World Health Organization Reference Research Articles

Charting the course of young children with cystic fibrosis

In addition to aggressive monitoring of disease course and the use of novel strategies for respiratory and antimicrobial therapies, marked attention to the maintenance of excellent growth and nutrition has played a key role in improving long-term outcomes of children with cystic fibrosis (CF). CF centers play particular attention to changes in growth measurements as useful markers of nutrition and disease activity, leading to earlier and more rigorous evaluations and interventions. As such, the optimal care of young children with CF is highly dependent on the use of standardized growth charts. In this study, Zhang et al analyzed data from 2587 children followed in the Cystic Fibrosis Foundation Patient Data Registry in order to compare differences in the classification of growth status of young children with CF as assessed by the World Health Organization (WHO) and Centers for Disease Control (CDC) growth percentiles. Currently, WHO standards often are followed up to 23.9 months, followed by the use of CDC references. Among several findings, this study reports that using weight status measures (weight-for-length and body mass index) at 24 months, 26% of children who were classified as normal growth using WHO references were underweight using CDC references. These findings are important to ensure greater understanding of the potential impact of changing growth standards on the interpretation of individual growth status, the impact on clinical practice, and to allow accurate comparisons between CF centers. These findings further set the stage to explore relationships between early nutritional interventions and long-term growth and pulmonary outcomes.Article page 1089▶ In addition to aggressive monitoring of disease course and the use of novel strategies for respiratory and antimicrobial therapies, marked attention to the maintenance of excellent growth and nutrition has played a key role in improving long-term outcomes of children with cystic fibrosis (CF). CF centers play particular attention to changes in growth measurements as useful markers of nutrition and disease activity, leading to earlier and more rigorous evaluations and interventions. As such, the optimal care of young children with CF is highly dependent on the use of standardized growth charts. In this study, Zhang et al analyzed data from 2587 children followed in the Cystic Fibrosis Foundation Patient Data Registry in order to compare differences in the classification of growth status of young children with CF as assessed by the World Health Organization (WHO) and Centers for Disease Control (CDC) growth percentiles. Currently, WHO standards often are followed up to 23.9 months, followed by the use of CDC references. Among several findings, this study reports that using weight status measures (weight-for-length and body mass index) at 24 months, 26% of children who were classified as normal growth using WHO references were underweight using CDC references. These findings are important to ensure greater understanding of the potential impact of changing growth standards on the interpretation of individual growth status, the impact on clinical practice, and to allow accurate comparisons between CF centers. These findings further set the stage to explore relationships between early nutritional interventions and long-term growth and pulmonary outcomes. Article page 1089▶ Comparing the Use of Centers for Disease Control and Prevention and World Health Organization Growth Charts in Children with Cystic Fibrosis through 2 Years of AgeThe Journal of PediatricsVol. 167Issue 5PreviewTo examine differences between use of World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) growth reference in children with cystic fibrosis (CF) up to 2 years of age. Full-Text PDF

Physical Activity, Sedentary Time, and Obesity in an International Sample of Children.

To determine the relationships between moderate-to-vigorous physical activity (MVPA), vigorous physical activity (VPA), sedentary time, and obesity in children from 12 countries representing a wide range of human development. The sample included 6539 children age 9-11 yr. Times in MVPA, VPA, and sedentary behaviors were assessed by accelerometry. The body mass index (BMI; kg·m) was used to classify children as obese based on z-scores (> +2 SD) from World Health Organization reference data. The mean (SD) times spent in MVPA, VPA, and sedentary behavior were 60 (25) min·d, 18 (11) min·d, and 513 (69) min·d, respectively. The overall proportion of the sample that was obese ranged from 5.2% to 24.6% across sites. The odds ratios for obesity were significant for MVPA (0.49; 95% CI, 0.44-0.55), VPA (0.41; 0.37-0.46), and sedentary time (1.19; 1.08-1.30) in the overall sample. The associations of MVPA and VPA with obesity were significant in all 12 sites, whereas the association between sedentary time and obesity was significant in five of the 12 sites. There was a significant difference in BMI z-scores across tertiles of MVPA (P < 0.001) but not across tertiles of sedentary time in a mutually adjusted model. The results of receiver operating characteristic curve analyses for obesity indicated that the optimal thresholds for MVPA (area under the curve [AUC], 0.64), VPA (AUC, 0.67) and sedentary behavior (AUC, 0.57) were 55 (95% CI, 50-64) min·d, 14 (11-16) min·d, and 482 (455-535) min·d, respectively. Greater MVPA and VPA were both associated with lower odds of obesity independent of sedentary behavior. Sedentary time was positively associated with obesity, but not independent of MVPA. Attaining at least 55 min·d of MVPA is associated with lower obesity in this multinational sample of children, which supports current guidelines.

Interventions for preventing postpartum constipation

Interventions for preventing postpartum constipation

Low breastfeeding rates and body mass index in Danish children of women with gestational diabetes mellitus.

