Body Mass Index Standard Deviation Research Articles

Kidney damage predictors in children with metabolically healthy and metabolically unhealthy obesity phenotype.

Obesity and kidney damage have been closely linked in adults, but little is still known in childhood. To identify predictors of kidney damage in children with metabolically healthy (MHO) and metabolically unhealthy (MUO) obesity phenotypes. We retrospectively examined 396 children with obesity (mean age 10.72 ± 2.71 years, body mass index-standard deviation score, BMI-SDS, 2.23 ± 0.57) stratified according to metabolic phenotypes. Kidney damage was defined as the presence of reduced estimated glomerular filtration rate (eGFR < 90 mL/min/1.73m2) and/or albuminuria (≥ 30 mg/g urinary creatinine). Kidney damage was found in 20.9% of the study population. Children with kidney damage had higher BMI-SDS, homeostasis model assessment of insulin resistance (HOMA-IR), and inflammation markers levels and increased prevalence of non-alcoholic fatty liver disease (NAFLD) than those without kidney damage (all p < 0.005). MUO and MHO subjects had respectively an odds ratio (OR) to show kidney damage of of 1.92 (95%CI:1.22-3.01; p = 0.005) and 1.05 (95%CI:1.00-1.09; p = 0.028) after adjustments. Moreover, we found that only HOMA-IR was closely associated to kidney damage in MUO group (OR = 2.07;95%CI:1.20-3.57; p = 0.007), while HOMA-IR (OR = 1.15;95%CI:1.02-1.29; p = 0.011) and uric acid (OR = 1.15;95% CI:1.02-1.30; p = 0.010) were the only significant risk factors for kidney damage in MHO group. An increased risk of kidney damage has been observed in children with obesity and in particular in those with MUO phenotype. As their role on kidney function, HOMA-IR should be monitored in MUO children and both HOMA-IR and uric acid in MHO children.

Characteristics of Children and Adolescents with Hyperinsulinemia Undergoing Oral Glucose Tolerance Test: A Single-Center Retrospective Observational Study.

The aim of this study was to evaluate a potential correlation between results of the oral glucose tolerance test (OGTT) and the auxological/metabolic parameters in a cohort of overweight patients assessed for suspicion of hyperinsulinism. We analyzed 206 patients, comparing those with insulin peak below (nonhyperinsulinemic) and over 100 uIU/mL (hyperinsulinemic) at the OGTT. We found a significant difference in weight (p = 0.037), body mass index (BMI, p < 0.001) and BMI standard deviations (SD, p < 0.001), waist circumference (p = 0.001), hip circumference (p = 0.001), and waist-to-height ratio (WHtR, p = 0.016) between the two groups. Analyzing the median insulin value during OGTT in the whole population, a weakly positive correlation emerged with weight SD (p < 0.001; rho = 0.292) and a moderate positive correlation with BMI SD (p < 0.001; rho = 0.323). We also found a weakly positive correlation with waist circumference (p = 0.001; rho = 0.214), hip circumference (p = 0.001; rho = 0.217), and WHTR (p = 0.016; rho = 0.209) and a moderate positive correlation with the HOMA index (p < 0.001; rho = 0.683). The median insulin value correlates with high triglyceride (p < 0.001; rho = 0.266) and triiodothyronine values (p = 0.003; rho = 0.193) and with low HDL values (p < 0.001; rho = -0.272). In clinical practice the interpretation of laboratory and anthropometric parameters could predict the level of insulin, highlighting also a possible underlying diagnosis of insulin resistance and/or hyperinsulinemia without performing an OGTT.

The link between obesity and insulin resistance among children: Effects of key metabolites.

Childhood obesity became a severe public health challenge, and insulin resistance (IR) was one of the common complications. Both obesity and IR were considered as the basis of metabolic disorders. However, it is unclear which common key metabolites are associated with childhood obesity and IR. The children were divided into normal weight and overweight/obese groups. Fasting blood glucose and fasting insulin were measured, and homeostasis model assessment of insulin resistance was calculated. Liquid chromatography-tandem mass spectrometry was applied for metabonomic analysis. Multiple linear regression analysis and correlation analysis explored the relationships between obesity, IR, and metabolites. Random forests were used to rank the importance of differential metabolites, and relative operating characteristic curves were used for prediction. A total of 88 normal-weight children and 171 obese/overweight children participated in the study. There was a significant difference between the two groups in 30 metabolites. Childhood obesity was significantly associated with 10 amino acid metabolites and 20 fatty acid metabolites. There were 12 metabolites significantly correlated with IR. The ranking of metabolites in random forest showed that glutamine, tyrosine, and alanine were important in amino acids, and pyruvic-ox-2, ethylmalonic-2, and phenyllactic-2 were important in fatty acids. The area under the curve of body mass index standard deviation score (BMI-SDS) combined with key amino acid metabolites and fatty acid metabolites for predicting IR was 80.0% and 76.6%, respectively. There are common key metabolites related to IR and obese children, and these key metabolites combined with BMI-SDS could effectively predict the risk of IR.

