Postpubertal Adolescents Research Articles

Comparison of lumbar force between pubertal and post-pubertal adolescents: interference of physical growth, body fat and lifestyle.

Comparison of lumbar force between pubertal and post-pubertal adolescents: interference of physical growth, body fat and lifestyle.

Association between Neck Circumference and Glycemia in Adolescents

Background: The determination of glycemia is an essential element for the diagnosis of diabetes or possible glycemic alterations. The body composition and fat distribution are related to this parameter. The neck circumference (NC) is an anthropometric measure that has been used to evaluate the overweight and accumulation of subcutaneous fat in the upper body, regardless of age. It is also a useful tool to predict insulin resistance and other risk factors. This research aimed to study the relationship between the NC and glycemia in adolescents and, thus, to analyze the applicability of this anthropometric measure in the screening of glycemic alterations in this group. Methods: The study population consisted of 600 adolescents aged 10 to 19 years. Data on sex, birth date, NC, fasting blood glucose and stage of sexual maturation was collected. Results: The evolution of sexual maturation generated a significant difference in the NC in both sexes, but not affected glycemia. Thus, the association between NC and glycemia was investigated according to this parameter. Among the pre-pubertal adolescents, the NC was significantly higher among those who had glycemia within borderline values, and the opposite occurred among pubertal adolescents. Among post-pubertal adolescents, NC was similar between the two groups. A negative correlation was found in all adolescents, as well as among those who were in the pubertal and post-pubertal stages of sexual maturation. Differently, adolescents in the pre-pubertal stage showed a positive correlation between the NC and the biochemical parameters. Conclusion: This study showed that the relationship between the NC and glycemia varies according to the stage of sexual maturation. As this maturation factor is rarely considered in the glycemic alteration screening, the use of the NC in this age group is not safe and requires further investigations.

Bone density and body composition in post-pubertal adolescents treated with GnRH analogues in a gender identity development service

Bone density and body composition in post-pubertal adolescents treated with GnRH analogues in a gender identity development service

Human Adolescent Phase Response Curves to Bright White Light.

Older adolescents are particularly vulnerable to circadian misalignment and sleep restriction, primarily due to early school start times. Light can shift the circadian system and could help attenuate circadian misalignment; however, a phase response curve (PRC) to determine the optimal time for receiving light and avoiding light is not available for adolescents. We constructed light PRCs for late pubertal to postpubertal adolescents aged 14 to 17 years. Participants completed 2 counterbalanced 5-day laboratory sessions after 8 or 9 days of scheduled sleep at home. Each session included phase assessments to measure the dim light melatonin onset (DLMO) before and after 3 days of free-running through an ultradian light-dark (wake-sleep) cycle (2 h dim [~20 lux] light, 2 h dark). In one session, intermittent bright white light (~5000 lux; four 20-min exposures) was alternated with 10 min of dim room light once per day for 3 consecutive days. The time of light varied among participants to cover the 24-h day. For each individual, the phase shift to bright light was corrected for the free-run derived from the other laboratory session with no bright light. One PRC showed phase shifts in response to light start time relative to the DLMO and another relative to home sleep. Phase delay shifts occurred around the hours corresponding to home bedtime. Phase advances occurred during the hours surrounding wake time and later in the afternoon. The transition from delays to advances occurred at the midpoint of home sleep. The adolescent PRCs presented here provide a valuable tool to time bright light in adolescents.

The impact of adiponectin levels on biomarkers of inflammation among adolescents with obesity

