. Height, weight, and detailed body composition of the children were measured at their age of 10 years. Body composition was assessed using dual-energy X-ray absorptiometry. We calculated sex- and age-specific SD-scores for body mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI), bone mineral density (BMD), bone mineral content (BMC), and area-adjusted BMC (aBMC). ResultsMean diet quality score of the children was 4.5 (±1.2) out of 10, and 12.4% of the children had overweight. After adjustment for socioeconomic and lifestyle factors, we observed that a higher diet quality was associated with a higher height, weight, and BMI in childhood. This positive association of diet quality with BMI was fully driven by a higher FFMI (0.07 SDS per 1 point higher diet quality, 95%CI: 0.05,0.10), and not FMI. For bone health, we observed associations of higher diet quality with higher BMD (0.05 SDS, 95%CI: 0.03,0.08) and BMC (0.06 SDS, 95%CI: 0.03,0.09), but not with aBMC. These associations were independent of diet quality in infancy and not driven by specific food components included in the diet quality score. ConclusionsIn this healthy population of children in Europe, we observed a high prevalence of overweight, whereas overall diet quality of the children was suboptimal. Our findings emphasize that an adequate diet in childhood is of high importance, not only for body composition, but also for bone health already at this young age. Dietary intake according to dietary guidelines in childhood may have a beneficial effect on growth and bone development, and may decrease the risk of obesity and osteoporosis later in life. Funding SourcesThis specific project did not receive any funding.