Pediatric Macrocorticotropinoma: Do They Differ from Microcorticotropinoma?

Introduction: Cushing’s disease (CD) due to macrocorticotropinoma (MC) in children and adolescents is a rare entity with limited information regarding its characteristics. The objective of the study is to describe the clinical, biochemical, imaging, management, outcome, and genetic characteristics of children and adolescents with CD due to MC and compare them with those of microcorticotropinoma (mc). Methods: This retrospective study was conducted at a single tertiary care center. Thirty-two patients with CD and MC (maximum tumor dimension ≥10 mm on imaging) and 65 patients with mc (<10 mm on imaging) aged ≤20 years at presentation were enrolled. Results: Nineteen girls and 13 boys with MC presented at a median (IQR) age of 14.5 (12.0–17.9) years. Patients with MC had higher body mass index-standard deviation score (BMI-SDS) (3.70 ± 2.60 vs. 2.59 ± 2.01, p = 0.04), more frequent neuro-ophthalmic symptoms (25% vs. 9% p = 0.04) and short stature (59% vs. 34%, p = 0.049) but less frequent livid striae (53% vs. 77%, p = 0.01), hypokalemia (12% vs. 36%, p = 0.04), and lower cortisol (nmol/L) to corticotropin (pmol/L) ratio (41.20 vs. 55.74, p = 0.04) than those with mc. The remission (59% vs. 64%, p = 1.0) and relapse (53% vs. 37%, p = 0.26) rates after first-line surgery and remission rate after radiotherapy (RT) were comparable between the two cohorts, whereas time to remission after RT (27 vs. 13 months, p = 0.05) was longer in the MC group. A patient with MC had a pathogenic germline variant in CDH23. Conclusion: In this large monocentric series of pediatric CD, frequent mass effect symptoms and short stature, higher BMI-SDS, less frequent livid striae, and hypokalemia with lower effective cortisol secretion characterize the MC cohort. The outcomes of surgery and RT were similar between the groups except for a longer time to remission after RT in the MC cohort. Germline variants are rare (4%) in pediatric MC.

Endovenous Thermal Ablation for Treatment of Symptomatic Saphenous Veins-Does the Body Weight Matter?

This study aimed to examine whether body weight may affect the effectiveness and safety of endovenous thermal ablation (ETA) for the treatment of symptomatic varicose veins. This retrospective single-center cohort study analyzed the outcomes and patient demographic data with a focus on the body weight of all patients who had ETA of symptomatic varicose veins between September 2017 and October 2020. A total of 1178 treated truncal veins from 636 patients were analyzed. The mean ± standard deviation body mass index (BMI) was 25.5 ± 4.9. In 2.3% of cases, the patients were underweight (BMI < 18.5), 31.0% were overweight (BMI > 25), and 16.6% were obese (BMI > 30). Complete truncal occlusion was observed 1 year post intervention in 97.6-100% and patients were satisfied or very satisfied in 96.2-100% across BMI groups. Pain was low but significantly higher in the patients with obesity 6 weeks post intervention (visual analog scale 0.84 ± 1.49) and a higher infection rate was observed in the patients with obesity (n = 4/132; 3.0%). No significant association was observed between BMI and bleeding or thromboembolic events. Patients with obesity experienced prolonged pain and more infections after ETA, but ETA for varicose vein treatment remains effective and safe, independent of the patient's BMI.

Genetics of Plasma Bilirubin and Associations between Bilirubin and Cardiometabolic Risk Profiles in Danish Children and Adolescents.