AimsConsidering the protective role of adiponectin, we aimed to investigate the impact of different levels of adiponectin on biomarkers of inflammation among adolescents with obesity. MethodsWere recruited 220 post-pubertal adolescents with obesity. Body composition, lipid profile, adiponectin and leptin concentrations were obtained. Adolescents were distributed in 3 groups (lower levels of adiponectin ≤4.85; medium levels of adiponectin >4.85 e ≤ 9.63; higher levels of adiponectin >9.63). GLM test was performed to analyze difference between groups with p level set at ≤0.05. Pathway analyze was performed. ResultsThe most important find in the present low tertile has higher values of body fat compared to medium values. Interesting, insulin(μU/mL), HOMA –AD, total cholesterol (mg/dL), LDL, VLDL, Triglycerides (mg/dL), leptin and leptin/adiponectin ratio presented statistical higher values; inversely; QUICKI, HDL, and adiponectin/leptin ratio has lower when compared low with higher tertile. Analyzing the adiponectin pathway, the comportment of adiponectin was partially mediated by negative correlation with leptin/adiponectin ratio, HOMA-AD and HOMA-IR and positive correlation with HDL-col. ConclusionTogether, these results may partly contribute to explain the role of adiponectin linking obesity whit atherosclerosis, as depended dose-response of this hormone concentration once in the lower tertile of adiponectin these results were not showed.

Cardiac parasympathetic reactivation after small-sided soccer games and repeated sprints in untrained healthy adolescents.

It has been shown that recreational soccer was a highly motivating and social activity which produces large improvements in health-related indices in sedentary healthy and unhealthy subjects. The purpose of this study was to compare the acute parasympathetic reactivation after small-sided soccer games (SSG) and repeated sprints training (RST) sessions. Eight post-pubertal untrained adolescents (age 15.8±0.6 years, body mass 59.1±3.7 kg, height 1.7±0.1 m) performed a RST, SSG and a control session in a counterbalanced order. Heart rate variability (HRV) indices in time and frequency domain, heart rate recovery and rating of perceived exertion (RPE) were evaluated. RPE was significantly lower after SSG compared with RST (P=0.02, ES=1.1). There was a significant decrease in mean R-R intervals after RST (difference: -19.6%, P<0.01, ES=1.7) and after SSG (-19.2%, P<0.01, ES=2.3). A significant decrease was also noted in SDNN after RST (-26.6%, P=0.02, ES=1.8) and SSG (-37.8%, P=0.01, ES=1.1). For RMSSD, a significant decrease was observed only after SSG (48%, P=0.01, ES=1.3). No significant change in all HRV indices after the control condition. SSG and RST elicited high and similar heart rates responses. A low parasympathetic reactivation during early recovery was noted after both RST and SSG. These results were important especially for clinician looking to prescribe repeated sprint or small-sided game for sedentary subjects.

Effect of weight loss on Resting Energy Expenditure in pre- and post-pubertal obese children

Background: In obese adults, caloric restriction leads to a reduction in energy expenditure, and it is this compensatory adaptive down-regulation that is cited as one of the causes of weight regain in adults. There are currently insufficient data to establish if this phenomenon also occurs in obese children who lose weight and whether puberty affects this adaptive response.Objective: We hypothesised that obese children who lose weight have less 'reflex' changes in Resting Energy Expenditure (REE) (that may drive weight regain), compared with obese adolescents with a similar degree of weight change.Method: Prospective cohort study. 41 subjects; 21 obese pre-pubertal children (age 3–7 years; 11 male) and 20 obese adolescents (age 14–18 years; 10 male). Obesity defined as BMI >2.4 SDS. Subjects recruited as either 'reducers' (relative/absolute weight loss of =10% in preceding 9–15 months) or 'maintainers' (controls). REE measured using Medgem® indirect calorimetry in all 41 participants at baseline and REE measured at follow-up in 23 subjects, 6–21 months later (average 10.6 months); 13 obese pre-pubertal children (6 male) and 10 obese adolescents (5 male).Results: At baseline, REE (Kcal/day) in pre-pubertal weight reducers and maintainers had similar mean values (SD) of 1197(274) and 1246(160), but post-pubertal reducers had 252 kcal lower REE compared to post-pubertal maintainers, 1852 (279) and 2104 (393) respectively. When REE was expressed as Kcal/Kg/day (division of mean REE by mean weight in each group), baseline values for the pre-pubertal reducer and maintainer group and the post-pubertal reducer and maintainer group were 25.4, 23.7, 18.9 and 17.8 Kcal/Kg/day respectively. At follow-up, values were 28, 25.5, 18.4 and 16.6 Kcal/Kg per day respectively. Therefore compared with baseline, changes in REE/Kg per day between baseline and follow-up measures were +2.6 in pre-pubertal reducers, +1.8 in pre-pubertal maintainers, -0.5 in post-pubertal reducers and -1.2 in post-pubertal maintainers.Conclusions: Pre-pubertal children have a greater REE compared to post-pubertal adolescents, which would help them to maintain weight loss. Larger studies are needed to explore the relationship between weight loss and REE in pre and post pubertal children.

