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OBJECTIVE: Vitamin D deficiency is common in children. The effects of Vitamin D on bone health are well-known. However, its effect on glucose and lipid metabolism in obese children remains controversial. This study projected to evaluate the association between Vitamin D level and glucose, lipid, and bone metabolism parameters in obese children. In addition, the objective of the study was to determine the change in insulin resistance after Vitamin D replacement therapy in obese children with Vitamin D deficiency. METHODS: Hundred fifty children with obesity were included in our retrospective cross-sectional study. The patients were separated into two groups as the study group (serum 25(OH)D level <20 ng/ml) and the control group (serum 25(OH)D level =20 ng/ml). Physical examination, body fat mass, and laboratory findings of the two groups were compared. Moreover, patients in the study group were supplemented with Vitamin D 2000 IU/d for 24 weeks. Glucose, insulin levels were analyzed before and after treatment. RESULTS: Body fat mass and percentage were evaluated as more raised in the study group than those in the control group. The study group had a higher level of insulin resistance. There was a significant loss in body weight of patients after treatment in the study group and insulin resistance of the study group decreased after Vitamin D3 treatment. CONCLUSION: Considering the low side effects and affordability of Vitamin D, it would be a reasonable approach to identify serum Vitamin D levels in obese children and to administer a treatment to those with Vitamin D deficiency. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the effect of a phenylketonuria camp on adolescents with phenylketonuria (PKU). Material and Methods: A small cohort-type study was carried out with 67 participants between the ages of 1216. Participants were selected from PKU patients who were attended a PKU camp, organized for patients with phenylketonuria, aiming socialization, disease-related information transfer, and providing pleasant time with various social activities. Besides the patients, specialists of pediatric metabolism, psychologist and dieticians attended the camp. The study questionnaire was applied by a face-to-face interview on the first and last days of the camp. The primary outcome Questions were asked about PKU perception, and knowledge scores were calculated for each participant by adding the number of correct answers in the 10-item test. Results: Of the participants, 34 (50.7%) were females, while 33 (49.3%) were males. Twenty-one (31.3%) patients had another family member with phenylketonuria. The mean knowledge scores were already high at the beginning of the PKU camp (median 8, min. 4, max. 10). When the patients' knowledge of PKU was compared, there was no significant difference between before (7.40±1.62) and after (7.72±1.80) the camp (p=0.097). However, it was found that the opinions of the participants about the difficulty of being a PKU patient improved significantly (p= 0.039). Conclusion: A PKU camp for adolescents is effective in improving the perceptions of the participants. However, it would be beneficial to increase the duration and frequency of PKU camps to achieve better outcomes. [ABSTRACT FROM AUTHOR]

Focuses on the search of a denominator for VO[sub 2] max in measuring body dimensions of children. Impact of body metabolism on body mass; Use of allometric analysis; Influence of gender and body composition on scaling components.

Physical activity (PA) favorably affects metabolic health in children, but it is unclear how total volumes versus patterns (bouts and breaks) of PA relate to health. By means of multivariate pattern analysis that can handle collinear variables, we determined the associations of PA volumes and patterns with children's metabolic health using different epoch settings. A sample of 841 Norwegian children (age 10.2 ± 0.3 years) provided in 2014 data on accelerometry (ActiGraph GT3X+), using epoch settings of 1, 10, and 60 s and several indices of metabolic health used to create a composite metabolic health score. We created 355 PA indices covering the whole intensity and bout duration spectrum, and used multivariate pattern analysis to analyze the data. Findings showed that bouts of PA added information about childhood health beyond total volumes of PA for all epoch settings. Yet, associations of PA patterns with metabolic health were completely dependent on the epoch settings used. Vigorous PA was strongly associated with metabolic health, while associations of light and moderate PA were weak to moderate, and associations of sedentary time with metabolic health was non-existing. Short intermittent bursts of PA were favorably associated with children's metabolic health, whereas associations of prolonged bouts were weak. This study is the first to determine the multivariate physical activity association pattern related to metabolic health in children across the whole PA intensity and bout duration spectrum. The findings challenge our understanding of PA patterns, and are of major importance for the analysis of accelerometry data. [ABSTRACT FROM AUTHOR]

Objective: Urinary system stone disease has become more common in children due to the widespread use of diagnostic methods, an increase in sedentary lifestyles and changes in nutrition habits. Compared to adults, children are exposed to stone-related morbidity due to the presence of metabolic risk factors. In this study, it was aimed to evaluate the metabolic etiologies of children with urolithiasis and their medical care response. Material and Method: Metabolic risk factors and treatment responses were evaluated for children who were treated for urinary system stone disease and regularly monitored bimonthly. Stone disease was detected by ultrasonography and / or computed tomography. Calcium, uric acid, oxalate, citrate, cystine and phosphate measurements were performed in 24-hour urine in all cases. Results: The median age at diagnosis of urolithiasis in 196 children was 3.9 years (range: 3 months-16 years), and follow-up duration was 4.2 years (range: 3 months-8 years). The most common presenting symptoms were flank or abdominal pain (30.6%). Hyperuricosuria (n:59, %23.8), hypocitraturia (n:55, %22.2) and hypercalciuria (n:51, %20.6) was the most common metabolic abnormality. The patients who had metabolic risk factors were treated according to underlying metabolic abnormalities. At the last control visit, while about half of the patients (%52) were stone free, the stones were diminished in size in 28 patients (%14.3); there was no change in the size of the stone in 51 patients (26%), whereas stone size increased in 15 patients (7.7%). Conclusion: By planning appropriate treatment for the metabolic abnormalities determined in children with urolithiasis, success can be achieved in many patients by medical treatments without the need of surgical methods. [ABSTRACT FROM AUTHOR]

Phytoestrogens are plant-derived polyphenols with structural and functional similarities to mammalian oestrogens. The aim of this work was to study the metabolism of phytoestrogens by children's intestinal microbiota and to compare it with previous results in adults. Faecal samples of 24 healthy children were subjected to phytoestrogen fermentation assay. Only one child produced equol, while O-desmethylangolensin was found in all. Urolithin production was detected in 14 children and enterolactone in 10. Further comparison with the metabolism of phytoestrogens by adult intestinal microbiota reflected that glycitein, dihydrogenistein, urolithins D and E, enterolactone, secoisolariciresinol and arctigenin were the most important metabolites differentiating between adult and child microbial gut metabolism. Although the child intestinal microbiota showed the ability to metabolise isoflavones, ellagitannins and lignans to a certain extent, it generally showed a reduced metabolism of phytoestrogens, with a lack of 5-hydroxy equol and enterodiol, and less urolithins and enterolactone producers. [ABSTRACT FROM AUTHOR]

This article presents a new adaptive framework for understanding children's growth in the past. Drawing upon the recent work on adaptive responses in relation to growth, it presents prenatal and postnatal adaptive mechanisms that affect the growth patterns of children. The most novel adaptive response to the historical literature is the prenatal predictive adaptive response where the metabolism and growth trajectory of a child is programmed to match predicted conditions later in life. Having discussed the framework in detail, a reinterpretation of the growth pattern of American slaves is then suggested. It seems likely that a mismatch between relatively good conditions in utero and absolutely appalling conditions in infancy and early childhood led slave children to become extremely stunted by the age of three or four. However, after this age, slave children experienced catch-up growth because their immune systems had become more developed and because their diet improved tremendously and hookworm exposure was reduced. Thus, it seems that American slave children may have experienced substantial catch-up growth because they were prenatally programmed for a higher metabolism and growth trajectory. The article concludes by setting out some stylized facts about children's growth in the past and pointing toward areas of future research. [ABSTRACT FROM AUTHOR]

