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ObjectiveFetal macrosomia is defined as a birth weight more than 4,000 g and is associated with maternal and fetal complications. This early metabolic disease may influence the entire life of the infant. Currently, macrosomia is predicted by using the estimated fetal weight (EFW). However, the EFW is inaccurate when the gestational week is gradually increasing. To assess precisely the risk of macrosomia, we developed a new predictive model to estimate the risk of macrosomia.MethodsWe continuously collected data on 655 subjects who attended regular antenatal visits and delivered at the Second Hospital of Hebei Medical University (Shijiazhuang, China) from November 2020 to September 2021. A total of 17 maternal features and 2 fetal ultrasonographic features were included at late-term pregnancy. The 655 subjects were divided into a model training set and an internal validation set. Then, 450 pregnant women were recruited from Handan Central Hospital (Handan, China) from November 2021 to March 2022 as the external validation set. The least absolute shrinkage and selection operator method was used to select the most appropriate predictive features and optimize them via 10-fold cross-validation. The multivariate logistical regressions were used to build the predictive model. Receiver operating characteristic (ROC) curves, C-indices, and calibration plots were obtained to assess model discrimination and accuracy. The model’s clinical utility was evaluated via decision curve analysis (DCA).ResultsFour predictors were finally included to develop this new model: prepregnancy obesity (prepregnancy body mass index ≥ 30 kg/m2), hypertriglyceridemia, gestational diabetes mellitus, and fetal abdominal circumference. This model afforded moderate predictive power [area under the ROC curve 0.788 (95% confidence interval [CI] 0.736, 0.840) for the training set, 0.819 (95% CI 0.744,0.894) for the internal validation set, and 0.773 (95% CI 0.713,0.833) for the external validation set]. On DCA, the model evidenced a good fit with, and positive net benefits for, both the internal and external validation sets.ConclusionsWe developed a predictive model for macrosomia and performed external validation in other regions to further prove the discrimination and accuracy of this predictive model. This novel model will aid clinicians in easily identifying those at high risk of macrosomia and assist obstetricians to plan accordingly.

PurposePatients with primary aldosteronism (PA) tend to exhibit a high prevalence of osteoporosis (OP) that may vary by whether PA is unilateral or bilateral, and responsive to PA treatment. To explore relationships between bone metabolism, PA subtypes, and treatment outcomes, we performed a systematic review and meta-analysis.MethodsThe PubMed, Embase, and Cochrane databases were searched for clinical studies related to PA and bone metabolism markers. Articles that met the criteria were screened and included in the systematic review; the data were extracted after evaluating their quality. R software (ver. 2022-02-16, Intel Mac OS X 11.6.4) was used for the meta-analysis.ResultsA total of 28 articles were subjected to systematic review, of which 18 were included in the meta-analysis. We found that PA patients evidenced a lower serum calcium level (mean difference [MD] = –0.06 mmol/L, 95% confidence interval [CI]: −0.10 ~ −0.01), a higher urine calcium level (MD = 1.29 mmol/24 h, 95% CI: 0.81 ~ 1.78), and a higher serum parathyroid hormone (PTH) level (MD = 2.16 pmol/L, 95% CI: 1.57 ~ 2.75) than did essential hypertension (EH) subjects. After medical treatment or adrenal surgery, PA patients exhibited a markedly increased serum calcium level (MD = –0.08 mmol/L, 95% CI: –0.11 ~ –0.05), a decreased urine calcium level (MD = 1.72 mmol/24 h, 95% CI: 1.00 ~ 2.44), a decreased serum PTH level (MD = 2.67 pmol/L, 95% CI: 1.73 ~ 3.62), and an increased serum 25-hydroxyvitamin D (25-OHD) level (MD = –6.32 nmol/L, 95% CI: –11.94 ~ –0.70). The meta-analysis showed that the ser um PTH level of unilateral PA patients was significantly higher than that of bilateral PA patients (MD = 0.93 pmol/L, 95% CI: 0.36 ~ 1.49) and the serum 25-OHD lower than that of bilateral PA patients (MD = –4.68 nmol/L, 95% CI: –7.58 ~ 1.77). There were, however, no significant differences between PA and EH patients of 25-OHD, or BMD of femoral neck and lumbar spine. BMDs of the femoral neck or lumbar spine did not change significantly after treatment. The meta-analytical results were confirmed via sensitivity and subgroup analyses.ConclusionExcess aldosterone was associated with decreased serum calcium, elevated urinary calcium, and elevated PTH levels; these effects may be enhanced by low serum 25-OHD levels. The risks of OP and fracture might be elevated in PA patients, especially unilateral PA patients, but could be reduced after medical treatment or adrenal surgery. In view, however, of the lack of BMD changes, such hypothesis needs to be tested in further studies.