BackgroundOffspring from women with gestational diabetes mellitus (GDM) are at risk for later overweight, and the aim of treatment regimens is to normalize their prognosis. While the general concept is that breastfeeding is protective and should be promoted, some studies report increased levels of insulin and glucose in breast milk of women with diabetes, possibly increasing risks to the children. Previous studies may have low retention rates or mix GDM and pre-GDM, and often knowledge of confounders like maternal body mass index (BMI), level of hyperglycemia and feeding patterns is lacking. Data on breastfeeding rates, growth patterns and their associations are important to optimize future strategies among offspring from women with GDM managed by diet.MethodsBased on 10.730 births, a cohort of 131 singletons of Danish women with GDM managed by diet was defined. Data on feeding patterns, offspring length, weight and head circumference were obtained at the initial admission and from examinations by the general practitioner at five weeks and at five months postpartum. Breastfeeding rates were described in relation to neonatal and maternal characteristics and compared to national rates, while anthropometric data were compared to reference standards. The association between breastfeeding and offspring growth was analysed with and without correcting for confounding.ResultsMore than 99 % of the cohort contributed to anthropometric data, while data on feeding patterns were available for 96–98 %. Of mothers, 8 % did not initiate breastfeeding and the rate of fully breastfeeding at five weeks and at five months of age were 61 % and 18 %, respectively, which is considerably lower than generally reported in Denmark. Lowest breastfeeding rates were seen following prelabour Caesarean delivery. Complementary feeding was introduced earlier than recommended among 11 %. At the age of five weeks and at five months, children had grown longer and had lower BMI than expected from Danish and World Health Organization references. In the study periods, breastfeeding was significantly associated with lower BMI.ConclusionDespite lower breastfeeding rates than normally reported in Denmark, offspring BMI at the age of five months were low. Still new initiatives to promote breastfeeding among Danish women with GDM should be considered.

Reference Ranges for Head Circumference in Ethiopian Children 0–2 Years of Age

Head circumference (HC) charts are important for early detection of hydrocephalus during childhood. In low-income countries where population-based HC charts are rarely available, hydrocephalus occurs more commonly than in developed countries, and is usually not diagnosed early enough to prevent severe brain damage. This applies to Ethiopia as well. The World Health Organization (WHO) has provided standard HC charts advocated for global use, but recent studies cast doubts whether these charts are equally applicable in various populations. The aim of the study was therefore to establish reference ranges for early childhood HC in Ethiopia. In this prospective, observational cross-sectional study, measurements of HC were collected from healthy children of different ethnicities between birth and 24 months, in health centers situated in 5 Ethiopian cities. Reference ranges for HC were estimated using the LMS method and compared with those recommended by WHO. A total of 4019 children were included. Overall, 6.7% of boys and 7.1% of girls were above the +2 standard deviation (SD) of the WHO reference ranges, whereas the corresponding figures below -2 SD were 2.8% and 2.1%. Similarly, the +2 SD lines of the Ethiopian reference curves were considerably higher than those of the WHO growth standards, whereas the median and -2 SD lines were more comparable. Ethiopian HC reference ranges for children from birth to 24 months of age were found to differ significantly from those established by WHO and should correspondingly be considered as the first choice for screening for hydrocephalus in that population.

Sublingual immunotherapy for asthma.