Longitudinal changes in bone density and body composition in post-pubertal adolescents treated with GnRH analogues in a Gender Identity Development Service

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Weight-for-length/height growth curves for children and adolescents in China in comparison with body mass index in prevalence estimates of malnutrition

Background: It is important to update weight-for-length/height growth curves in China and re-examine their performance in screening malnutrition.Aim: To develop weight-for-length/height growth curves for Chinese children and adolescents.Subjects and methods: A total of 94 302 children aged 0–19 years with complete sex, age, weight and length/height data were obtained from two cross-sectional large-scaled national surveys in China. Weight-for-length/height growth curves were constructed using the LMS method before and after average spermarcheal/menarcheal ages, respectively. Screening performance in prevalence estimates of wasting, overweight and obesity was compared between weight-for-height and body mass index (BMI) criteria based on a test population of 21 416 children aged 3–18.Results: The smoothed weight-for-length percentiles and Z-scores growth curves with length 46–110 cm for both sexes and weight-for-height with height 70–180 cm for boys and 70–170 cm for girls were established. The weight-for-height and BMI-for-age had strong correlation in screening wasting, overweight and obesity in each age–sex group. There was no striking difference in prevalence estimates of wasting, overweight and obesity between two indicators except for obesity prevalence at ages 6–11.Conclusion: This set of smoothed weight-for-length/height growth curves may be useful in assessing nutritional status from infants to post-pubertal adolescents.

The mediating role of energy intake on the relationship between screen time behaviour and body mass index in adolescents with obesity: The HEARTY study

Adolescents spend up to 6–8 h/day in sedentary screen behaviour and screen time is an independent risk factor for obesity. However, the mechanisms by which screen time confers obesity risk remain unclear. Via community level recruitment this study examined whether the relationship between screen time behaviours and body mass index (BMI: kg/m2) was mediated by total energy intake or macronutrient consumption. In a cross-sectional study of post-pubertal adolescents (N = 283: 86M, 197F) with overweight or obesity at baseline of an intervention for weight control, we examined self-reported total energy intake (mean Calories from 3 day food diary), macronutrient intake (grams/day of carbohydrate, fat, protein) and total screen time (aggregate of hours/day watching TV, playing seated video games, and recreational computer use). BMI was objectively measured and converted to standardized scores (z-BMI). Simple and multiple mediation analyses were conducted using the bootstrapping approach described by Preacher and Hayes. Covariates included age, sex, ethnicity, parental education, Tanner stage, and self-reported physical activity. The relationship between screen time and z-BMI was significantly mediated by energy intake. Higher levels of carbohydrate intake, but not fat or protein intake, significantly mediated the relationship between screen time and z-BMI (95% bias-corrected and accelerated confidence interval [0.0004, 0.0074]). Higher carbohydrate intake mediated the relationship between TV viewing and z-BMI, and video gaming and z-BMI. In conclusion, the relationship between screen time and BMI appears to be mediated by increased energy intake, primarily in the form of higher carbohydrate intake. It is possible that reducing time spent watching TV and playing video games may reduce food intake and help promote dietary adherence needed for weight management in obese adolescents. Clinical Trial RegistrationClinicalTrials.gov ID: NCT00195858.

Body composition and energy intake - skeletal muscle mass is the strongest predictor of food intake in obese adolescents: The HEARTY trial.