Using the 2017-2018 National Health and Nutrition Examination Survey (weighted population size = 35,460,209; 8-18 years old; 52.1% males), we compared the obesity prevalence in children and adolescents between body mass index-based (BMI-based) and total percent body fat-based (BF%-based, measured by the dual-energy x-ray absorptiometry) cutoffs. The BMI-based cutoffs exhibited closer alignments (k, 0.88-0.97) in the childhood obesity prevalence, while the absolute (sex-specific) BF% cutoffs had higher prevalence rates than the relative (age- and sex-specific) BF% cutoffs (k = 0.43 [95% CI, 0.38-0.49]), overly labeling Non-Hispanic white and Other race/ethnicity females with obesity. The BF%-based cutoffs had higher prevalence rates in most sex, age, and race/ethnicity groups than the BMI-based cutoffs. Furthermore, the absolute BF% cutoffs overly labeled Hispanic and Other race/ethnicity females with obesity. In summary, childhood obesity prevalence varied by sex, age, race/ethnicity across different cutoffs, with the BMI-based cutoffs showing closer alignments than the BF%-based cutoffs.

Body composition measures, such as body mass index (BMI) and skinfold thickness, have been used to assess preschool children's weight status, but their relationship with physical activity (PA) participation is still unclear. PURPOSE: To determine the U.S. preschool children's body composition and its associations with their PA participation. METHODS: The weighted sample data of preschool children in the 2012 National Health and Nutrition Examination Survey (NHANES; 3-5 years old, N = 12509706, with 50.96% males) were used for the study. Children's BMI and calf, triceps, and subscapular skinfolds, as well as their PA measured by ActiGraph GT3X+ (for 7 consecutive days with the outcome in the Monitor-Independent Movement Summary unit (MIMS)), were used for this study. % of Underweight, Normal weight, Overweight (%OW), and Obese (%OB) by age and sex, as well as corresponding total skinfold (TS) and PA, were computed. RESULTS: Boys had a higher BMI score than girls at 3-, 4, and 5-yr.-old (16.55 vs. 16.43, 16.94 vs. 16.15, and 16.43 vs. 16.28), respectively. TS showed an increasing trend from 3- to 5-yr.- old (26.00 to 27.32 mm for boys & 29.61 to 31.45 mm for girls). As expected, girls had a larger TS than boys at 3-, 4- and 5-yr.-old (29.61 vs. 26.00, 29.56 vs. 26.85, &31.45 vs. 27.32 mm), respectively. As they aged, the %OW of both boys and girls decreased (from 24.77% to 18.82% for boys & from 15.70% to 9.28% for girls), but their %OB increased (from 11.48% to 15.45% for boys & from 12.30% to 19.67% for girls). 4-year-old children had the highest PA (MIMS: 17956.14 for boys, & 18537.13 for girls) compared to other age groups. The overall correlation between BMI and PA was low (r= .023), no correlation was found between TS and PA (r = .003). CONCLUSION: A significant percentage of U.S. preschool children are either overweight or obese and a low correlation was found between children's BMI and PA participation. There is an urgent need to start obesity prevention and PA promotion for U.S. preschool children. [ABSTRACT FROM AUTHOR]