Bilirubin is the end product of heme catabolism, mainly produced by the breakdown of mature red blood cells. Due to its anti-inflammatory, antioxidant, antidiabetic, and antilipemic properties, circulating bilirubin concentrations are inversely associated with the risk of cardiovascular disease, type 2 diabetes, and all-cause mortality in adults. Some genetic loci associated with circulating bilirubin concentrations have been identified by genome-wide association studies in adults. We aimed to examine the relationship between circulating bilirubin, cardiometabolic risk factors, and inflammation in children and adolescents and the genetic architecture of plasma bilirubin concentrations. We measured fasting plasma bilirubin, cardiometabolic risk factors, and inflammatory markers in a sample of Danish children and adolescents with overweight or obesity (n = 1530) and in a population-based sample (n = 1820) of Danish children and adolescents. Linear and logistic regression analyses were performed to analyze the associations between bilirubin, cardiometabolic risk factors, and inflammatory markers. A genome-wide association study (GWAS) of fasting plasma concentrations of bilirubin was performed in children and adolescents with overweight or obesity and in a population-based sample. Bilirubin is associated inversely and significantly with a number of cardiometabolic risk factors, including body mass index (BMI) standard deviation scores (SDS), waist circumference, high-sensitivity C-reactive protein (hs-CRP), homeostatic model assessment for insulin resistance (HOMA-IR), hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), triglycerides, and the majority of measured inflammatory markers. In contrast, bilirubin was positively associated with fasting plasma concentrations of alanine transaminase (ALT), high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SDS), and the inflammatory markers GH, PTX3, THBS2, TNFRSF9, PGF, PAPPA, GT, CCL23, CX3CL1, SCF, and TRANCE. The GWAS showed that two loci were positively associated with plasma bilirubin concentrations at a p-value threshold of <5 × 10-8 (rs76999922: β = -0.65 SD; p = 4.3 × 10-8, and rs887829: β = 0.78 SD; p = 2.9 × 10-247). Approximately 25% of the variance in plasma bilirubin concentration was explained by rs887829. The rs887829 was not significantly associated with any of the mentioned cardiometabolic risk factors except for hs-CRP. Our findings suggest that plasma concentrations of bilirubin non-causally associates with cardiometabolic risk factors in children and adolescents.

Early weight gain after diagnosis may have an impact on remission status in children with new-onset type 1 diabetes mellitus.

Residual beta-cell function and improvement in insulin sensitivity by reversal of glucose toxicity are two phenomena thought to be related to partial remission (PR). Body fat mass is the major determinant of insulin sensitivity. The aim of this study is to investigate the relationship between the rate of body weight gain after diagnosis of type 1 diabetes mellitus (T1DM) and other clinical factors for the development and duration of PR. Children (2-16 years) with new-onset T1DM (n = 99) were grouped into remitters and non-remitters by using insulin dose-adjusted glycosylated hemoglobin (HbA1c) values. Laboratory and clinical data as well as daily insulin requirement per kilogram of body weight at diagnosis and each visit were recorded, and the duration of PR was determined. Changes in body mass index standard deviation score (BMI-SDS) were calculated by the auxological data collected every 6 months. There were 47 remitters (47.5%) and 52 (52.5%) non-remitters. The mean increase in BMI-SDS at the first 6 months of diagnosis was higher in the non-remitters than in the remitters (p = 0.04). Duration of PR was negatively correlated with the change in BMI-SDS between 6 and 12 months after diagnosis. Male sex, younger age, prepubertal status, and lower HbA1c were predictors of remission, among which male sex had the highest chance by multivariate regression. Early rapid weight gain after diagnosis of T1DM may play a role in the lack of remission and shorter duration of PR. Interventions to prevent early rapid weight gain can maintain the development and prolongation of remission.

Prevalence of refractoriness when testing growth hormone levels in children

ObjectiveLate night spontaneous growth hormone (GH) pulses may influence the pituitary GH response to provocation tests. We evaluated GH response during arginine-insulin-tolerance test (AITT) after a GH peak during a short spontaneous nocturnal profile (SSNP) in children with short stature or low growth velocity. DesignUsing SSNP and subsequent AITT, we examined 257 children 4–18 years old (138 (53.7%) males) recruited from three hospitals. Medical records were reviewed retrospectively. Refractory children were defined as a GH peak ≥7 μg/L during SSNP but no GH peak ≥7 μg/L during AITT. ResultsIn total, 201/257 children had a GH peak ≥7 μg/L at SSNP and/or AITT. Of these, 21.9% were refractory. The proportion of males (p = 0.033) and body mass index (BMI) standard deviation score (SDS) (p = 0.037) were higher in the refractory group than in children with a GH peak ≥7 μg/L during AITT. The median period between last GH peak ≥7 μg/L during SSNP and GHmax at AITT was 210 (30–390) minutes. The GHmax at AITT occurred 30 min earlier for children without a peak ≥7 μg/L during the SSNP (p = 0.004). The number of refractoriness differed somewhat between the hospitals (p = 0.025). ConclusionsMany children with short stature were refractory at testing; among them we found few clinical characteristics. Refractoriness might be influenced by some differences in procedure, but needs to be considered when evaluating GH response in children.