There has been renewed interest in examining the relationship between specific components of energy expenditure and the overall influence on energy intake (EI). The purpose of this cross-sectional analysis was to determine the strongest metabolic and anthropometric predictors of EI. It was hypothesized that resting metabolic rate (RMR) and skeletal muscle mass would be the strongest predictors of EI in a sample of overweight and obese adolescents. 304 post-pubertal adolescents (91 boys, 213 girls) aged 16.1 (±1.4) years with body mass index at or above the 95th percentile for age and sex OR at or above the 85th percentile plus an additional diabetes risk factor were measured for body weight, RMR (kcal/day) by indirect calorimetry, body composition by magnetic resonance imaging (fat free mass (FFM), skeletal muscle mass, fat mass (FM), and percentage body fat), and EI (kcal/day) using 3 day food records. Body weight, RMR, FFM, skeletal muscle mass, and FM were all significantly correlated with EI (p < 0.005). After adjusting the model for age, sex, height, and physical activity, only FFM (β = 21.9, p = 0.007) and skeletal muscle mass (β = 25.8, p = 0.02) remained as significant predictors of EI. FFM and skeletal muscle mass also predicted dietary protein and fat intake (p < 0.05), but not carbohydrate intake. In conclusion, with skeletal muscle mass being the best predictor of EI, our results support the hypothesis that the magnitude of the body's lean tissue is related to absolute levels of EI in a sample of inactive adolescents with obesity.

Two-center Analysis of Long-term Outcomes after High Ligation Inguinal Hernia Repair in Adolescents

High ligation of the inguinal hernia sac is standard practice for many pediatric surgeons in postpubertal adolescents. Most adult surgeons do not use this technique to repair indirect inguinal hernias because of concerns for higher recurrence rates compared with mesh repairs. Therefore, we examined long-term outcomes of adolescent high ligation hernia repair performed by pediatric surgeons. Telephone surveys were conducted on children over 12 years old at the time of repair, and patients and/or their parents were contacted 18 months postrepair. Patients were identified from two institutions between 1998 and 2010. The incidences of reoperation, recurrence, presence of bulge, chronic pain, or numbness were determined. A total of 210 patients (40.7% response rate) were available for phone interviews at 18.6 to 159.5 months postrepair. Mean age was 14.6 ± 1.8 (range: 12.0-19.0 years). Fourteen patients had pain (6.7%) and five had numbness (2.4%). There were four (1.9%) patients with a second operation, two of which confirmed a recurrent hernia. Three patients expressed concern about possible recurrence. Two report a bulge, but have not been evaluated. Pediatric hernia repair with high sac ligation appears effective in patients anatomically similar to adults with low recurrence rate and low incidence of chronic symptoms. These data suggest that prospective trials on the adequacy of high ligation in adults are warranted.

Human Chorionic Gonadotropin Stimulation Test in Prepubertal Children with Micropenis Can Accurately Predict Leydig Cell Function in Pubertal or Postpubertal Adolescents

Background/Aim: To evaluate the accuracy of the human chorionic gonadotropin (hCG) stimulation test in children with micropenis in predicting later Leydig cell function. Methods: We conducted a retrospective investigation of testosterone response to a 3-day hCG test (3,000 IU/m²/day) in prepuberty to indicate the need for hormone replacement therapy (HRT) in adolescence. Results: Fifty Japanese boys (range, 0.8-15.4 years of age; median, 8.9) with micropenis were enrolled. Thirty-four spontaneously developed puberty and preserved the ability of testosterone production (group 1), while 16 did not develop any pubertal signs without HRT (group 2). Serum testosterone levels after the hCG test (post-hCG T) in group 2 (range, <0.05-1.1 ng/ml; median, 0.24) were significantly lower than in group 1 (range, 0.5-8.7 ng/ml; median, 2.4; p < 0.0001). Based on true positives who required continuous HRT, the area under the receiver-operating characteristics curve for post-hCG T was 0.983 [95% confidence interval (CI), 0.90-1.00]. The post-hCG T cut-off level corresponding to the Youden index was 1.1 ng/ml (95% CI, 1.0-1.1), with a sensitivity of 100.0% (95% CI, 79.4-100.0) and a specificity of 94.1% (95% CI, 80.3-99.3). Conclusions: The hCG test in prepubertal children with micropenis can be useful for predicting Leydig cell function in pubertal or postpubertal adolescents. The post-hCG T cut-off level of 1.1 ng/ml is recommended to screen for those who will likely require HRT for pubertal development.

