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BACKGROUND Recent studies demonstrated that low-density lipoprotein-tryglyceride (LDL-TG) may represent another marker of cardiovascular risks. We therefore measured LDL-TG including the low-density lipoprotein (LDL) subclass distribution and investigated the association between LDL-TG subclass profile and the clustering of metabolic syndrome (MetS) components and insulin resistance in Japanese children. METHODS The study included 237 schoolchildren (boys 115, girls 122). Four subclasses of low-density lipoprotein-tryglyceride (large, medium, small, and very small) was quantified using high-performance liquid chromatography. Total LDL-TG and TG levels in LDL subclasses were evaluated among four MetS component groups; non-abdominal obesity, abdominal obesity, pre-MetS, and MetS. RESULTS Total LDL-TG (P = 0.0003, P = 0.0175) and triglyceride levels in LDL subclasses were significantly different among four MetS component groups (large: P = 0.0002, P = 0.0084; medium: P = 0.0009, P = 0.0491; small: P =0.0025, P = 0.0509; very small: P = 0.0808, P = 0.0228; boys and girls, respectively). Total LDL-TG (r = 0.411, P < 0.0001, r = 0.378. P < 0.0001) and triglyceride levels in LDL subclasses correlated positively with the homeostasis model of assessment ratio (large: r = 0.396, P < 0.0001, r = 0.346, P < 0.0001; medium: r = 0.274, P = 0.0030, r = 0.228, P = 0.0115; small: r = 0.342, P = 0.0002, r = 0.292, P = 0.0011; very small: r = 0.385, P < 0.0001, r = 0.426, P < 0.0001, boys and girls, respectively). CONCLUSIONS Subclass distribution of LDL-TG was significantly associated with the clustering of MetS components in both sexes, and insulin resistance is a significant determinant of LDL-TG in all LDL subclasses. Lipoprotein-tryglyceride subclass analysis, rather than LDL-C, may provide a precise evaluation for cardiovascular disease risks in children with MetS.

For preterm and very low birthweight infants, the mother’s own milk is the best nutrition. Based on the latest information for mothers who give birth to preterm and very low birthweight infants, medical staff should encourage and assist mothers to pump or express and provide their own milk whenever possible.If the supply of maternal milk is insufficient even though they receive adequate support, or the mother’s own milk cannot be given to her infant for any reason, donor human milk should be used.Donors who donate their breast milk need to meet the Guideline of the Japan Human Milk Bank Association.Donor human milk should be provided according to the medical needs of preterm and very low birthweight infants, regardless of their family’s financial status.In the future, it will be necessary to create a system to supply an exclusive human milk‐based diet (EHMD), consisting of human milk with the addition of a human milk‐derived human milk fortifier, to preterm and very low birthweight infants.

Purpose The aim was to investigate the characteristics of abdominal fat distribution in Japanese adolescents with type 2 diabetes mellitus. Patients and methods Eighty-six Japanese adolescents with simple obesity or type 2 diabetes mellitus treated between 2002 and 2018 were included. The subjects were classified into the simple obesity group (SO group, n=38) and type 2 diabetes mellitus group (DM group, n=23) by matching average age and gender ratio. The metabolic parameters VFA, SFA, and V/S ratio were compared between the 2 groups. Multivariate logistic regression analysis was performed to identify clinical factors associated with type 2 diabetes mellitus. Linear regression analysis was performed between hemoglobin A1c (HbA1c) and visceral fat area (VFA), subcutaneous fat area (SFA), or VFA-to-SFA ratio (V/S ratio) among all enrolled subjects. Finally, correlation analyses were performed to determine the relationships between VFA, SFA, and V/S ratio and metabolic parameters of the DM group. For the metabolic parameters, serum lipids, alanine aminotransferase (ALT), and HbA1c were measured without fasting. The VFA and SFA at umbilical level were investigated using computed tomography. Results VFA and V/S ratio in DM group were higher than those in SO group (p=0.04 and p

Abdominal bioelectrical impedance analysis (aBIA) has been in use to measure visceral fat area (VFA) in adults. Accurately measuring visceral fat using aBIA in children is challenging. Forty-six school-aged Japanese children aged 6–17 years (25 boys and 21 girls) were included in this study. All were measured, and their VFA obtained using aBIA (VFA-aBIA) and abdominal computed tomography (CT) (VFA-CT) were compared. VFA-aBIA was corrected using the Passing–Bablok method (corrected VFA-aBIA). The relationships between corrected VFA-aBIA and obesity-related clinical factors were analyzed, including non-alcoholic fatty liver disease (NAFLD) and serum leptin and adiponectin levels. Boys had higher VFA-CT than girls (p = 0.042), although no significant differences were found in their waist circumference, waist-to-height ratio, and body mass index. The corrected VFA-aBIA using y = 9.600 + 0.3825x (boys) and y = 7.607 + 0.3661x (girls) correlated with VFA-CT in both boys and girls. The corrected VFA-aBIA in patients with NAFLD was higher than that in those without NAFLD. Serum leptin and adiponectin levels were positively and negatively correlated with corrected VFA-aBIA, respectively. In conclusion, corrected VFA-aBIA was clearly correlated with VFA-CT and was related to NAFLD and serum leptin and adiponectin levels in school-aged Japanese children.