An evaluation of basal metabolic rate among healthy individuals — a cross-sectional study

BackgroundThe main source of daily energy requirement in Asian societies is basal metabolic rate (BMR). Even though the reason for this fluctuation is debatable, prior research have shown that BMR is highly varied in individuals. All studies concur that variation in fat-free mass (FFM) is important, although the effects of fat mass (FM), age, sex, and the hormones leptin, triiodothyronine (T3), and thyroxine (T4) are still unknown.ObjectiveThe main objectives of the study are as follows:• To evaluate the basal metabolic rate among healthy individuals• To identify the risk factors on basal metabolic rate among healthy individualsMethodologyIn total, 50 individuals were consecutively enrolled in the study during the entrepreneurship studio on 29th June 2022 held at Garden City University (GCU). The inclusion criteria were age between 18 and 50 years, both males and females, students and professors of GCU, and healthy individuals. The exclusion criteria were subjects who had overt metabolic and/or endocrine diseases (e.g., diabetes, hypothyroidism, hypertension, amenorrhea) and those taking any drug known to influence energy metabolism. The convenient samples of 50 subjects were taken from this study.Outcome measuresBasal metabolic rate (BMR) and body mass index (BMI).ResultsThe demographic data, height, weight, BMI, and BMR were recorded. The mean and standard deviation of age are 25.81 ± 8.71 and 23.95 ± 6.67 of males and females, respectively. The mean and standard deviation of height are 1.68 ± 0.68 and 1.63 ± 0.07, respectively. The mean and standard deviation for weight are 63.8 ± 11.49 and 54.86 ± 10.43, respectively. The mean and standard deviation of BMI are males and females which are 22.3 ± 3.22 and 20.47 ± 3.62, respectively. The mean and standard deviation of BMR are males and females which are 1552.41 ± 127.3 and 1327.7 ± 147.9.ConclusionThe energy used up while lying still at rest and being awake during the nocturnal postabsorptive state is known as the basal metabolic rate (BMR). The values can be used as a reference for comparison with the normative values, and cardiorespiratory endurance training can be included in the rehabilitation program.

Blood pressure in girls with central precocious puberty receiving GnRH analogue therapy.

Case reports show hypertension in children treated with GnRH analogues for central precocious puberty (CPP). However, relevant data on blood pressure are scarce. We aimed to evaluate blood pressure (BP) among girls with idiopathic CPP and early-onset puberty before and during GnRH analogue therapy; and to examine associations of blood pressure with clinical parameters. For this retrospective longitudinal cohort study, demographic, anthropometric, clinical, and laboratory data were collected from electronic files. The study group included 112 girls with idiopathic CPP or early-onset puberty followed in a tertiary pediatric endocrinology institute, and a control group of 37 healthy pre-pubertal girls. The main outcome measures were BP percentile, before, and during treatment with GnRH analogue. At baseline, similar proportions of the study and control groups had BP values>90th percentile: 64 (53 %) and 17 (46 %), respectively (p=0.57). The mean systolic and diastolic BP percentiles measured under treatment remained unchanged. In the study group, baseline BP>90th percentile compared to normal baseline BP was associated with lower birthweight and a higher body mass index-standard deviation score: 2,821 ± 622 vs. 3,108 ± 485 g and 1.0 ± 0.7 vs. 0.70 ± 0.8, respectively, p=0.01 for both. GnRH analogue therapy for precocious or early puberty was not associated with increased blood pressure. The stability of mean blood pressure percentile during treatment is reassuring.

#6054 CLINICAL CHARACTERISTICS AND RENAL RISK OF PATIENTS WITH CHRONIC KIDNEY DISEASE: REAL-WORLD EVIDENCE FROM THE ICAREME GLOBAL REGISTRY