Objective: We examine weight gain and metabolic consequences of risperidone monotherapy in children with autism spectrum disorder (ASD).Method: This was a 24-week, multisite, randomized trial of risperidone only versus risperidone plus parent training in 124 children (mean age 6.9 ± 2.35 years; 105 boys and 19 girls) with ASD and serious behavioral problems. We monitored height, weight, waist circumference, and adverse effects during the trial. Fasting blood samples were obtained before treatment and at week 16.Results: In 97 children with a mean of 22.9 ± 2.8 weeks of risperidone exposure, there was a 5.4 ± 3.4 kg weight gain over 24 weeks (p < .0001); waist circumference increased from 60.7 ± 10.4 cm to 66.8 ± 11.3 cm (p < .0001). At baseline, 59 of 97 children (60.8%) were classified as having normal weight; by week 24, only 25 of 85 (29.4%) remained in that group. Growth curve analysis showed a significant change in body mass index (BMI) z scores from pretreatment to week 24 (p < .0001). This effect was significantly greater for children with reported increased appetite in the first 8 weeks. From before treatment to week 16, there were significant increases in glucose (p = .02), hemoglobin A1c (p = .01), insulin (p <.0001), homeostatic model assessment-insulin resistance (HOMA-IR; p < .001), alanine aminotransferase (p = .01), and leptin (p < .0001). Adiponectin declined (p = .003). At baseline, 7 children met conventional criteria for metabolic syndrome; by week 16, 12 additional children were so classified.Conclusion: Rapid weight gain with risperidone treatment may promote the cascade of biochemical indices associated with insulin resistance and metabolic syndrome. Appetite, weight, waist circumference, liver function tests, blood lipids, and glucose warrant monitoring. Clinical trial registration information-Drug and Behavioral Therapy for Children With Pervasive Developmental Disorders; http://clinicaltrials.gov/; NCT00080145. [ABSTRACT FROM AUTHOR]

Objectives: A detailed understanding of the metabolic processes governing rapid growth in early life is still lacking. The aim of this study was to investigate the age-related metabolic changes in healthy children throughout early childhood. Methods: Healthy children from a birth cohort were enrolled in this study from birth through 4 years of age. Urinary metabolites were assessed at 6 months, and 1, 2, 3, and 4 yr of age by using 1H-nuclear magnetic resonance (NMR) spectroscopy coupled with multivariate statistical analysis including principal components analysis (PCA) and partial least-squares discriminant analysis (PLS-DA). Metabolic pathway analysis was performed using the MetPA web tool. Results: A total of 105 urine samples from 30 healthy children were collected and analyzed. Metabolites contributing to the discrimination between age groups were identified by using supervised PLS-DA (Q2 = 0.60; R2 = 0.66). A significantly higher urinary trimethylamine N-oxide (TMAO) and betaine level was found in children aged 6 months. Urinary glycine and glutamine levels declined significantly after 6 months of age and there was a concomitant compensatory increase in urinary creatine and creatinine. Metabolic pathway analysis using MetPA revealed similar nitrogen metabolism associated energy production across all ages assessed. Pathways associated with amino acid metabolism were significantly different between infants aged 6 months and 1 year, whereas pathways associated with carbohydrate metabolism were significantly different between children at ages 2 and 3 years. Conclusions: Urine metabolomics ideally represents dynamic metabolic changes across age. Urinary metabolic profiles change significantly within the first year of life, which can potentially provide crucial information about infant nutrition and growth. [ABSTRACT FROM AUTHOR]

Background: In adults, increased sympathetic and decreased parasympathetic nervous system activity are associated with a less favorable metabolic profile. Whether this is already determined at early age is unknown. Therefore, we aimed to assess the association between autonomic nervous system activation and metabolic profile and its components in children at age of 5–6 years. Methods: Cross-sectional data from an apparently healthy population (within the ABCD study) were collected at age 5–6 years in 1540 children. Heart rate (HR), respiratory sinus arrhythmia (RSA; parasympathetic activity) and pre-ejection period (PEP; sympathetic activity) were assessed during rest. Metabolic components were waist-height ratio (WHtR), systolic blood pressure (SBP), fasting triglycerides, glucose and HDL-cholesterol. Individual components, as well as a cumulative metabolic score, were analyzed. Results: In analysis adjusted for child’s physical activity, sleep, anxiety score and other potential confounders, increased HR and decreased RSA were associated with higher WHtR (P< 0.01), higher SBP (p<0.001) and a higher cumulative metabolic score (HR: p < 0.001; RSA: p < 0.01). Lower PEP was only associated with higher SBP (p <0.05). Of all children, 5.6% had 3 or more (out of 5) adverse metabolic components; only higher HR was associated with this risk (per 10 bpm increase: OR = 1.56; p < 0.001). Conclusions: This study shows that decreased parasympathetic activity is associated with central adiposity and higher SBP, indicative of increased metabolic risk, already at age 5–6 years. [ABSTRACT FROM AUTHOR]

Background. Metabolic control is an important factor in growth of children with type I diabetes. This study assessed the relationship between growth and metabolic control in such children. Materials and Methods. 83 children with diabetes were studied. They were examined for weight and height gain and HbA1C was quantified every 3 months for one year. The growth process was studied in patients who were divided into 3 groups according to their HbA1C amounts, consisting of good, intermediate, and poor metabolic control. Results. Mean age of cases was 7.6 ± 2. The presenting sign at the onset of disease was diabetic ketoacidosis in 44.6%. The average HbA1C amount was 8.89%. The average weight SDS at diagnosis was −0.18 and at the end of the study was 0.45 (P<0.001). The average height SDS at diagnosis was −0.04 and at the end of the study was −0.07 (P=0.64). A significant difference in weight SDS changes was only seen between patients with good and poor metabolic control (P=0.04). Conclusion. Poor metabolic control can decrease height growth but has minimal influence on weight. Metabolic control was not the only predictive factor of physical growth in children with diabetes. [ABSTRACT FROM AUTHOR]

Objective Identifying groups of individuals with similar patterns of body mass index (BMI) change during childhood may increase understanding of the relationship between childhood BMI and adult health. Methods Discrete classes of BMI z-score change were determined in 1,920 American Indian children with at least four non diabetic health examinations between the ages of 2 and 18 years using latent class trajectory analysis. In subsets of subjects, data were available for melanocortin-4 receptor ( MC4R) sequencing; in utero exposure to type 2 diabetes (T2D); or, as adults, oral glucose tolerance tests, onset of T2D, or body composition. Results Six separate groups were identified. Individuals with a more modern birth year, an MC4R mutation, or in utero exposure to T2D were clustered in the two groups with high increasing and chronic overweight z-scores ( P < 0.0001). The z-score classes predicted adult percent fat ( P < 0.0001, partial r2 = 0.18 adjusted for covariates). There was a greater risk for T2D, independent from adult BMI, in three classes (lean increasing to overweight, high increasing, and chronic overweight z-scores) compared to the two leanest groups (respectively: HRR= 3.2, P = 0.01; 6.0, P = 0.0003; 11.6, P < 0.0001). Conclusions Distinct patterns of childhood BMI z-score change associate with adult adiposity and may impact risk of T2D. [ABSTRACT FROM AUTHOR]