Increased Sensitivity of the Circadian System to Light in Early/Mid-Puberty.

Late adolescence is marked by a delay in sleep timing, which is partly driven by a delay shift of the circadian timing system. This study examined whether the sensitivity of the circadian system to light-the primary entraining stimulus to the circadian system-differs between pre- to mid-pubertal and late to postpubertal adolescents. The study was designed to determine the influence of puberty on the sensitivity of the circadian system to light in humans. Melatonin suppression to low and moderate light levels was assessed in 38 pre- to mid-pubertal (9.1-14.7 years) and 29 late to postpubertal (11.5-15.9 years) adolescents. They received 1 hour of four light levels on consecutive nights: approximately 0.1 (near-dark baseline condition), 15, 150, and 500 lux. One group received evening light beginning at 11:00 pm (n = 39); a second group received morning light beginning at 3:00 am (n = 28). Salivary melatonin was sampled every 30 minutes. Melatonin suppression for 15, 150, and 500 lux was calculated relative to unsuppressed baseline levels in the 0.1 lux setting, within individuals. The pre- to mid-pubertal group showed significantly greater melatonin suppression to 15 lux (9.2 ± 20.5%), 150 lux (26.0 ± 17.7%), and 500 lux (36.9 ± 11.4%) during evening light exposure compared to the late to postpubertal group (-5.3 ± 17.7%, 12.5 ± 17.3%, and 23.9 ± 21.7%, respectively; P < .05). No significant differences were seen between developmental groups in morning melatonin suppression. These results indicate support for a greater sensitivity to evening light in early pubertal children. The increased sensitivity to light in younger adolescents suggests that exposure to evening light could be particularly disruptive to sleep regulation for this group.

Effects of aerobic and resistance training on abdominal fat, apolipoproteins and high-sensitivity C-reactive protein in adolescents with obesity: the HEARTY randomized clinical trial.

To investigate the effects of aerobic training, resistance training, or both on abdominal subcutaneous fat (subcutaneous adipose tissue (SAT)) (deep and superficial), visceral fat (visceral adipose tissue (VAT)), apolipoproteins A-1 and B (ApoA-1, ApoB), ApoB/ApoA-1 ratio and high-sensitivity C-reactive protein (HSCRP) in post-pubertal adolescents with obesity. After a 4-week supervised moderate-intensity exercise run-in period, 304 postpubertal adolescents with overweight (body mass index (BMI) ⩾85th percentile for age and sex+diabetes risk factor) or obesity (⩾95th BMI percentile) aged 14-18 years were randomized to four groups for 22 weeks (5 months): aerobic training, resistance training, combined training or a non-exercising control. This study used a randomized controlled design. All groups received dietary counseling designed to promote healthy eating with a maximum daily energy deficit of 250 kcal. Abdominal fat (SAT and VAT) at the level of the fourth and fifth lumbar vertebrae (L4-L5) was measured by magnetic resonance imaging and ApoA-1, ApoB and HSCRP were measured after a 12-h fast at baseline and after 6 months. Changes in SAT at L4-L5 were -16.2 cm(2) in aerobic (P=0.04 vs control), -22.7 cm(2) in resistance (P=0.009 vs control) and -18.7 cm(2) in combined (P=0.02 vs control). Combined training reduced ApoB levels from 0.81±0.02 to 0.78±0.02 g l(-1) (P=0.04 vs control) and ApoB/ApoA-1 ratio from 0.67±0.02 to 0.64±0.02 (P=0.02 vs control and P=0.04 vs aerobic). There were no significant differences in VAT, ApoA-1 or HSCRP levels between groups. Aerobic and resistance training and their combination decreased abdominal SAT in adolescents with obesity. Combined training caused greater improvements in ApoB/ApoA-1 ratio compared with aerobic training alone.