Asthma is a common long-term respiratory disease affecting approximately 300 million people worldwide. Approximately half of people with asthma have an important allergic component to their disease, which may provide an opportunity for targeted treatment. Sublingual immunotherapy (SLIT) aims to reduce asthma symptoms by delivering increasing doses of an allergen (e.g. house dust mite, pollen extract) under the tongue to induce immune tolerance. However, it is not clear whether the sublingual delivery route is safe and effective in asthma. To assess the efficacy and safety of sublingual immunotherapy compared with placebo or standard care for adults and children with asthma. We identified trials from the Cochrane Airways Group Specialised Register (CAGR), ClinicalTrials.gov (www.ClinicalTrials.gov), the World Health Organization (WHO) trials portal (www.who.int/ictrp/en/) and reference lists of all primary studies and review articles. The search is up to date as of 25 March 2015. We included parallel randomised controlled trials (RCTs), irrespective of blinding or duration, that evaluated sublingual immunotherapy versus placebo or as an add-on to standard asthma management. We included both adults and children with asthma of any severity and with any allergen-sensitisation pattern. We included studies that recruited participants with asthma, rhinitis, or both, providing at least 80% of trial participants had a diagnosis of asthma. Two review authors independently screened the search results for included trials, extracted numerical data and assessed risk of bias, all of which were cross-checked for accuracy. We resolved disagreements by discussion.We analysed dichotomous data as odds ratios (ORs) or risk differences (RDs) using study participants as the unit of analysis; we analysed continuous data as mean differences (MDs) or standardised mean differences (SMDs) using random-effects models. We rated all outcomes using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) and presented results in the 'Summary of findings' table. Fifty-two studies met our inclusion criteria, randomly assigning 5077 participants to comparisons of interest. Most studies were double-blind and placebo-controlled, but studies varied in duration from one day to three years. Most participants had mild or intermittent asthma, often with co-morbid allergic rhinitis. Eighteen studies recruited only adults, 25 recruited only children and several recruited both or did not specify (n = 9).With the exception of adverse events, reporting of outcomes of interest to this review was infrequent, and selective reporting may have had a serious effect on the completeness of the evidence. Allocation procedures generally were not well described, about a quarter of the studies were at high risk of bias for performance or detection bias or both and participant attrition was high or unknown in around half of the studies.One short study reported exacerbations requiring a hospital visit and observed no adverse events. Five studies reported quality of life, but the data were not suitable for meta-analysis. Serious adverse events were infrequent, and analysis using risk differences suggests that no more than 1 in 100 are likely to suffer a serious adverse event as a result of treatment with SLIT (RD 0.0012, 95% confidence interval (CI) -0.0077 to 0.0102; participants = 2560; studies = 22; moderate-quality evidence).Within secondary outcomes, wide but varied reporting of largely unvalidated asthma symptom and medication scores precluded meaningful meta-analysis; a general trend suggested SLIT benefit over placebo, but variation in scales meant that results were difficult to interpret.Changes in inhaled corticosteroid use in micrograms per day (MD 35.10 mcg/d, 95% CI -50.21 to 120.42; low-quality evidence), exacerbations requiring oral steroids (studies = 2; no events) and bronchial provocation (SMD 0.69, 95% CI -0.04 to 1.43; very low-quality evidence) were not often reported. This led to many imprecise estimates with wide confidence intervals that included the possibility of both benefit and harm from SLIT.More people taking SLIT had adverse events of any kind compared with control (OR 1.70, 95% CI 1.21 to 2.38; low-quality evidence; participants = 1755; studies = 19), but events were usually reported to be transient and mild.Lack of data prevented most of the planned subgroup and sensitivity analyses. Lack of data for important outcomes such as exacerbations and quality of life and use of different unvalidated symptom and medication scores have limited our ability to draw a clinically useful conclusion. Further research using validated scales and important outcomes for patients and decision makers is needed so that SLIT can be properly assessed as clinical treatment for asthma. Very few serious adverse events have been reported, but most studies have included patients with intermittent or mild asthma, so we cannot comment on the safety of SLIT for those with moderate or severe asthma. SLIT is associated with increased risk of all adverse events.

Changes in physical fitness and nutritional status of schoolchildren in a period of 30 years (1980–2010)

ObjectiveTo analyze and compare the changes in physical fitness according to the nutritional status and gender of schoolchildren during a period of 30 years (1980–2010). MethodsFour cross-sectional evaluations were performed every 10 years in a period of 30 years from 1978 to 1980 (baseline), 1988–1990 (10 years), 1998–2000 (20 years) and 2008–2010 (30 years). The sample consisted of 1291 schoolchildren (188 in baseline, 307 in 10 years; 375 in 20 years; 421 in 30 years) of 10 and 11 years old. The variables assessed were: body weight (kg), height (cm), upper limb strength (ULS; kg), lower limb strength (LLS; cm), agility (seconds) and velocity (seconds). Schoolchildren were classified as normal weight and overweight according to World Health Organization reference of body mass index for age and gender. Comparisons among periods applied ANOVA followed by Bonferroni test, with a significance level set at of p<0.01. Variation between baseline and 30 years was assessed by the percentage delta. Seven different percentile values were presented for each variable. ResultsIn eutrophic boys and girls, mean values of ULS (−16.7%; −3.2%), agility (−1.5%; −1.6%) decreased significantly after 30 years (p<0.001). In the overweight boys and girls, only the average ULS (−15.5%; −12.5%) decreased significantly over time (p<0.001). After 30 years, the ULS percentile changed in boys. ConclusionsThe decline in physical fitness was greater in schoolchildren with normal weight than in those with overweight.