Background There are no previous data on the association of PNPLA3 I148M polymorphism (rs738409) with circulating adipokines and myokines in children. Subjects/Methods Subjects were a population sample of 481 Caucasian children aged 6–8 years. We assessed circulating levels of irisin together with IL-6, TNF-α, leptin, high molecular weight (HMW)-adiponectin, alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) while the subjects were stratified according to PNPLA3 I148M variants. Results The PNPLA3 rs738409 polymorphism had a linear relationship with plasma levels of irisin after adjustment for age, sex and body height (p = 0.007) but it was not associated with circulating levels of interleukin- 6 (IL-6), tumor-necrosis factor α (TNF-α), leptin or HMW-adiponectin. Conclusion PNPLA3 148 M allele carriers had higher plasma levels of irisin than the non-carriers. This might be due to compensatory mechanism to limit early steatotic and inflammatory changes in the liver. [ABSTRACT FROM AUTHOR]

To examine differences in growth and metabolism in prepubertal children born early term, full term, and late term. We retrospectively studied 294 prepubertal children aged 7.3 years (range 3.0-12.1 years). Children were separated into those born early term (37 0/7-38 6/7 weeks of gestation; n568), full term (39 0/7-40 6/7 weeks; n = 179), and late term (41 0/7-41 6/7 weeks; n = 47). Clinical assessments included anthropometry, DXA-derived body composition, fasting lipids, and glucose homeostasis. Statistical models accounted for important confounding factors, such as gender, age, birth weight SDS, birth order, and parental variables. When birth weight was adjusted for sex and gestational age (birth weight SDS), late terms were heavier than both early (p = 0.034) and full (p = 0.020) terms. Early term children were shorter than both full (p = 0.010) and late (p = 0.049) term children, but differences in height disappeared following correction for parents' heights. There were no differences in glucose homeostasis, BMI SDS, adiposity, or fat distribution between groups. Lipid profiles were also similar. When important confounding factors were accounted for, there were no meaningful differences in anthropometry, glucose homeostasis, and lipid profile among children born early term, full term, or late term. [ABSTRACT FROM AUTHOR]

Objective: To assess feasibility and recall rates for newborn screening for congenital hypothyroidism, galactosemia and biotinidase deficiency in a predominantly rural and inner city population in and around the City of Lucknow in Uttar Pradesh, India. Design: Prospective observational study. Setting: Two tertiary-care and 5 district hospitals in and around Lucknow. Participants: All babies born in above hospitals during the study period. Methods: Heel prick samples were collected after 24 hours of life. Dried blood spot TSH, total galactose and biotinidase were assayed by immunofluorometry. Age related cut-offs were applied for recall for TSH. For galactosemia and biotinidase deficiency, manufacturer-suggested recall cut-offs used initially were modified after analysis of initial data. Main outcome measure: Recall rate for hypothyroidism, galactosemia and biotinidase deficiency. Results: Screening was carried out for 13426 newborns, 73% of all deliveries. Eighty-five percent of those recalled for confirmatory sampling responded. Using fixed TSH cut off of 20 mIU/L yielded high recall rate of 1.39%, which decreased to 0.84% with use of age-related cut-offs. Mean TSH was higher in males, and in low birth weight and vaginally delivered babies. Eleven babies had congenital hypothyroidism. Recall rates with modified cut-offs for galactosemia and biotinidase deficiency were 0.32% and 0.16%, respectively. Conclusion: An outreach program for newborn screening can be successfully carried out in similar socio-cultural settings in India. For hypothyroidism, the high recall rate due to early discharge was addressed by age-related cut-offs. [ABSTRACT FROM AUTHOR]

The variability and predictors of urinary concentrations of phthalate metabolites in preschool-aged children have not been thoroughly examined. Additionally, the impact of temporal changes in the use and restriction of phthalates in children's products has not been assessed. Our objective was to identify demographic, behavioral, and temporal predictors of urinary phthalate metabolite concentrations in young children. Between 2004 and 2011, we collected up to five urine samples from each of 296 children participating in a prospective birth cohort during annual study visits at ages 1-5 years. We used linear mixed models to calculate intraclass correlation coefficients (ICCs), a measure of within-individual reproducibility, and identify demographic predictors of urinary phthalate metabolites. We used multivariable linear regression to examine cross-sectional relationships between food packaging or personal care product use and phthalate metabolites measured at age 5 years. Across annual measurements, monoethyl phthalate exhibited the least variation (ICC = 0.38), while di-2-ethylhexyl phthalate (ΣDEHP) metabolites exhibited the most variation (ICC = 0.09). Concentrations changed with age, suggesting age-related changes in phthalate exposure and perhaps metabolism. Our findings suggest that fast food consumption may be a source of butylbenzyl phthalate and di-isononyl phthalate (DiNP) exposure, and some personal care products may be sources of diethyl phthalate exposure. Concentrations of ΣDEHP metabolites decreased over the study period; however, concentrations of DiNP metabolites increased. This finding suggests that manufacturer practices and regulations, like the Consumer Product Safety Improvement Act of 2008, may decrease DEHP exposure, but additional work characterizing the nature and toxicity of replacements is critically needed. [ABSTRACT FROM AUTHOR]

Background Because body proportions in childhood are different to those in adulthood, children have a relatively higher centre of mass location. This biomechanical difference and the fact that children's movements have not yet fully matured result in different sway performances in children and adults. When assessing static balance, it is essential to use objective, sensitive tools, and these types of measurement have previously been performed in laboratory settings. However, the emergence of technologies like the Nintendo Wii Board (NWB) might allow balance assessment in field settings. As the NWB has only been validated and tested for reproducibility in adults, the purpose of this study was to examine reproducibility and validity of the NWB in a field setting, in a population of children. Methods Fifty-four 10-14 year-olds from the CHAMPS-Study DK performed four different balance tests: bilateral stance with eyes open (1), unilateral stance on dominant (2) and non-dominant leg (3) with eyes open, and bilateral stance with eyes closed (4). Three rounds of the four tests were completed with the NWB and with a force platform (AMTI). To assess reproducibility, an intra-day test-retest design was applied with a two-hour break between sessions. Results Bland-Altman plots supplemented by Minimum Detectable Change (MDC) and concordance correlation coefficient (CCC) demonstrated satisfactory reproducibility for the NWB and the AMTI (MDC: 26.3-28.2%, CCC: 0.76-0.86) using Centre Of Pressure path Length as measurement parameter. Bland-Altman plots demonstrated satisfactory concurrent validity between the NWB and the AMTI, supplemented by satisfactory CCC in all tests (CCC: 0.74- 0.87). The ranges of the limits of agreement in the validity study were comparable to the limits of agreement of the reproducibility study. Conclusion Both NWB and AMTI have satisfactory reproducibility for testing static balance in a population of children. Concurrent validity of NWB compared with AMTI was satisfactory. Furthermore, the results from the concurrent validity study were comparable to the reproducibility results of the NWB and the AMTI. Thus, NWB has the potential to replace the AMTI in field settings in studies including children. Future studies are needed to examine intra-subject variability and to test the predictive validity of NWB. [ABSTRACT FROM AUTHOR]

The article presents a study which examined whether a phenylaline-free protein substitute with prolonged release may be beneficial to the protein status of children with phenlyketonuria (PKU) compared to conventional substitutes. Topics discussed include the allocation either a prolonged-release or the current conventional protein substitute for 60 children. Also mentioned was the finding that protein substitutes with prolonged release might be beneficial to protein status in children with PKU.