Optic Neuritis in Korean Children: Low Risk of Subsequent Multiple Sclerosis

BackgroundA relationship between optic neuritis and multiple sclerosis has previously been reported in non-Asian adults. We extended the investigation to Korean children. ObjectivesWe compared the clinical features, laboratory findings, and visual outcomes of optic neuritis between prepubertal children and postpubertal adolescents and evaluated the conversion rate of optic neuritis to multiple sclerosis in Korean children. MethodsWe conducted a retrospective analysis of children less than 18 years of age presenting with optic neuritis at Pusan National University Hospital between January 2002 and December 2013. Outcomes and clinical, ophthalmologic, magnetic resonance imaging, and laboratory findings were reviewed. ResultsTwenty-six children (male:female, 1:1.2) were included. Follow-up duration was 16.3 ± 27.5 months in the prepubertal children (≤10 years, n = 13) and 8.2 ± 9.2 months in postpubertal adolescent (>10 years, n = 13) (P = 0.32). There was no significant difference between the prepubertal group and postpubertal group in clinical, ophthalmologic, magnetic resonance imaging, or laboratory findings. Of two patients (7.7%) with abnormal brain magnetic resonance images, one developed multiple sclerosis and the other developed acute disseminated encephalomyelitis. Of three patients (11.5%) with relapsing optic neuritis, two developed systemic lupus erythematosus and one developed multiple sclerosis. ConclusionThe risk of developing multiple sclerosis after pediatric optic neuritis was low (7.7%). Abnormal brain magnetic resonance imaging and relapsing optic neuritis should alert the clinician to systemic or neurological disorders.

Childhood obesity, physical activity, and exercise.

Importance:Little evidence exists on which exercise modality is optimal for obese adolescents. Objective: To determine the effects of aerobic training, resistance training, and combined training on percentage body fat in overweight and obese adolescents.Design, Setting, and Participants:Randomized, parallel-group clinical trial at community-based exercise facilities in Ottawa (Ontario) and Gatineau (Quebec), Canada, among previously inactive postpubertal adolescents aged 14-18 years (Tanner stage IV or V) with body mass index at or above the 95th percentile for age and sex or at or above the 85th percentile plus an additional diabetes mellitus or cardiovascular risk factor. Interventions: After a 4-week run-in period, 304 participants were randomized to the following 4 groups for 22 weeks: aerobic training (n = 75), resistance training (n = 78), combined aerobic and resistance training (n = 75), or nonexercising control (n = 76). All participants received dietary counseling, with a daily energy deficit of 250 kcal.Main Outcomes and Measures:The primary outcome was percentage body fat measured by magnetic resonance imaging at baseline and 6 months. We hypothesized that aerobic training and resistance training would each yield greater decreases than the control and that combined training would cause greater decreases than aerobic or resistance training alone.Results:Decreases in percentage body fat were −0.3 (95% CI, −0.9 to 0.3) in the control group, −1.1 (95% CI, −1.7 to −0.5) in the aerobic training group (p = .06 vs. controls), and −1.6 (95% CI, −2.2 to −1.0) in the resistance training group (p = .002 vs controls). The −1.4 (95% CI, −2.0 to −0.8) decrease in the combined training group did not differ significantly from that in the aerobic or resistance training group. Waist circumference changes were −0.2 (95% CI, −1.7 to 1.2) cm in the control group, −3.0 (95% CI, −4.4 to −1.6) cm in the aerobic group (p = .006 vs controls), −2.2 (95% CI −3.7 to −0.8) cm in the resistance training group (p = .048 vs controls), and −4.1 (95% CI, −5.5 to −2.7) cm in the combined training group. In per-protocol analyses (&gt; 70% adherence), the combined training group had greater changes in percentage body fat (-2.4, 95% CI, −3.2 to −1.6) vs the aerobic group (-1.2; 95% CI, −2.0 to −0.5; p = .04 vs the combined group) but not the resistance group (-1.6; 95% CI, −2.5 to −0.8).Conclusions and Relevance:Aerobic, resistance, and combined training reduced total body fat and waist circumference in obese adolescents. In more adherent participants, combined training may cause greater decreases than aerobic or resistance training alone.