Nutritional Status of Rural Bengali Adolescent Boys of Tripura

To the Editor: Assessment of nutritional status is significant in developing countries like India where the vast majority of the populations are undernourished and underprivileged. Studies describing the nutritional status of adolescents from northeastern part of India are limited. This community based cross-sectional study was conducted to determine the current nutritional status of rural adolescent Bengali boys of Tripura. A total of 550 school-going Bengali boys (aged 8–16 y) from 30 randomly selected villages, representing the state of Tripura, were included using multistage cluster sampling method. Standing height and body weight were measured; body mass index (BMI) was derived. Age specific prevalences of stunting, thinness, overweight and obesity were calculated according to the classification of World Health Organization (WHO) [1], using the new IAP growth charts [2]. Nutritional status was also assessed using the 2007 WHO growth reference data [3]. These boys had lower socio-economic status. Using the IAP growthcharts [2] as reference,the overall (agecombined) prevalence of stunting (height-for-age <3rd percentile) was found low: 9.09 %. Prevalence across age groups fluctuated from 0 to 21.31 % below the 3rd percentile. The overall prevalence of thinness (i.e., BMI-for-age <5th percentile) was 12 %, which is higher than that of stunting. Prevalence across age groups fluctuated from 6.45 to 16.67 % below the 5th percentile. The overall prevalence of overweight (i.e. ,B MIfor-age ≥23 adult equivalent) was 7.09 %. Prevalence across age groups fluctuated from 1.67 to 11.29 %. The overall age specific prevalence of obesity (i.e., BMI-for-age ≥27 adult equivalent) was very low (0.36 %). The overall prevalence of stunting and thinness (21.15 and 40.32 % respectively) was found higher and overweight (4.30 %) was found lower when WHO reference data [3] was used. The prevalence rate of undernutrition among the boys of the present study was comparatively lower than the urban Bengali boys of Kolkata [4] and rural tribal children of Tripura [5]. In general, the Bengali boys of Tripura had lower rates of undernutrition. The over diagnosis of undernutrition and under diagnosis of overnutrition may be avoided by using the new IAP growth charts. We propose that future studies should use these charts to determine the growth and nutritional status of children and adolescents from India.

Comparing the Use of Centers for Disease Control and Prevention and World Health Organization Growth Charts in Children with Cystic Fibrosis through 2 Years of Age

To examine differences between use of World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) growth reference in children with cystic fibrosis (CF) up to 2 years of age. Growth from 1-24 months in 2587 children, born 2003-2006 and recorded in the US CF Foundation Registry, was evaluated using WHO and CDC references. In both boys and girls with CF aged 1-24 months, use of WHO charts resulted in ∼8 percentile lower length-for-age and ∼13% higher short stature rate (length-for-age <5th percentile). WHO weight-for-age was ∼9 percentile lower prior to age 6 months, crossed at 6-7 months, and remained ∼14 percentile higher at 8-24 months. WHO weight-for-length (WFL) percentile (WFLp) was similar before 12 months but ∼10 percentile higher at 12-24 months compared with CDC. When using WHO charts, 9% of children had underweight (WFLp <50th) classified differently and this rate varied with age: 4% in the first year, 7% at 12, 13% at 15, and 16% at 18 months, respectively. Weight status assessed by WHO body mass index (BMI) charts was different from WHO WFL charts. At 24 months when switching back to CDC, 26% of children with normal WFLp on WHO charts appeared underweight on CDC charts. A 70th percentile of WHO BMI percentile was equivalent to the 50th percentile CDC BMI percentile. Growth status in children with CF differed when using WHO and CDC references, particularly during the second year of life. These differences need to be considered for all uses of growth assessment in CF.

Performance of a real time PCR for leishmaniasis diagnosis using a L. (L.) infantum hypothetical protein as target in canine samples

Visceral leishmaniasis represents an important public health issue in different parts of the world, requiring that measures be put in place to control the spread of the disease worldwide. The canine leishmaniasis diagnosis is not easy based on clinical signs, since dogs may not develop the infection with recognizable signs. Thus, the laboratorial diagnosis is essential to ascertain the incidence and prevalence of canine leishmaniasis especially in areas with major control efforts. Although, the diagnosis can be performed by the use of different approaches, the molecular methods such as PCR have become an indispensable tool for leishmaniases diagnosis. A TaqMan assay for real-time PCR (Linj31-qPCR) was developed to determine the parasite occurrence in clinical cases of leishmaniasis. The assay targets an L. (L.) infantum hypothetical protein region. The specificity of the assay was verified by using Leishmania World Health Organization reference strains including parasites belonging to subgenus L. (Leishmania), subgenus L. (Viannia), other Leishmania species and Trypanosoma cruzi. The sensitivity was verified by using isolates of L. (L.) amazonensis and L. (L.) infantum. The usefulness of the assay for diagnosis was ascertained by testing 277 samples from dogs in regions endemic for visceral and/or cutaneous leishmaniasis and from regions in which leishmaniasis was not endemic in São Paulo State, Brazil. Diagnosis of canine visceral leishmaniasis (CVL) was determined on these animals by conventional PCR and three serological tests. The dog samples were divided into four groups. I, dogs with CVL (n = 101); II, dogs with other diseases and without CVL (n = 97); III, dogs with American cutaneous leishmaniasis (n = 7), and, IV, dogs without CVL (n = 72) from areas where leishmaniasis was not endemic as control group. Results indicated that Linj31-qPCR was able to identify parasites belonging to subgenus L. (Leishmania) with no cross-amplification with other parasite subgenera. The Linj31-qPCR detected Leishmania parasites DNA in 98% of samples from Group I. In conclusion this methodology can be used as routine diagnostic tools to detect parasites from subgenus Leishmania.