Background There is evidence suggesting that first-born children and adults are anthropometrically different to later-borns. Thus, we aimed to assess whether birth order was associated with changes in growth and metabolism in childhood. Methods We studied 312 healthy prepubertal children: 157 first-borns and 155 later-borns. Children were aged 3-10 years, born 37-41 weeks gestation, and of birth weight appropriate-for-gestational-age. Clinical assessments included measurement of children's height, weight, fasting lipid and hormonal profiles and DEXA-derived body composition. Results First-borns were taller than later-borns ( P < 0·0001), even when adjusted for parents' heights (0·31 vs 0·03 SDS; P = 0·001). There was an incremental height decrease with increasing birth order, so that first-borns were taller than second-borns ( P < 0·001), who were in turn taller than third-borns ( P = 0·007). Further, among sibling pairs both height SDS ( P = 0·009) and adjusted height SDS ( P < 0·0001) were lower in second- vs first-born children. Consistent with differences in stature, first- ( P = 0·043) and second-borns ( P = 0·003) had higher IGF-I concentrations than third-borns. Both first- ( P < 0·001) and second-borns ( P = 0·004) also had reduced abdominal adiposity (lower android fat to gynoid fat ratio) when compared with third-borns. Other parameters of adiposity and blood lipids were unaffected by birth order. Conclusions First-borns were taller than later-born children, with an incremental height reduction from first to third birth order. These differences were present after correction for genetic height, and associated to some extent with alterations in plasma IGF-I. Our findings strengthen the evidence that birth order is associated with phenotypic changes in childhood. [ABSTRACT FROM AUTHOR]

A basal metabolic rate(BMR) that is too low is an indicator of a poor physical condition, and could be one of the reasons for overweight. Measuring BMR though, is a time-consuming exercise, and there has long been interest in developing statistical models to predict BMR from demographic and anthropometric measurements. Poh et al. [1] developed ordinary linear regression models on a cohort of 139 Malaysian children measured three years bi-annually. However, since each child contributed six times to the total data set, these models ignore the correlated nature of the data. We re-analyzed these data using correlated linear models. We show that our approach taking correlation into account is important to establish important covariates, but does not improve prediction. [ABSTRACT FROM AUTHOR]

Background In vitro fertilisation ( IVF) has been widely used during the last decades. Recent studies demonstrated some alterations in IVF children's metabolic profile compared with controls. The recently reported lipocalins retinol-binding protein 4 ( RBP-4) and neutrophil gelatinase-associated lipocalin ( NGAL), as well as visfatin, which are associated with glucose intolerance and could help in the early detection of metabolic abnormalities, have not been studied in IVF children as yet. We studied the lipocalins RBP-4 and NGAL as well as visfatin in children born after IVF. Subjects and methods A total of 100 children born after IVF (47 boys) and 60 controls born after normal conception (30 boys), aged 4-14 year, were studied cross-sectionally. All children had a physical examination, their fasting glucose, insulin, lipid profile, RBP-4, NGAL, and visfatin were determined and their homoeostasis model assessment ( HOMA) index was calculated. Results Children born after IVF had significantly higher RBP-4 ( P = 0·009) and NGAL ( P = 0·028) levels than controls. When divided by gender, RBP-4 remained higher in IVF girls ( P = 0·002), whereas NGAL was higher in IVF boys ( P = 0·021). Linear regression analysis had revealed that the differences are attributed to the IVF procedure per se. Conclusions In our study, IVF children had significantly higher RBP-4 and NGAL levels than controls, suggesting early metabolic derangements that could be attributed to an epigenetic phenomenon. These results are in accordance with our earlier findings of higher blood pressure and triglycerides in IVF children than controls. Further prospective studies in IVF children will determine the natural course of their metabolic profile. [ABSTRACT FROM AUTHOR]

Urinary bisphenol A (BPA), a widely used biomarker of exposure to BPA, has been associated with cardiometabolic derangements in laboratory studies and with low-grade albuminuria in Chinese adults. Despite the known unique vulnerability of children to environmental chemicals, no studies have examined associations of urinary BPA with albuminuria in children. As exposure to BPA is widespread in the United States population, we examined data from 710 children in the 2009-10 National Health and Nutrition Examination Survey with urinary BPA measurements and first morning urine samples with creatinine values. Controlled for a broad array of sociodemographic and environmental risk factors as well as insulin resistance and elevated cholesterol, children with the highest compared with the lowest quartile of urinary BPA had a significant 0.91 mg/g higher albumin-to-creatinine ratio, adjusted for the urinary BPA concentration. When the multivariable model was reprised substituting continuous measures of BPA, a significant 0.28 mg/g albumin-to-creatinine ratio increase was identified for each log unit increase in urinary BPA. Thus, an association of BPA exposure with low-grade albuminuria is consistent with previous results found in Chinese adults and documents this in children in the United States. Our findings broaden the array of adverse effects of BPA to include endothelial dysfunction as evidenced by the low-grade albuminuria and support proactive efforts to prevent harmful exposures. [ABSTRACT FROM AUTHOR]

Abstract: The ability of parents to accurately report energy intake in toddlers has rarely been validated using the gold-standard doubly labeled water (DLW) method to assess total energy expenditure (TEE). The aim of the study was to evaluate the accuracy of toddler energy intake (EI), estimated using the Australian Child and Adolescent Eating Survey (ACAES) food frequency questionnaire (FFQ) by parent report compared with a weighed food record (WFR) and TEE measured by DLW. Twelve toddlers had TEE assessed over 10 days using DLW. Usual energy intake was estimated by the primary caregiver, using standard toddler portions in ACAES-FFQ and a 4-day WFR and daily EI (in kilocalories) derived using national nutrient databases. Accuracy of reporting was calculated from absolute (EI-TEE) and percentage (EI/TEE×100) differences between EI and TEE and Pearson correlations and limits of agreement from Bland-Altman plots. Toddlers (n=12, 7 boys) had a mean age of 3.2±0.5 years, body mass index 16.2±0.9 kg, body mass index z score 0.1±0.8, EI from ACAES-FFQ 1,183±281kcal/day, and WFR 1,179±278 kcal/day and DLW TEE 1,251±149 kcal/day. The mean difference and limits of agreement (±2 standard deviations) compared with DLW was −68 (−623, 488) kcal/day for the FFQ and for the WFR −72 (−499, 354) kcal/day. Although both a semiquantitative FFQ and WFR can adequately estimate toddler energy intake at the group level in this population, toddler-specific portion size estimates should be assigned to foods listed in the FFQ. Choice of method is likely to depend on practical issues, including cost and burden. [Copyright &y& Elsevier]

Objective: To determine the effect of Casilan® on 13C-caffeine metabolism in healthy Nigerian children. Materials and Methods: Twelve healthy Nigerian children (male: six, female: six) aged 3-8 years were studied on three occasions. After an overnight fast, the children were studied after ingesting Casilan® only (Week 1). They were restudied after ingesting 3 mg/kg of labeled caffeine only (Week 2), and further re-studied after ingesting both Casilan® and labeled caffeine (Week 3). Breath samples were collected by blowing via a straw into an exentainer bottle. The cumulative percentage of 13C-caffeine exhaled as 13CO2 was measured over 2 h. Results: The time courses of 13C-enrichments in exhaled CO2 for all the children, after they had ingested labeled caffeine only and after they had ingested both Casilan® and labeled caffeine, were identical. There was a gradual rise and peak of the enrichments at about 60-75 min, followed by a gradual fall (II) or a plateau (III). Contrarily, the time course of 13C-enrichments for all the children was consistently low and stable after they had ingested Casilan® only (I). The mean values of cumulative percent 13C-doses recovered in the CO2 exhaled over a 2-h period, after ingesting labeled caffeine only (8.59 ± 1.10 δ%/mg) and after ingesting both Casilan® and labeled caffeine (8.58 ± 1.33 δ%/mg), were identical, with no statistically significant difference (P = 0.972). This suggests that Casilan® did not affect the CYP1A2 metabolic pathway. Conclusions: Casilan® is a safe, reliable and quantitative food supplement for overnight-fasted children undergoing caffeine breath test. [ABSTRACT FROM AUTHOR]