Abstract Background and Aims Chronic kidney disease (CKD) has emerged as a leading global public health concern due to its growing prevalence and associated morbidity and mortality. Throughout the disease progression, CKD is associated with a substantial health and socio-economic burden on patients, families, and healthcare systems worsened by complex interactions with type 2 diabetes (T2D), hypertension (HTN), and heart failure (HF). To help current and future patients get the best possible care, it is of the greatest importance to better understand how they are managed routinely, but real-world data on coexisting cardiovascular, renal, and metabolic diseases are scarce or non-existent in many countries. The iCaReMe Global Registry aims to address these knowledge gaps by providing observational data on patients’ characteristics, risk factors, management patterns, disease progression, and outcomes related to CKD and associated comorbidities namely: T2D, HTN, and HF. Method The iCaReMe Global Registry (NCT03549754) is a prospective, investigator-led, multinational, observational registry relying on voluntary participation by treating physicians to assess the management and quality of care through socio-demographic and clinical characteristics, disease management patterns (including screening, diagnosis, treatment approaches), healthcare resource utilization and clinical outcomes in patients with CKD, T2D, HTN, and/or HF. Eligible and consented patients were enrolled during routine clinical practice based on the physician's discretion and were followed up per routine clinical care. We present the descriptive analysis of baseline clinical and demographic characteristics of the CKD cohort enrolled in the iCaReMe Global Registry from February 2018 to December 2022. Results Overall 2977 patients with CKD have been enrolled from 21 countries (Argentina, Costa Rica, Egypt, Ethiopia, Georgia, Greece, Hong Kong, Indonesia, India, Jordan, Kenya, Lebanon, Malaysia, Mexico, Russia, South Africa, Thailand, The Philippines, Turkey, Ukraine, and the United Arab Emirates). At baseline, the mean ± standard deviation (SD) age was 60.4 ± 13.8 years and 54.6% were males. The mean ± SD systolic and diastolic blood pressures of the cohort were 120.4 ± 43.6 and 70.5 ± 25.6 mmHg and the mean ± SD body mass index was 21.6 ± 12.9 kg/m2. 68.9% had T2D and 68.3% had hypertension. Diabetic kidney disease and hypertensive kidney disease were the most common etiologies in 78.8% of the patients (Figure 2). Serum creatinine was reported in 85.3% of patients and urine albumin-creatinine ratio (UACR) in 30.5% and only 25.9% had both. The prevalence of KDIGO GFR categories G3-5 based on estimated glomerular filtration rate (eGFR) using CKD-EPI was 72.5% and the prevalence of albuminuria A2/A3 was 75.9%. In total, 7.9% patients were undergoing dialysis. In patients with T2D (n = 2051); 69.1% (1250/1808) had G3-5 GFR category and 76.1% (484/636) had albuminuria stage A2 and A3. In patients with HTN (n = 2033); 77.6% (1367/1761) had G3-5 GFR category and 76.6% (485/633) had albuminuria stage A2 and A3. Conclusion At baseline most of iCaReMe Registry CKD cohort fall within the KDIGO high or very high risk of outcomes associated with a high prevalence of T2D and HTN. Our results also indicate an underutilization of albuminuria testing despite its critical role in diagnosis, risk stratification and follow up which raises concerns about CKD early detection, management, and prognosis.

Differences in Telomere Length between Adolescent Females with Anorexia Nervosa Restricting Type and Anorexia Nervosa Binge-Purge Type.

Physiological and psychological distress may accelerate cellular aging, manifested by shortening of telomere length (TL). The present study focused on TL shortening in anorexia nervosa (AN), an illness combining physiological and psychological distress. For that purpose, we measured TL in 44 female adolescents with AN at admission to inpatient treatment, in a subset of 18 patients also at discharge, and in 22 controls. No differences in TL were found between patients with AN and controls. At admission, patients with AN-binge/purge type (AN-B/P; n = 18) showed shorter TL compared with patients with AN-restricting type (AN-R; n = 26). No change in TL was found from admission to discharge, despite an improvement in body mass index standard deviation score (BMI-SDS) following inpatient treatment. Older age was the only parameter assessed to be correlated with greater TL shortening. Several methodological changes have to be undertaken to better understand the putative association of shorter TL with B/P behaviors, including increasing the sample size and the assessment of the relevant pathological eating disorder (ED) and non-ED psychological correlates in the two AN subtypes.

Evaluating potential predictors of weight loss response to liraglutide in adolescents with obesity: A post hoc analysis of the randomized, placebo-controlled SCALE Teens trial.

As childhood obesity prevalence increases, determining which patients respond to anti-obesity medications would strengthen personalized approaches to obesity treatment. In the SCALE Teens trial among pubertal adolescents with obesity (NCT02918279), liraglutide 3.0 mg (or maximum tolerated dose) significantly reduced body mass index (BMI) standard deviation score on average versus placebo. That said, liraglutide effects on BMI reduction varied greatly among adolescents, similar to adults. To identify post hoc characteristics predictive of achieving ≥5% and ≥10% BMI reductions at 56 weeks with liraglutide versus placebo in adolescents from the SCALE Teens trial. Logistic regression analysis was performed in 251 adolescents treated with liraglutide (n = 125) or placebo (n = 126) for 56 weeks. Baseline characteristics (selected a priori) included sex, race, ethnicity, age, Tanner (pubertal) stage, glycemic status (hyperglycemia [type 2 diabetes/prediabetes] vs. normoglycemia), obesity category (Class II/III vs. I), severity of depression symptoms (Patient Health Questionnaire-9), and weight variability (weight fluctuations over time). The effects of early responder status (≥4% BMI reduction at week 16) on week 56 response were assessed using descriptive statistics. Baseline characteristics did not affect achievement of ≥5% and ≥10% BMI reductions at week 56 in adolescents treated with liraglutide. Further, there was no association between weight variability and BMI reduction. Early liraglutide responders appeared to have greater BMI and body weight reductions at week 56 compared with early non-responders. This secondary analysis suggests that adolescents with obesity may experience significant BMI reductions after 56 weeks of liraglutide treatment, regardless of their sex, race, ethnicity, age, pubertal stage, glycemic status, obesity category, severity of depression symptoms, or weight variability. Early response may predict greater week 56 response.