Purpose The aim was to investigate the characteristics of abdominal fat distribution in Japanese adolescents with type 2 diabetes mellitus. Patients and methods Eighty-six Japanese adolescents with simple obesity or type 2 diabetes mellitus treated between 2002 and 2018 were included. The subjects were classified into the simple obesity group (SO group, n=38) and type 2 diabetes mellitus group (DM group, n=23) by matching average age and gender ratio. The metabolic parameters VFA, SFA, and V/S ratio were compared between the 2 groups. Multivariate logistic regression analysis was performed to identify clinical factors associated with type 2 diabetes mellitus. Linear regression analysis was performed between hemoglobin A1c (HbA1c) and visceral fat area (VFA), subcutaneous fat area (SFA), or VFA-to-SFA ratio (V/S ratio) among all enrolled subjects. Finally, correlation analyses were performed to determine the relationships between VFA, SFA, and V/S ratio and metabolic parameters of the DM group. For the metabolic parameters, serum lipids, alanine aminotransferase (ALT), and HbA1c were measured without fasting. The VFA and SFA at umbilical level were investigated using computed tomography. Results VFA and V/S ratio in DM group were higher than those in SO group (p=0.04 and p

Background: Visceral fat accumulation is strongly associated with type 2 diabetes (T2DM). In contrast to visceral fat, subcutaneous fat might even be beneficial against metabolic abnormalities. Objective: To investigate the association between simple obesity or T2DM and the ratio of visceral fat area (VFA) to subcutaneous fat area (SFA) (V/S ratio) in Japanese adolescents. Design/Methods: An age- and sex-matched retrospective study was conducted in Tokyo Metropolitan Hiroo Hospital, Nihon University Hospital, and Nihon University Itabashi Hospital with ethics approval. Sixty-one adolescents with simple obesity or T2DM aged 10 to 15 years who have been visiting in these outpatient clinics between 2002 and 2018 were enrolled in this study. Simple obesity was defined as BMI ≥95%ile but without T2DM. VFA and SFA were investigated using CT at the umbilical levels. Subjects were classified into 2 groups: simple obesity group (n=38) and T2DM group (n=23). Results: Comparisons between the 2 groups are shown in Table 1. In simple obesity group, ALT, TC, HDLC or non-HDLC levels were significantly different that those in T2DM group. SFA and V/S ratio in simple obesity group were significantly higher and lower than those in T2DM group, respectively. Conclusion: V/S ratio is different between simple obesity and T2DM in Japanese adolescents. V/S ratio is the most useful predicter of T2DM in adolescents. Disclosure Y. Abe: None. T. Urakami: None. K. Yoshida: None. M. Aoki: None. M. Hara: None. I. Morioka: None.

Background The aim of this preliminary study was to investigate the clinical use of acute-stage susceptibility-weighted imaging (SWI) in children with prolonged convulsive disorder. Methods Ten children with prolonged convulsive disorder who underwent SWI within 2 h after termination of seizure (acute-stage SWI group) and 15 control children who underwent SWI > 2 h after their seizures terminated or for other purposes were enrolled. The cerebral venous vasculature was compared between the groups. The acute-stage SWI group was further divided into three subgroups: normal group, those with regional low signals in the cerebral veins (regional group) and those with diffuse low signals in the cerebral veins (generalized group). Inter-ictal electroencephalography (EEG) and venous blood gas findings during seizure activity were compared between these subgroups. Results All patients in the acute-stage SWI group had low cerebral vein signal. Four patients were assigned to the regional group and six patients to the generalized group. Decrease of venous pH and the increase of venous pCO2 during seizure activity was more prominent in the regional group than in the generalized group. In the regional group, low-signal areas in the cerebral veins were consistent with abnormal areas on EEG; these low-signal areas resolved completely in all patients on follow-up SWI. Ten patients in the control group had normal SWI, and five had a generalized low signal. Conclusions Acute-stage SWI may be a useful alternative for identifying lateralization of seizures in children with prolonged convulsive disorder.