Abstract: Inborn errors of metabolism (IEMs) are a large group of very heterogeneous diseases, and the impact of the available vaccines on children with IEMs may vary depending on the child''s metabolic characteristics. The main aim of this review is to re-analyse the administration of vaccines to such children in the light of the most recent data. As a whole, these indicate that children with stable or slowly progressing IEMs can receive the recommended schedules of all of the recommended vaccinations. However, vaccines should be administered more cautiously to children with IEMs associated with a significant risk of morbidity and/or mortality with catabolic events: i.e. under strict medical supervision, and only when the children are clinically well and their metabolic condition is acceptably controlled. Furthermore, a number of IEMs have been associated with immune deficiency although, in most cases, the immunological abnormalities disappear or are significantly reduced when the metabolic defect is corrected. The response to vaccines is therefore unpredictable, but it is reasonable to think that it may be inadequate in children with the most severe immune defects. In addition to defective protection, vaccines administered to children with IEM and severe immunodeficiency can actually cause the disease they were meant to prevent. This explains why experts suggest that vaccines based on live attenuated viruses should not be given to such children, although all of the other vaccines can be administered without limitation regardless of the type of immune defect. Nevertheless, only specific multicentre studies will make it possible to say when and how to use vaccines in children with different types of IEM in order to protect them from vaccine-preventable diseases without any risk of worsening their metabolic situation. [Copyright &y& Elsevier]

Hypothalamic obesity is an intractable form of obesity syndrome that was initially described in patients with hypothalamic tumours and surgical damage. However, this definition is now expanded to include obesity developing after a variety of insults, including intracranial infections, infiltrations, trauma, vascular problems and hydrocephalus, in addition to acquired or congenital functional defects in central energy homeostasis in children with the so-called common obesity. The pathogenetic mechanisms underlying hypothalamic obesity are complex and multifactorial. Weight gain results from damage to the ventromedial hypothalamus, which leads, variously, to hyperphagia, a low-resting metabolic rate; autonomic imbalance; growth hormone-, gonadotropins and thyroid-stimulating hormone deficiency; hypomobility; and insomnia. Hypothalamic obesity did not receive enough attention, as evidenced by rarity of studies in this group of patients. A satellite symposium was held during the European Congress of Obesity in May 2011, in Istanbul, Turkey, to discuss recent developments and concepts regarding pathophysiology and management of hypothalamic obesity in children. An international group of leading researchers presented certain aspects of the problem. This paper summarizes the highlights of this symposium. Understanding the central role of the hypothalamus in the regulation of feeding and energy metabolism will help us gain insights into the pathogenesis and management of common obesity. [ABSTRACT FROM AUTHOR]

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The article offers information on a research conducted on inborn errors of metabolism(IEM) in Chinese children who had symptoms. It states that among 11,060 symptomatic patients, 62 were diagnosed with IEM, and 43.5 percent had aminoacidemias, 41.9 percent had organic acidemias and nine had fatty acid oxidation disorders. If diagnosed at an older age, mental retardation and motor delay are difficult to reverse, so extensive newborn screening is required for early diagnosis and treatment.

. Coca-Prieto I, Kroupa O, Gonzalez-Santos P, Magne J, Olivecrona G, Ehrenborg E, Valdivielso P (Hospital Virgen de la Victoria, Malaga University, Malaga, Spain; Umea University, Umea; and Karolinska Institutet, Stockholm; Sweden). Childhood-onset chylomicronaemia with reduced plasma lipoprotein lipase activity and mass: identification of a novel GPIHBP1 mutation. J Intern Med 2011; 270: 224-228. Objectives. Deficiency in the catabolism of triglyceride-rich lipoproteins is the main cause of childhood-onset chylomicronaemia syndrome. Missense mutations in lipoprotein lipase (LPL) or in proteins influencing LPL activity or stability have been shown to be critical determinants of chylomicronaemia syndrome. The main objective of this study was to assess the primary deficiency in five cases of childhood-onset chylomicronaemia syndrome. Setting. Lipid clinic at a university hospital, Subjects. Subjects presenting with severe hypertriglyceridaemia and chylomicronaemia syndrome in which reduced LPL activity and mass were observed. Interventions. Analysis of LPL and GPIHBP1 genes. Results. Amongst the five patients, one novel homozygous missense mutation (p.C68Y) in exon 3 of GPIHBP1 was identified. The other four patients were homozygous for the common LPL mutation p.G188E. Conclusion. These findings provide further evidence that GPIHBP1 is involved in the catabolism of triglyceride-rich lipoproteins and plays a role in childhood-onset chylomicronaemia. [ABSTRACT FROM AUTHOR]

Summary Context The association between large for gestational age (LGA) phenotype, postnatal growth and cardiometabolic risk (CMR) in adult life remains unclear. The role of IGF1 genotype on LGA-related outcomes in adult life is unknown. Aim To assess the postnatal growth, IGF-I levels, CMR and the influence of the 737.738 IGF1 in adults born LGA. Subjects Case-control study ( n = 515) nested in a population-based prospective cohort ( n = 2063); 117 LGA and 398 gender-matched controls appropriate for gestational age (AGA) subjects. Methods Anthropometry was evaluated at birth, at 9-10 and at 23-25 years old. At the age of 23-25 years, blood pressure (BP), glycaemia, insulinaemia, homeostasis model assessment - insulin resistance, lipids, fibrinogen, and plasma IGF-I and 737.738 IGF1 polymorphism were assessed. Results Large for gestational age subjects remained heavier and taller than AGA at 9-10 and 23-25 years ( P < 0·05); at 23-25 years, LGA had greater waist circumference (WC; P < 0·05) and higher BP ( P < 0·05) than controls. Body proportionality at birth did not predict metabolic outcome. LGA subjects presenting catch-down of weight in childhood had lower body mass index (BMI; P = 0·001), lower WC ( P < 0·05) and lower BP ( P < 0·05) at 23-25 years. 737.738 IGF-I genotype differed between groups ( P < 0·001). Homozygosis for polymorphic alleles was associated with increased odds of LGA (OR: 3·2; 95% CI: 1·5-6·9), higher IGF-I (56·9 ± 16·4 vs 37·7 ± 16·0 n m; P < 0·01) and lower BP (114/68 vs 121/73 mmHg; P < 0·05). Conclusions Young adults born LGA presented higher BMI, WC and BP and appear to be at higher CMR risk than AGA subjects. The 737.738 IGF1 polymorphism appears to play a role on birth size and LGA-related metabolic outcomes. [ABSTRACT FROM AUTHOR]