Modificações da aptidão física e estado nutricional de escolares em um período de 30 anos (1980‐2010)

ObjectiveTo analyze and compare the changes in physical fitness according to the nutritional status and gender of schoolchildren during a period of 30 years (1980‐2010). MethodsFour cross‐sectional evaluations were performed every 10 years in a period of 30 years from 1978 to 1980 (baseline), 1988‐1990 (10 years), 1998‐2000 (20 years) and 2008‐2010 (30 years). The sample consisted of 1,291 schoolchildren (188 in baseline, 307 in 10 years; 375 in 20 years; 421 in 30 years) of 10 and 11 years old. The variables assessed were: body weight (kg), height (cm), upper limb strength (ULS; kg), lower limb strength (LLS; cm), agility (seconds) and velocity (seconds). Schoolchildren were classified as normal weight and overweight according to World Health Organization reference of body mass index for age and gender. Comparisons among periods applied ANOVA folled by Bonferroni test, with a significance level set at of p<0.01. Variation between baseline and 30 years was assessed by the percentage delta. Seven different percentile values were presented for each variable. ResultsIn eutrophic boys and girls, mean values of ULS (‐16.7%; ‐3.2%), agility (‐1.5%; ‐1.6%) decreased significantly after 30 years (p<0,001). In the overweight boys and girls, only the average ULS (‐15.5%; ‐12.5%) decreased significantly over time (p<0,001). After 30 years, the ULS percentile changed in boys. Conclusionsthe decline in physical fitness was greater in schoolchildren with normal weight than in those with overweight.

Antiretroviral therapy for HIV-1 infected adolescents in Uganda: Assessing the impact on growth and sexual maturation

There is a paucity of knowledge about perinatally infected human immunodeficiency virus (HIV) positive children surviving into their adolescent years, especially from sub-Saharan Africa. Although studies have described the effects of the disease on the physical and sexual maturation of this population, their response to highly active antiretroviral therapy has not been systematically studied. At the pediatric infectious diseases clinic in Mulago hospital, Kampala, Uganda, we evaluated the effect of antiretroviral therapy (ART) on 118 treatment-naive, perinatally-infected HIV positive adolescents between the ages of 10–19 for 12 months. We monitored physical growth using The Centers for Disease Control and Prevention and recently published World Health Organization (WHO) reference growth standards for height and weight measurements as well as sexual maturation using Tanner staging. Laboratory tests including: complete blood count, absolute CD4 cell count and percentage, and HIV-1 RNA viral load, were performed at baseline and at 3-month intervals. Of 118 children, 64% were female; the median age was 13.6 years old. At baseline, 75% were classified as WHO clinical stages III and IV, with a median CD4 count of 124 cells/ul. Apart from four adolescents, all were on first-line antiretroviral therapy with 2 nucleoside reverse transcriptase inhibitors and 1 non-nucleoside reverse transcriptase inhibitors. After 6 months, the median CD4 count was 304 cells/μL, increasing to 370 cells/μL, by 12 months. Antiretroviral therapy was virologically suppressive (HIV-1 RNA viral load

Do malignant diseases affect semen quality? Sperm parameters of men with cancers.

The advent of modern treatments together with the improvement of the surgical techniques has significantly increased 5-year survival rates of young patients with cancer. Although the deleterious effects of chemotherapy and radiation are well documented, controversies exist about the effect of cancer itself on semen parameters before treatment. We collected data on 236 patients representative of different types of cancers reoffered at our institution for sperm cryopreservation with the aim to correlate the pre-freeze semen parameters with type of cancer, disease stage and with semen quality of 102 fertile and healthy men. The median baseline semen parameters of all our patients with cancer are placed above the 5th percentile of the World Health Organization reference value, but the type of cancer may impact the sperm parameters. In testicular tumours and in Hodgkin lymphoma, we show a semen concentration statistically lower than in the fertile population, while in patients with other cancers, there is no difference with the healthy men. We found no correlation between semen quality and disease stage. Eighty-six per cent of our patients do not have children at the time of semen cryopreservation, and the only established clinical option for preserving fertility of these men is cryopreservation of spermatozoa.

Accuracy of body mass index for age to diagnose obesity in Mexican schoolchildren.

To compare the accuracy of three BMI-forage references (World Health Organization reference, WHO; the updated International Obesity Task Force reference, IOTF; and Centers for Disease Control and Prevention (CDC) growth charts) to diagnose obesity in Mexican children. A convenience sample of Mexican schoolchildren (n = 218) was assessed. The gold standard was the percentage of body fat estimated by deuterium dilution technique. Sensitivity and specificity of the classical cutoff point of BMI-for-age to identify obesity (i.e. > 2.00 standard deviation, SD) were estimated. The accuracy (i.e. area under the curve, AUC) of three BMI-for-age references for the diagnosis of obesity was estimated with the receiver operating characteristic (ROC) curves method. The optimal cutoff point (OCP) was determined. The cutoff points to identify obesity had low (WHO reference: 57.6%, CDC: 53.5%) to very low (IOTF reference: 40.4%) sensitivities, but adequate specificities (91.6%, 95.0%, and, 97.5%, respectively). The AUC of the three references were adequate (0.89). For the IOTF reference, the AUC was lower among the older children. The OCP for the CDC reference (1.24 SD) was lower than the OCP for WHO (1.53 SD) and IOTF charts (1.47 SD). The classical cutoff point for obesity has low sensitivity--especially for the IOTF reference. The accuracy of the three references was similar. However, to obtain comparable diagnosis of obesity different cutoff points should be used depending of the reference.