To investigate the effects of n-3 polyunsaturated fatty acids on stearoyl-CoA desaturase (SCD) activity, we treated 10 obese children (mean age: 12.9 years) with cod liver oil once daily for 12 weeks. The effects of cod liver oil supplementation on SCD activity, as estimated by the palmitoleate/palmitate ratio, depended on the docosahexaenoic acid (DHA) contents at baseline. Baseline DHA contents were negatively correlated with baseline SCD activity. After the treatment, baseline DHA contents were found to be significantly associated with the reduction of SCD activity. Cod liver oil supplementation may be a complementary treatment for obese children with low baseline contents of DHA.

BACKGROUND: Susceptibility-weighted imaging is a novel high-spatial-resolution three-dimensional gradient-echo magnetic resonance imaging technique with phase postprocessing that accentuates the paramagnetic properties of blood products. The use of susceptibility-weighted imaging for epileptic focus localization in the acute stage of encephalopathy in a child has not been documented. PATIENTS: We report three pediatric patients with status epilepticus in the setting of fever, in whom susceptibility-weighted imaging showed transient prominence of the focal venous vasculature. RESULTS: Conventional cranial T1- and T2-weighted images and diffusion-weighted images showed no abnormalities. The prominence of the focal venous vasculature in these patients, as demonstrated by susceptibility-weighted imaging, was consistent with the epileptic focuses suggested by both clinical symptoms and electroencephalograph findings and resolved completely without neurological sequelae in all patients. CONCLUSIONS: Susceptibility-weighted imaging may facilitate assessing epileptic focus localization in the acute stage of encephalopathy in children.

The large HDL subclass is considered to possess cardioprotective properties. The purpose of this study is to determine the relationship among abdominal adiposity, insulin resistance and HDL subclass profiles of Japanese schoolchildren.The study subjects included 164 children (79 boys and 85 girls). We obtained waist to height ratio (WHtR), lipid profile, and HOMA-IR. The HDL subclass profile was analyzed by HPLC.Children of either sex with abdominal obesity (WHtR≥0.5) had reduced concentrations of very large, large, and medium HDLC in conjunction with elevated triglyceride (TG) concentrations and HOMA-IR. WHtR was inversely related to the concentrations of very large (boys: r=-0.5306, p0.0001; girls: r=-0.3483, p=0.0011), large (r=-0.6168, p0.0001; r=-0.4387, p0.0001), and medium (r=-0.4170, p=0.0001; r=-0.4116, p0.0001) HDLC. The multiple regression analyses revealed that WHtR was an independent factor of the concentrations of very large, large, small, and very small HDLC in boys and the concentrations of large and medium HDLC in girls.In Japanese schoolchildren, abdominal obesity is associated with atherogenic HDL subclass profile. Abdominal obesity may be an important target for the prevention and management of HDL subclass alteration, even in children who do not suffer from insulin resistance or hypertriglyceridemia.

Background: Alterations in the very low-density lipoprotein (VLDL) subclass profile have been demonstrated in obese and insulin resistant adults; however, little information on VLDL subclasses is available in children. We determined the association between abdominal adiposity, insulin resistance, and triglyceride (TG) levels in each VLDL subclass in Japanese school children. Methods: One hundred sixty-four children (79 boys and 85 girls), 10.9 ± 1.6 years of age (mean ± SD), were recruited. We obtained the waist-to-height ratio (WHtR), lipid profile, and HOMA-R data from all children. The VLDL subclass profile was analyzed by HPLC. Results: Children of either gender with abdominal obesity (WHtR ≥ 0.5) had higher concentrations of large, medium, and small VLDL-TG in conjunction with the shift to larger size and elevated HOMA-R. The WHtR was positively related to concentrations of large (boys: r = 0.5800, p < 0.0001; girls: r = 0.3841, p = 0.0003) and medium (r = 0.5265, p < 0.0001; r = 0.3320, p = 0.0019) VLDL-TG. The small VLDL-TG concentration was positively correlated to the WHtR in boys (r = 0.4902, p < 0.0001), but not girls. In multiple regression analyses, the WHtR was an independent determinant of large, medium, and small VLDL-TG concentrations in boys, but not in girls, taking HOMA-R into account. Conclusions: Abdominal obesity was associated with the VLDL subclass profile in Japanese school children; however, the impact of abdominal adiposity on the VLDL subclass alteration demonstrated a gender difference.