Pediatric urolithiasis is an endemic disease in Turkey. We evaluated the clinical, radiological and metabolic features of children with urolithiasis in Western Turkey. We retrospectively reviewed the records of 85 children with urolithiasis who were followed-up between 2004 and 2010 in Pediatric Nephrology Department of Celal Bayar University, Manisa. The male/female ratio was 1.23/1. The mean age at diagnosis was 66.1 months (range 3-210 months). Family history of urolithiasis was found in 58 (68.2%) patients. 23 (27%) patients were born from consanguineous marriages. Stones were located in the upper urinary tract in 79 (92.9%) patients. In 66 (77.6%) patients, stones were single-sided and 41 (48.2%) patients had multiple stones. Calcium oxalate stones were the most common one among patients in whom stone analysis was performed (78.5%). Hypocitraturia was the most commonly detected urinary metabolic risk factor. In patients who were under 12 months of age at diagnosis, hypercalciuria was the most commonly seen urinary metabolic risk factor. At the end of follow-up period, 24 patients became free of stone disease and 4 patients had recurrence. In conclusion, metabolic abnormalities are common in pediatric stone patients and are strongly associated with recurrence. Considering that urolithiasis in children is an important risk factor for renal failure, early diagnosis, detailed metabolic evaluation and implementing appropriate treatment and follow-up protocols may prevent recurrence and renal damage. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the association of age and sex on quadriceps muscle phosphate and potential of Hydrogen (pH) responses in children and adults during incremental exercise. The subjects consisting of 15 boys and 18 girls of nine to years old, eight men, and eight women have undergone quadriceps step-incremental test exhaustion inside a magnetic resonance (MR) scanner to determine the metabolic and pH responses of muscle when exercising. The results reveal that the output in a normalized power and cellular energetic state at metabolic intracellular threshold (IT) are the same in children and adults and on both sexes. The study concludes that age-and sex-related differences in muscle metabolism in children and adults depend on the exercise intensity.

The article discusses the case of a 3-year-old boy admitted with complaints of enlarged penis and pubic hair development. The boy was diagnosed with 11β-hydroxylase deficient congenital adrenal hyperplasia and started in hydrocortisone treatment. However, due to irregular check-up and refusal of the boy's family to accept treatment, the child's metabolic control was poor. It recommends monitoring of congenital adrenal hyperplasia with ultrasonography, especially in puberty.

The article discusses the case of Ellis-Van Creveld (EVC) syndrome associated with metabolic aberrations in a 16-year-old girl. It cites that EVC syndrome occurs in children whose average-sized parents carry the mutation for the disorder. Researchers were not able to determine how the metabolic disturbances resulted in EVC syndrome, but proposed the existence of biochemical association and components at birth.

Childhood malnutrition is not just due to lack of nutrients, it can also be caused by enteric infections leading to intestinal inflammation and malabsorption of nutrients. Human genetic polymorphisms can alter host genes that affect nutrient absorption and metabolism. Changes in intestinal microbial ecology and the microbiome (the collective genome of the intestinal microbiota) can also affect the harvest of nutrients from the diet. A substantial proportion of malnourished children fail to recover due to inappropriate treatment. However, there may be other causes for treatment failure, including changes in the microbiome and infection with an enteropathogen, and a genetic predisposition to malnutrition may exist. It is, therefore, logical to undertake the following: 1) investigate genetic predisposition to malnutrition, 2) determine the genetic markers and biomarkers that can help identify children at risk of malnutrition, and 3) look for new treatment modalities that can improve the clinical management of children with malnutrition. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the agreement between the ActiGraph accelerometer and the Bouchard diary to estimate energy expenditure (EE) in a Spanish adolescent population. Methods: Sixty-one Spanish adolescents, aged 12-16 years, were recruited for this study. The Bouchard diary and the ActiGraph were administered for 3 consecutive days. EE estimated by the Bouchard diary was calculated using 2 different MET category values (BD-Bouchard and BD-Bratteby). EE estimated by the ActiGraph was calculated using 3 predictive equations (AC-Trost, AC-Freedson, and AC-Ekelund). Participants with complete 24 h data were also analyzed to control the possible loss of accuracy. Agreement was examined by Pearson and concordance correlations, paired (-test, and Bland-Altman method. Results: Thirty-seven adolescents were included in the analyses with complete 72 h. Relationships between EE calculated by the Bouchard diary and the ActiGraph were high (ranged: r = 0.61-0.78). Concordance correlations were moderate (rc = 0.60) by BD-Bratteby and AC-Trost, and low using BD-Bratteby and AC-Ekelund (ç= 0.15). EE estimated by BD-Bratteby and AC-Trost also showed no significant differences (P >0.05) and absolutely agree 0.0 ± 5.0 Mild (95% confidence interval: ± 0.90 Mild), but with wide limits of agreement (± 9.80 Mild). Relationships were higher and differences were smaller in the 72 h sample than in the 24 h sample. Conclusions: The Bouchard diary and the ActiGraph showed high relationships, moderate concordance, and large differences to estimate EE in Spanish adolescents. Advantages, disadvantages, and agreements between both instruments must be taking into consideration for health-related research. [ABSTRACT FROM AUTHOR]

Considerable advances have been achieved in paediatric surgery during the last two decades, which can be partly ascribed to a better understanding of the physiological response to operations and the use of that knowledge to decrease the metabolic response where appropriate. Alongside this, minimally invasive surgery is now well established for many surgical conditions in the neonate, infant and child. The metabolic response to surgery differs in neonates to that seen in adults: there is a small increase in oxygen consumption and resting energy expenditure immediately after surgery with a return to normal levels by 12-24?h. The increase in resting energy expenditure is significantly greater in infants undergoing a major operation than in those subjected to a minor procedure. The limited increase in energy expenditure may be due to diversion of energy from growth to tissue repair. There are limited data available on older children, but they appear to have a different pattern of postoperative resting energy expenditure. There is a fall in the early postoperative period, similar to data collected in adults, but no late hypermetabolism. Protein metabolism mirrors energy expenditure and contributes to the overall changes observed. Various factors affect the magnitude of the response. It seems that in children intraoperative thermoregulation and metabolism are significant drivers of many of the postoperative changes. Minimally invasive surgery may maintain preoperative metabolic processes by altering the postoperative processes on a physiological level or by maintaining thermoregulation in children. The mechanism and potential benefit of these observations need further investigation. [ABSTRACT FROM AUTHOR]

AIM: The objective of this study was to assess the prevalence of obesity among preschool-age children and identify its associated factors. METHOD: This research has two steps, involving 375 preschool-age children ranging from 5 to 6 years-old, registered to a public kindergarten in Keçiören, Ankara. In the first step, measurements of weight, height, waist and hip circumferences were taken, body mass index (BMI) and waist-hip ratio were calculated, BMI according to age and gender was classified considering the reference data of WHO-2007, the results were evaluated ⩾85-<95. percentile as overweight, and ⩾95. percentile as obese. In the second stage, forms prepared by the researchers were given to parents and the data obtained were assessed by statistical methods. RESULTS: The overall prevalence of overweight was 8.3%; the overall prevalence of obesity was 10.1%. The prevalence of overweight was higher in boys than in girls. The circumference of waist and hip of overweight/obese children were higher than other children (p<0.001). Negative and significant correlation was obtained (p<0.05) between the body weight and daily sportive activities of children and also between the period of exclusive breastfeeding. Moreover, positive correlation (p<0.01) was found between the body weight of children and the body weight of their parents. CONCLUSION: Obesity among preschool children is an important health problem. To evaluate obesity of children and encouraging them for having healthy eating behaviors and for doing sportive activities could contribute to prevent them to develop obesity in later ages. [ABSTRACT FROM AUTHOR]