Effects of aerobic training, resistance training, or both on psychological health in adolescents with obesity: The HEARTY randomized controlled trial.

To determine the effects of aerobic training, resistance training, and combined training on mood, body image, and self-esteem in adolescents with obesity. After a 4-week prerandomization treatment, 304 postpubertal adolescents (91 males, 213 females) with obesity ages 14-18 years were randomized to 1 of 4 groups for 22 weeks: aerobic training (n = 75), resistance training (n = 78), combined aerobic and resistance training (n = 75), or nonexercising control (n = 76). All participants received dietary counseling, with a daily energy deficit of 250 kcal. Mood was measured using the Brunel Mood Scale. Body image was assessed using the Multiple Body Self-Relations Questionnaire, and physical self-perceptions and global self-esteem were measured using the Harter Physical Self-Perceptions Questionnaire. Median adherence was 62%, 56%, and 64% in aerobic, resistance, and combined training, respectively. Resistance and combined training produced greater improvements than control on vigor, and resistance training reduced depressive symptoms. All groups improved on body image and physical self-perceptions, but combined showed greater increases than control on perceived physical conditioning, while only resistance training showed greater increases than controls on global self-esteem. Both combined and resistance training demonstrated greater increases in perceived strength than control. Psychological benefits were more related to better adherence and reductions in body fat than changes in strength or fitness. Resistance training, alone or in combination with aerobic training, may provide psychological benefits in adolescents with overweight or obesity, and therefore could be an alternative to aerobic training for some individuals in the biological and psychological management of adolescent obesity.

Increasing the number of clinical trials available to adolescents diagnosed with cancer.

Improving access to clinical trials for adolescents with cancer remains an important issue for pediatric health care providers. In this brief report, we highlight barriers to increasing the number of clinical trials as a mechanism for addressing this problem. The challenges discussed include: (1) engaging stakeholders to increase funding; (2) increasing cooperation between clinical trial cooperative groups; and (3) permitting delivery of novel drugs to postpubertal adolescents, in the absence of formal pediatric Phase I evaluation.

Risk Stratification of Pubertal Children and Postpubertal Adolescents with Clinical Stage I Testicular Nonseminomatous Germ Cell Tumors

The COG (Children's Oncology Group) currently recommends surveillance for all children and adolescents with clinical stage I testicular germ cell tumors. However, up to 30% of adults with clinical stage I testicular germ cell tumors harbor occult metastatic disease. In adults with clinical stage I nonseminoma some groups advocate a risk stratified approach. Occult metastases were noted in 50% of patients with features such as lymphovascular invasion or embryonal carcinoma predominance in the orchiectomy. However, to our knowledge there are no data on the impact of high risk features in such pubertal children and postpubertal adolescents. We reviewed an institutional testis cancer database for pubertal children and postpubertal adolescents younger than 21 years. We tested the hypothesis that lymphovascular invasion, or 40% or greater embryonal carcinoma in the orchiectomy specimen, would increase the risk of occult metastases, ie relapse during surveillance or positive nodes on retroperitoneal lymph node dissection. We identified 23 patients with a median age of 18.6 years (range 7.1 to 20.9) at diagnosis. Of these patients 14 (60.9%) were on surveillance, 9 (39.1%) underwent primary retroperitoneal lymph node dissection and none received initial chemotherapy. Seven patients (30.4%) had occult metastatic disease. High risk pathological features were found in the orchiectomy specimen in 12 patients (52.2%), including all 12 (52.2%) with 40% or greater embryonal carcinoma and 3 (13.0%) with lymphovascular invasion. Seven patients (58.3%) with high risk features had occult metastatic disease vs none (0%) without high risk features (log rank p = 0.031). Approximately half of pubertal children and postpubertal adolescents with high risk clinical stage I testicular germ cell tumors harbor occult metastatic disease. These results may be useful when discussing prognosis and treatment with patients and families.