Associations between cardiorespiratory fitness and cardiometabolic risk factors in children and adolescents with obesity

It is unclear if associations between cardiorespiratory fitness (CRF) and cardiometabolic risk factors are independent of degree of obesity, in children with obesity. The aim of this cross-sectional study on 151 children (36.4% girls), 9–17 years, from a Swedish obesity clinic, was to investigate associations between CRF and cardiometabolic risk factors, adjusted for body mass index standard deviation score (BMI SDS), in children with obesity. CRF was objectively assessed with the Åstrand-Rhyming submaximal cycle ergometer test, and blood samples (n = 96) and blood pressure (BP) (n = 84) according to clinical routine. Obesity specific reference values for CRF were used to create CRF levels. CRF was inversely associated with high-sensitivity C-reactive protein (hs-CRP), independent of BMI SDS, age, sex, and height. The inverse associations between CRF and diastolic BP did not remain significant when adjusted for BMI SDS. CRF and high-density lipoprotein cholesterol became inversely associated when adjusted for BMI SDS. Independent of degree of obesity, lower CRF is associated with higher levels of hs-CRP, as a biomarker of inflammation, in children with obesity and regular assessment of CRF should be encouraged. Future research in children with obesity should investigate if low-grade inflammation decreases when CRF is improved.

Long-Term Endocrinologic Follow-Up of Children with Brain Tumors and Comparison of Growth Hormone Therapy Outcomes: A SingleCenter Experience.

Brain tumors in childhood carry a high risk for endocrine disorders due to the direct effects of the tumor and/or surgery and radiotherapy. Somatotropes are vulnerable to pressure and radiotherapy; therefore, growth hormone deficiency is one of the most frequent abnormalities. This study aimed to evaluate endocrine disorders and recombinant growth hormone treatment outcomes in brain tumor survivors. In this study, 65 (27 female) patients were classified into 3 groups as craniopharyngioma (n = 29), medulloblastoma (n = 17), and others (n = 19). "Others" group included astrocytoma, ependymoma, germinoma, pineoblastoma, and meningioma patients. Anthropometric data and endocrine parameters of patients and their growth outcome with/without recombinant growth hormone therapy were collected from medical records, retrospectively. Mean age at the first endocrinological evaluation was 8.7 ± 3.6 years (range: 1.0- 17.1 years). Height, weight, and body mass index standard deviation score, mean ± standard deviation (median) values were -1.7 ± 1.7 (-1.5), -0.8 ± 1.9 (-0.8), and 0.2 ± 1.5 (0.4), respectively. Hypothyroidism (central 86.9%, primary 13.1%) was detected during follow-up in 81.5% of patients. Primary hypothyroidism in medulloblastoma (29.4%) was significantly higher compared to other groups (P = .002). The frequency of hypogonadotropic hypogonadism, central adrenal insufficiency, and diabetes insipidus was significantly high in the craniopharyngioma cases. In our study, endocrine disorders other than growth hormone deficiency were also frequently observed. In craniopharyngioma cases, the response to recombinant growth hormone therapy was satisfactory. However, there was no improvement in height prognosis during recombinant growth hormone therapy in medulloblastoma patients. A multidisciplinary approach to the care of these patients, referral for endocrine complications, and guidelines on when recombinant growth hormone therapy is required.

Identification of predictive factors of diabetic ketoacidosis in type 1 diabetes using a subgroup discovery algorithm.

To identify predictive factors for diabetic ketoacidosis (DKA) by retrospective analysis of registry data and the use of a subgroup discovery algorithm. Data from adults and children with type 1 diabetes and more than two diabetes-related visits were analysed from the Diabetes Prospective Follow-up Registry. Q-Finder, a supervised non-parametric proprietary subgroup discovery algorithm, was used to identify subgroups with clinical characteristics associated with increased DKA risk. DKA was defined as pH less than 7.3 during a hospitalization event. Data for 108 223 adults and children, of whom 5609 (5.2%) had DKA, were studied. Q-Finder analysis identified 11 profiles associated with an increased risk of DKA: low body mass index standard deviation score; DKA at diagnosis; age 6-10 years; age 11-15 years; an HbA1cof 8.87% or higher (≥ 73 mmol/mol); no fast-acting insulin intake; age younger than 15 years and not using a continuous glucose monitoring system; physician diagnosis of nephrotic kidney disease; severe hypoglycaemia; hypoglycaemic coma; and autoimmune thyroiditis. Risk of DKA increased with the number of risk profiles matching patients' characteristics. Q-Finder confirmed common risk profiles identified by conventional statistical methods and allowed the generation of new profiles that may help predict patients with type 1 diabetes who are at a greater risk of experiencing DKA.