BACKGROUND: Approximately 35 million people in Bangladesh are chronically exposed to inorganic arsenic (InAs) in drinking water. Methylation of InAs to monomethylarsonic (MMA) and dimethylarsinic acids (DMA) relies on folate-dependent one-carbon metabolism and facilitates urinary arsenic (uAs) elimination. OBJECTIVES: We examined the relationships between folate, cobalamin, cysteine, total homocysteine (tHcys), and uAs metabolites in a sample of 6-year-old Bangladeshi children (n = 165). METHODS: Children provided blood samples for measurement of tHcys, folate, cobalamin, and cysteine, and urine specimens for the measurement of total uAs and As metabolites. RESULTS: Consistent with our studies in adults, mean tHcys concentrations (7.9 µmol/L) were higher than those reported among children of similar ages in other populations. Nineteen percent of the children had plasma folate concentrations < 9.0 nmol/L. The proportion of total uAs excreted as InAs (%InAs) was inversely correlated with folate (r = --0.20, p = 0.01) and cysteine (r = --0.23, p = 0.003), whereas the correlations between %DMA and both folate (r = 0.12, p = 0.14) and cysteine (r = 0.11, p = 0.15) were positive. Homocysteine was inversely correlated (r = --0.27, p = 0.009) with %MMA in males, and the correlation with %DMA was positive (r = 0.13, p = 0.10). CONCLUSIONS: These findings suggest that, similar to adults, folate and cysteine facilitate As methylation in children. However, the inverse correlation between tHcys and %MMA, and positive correlation with %DMA, are both opposite to our previous findings in adults. We propose that upregulation of one-carbon metabolism, presumably necessary to meet the considerable demands for DNA and protein biosynthesis during periods of rapid growth, results in both increased tHcys biosynthesis and increased As methylation. [ABSTRACT FROM AUTHOR]

Purpose: To describe the physical and metabolic characteristics of children diagnosed with fatty liver disease in a gastroenterology clinic in El Paso, Texas. Data Sources: A retrospective chart review of 31 patients aged 8-18 diagnosed with fatty liver was conducted. Conclusions: These children were diagnosed with fatty liver by elevated alanine aminotransferase (ALT) levels (mean ALT levels 126 ± 08 U/L) and increased hepatic echogenicity measured via ultrasound. The majority of children were adolescents (12-17 years of age) and Mexican American. All subjects were overweight (body mass index [BMI] > or = 95th percentile) based on Centers for Disease Control and Prevention standards. In a subset of children for whom results from laboratory test were available, we found 40% had high triglycerides (> or = 150 mg/dL),53%had low high-density lipoprotein cholesterol (< or = 35 mg/dL), and 17% had prediabetes (fasting glucose > or = 100 mg/dL). The clinical and laboratory findings in this patient population with fatty liver are consistent with a diagnosis of nonalcoholic fatty liver disease (NAFLD). Implications for Practice: Despite the increasing trend in overweight among children and adolescents, data suggest low rates of diagnosis and management of overweight and related comorbidities by healthcare providers. Overweight has been associated with fatty liver disease in the pediatric population and includes other comorbidities such insulin resistance and features of metabolic syndrome. Screening for overweight in children should constitute the first step in identifying children at risk for NAFLD. Nurse practitioners should include in the evaluation of pediatric patients calculation of BMI and waist circumference for age and screening for other overweight-related comorbidities. [ABSTRACT FROM AUTHOR]

Aim Glycated haemoglobin (HbA1c) is considered the best index of glycaemic control in established diabetes. It may also be useful in the diagnosis of diabetes and as a screening tool. Little is known about the distribution of HbA1c in healthy children and its predictors. The aim of this study is to describe the distribution of HbA1c in non-diabetic Dutch children aged 8–9 years and to investigate potential associations of HbA1c in this group. Methods HbA1c was measured in 788 non-diabetic children aged 8–9 years participating in the PIAMA birth cohort study. Data on parents and children were collected prospectively by questionnaires. Weight, height and waist and hip circumference of the children were measured when blood samples were taken. Results Mean (sd) HbA1c was 4.9 ± 0.33%, range 3.5–6.0%. HbA1c was significantly higher in boys (4.9 ± 0.31 vs. 4.9 ± 0.33%) and in children of mothers with gestational diabetes (5.0 ± 0.37 vs. 4.9 ± 0.32%). We found a significant inverse association between HbA1c and haemoglobin (regression coefficient: −0.169 (95% CI −0.221 to −0.118), P < 0.001). HbA1c was not significantly associated with age, body mass index, waist circumference, parental diabetes or maternal body mass index. Conclusions We found no significant relation between known risk factors for Type 2 diabetes and HbA1c at age 8–9 years. Moreover, there was a significant inverse association between haemoglobin and HbA1c. These results suggest that HbA1c may not only reflect the preceding blood glucose levels, but seems to be determined by other factors as well. [ABSTRACT FROM AUTHOR]

Several prediction equations developed to convert body movement measured by accelerometry into energy expenditure have been published. The aim of this study was to examine the degree of agreement between three different prediction equations, when applied to data on physical activity in a large sample of children. We examined 1321 children (663 boys, 658 girls; mean age 9.6±0.4 years) from four different countries. Physical activity was measured by the MTI accelerometer. One equation, derived from doubly labeled water (DLW) measurements, was compared with one treadmill-based (TM) and one room calorimeter-based (CAL) equation (mixture of activities). Predicted physical activity energy expenditure (PAEE) was the main outcome variable. In comparison with DLW-predicted PAEE, both laboratory-derived equations significantly ( P<0.001) overestimated PAEE by 17% and 83%, respectively, when based on a 24-h prediction, while the TM equation significantly ( P<0.001) underestimated PAEE by 46%, when based on awake time only. In contrast, the CAL equation agreed better with the DLW equation under the awake time assumption. Predicted PAEE differ substantially between equations, depending on time-frame assumptions, and interpretations of average levels of PAEE in children from available equations should be made with caution. Further development of equations applicable to free-living scenarios is needed. [ABSTRACT FROM AUTHOR]

Abstract: Why do the epileptogenic foci appear hypometabolic on interictal glucose metabolism positron emission tomography (PET) in a substantial proportion of patients with focal epilepsy but appear normo- or even hyper-metabolic in others? Such observations on interictal PET have not been fully explained by the frequency of interictal spike discharges alone. In the present study using digital electrocorticography monitoring system with high-frequency sampling, we determined how well regression models using spectral ECoG measures and spike frequency derived from 651 intracranial electrode sites explained cortical glucose metabolic patterns in six children with nonlesional focal epilepsy. Univariate regression analysis demonstrated that spectral amplitudes at gamma ranges (32–64, 64–100, and 100–200 Hz) were tightly correlated with interictal glucose uptake in the given electrode site in all children. Spike frequency was negatively correlated with interictal glucose uptake in three patients, whose epileptogenic focus appeared hypometabolic and interictal epileptiform discharge often consisted of a spike followed by a subsequent delta-wave. Conversely, spike frequency was positively correlated with interictal glucose uptake in the other three patients, whose epileptogenic foci appeared more hypermetabolic compared to the surrounding regions and associated with frequent interictal spike bursts. The spatial pattern of interictal glucose metabolism in nonlesional focal epilepsy may be better explained by gamma-oscillations derived from epileptiform and physiological neuronal activities rather than the frequency of interictal epileptiform discharges alone. [Copyright &y& Elsevier]