Infertility as a proxy of general male health: results of a cross-sectional survey

To evaluate the prevalence, and clinical and seminal impact of comorbidities in white European men presenting for couple infertility. Cross-sectional study. Academic reproductive medicine outpatient clinic. Cohort of 2,100 consecutive infertile men (noninterracial infertile couples). Obtaining complete demographic, clinical, and laboratory data from 2,100 consecutive infertile men with health-significant comorbidities scored via the Charlson comorbidity index (CCI; categorized 0 vs. 1 vs. ≥2) and semen analysis values assessed based on 2010 World Health Organization reference criteria. Assessment of the rate of comorbidities by means of CCI scores and possible associations between CCI, semen and hormonal parameters. Descriptive statistics and regression models tested the associations among semen parameters, clinical characteristics, and CCI. When assessing general comorbidity prevalence, CCI 0, CCI 1, and CCI ≥2 was found in 1,921 (91.5%), 102 (4.9%), and 77 (3.6%) patients, respectively. Patient age and follicle-stimulating hormone levels increased as the general health status decreased. Conversely, the total testosterone levels and sperm concentration decreased as CCI scores increased. A higher rate of oligozoospermia and nonobstructive azoospermia was observed in patients with CCI ≥1. No differences were observed among the considered comorbidity groups in terms of testicular volume or further hormonal or seminal parameters. Both continuously coded and categorized sperm concentrations were independent predictors of CCI ≥1. Patients with sperm concentration <45.6 million/mL (most informative cutoff value) had a 2.74-fold increased risk of having a CCI ≥1. Decreased general health status appears to be associated with impaired male reproductive health, including lower sperm concentration, lower total testosterone levels, and higher follicle-stimulating hormone values.

Body mass index and childhood obesity classification systems: A comparison of the French, International Obesity Task Force (IOTF) and World Health Organization (WHO) references

AimThis study aims to compare three body mass index (BMI)-based classification systems of childhood obesity: the French, the International Obesity Task Force (IOTF) and the World Health Organization (WHO) references. MethodsThe study involved 1382 schoolchildren, recruited from the Lille Academic District in France in May 2009 aged 8.4±1.7 years (4.0–12.0 years). Their mean height and body mass were 131.5±10.9cm and 30.7±9.2kg, respectively, resulting in a BMI of 17.4±3.2kg/m2. The weight status was defined according to the three systems considered in this study. The agreement between these references was tested using the Cohen's kappa coefficient. ResultsThe prevalence of overweight was higher with the WHO references (20.0%) in comparison with the French references (13.8%; P<0.0001) and the IOTF (16.2%; P≤0.01). A similar result was found with obesity (WHO: 11.6% vs. IOTF: 6.7%; or French references: 6.7%; P<0.0001). Agreement between the three references ranged from “moderate” to “perfect” (0.43≤κ≤1.00; P<0.0001). Kappa coefficients were higher when the three references were used to classify children as obese (0.63≤κ≤1.00; P<0.0001) as compared to classification in the overweight (obesity excluded) category (0.43≤κ≤0.94; P<0.0001). When sex and age categories (4–6 years vs. 7–12 years) were considered to define the overweight status, the lowest kappa coefficient was found between the French and WHO references in boys aged 7–12 years (κ=0.28; P<0.0001), and the highest one in girls aged 7–12 years between the French references and IOTF (κ=0.97; P<0.0001). As for obesity, agreement between the three references ranged from 0.60 to 1.00 (P<0.0001), with the lowest values obtained in the comparison of the WHO references against French references or IOTF among boys aged 7–12 years (κ=0.60; P<0.0001). ConclusionOverall, the WHO references yield an overestimation in overweight and/or obesity within this sample of schoolchildren as compared to the French references and the IOTF. The magnitude of agreement coefficients between the three references depends on of both sex and age categories. The French references seem to be in rather close agreement with the IOTF in defining overweight, especially in 7–12-year-old children.

Comparing Growth Assessments Using CDC and WHO Reference Data in Native Hawaiian Pacific Islander Children: Baseline Data from the Children's Healthy Living (CHL) Program in Hawaiʻi