Normative data for macular and retinal nerve fibre layer thickness in healthy German children and adolescents using optical coherence tomography.

To establish normative data for macular thickness, macular volume and peripapillary retinal nerve fibre layer (RNFL) thickness using Spectralis® spectral-domain optical coherence tomography (SD-OCT) in healthy German children and adolescents and investigate influencing factors. The cross-sectional study included the right eye of 695 children with at least one complete retinal OCT scan. As part of the LIFE Child study, the children underwent an ophthalmological examination including axial length (AL), spherical equivalent (SE) and OCT measurements. Various questionnaires were answered by the children or their parents to identify media use or outdoor time. Multiple linear regression models were used to investigate the potential influencing factors. A total of 342 boys and 353 girls with an average age (SD) of 12.91 (3.29) years participated. The mean AL (SD) was 23.20 (0.86)mm. The mean macular thickness (SD) was 320.53 (12.29) μm and the mean RNFL thickness (SD) was 102.88 (8.79)μm. Statistical analysis revealed a significant correlation between average macular thickness and age (p < 0.001, β=0.77) as well as AL (p < 0.001, β=-4.06). In addition, boys had thicker maculae (p < 0.001, β=5.36). The RNFL thickness showed no significant correlation with children's age (p > 0.05), but with AL (p=0.002, β=-2.15), birth weight (p=0.02, β=0.003) and a gender-specific effect of the body mass index standard deviation score for male participants (p=0.02, β=1.93). This study provides normative data and correlations between macular and RNFL thickness in healthy German children. Especially age, gender and AL must be taken into account when evaluating quantitative OCT measurements to classify them as normal.

Cardiovascular endurance and psychosocial health predict short- and long-term BMI-SDS reduction: results from the CHILT III program

This longitudinal study analyzes data from the Children’s Health Interventional Trial (CHILT) III, an 11-month juvenile multicomponent weight management program. The objective is to identify predictors of changes in body mass index standard deviation scores (BMI-SDS), so as to further enable the advancement of existing interventions with sustained impact. This study’s sample consists of 237 children and adolescents with obesity (8–17 years, 54% girls) participating in the CHILT III program between 2003 and 2021. Anthropometrics, demographics, relative cardiovascular endurance (W/kg), and psychosocial health (i.e., physical self-concept and self-worth) were assessed at program entry (t1), end (t2), and one-year follow-up (t3; n = 83). From t1 to t2, the mean BMI-SDS was reduced by −0.16 ± 0.26 units (p < 0.001). Media use and cardiovascular endurance at baseline and improvements in endurance and self-worth over the course of the program predicted changes in BMI-SDS (adj. R2 = 0.22, p < 0.001). From t2 to t3, mean BMI-SDS increased (M = 0.09 pm 0.29, p = 0.005). Changes in BMI-SDS from t2 to t3 were associated with parental education, improvements in cardiovascular endurance and physical self-concept, and BMI-SDS, media use, physical self-concept, and endurance level at program end (adj. R2 = 0.39, p < 0.001). Conclusions: This study highlights the need for comprehensive, sustainable weight management approaches, in order to sustain the initial treatment benefits. In this context, improvements in cardiovascular endurance and psychosocial health could be essential strategies to pursue in practice, as they significantly predicted reductions in BMI-SDS – both pre- to post-intervention and at follow-up.Trial registration: DRKS00026785; date of registration: 13.10.202, retrospectively registered.What is Known:• Childhood obesity is associated with the onset of noncommunicable diseases, many of which are likely to carry into adulthood. Thus, effective weight management strategies for affected children and their families are vital. However, achieving lasting positive health outcomes with multidisciplinary weight management programs remains challenging.What is New:• According to this study, short- and longer-term BMI-SDS reductions are associated to cardiovascular endurance and psychosocial health. These factors should therefore be given even greater consideration in weight management strategies, as they may be important not only in themselves but also for long-term weight loss (maintenance).