Abstract: Objective: The “tunnel technique” may be used as an alternative to the “conventional” class II preparation for the treatment of proximal dentin caries. The purpose of this article was to summarize and discuss the available information concerning the tunnel technique and the clinical success of tunnel restorations. Methods: Information from original scientific full papers or reviews listed in PubMed (search term: tunnel preparation or tunnel restoration) were included in the review. Papers dealing with endodontic or periodontal topics and case reports were not taken into consideration. Clinical studies were included when at least 20 restorations could be followed-up for at least 24 months. In vivo- and in vitro-studies were excluded when the number of restorations under observation or the decision criteria were not clearly defined. Insufficient data about tunnel restorations in the primary dentition do not allow for analysis. Results: Both effectiveness of caries removal and marginal ridge strength are reduced in tunnel restorations compared to conventional class II. Glass-ionomer tunnel restorations exhibit an annual failure rate of 7–10%. Therefore, the main reasons for clinical failure are marginal ridge fracture, recurrent caries and progression of demineralization. However, clinical studies indicate that composite but not glass-ionomer tunnel restorations might be a promising alternative. Conclusion: Tunnel restorations filled with glass-ionomer cements exhibit technical deficiencies and a limited life-span compared to conventional class II composite or amalgam restorations and could not be recommended as an alternative preparation for proximal carious lesions. Promising clinical results of composite tunnel restorations need to be confirmed by long-term studies. [Copyright &y& Elsevier]

The article examines the validity of SenseWear Pro2 Armband in assessing energy cost of physical activities in children. Energy cost of physical activities of 20 children aged 11 to 13 years were measured using Oxycon Mobile portable metabolic system and was compared to the values measured by the SenseWear Pro2 Armband. Among the physical activities evaluated include playing games on mobile phone, bicycling, jumping on a trampoline and playing basketball. Results showed that the energy cost measured by the SenseWear Pro2 Armband were underestimated. The underestimation also increases with increased physical activity intensity.

Objectives The onset of anorexia nervosa (AN) during childhood can affect the timing of puberty and adult height. The aim of the study was to evaluate the determinants of late menarche and adult height in children with AN. Patients and methods We carried out a retrospective, longitudinal, university hospital-based study. All prepubertal or early pubertal girls diagnosed with AN between 1998 and 2002 were selected for the study. Participants ( n = 33) were studied at a median age of 21 (19·8–24·3) years. AN was diagnosed at 11·8 (10·7–12·3) years. Results Patients with AN reached menarche at significantly greater ages than their mothers [15·4 (13·5–16·8) vs. 13·2 (12·0–14·5) years, P < 0·01]. Chronological age at onset of AN and lowest body mass index (BMI) were important independent predictive factors for delayed menarche ( P < 0·01). Adult height was 165·0 (163·0–172·0) cm, 2·5 (–1·5 to 5·0) cm above target height. Twelve patients (36%) did not reach their target height and had a median height deficit of –3·9 cm with respect to their target height. The duration of hospitalization, a marker of disease severity and chronicity, was an independent predictor of the difference between adult height and target height for a given individual (β coefficient = –0·07; P = 0·01). The other factors studied (i.e. age at onset of AN, pubertal stage at diagnosis of AN, lowest BMI reached, associated comorbidity if any, type of AN, age at menarche) had no significant effect on adult height. Conclusion The intensity of the disease affects the timing of menarche but not adult height in most patients. Hospitalization, despite often being an effective means of managing AN, does not reduce the impact of AN on growth. [ABSTRACT FROM AUTHOR]

Abstract: Dilaceration is the result of a developmental anomaly in which there has been an abrupt change in the axial inclination between the crown and the root of a tooth, but the criteria in the literature for recognizing root dilaceration vary. Two possible causes of dilaceration are trauma and developmental disturbances, and it has also been proposed that it might be associated with some developmental syndromes. Dilaceration can be seen in both the permanent and deciduous dentitions, and it is more commonly found in posterior teeth and in the maxilla. Periapical radiographs are the most appropriate way to diagnose the presence of root dilacerations. Diagnosis, endodontic access cavity preparation, root canal preparation and filling, and other related treatments might be complicated by the presence of a dilaceration. A review of the literature and a discussion of the options for managing this condition are presented. [Copyright &y& Elsevier]

Objective. To verify the combined effect of body position, apparatus and distraction on children's resting metabolic rate (RMR). Methods. Experiments were carried out on 14 children aged 8-12 (mean age = 10.1 years ±1.4). Each participant underwent two test sessions, one week apart under three different situations: a) using mouthpiece and nose-clip (MN) or facemask (FM); b) sitting (SEAT) or lying (LY); and c) TV viewing (TV) or no TV viewing. In the first session, following 20 min rest and watching TV, the protocol was: LY: 20 min stabilization; 10 min using MN and 10 min using FM. Body position was then changed to seated: 20 min stabilization; 10 min using FM; 10 min using MN. In the second session, FM and MN order was changed and participants did not watch TV. Data were analysed according to the eight combinations among the three studied parameters. Results. Repeated measures ANOVA indicated statistically significant differences for [image omitted] O2 (p = 0.01) and RMR (p = 0.02), with TVMNSEAT showing higher values than TVFMLY. Bland-Altman analysis showed a bias for [image omitted] O2, [image omitted] CO2, respiratory quotient (RQ) and RMR between TVFMLY and TVMNSEAT, respectively, of -17.8±14.5 (ml min), -8.8±14.5 (ml min), 0.03±0.05 and -115.2±101.9 (kcal/day). Conclusion. There were no differences in RMR measurements due to body position and apparatus when each variable was isolated. Analyses of distraction in three of four combinations indicated no difference between TV and no TV. Different parameter combinations can result in increased bias and variability, and thereby the reported differences among children's RMR measurement. [ABSTRACT FROM AUTHOR]

The ability of the phase-sensitive steady-state free precession (SSFP) technique to distinguish subcutaneous and visceral adipose tissue in the abdomen at 3 T was evaluated. A phased array receiver radiofrequency coil and a commercially available SSFP sequence were used for imaging. The raw image data were postprocessed to generate fat-only and water-only images. A postprocessing algorithm that is computationally efficient and robust is presented. The postprocessing technique separates the fat and water pixels automatically without any user interference. The feasibility of the technique is demonstrated in vivo with breath-hold abdomen images. The short scan time and the ease of use of this technique are well suited to the quantification of body fat distribution in children. [ABSTRACT FROM AUTHOR]

Abstract: Reported literature data strongly suggest that steroid metabolism is dysregulated in Type 1 diabetes mellitus. The aim of this study was to non-invasively examine the cortisol metabolism in children with Type 1 diabetes mellitus (T1DM) in detail and to test the hypothesis that adrenarche is affected under conventional intensive insulin therapy. In 24-h urine samples of 109 patients aged 4–18 years with T1DM of more than 1 year, steroids were profiled using gas chromatography–mass spectrometry. Additionally, urinary free cortisol (UFF) and cortisone (UFE) were quantified by RIA after extraction and chromatographic purification. Data on urinary steroids from 400 healthy controls served as reference values. Enzyme activities were assessed by established steroid metabolite ratios, e.g. 5α-reductase and 11beta-hydroxysteroid dehydrogenase Type 2 (11beta-HSD2) by 5α-tetrahydrocortisol/tetrahydrocortisol and UFE/UFF, respectively. Urinary markers of adrenarche, especially dehydroepiandrosterone and its direct metabolites were elevated in patients, as were urinary 6β-hydroxycortisol, UFE, and 11beta-HSD2 activity. However, overall cortisol secretion, as reflected by the sum of major urinary cortisol metabolites, was mostly normal and activity of 5α-reductase clearly reduced. Our study provides evidence for an exaggerated adrenarche in T1DM children, which may help to understand reported sequelae in female patients like hyperandrogenic symptoms. The findings also suggest a reduced cortisol inactivation via 5α-reductase that is not compensated by a fall in cortisol secretion. Whether the elevated urinary 6β-hydroxycortisol and cortisone excretion, observed in the patients, are also present in other forms of hypercortisolism and may thus serve as non-invasive clinical stress markers deserves further study. [Copyright &y& Elsevier]