In the diverse US Affiliated Pacific Centers for Disease Control (CDC) 2000 and 2006 World Health Organization (WHO) reference data are available to assess child growth. WHO reference data includes children who met recommended breastfeeding guidelines from six countries, while CDC data describes growth of US children where few were breastfed. Baseline data from the CHL program in Hawai'i (n=941) was used to calculate BMI z‐scores and percentiles to compare growth relative to the two reference data sets and identify the role of breastfeeding history, age, sex, and ethnicity on growth assessment. Mean BMI z‐scores calculated with CDC reference data were lower than WHO (z‐score difference=‐0.31, p&lt;0.001). A general linear model on BMI z differences against child age, sex, ethnicity and breastfeeding history showed the difference by CDC reference was greater in boys than girls (z score difference = 0.20, p&lt;0.001). No difference was found by breastfeeding history, age or ethnicity. Kappa statistics showed strong agreement between the two references on CDC defined BMI categories (weighted Kappa=0.50, p&lt;0.001), with percentage of agreement highest for healthy weight (92%), followed by obese (85%), then overweight (76%). CDC and WHO growth reference data samples differ by breastfeeding history and ethnicity; differences between BMI z‐scores calculated from the two reference data sets were not related to either factor. Researchers and practitioners can choose either reference data to analyze BMI and child growth in NHPI children but should be cautious that CDC growth references may underestimate childhood overweight and obesity, and delay early intervention.

MP4-10 ONE OUT OF THREE INFERTILE MEN YOUNGER THAN 40 YEARS HAVE A TOTAL SERUM PSA VALUE GREATER THAN 1 NG/ML - FINDINGS OF A CROSS-SECTIONAL SURVEY IN WHITE-EUROPEAN MEN PRESENTING FOR COUPLE'S INFERTILITY

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2015MP4-10 ONE OUT OF THREE INFERTILE MEN YOUNGER THAN 40 YEARS HAVE A TOTAL SERUM PSA VALUE GREATER THAN 1 NG/ML - FINDINGS OF A CROSS-SECTIONAL SURVEY IN WHITE-EUROPEAN MEN PRESENTING FOR COUPLE'S INFERTILITY Alessandro Serino, Paolo Capogrosso, Luca Boeri, Eugenio Ventimiglia, Giovanni La Croce, Giulia Castagna, Angela Pecoraro, Marco Paciotti, Silvia Ippolito, Roberta Scano, Rocco Damiano, Francesco Montorsi, and Andrea Salonia Alessandro SerinoAlessandro Serino More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Luca BoeriLuca Boeri More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Giovanni La CroceGiovanni La Croce More articles by this author , Giulia CastagnaGiulia Castagna More articles by this author , Angela PecoraroAngela Pecoraro More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Silvia IppolitoSilvia Ippolito More articles by this author , Roberta ScanoRoberta Scano More articles by this author , Rocco DamianoRocco Damiano More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.153AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous data have suggested that infertile men have an increased risk of high-grade prostate cancer (PCa). In this context, male infertility may be considered an early and identifiable risk factor for the development of clinically significant PCa. We sought to assess serum PSA levels in men presenting for couples infertility, according to the EAU recommendation that a baseline serum PSA level should be obtained at 40–45 years of age (Heidenreich A, et al. Eur Urol 2013;64:347-54). METHODS Complete data from 403 consecutive men seeking medical help for couple's infertility were analyzed. Primary and secondary infertility were defined according to the World Health Organization (WHO) definition criteria. According to EAU recommendations, patients were stratified as younger (group 1) and older than 40 yrs (group 2). Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI; categorized 0 vs 1 vs ≥2). Testicular volume was assessed with a Prader orchidometer. Semen analysis values were assessed based on 2010 WHO reference criteria. Descriptive statistics and logistic regression models tested the association between potential predictors and total PSA levels. RESULTS Mean (SD; range) age was 36 [3.2 (21–40)] and 46.5 [5 (41–73)] in group 1 [n=198 (49.1%)] and group 2 [n=205 (50.9%)], respectively. Length of couple's infertility at first presentation was 27.7 (23.3; 12–204) and 31.3 (29.5; 12–280) months in group 1 and 2, respectively. Mean PSA levels were 0.93 ng/mL [0.6 (0.01-4.47)] and 0.96 ng/mL [1.2 (0.02-15.3)] in group 1 and group 2, respectively. Of group 1, 68 (34.3%) patients had serum PSA values >1 ng/mL. No differences were found in terms of age, BMI, CCI, testicular volumes, semen parameters, and rates of primary vs secondary infertility between patients of group 1 with PSA levels above vs below 1 ng/mL. At multivariate logistic regression analysis no clinical variables achieved independent predictive value for serum PSA >1 ng/mL in group 1. CONCLUSIONS These cross-sectional data showed that one out of three infertile men younger than 40 years have a total serum PSA value greater than 1 ng/mL. Current findings acquire significant clinical importance according to the EAU recommendations for early detection of PCa, which may reduce PCa-related mortality and reduce the risk of developing advanced and metastatic PCa. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e30 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alessandro Serino More articles by this author Paolo Capogrosso More articles by this author Luca Boeri More articles by this author Eugenio Ventimiglia More articles by this author Giovanni La Croce More articles by this author Giulia Castagna More articles by this author Angela Pecoraro More articles by this author Marco Paciotti More articles by this author Silvia Ippolito More articles by this author Roberta Scano More articles by this author Rocco Damiano More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD52-10 VALIDATION OF THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE GUIDELINES/RECOMMENDATIONS IN CAUCASIAN-EUROPEAN MEN PRESENTING FOR COUPLE'S INFERTILITY