Abstract MP32: Body Weight Variability in Young Adulthood and Echocardiographic Precursors of Heart Failure in Later Life: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: The association between variability in body mass index (BMI) in early adulthood and cardiac structure and function in midlife has not been previously examined. Methods: We examined 2371 Coronary Artery Risk Development in Young Adults (CARDIA) participants who had BMI assessments across 25-years (CARDIA exam year 0 [1985-1986], 2 [1987-1989], 5 [1990-1991], 7 [1992-1993], 10 [1995-1996], 15 [2000-2001], 20 [2005-2006], and 25 [2010-2011]) as well as echocardiography data at the year-25 exam (2010-2011). BMI variability was assessed by standard deviation (SD) across 25 years. Adjusted multivariable linear regression models were used to assess the association between echocardiography variables (dependent variable) and SD of BMI (independent variable). Model 1 was adjusted for standard cardiac risk factors (age, sex, race, education, blood pressure, anti-hypertension medication use, smoking, fasting plasma glucose, alcohol consumption, physical activity, HDL and total cholesterol. Model 2 was additionally adjusted for mean BMI. Results: Among participants included in the analysis, mean [SD] age at the year 25 exam [2010-2011] was 50.4 [3.6] years; 44.5% were men; and 41.3% were black). In model 1, greater SD of BMI was associated with greater left ventricular mass (β 5.18g, p&lt;0.001), left ventricular global longitudinal strain 0.08, p=0.01, and left atrial volume (β 1.60ml, p&lt;0.001). Additional adjustment for mean BMI, attenuated associations (p&gt;.05 for all). Greater SD of BMI was associated with worse diastolic function (E/é) (β 0.11, p&lt;0.001). Observed association between BMI variability and E/é persisted even after accounting for mean BMI (β 0.08, p=0.01). Conclusions: Greater body weight variability in young adulthood was associated with modest unfavorable midlife alterations in diastolic function.

Association of Achieving Time in Range Clinical Targets With Treatment Modality Among Youths With Type 1 Diabetes

Continuous glucose monitoring (CGM) devices have demonstrated efficacy in adults and more recently in youths and older adults with type 1 diabetes. In adults with type 1 diabetes, the use of real-time CGM compared with intermittently scanned CGM was associated with improved glycemic control, but there are limited data available for youths. To assess real-world data on achievement of time in range clinical targets associated with different treatment modalities in youths with type 1 diabetes. This multinational cohort study included children, adolescents, and young adults younger than 21 years (hereinafter referred to collectively as youths) with type 1 diabetes for a duration of at least 6 months who provided CGM data between January 1, 2016, and December 31, 2021. Participants were enrolled from the international Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. Data from 21 countries were included. Participants were divided into 4 treatment modalities: intermittently scanned CGM with or without insulin pump use and real-time CGM with or without insulin pump use. Type 1 diabetes and the use of CGM with or without an insulin pump. Proportion of individuals in each treatment modality group achieving recommended CGM clinical targets. Among the 5219 participants (2714 [52.0%] male; median age, 14.4 [IQR, 11.2-17.1] years), median duration of diabetes was 5.2 (IQR, 2.7-8.7) years and median hemoglobin A1c level was 7.4% (IQR, 6.8%-8.0%). Treatment modality was associated with the proportion of individuals achieving recommended clinical targets. Adjusted for sex, age, diabetes duration, and body mass index standard deviation score, the proportion achieving the recommended greater than 70% time in range target was highest with real-time CGM plus insulin pump use (36.2% [95% CI, 33.9%-38.4%]), followed by real-time CGM plus injection use (20.9% [95% CI, 18.0%-24.1%]), intermittently scanned CGM plus injection use (12.5% [95% CI, 10.7%-14.4%]), and intermittently scanned CGM plus insulin pump use (11.3% [95% CI, 9.2%-13.8%]) (P < .001). Similar trends were observed for less than 25% time above (real-time CGM plus insulin pump, 32.5% [95% CI, 30.4%-34.7%]; intermittently scanned CGM plus insulin pump, 12.8% [95% CI, 10.6%-15.4%]; P < .001) and less than 4% time below range target (real-time CGM plus insulin pump, 73.1% [95% CI, 71.1%-75.0%]; intermittently scanned CGM plus insulin pump, 47.6% [95% CI, 44.1%-51.1%]; P < .001). Adjusted time in range was highest among real-time CGM plus insulin pump users (64.7% [95% CI, 62.6%-66.7%]). Treatment modality was associated with the proportion of participants experiencing severe hypoglycemia and diabetic ketoacidosis events. In this multinational cohort study of youths with type 1 diabetes, concurrent use of real-time CGM and an insulin pump was associated with increased probability of achieving recommended clinical targets and time in range target as well as lower probability of severe adverse events compared with other treatment modalities.