You have accessJournal of UrologyInfertility: Evaluation1 Apr 2015PD52-10 VALIDATION OF THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE GUIDELINES/RECOMMENDATIONS IN CAUCASIAN-EUROPEAN MEN PRESENTING FOR COUPLE'S INFERTILITY Eugenio Ventimiglia, Giovanni La Croce, Paolo Capogrosso, Luca Boeri, Alessandro Serino, Giulia Castagna, Angela Pecoraro, Marco Paciotti, Silvia Ippolito, Dana Kuefner, Roberta Scano, Rocco Damiano, Francesco Montorsi, and Andrea Salonia Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Giovanni La CroceGiovanni La Croce More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Luca BoeriLuca Boeri More articles by this author , Alessandro SerinoAlessandro Serino More articles by this author , Giulia CastagnaGiulia Castagna More articles by this author , Angela PecoraroAngela Pecoraro More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Silvia IppolitoSilvia Ippolito More articles by this author , Dana KuefnerDana Kuefner More articles by this author , Roberta ScanoRoberta Scano More articles by this author , Rocco DamianoRocco Damiano More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1784AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The assessment of the hormonal milieu is not of unequivocal importance in the male infertility workup. We aimed to retrospectively validate the American Society for Reproductive Medicine (ASRM) guidelines/recommendations concerning the endocrine evaluation in Caucasian-European men presenting for couple's infertility. METHODS Complete socio-demographic, clinical and hormonal data from 1056 consecutive infertile men were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI; categorized 0 vs 1 vs ≥2). Testicular volume was assessed with a Prader orchidometer. Serum hormones were measured (8–10 AM) in all cases. Hypogonadism was defined as total testosterone < 3ng/ml, according to the Endocrine Society classification criteria. Semen analysis values were assessed based on the 2010 World Health Organization reference criteria. ASRM indications for endocrine assessment in infertile males (sperm concentration<10 million/mL; impaired sexual function; other clinical findings suggesting a specific endocrinopathy) were used to predict hypogonadism in our cohort. Moreover, a clinically user-friendly 3-item nomogram including patient age, BMI, and left testis volume was developed in order to predict hypogonadism in our population, and was compared to ASRM guidelines assessment. RESULTS Biochemical hypogonadism was diagnosed in 156 (14.8%) men. Overall, 669 (63.4%) patients would have necessitated tT assessment according to ASRM criteria; of these, only 119 (17.8%) were actually hypogonadal according to the Endocrine Society classification criteria. Conversely, 37 (23.7%) out of 156 patients with biochemical hypogonadism would have been overlooked. The overall predictive accuracy, sensibility, and specificity of the ASRM guidelines were 58%, 76%, and 39%, respectively. Our logistic regression-based nomogram, was not quite reliable enough to predict hypogonadism, despite demonstrating a significantly higher predictive accuracy (68%, p<0.001) than ASRM guidelines. CONCLUSIONS Current findings showed that the ASRM guidelines/recommendations for male infertility work-up may not be suitable for application to Caucasian-European men. As a matter of fact, one out of four hypogonadal men may miss out on a proper endocrine assessment when adhering to the ASRM guidelines/recommendations prompting the EAU guidelines suggestion to have tT assessed in every infertile patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1116-e1117 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugenio Ventimiglia More articles by this author Giovanni La Croce More articles by this author Paolo Capogrosso More articles by this author Luca Boeri More articles by this author Alessandro Serino More articles by this author Giulia Castagna More articles by this author Angela Pecoraro More articles by this author Marco Paciotti More articles by this author Silvia Ippolito More articles by this author Dana Kuefner More articles by this author Roberta Scano More articles by this author Rocco Damiano More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Usefulness of 2010 World Health Organization Reference Values for Determining Indications for Varicocelectomy

To investigate the impact of 2010 World Health Organization (WHO) reference values in patients who underwent microsurgical varicocelectomy. This retrospective cohort study included 206 men who underwent microsurgical varicocelectomy for a clinical varicocele with at least 1 abnormal semen parameter according to the 1999 WHO criteria. The preoperative semen analysis findings were reclassified according to the 2010 WHO criteria, and an improved seminal result after varicocelectomy was defined as a≥20% increase in sperm count or motility. Semen results of 114 men (55.3%) were reclassified as being above the reference values according to the 2010 WHO criteria. Among those with below reference values, 79.3% and 34.8% showed improved sperm counts and motility, respectively. However, in patients whose semen results converted to normal, 47.4% and 20.2% showed improved sperm counts and motility, respectively. Among those whose semen results were normal on the 2010 criteria, 58.8% showed improved sperm count or motility after microsurgical varicocelectomy. More than half of the patients whose semen results converted to normal on the 2010 WHO criteria showed improved seminal results after microsurgical varicocelectomy. It is necessary to reconsider the 2010 WHO criteria when determining the surgical indication for microsurgical varicocelectomy.