Aims Plasma fatty acid composition can change with age, reflecting diet and levels of desaturating enzymes such as stearoyl-CoA desaturase (SCD), delta-6 desaturase (D6D) and delta-5 desaturase (D5D), which contribute to the development of insulin resistance. This study analyzed longitudinal changes in fatty acid composition in Japanese children during early puberty and the association between changes in desaturase indices and changes in body fatness and insulin resistance. Methods The study included 77 children (38 boys and 39 girls) aged 9.6±0.5 years. Relative weight (RW) and waist-to-height ratio (WHtR) were determined. The fatty acid composition of plasma phospholipids was analyzed by gas chromatography, and the desaturase indices were calculated: SCD (16:1n-7/16:0: SCD16 and 18:1n-9/18:0: SCD18), D6D (20:3n-6/18:2n-6) and D5D (20:4n-6/20:3n-6) in 2006 and 2009. Results Obese children showed higher dihomo-gamma linolenic acid (DGLA; 20:3n-6), a higher D6D index and lower D5D index than non-obese children. Longitudinal changes in fatty acid com-position were generally similar in both sexes. Increased D6D index and DGLA and decreased D5D index were significantly associated with increased WHtR in boys and girls. In addition, increased D6D index was associated with an increased homeostasis model of assessment ratio (HOMA-R) only in girls. Conclusion The change in abdominal adiposity is a determinant of longitudinal changes in D6D and D5D indices and DGLA during early puberty.

Vitamin B6 (B6) is an essential cofactor of glutamate decarboxylase and catalyzes the decarboxylation of the excitatory neurotransmitter glutamate to the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Although immediate administration of B6 to patients with acute encephalopathy with febrile convulsive status epilepticus (AEFCSE) is effective, it is not known whether prolonged seizures in status epilepticus (SE) children prevent the transport of B6 to the central nervous system (CNS) and/or induce the consumption of B6 inside the CNS. We evaluated the B6 concentration in cerebrospinal fluid (CSF) and serum in SE children. Further, we performed a sequential serum B6 analysis on days 1 and 2 after admission and on the day before discharge. Among the several vitamers of B6, we used pyridoxal (PL) as a representative of B6 in this study. We enrolled 15 SE children (8 boys and 7 girls; age range,1–11 years; average age, 3.3 years) and 21 control children (3 boys and 18 girls; age range, 7 months–14 years; average age, 3.0 years) and each group was divided into 2 subgroups according to age (4 months–1 year and 2–14 years). We found no significant differences in the CSF PL levels, CSF/serum PL ratios, and serum PL levels in the SE and control subgroups. Our results suggest that prolonged seizures do not result in B6 deficiency in CSF and serum in SE children. Whenever necessary, B6 should be administered to SE children with caution to prevent possible adverse effects.

一般学童を対象とした従来の生活習慣病予防健診に，腹囲の測定を加えたメタボリックシンドローム (MetS) 健診を追加し健診後の指導を希望した学童を対象に，小児期における MetS や関連する事象について検討を行った．その結果，第二度近親者における 2 型糖尿病の家族歴を有する学童は，その家族歴のない者と比較して腹囲 (p = 0.0136)， 腹囲 /身長比 (p = 0.017)， ALT (p = 0.0019)， 中性脂肪 (TG) 値 (p = 0.0683) のいずれも有意に高値かその傾向を示した．また，MetS を構成するリスクファクターの数が増加するにつれ内臓脂肪蓄積の指標となる腹囲が増大していた．休日における屋外 (体育館を含む) での運動時間が長い群は短い群と比較して腹囲の平均が有意に小さいことも示された (運動時間 1 時間未満の群：5 時間以上の群，72.9 ± 11.6 v.s. 60.3 ± 11.7 cm, p = 0.0322)．MetS の予防や改善について運動の習慣が重要であることが示唆された．

The influence of obesity and fat distribution on serum levels of lipoprotein and apolipoprotein was investigated in 294 Japanese junior high school children (12-13 years of age). Serum levels of low-density lipoprotein cholesterol (LDLC) (P = 0.013), triglycerides (TG) (P = 0.0006), and apolipoprotein B (apoB) (P = 0.003), and the apoB/A-I ratio (P = 0.005) were significantly higher and serum levels of high-density lipoprotein cholesterol (HDLC) (P = 0.00003) and apoA-1(P = 0.003) were significantly lower in obese boys than in non-obese boys. The serum levels of TG (P = 0.013) and the apoB/A-I ratio (P = 0.011) were significantly higher and the serum levels of HDLC (P = 0.004) was significantly lower in obese girls than in non-obese girls. The LDLC/apoB ratio was lower in obese girls than in non-obese girls (P = 0.03). Obesity (> or = 20% of ideal weight) was strongly correlated with the serum levels of lipids and apolipoproteins in boys; this relationship was less clear in girls. The degree of obesity and the body mass index (BMI) were more strongly correlated with serum levels of lipids and apolipoproteins in boys than in girls. In boys, atherogenic lipoproteins and apolipoproteins, such as LDLC and apoB, showed a stronger correlation with the thickness of the triceps skinfold, while in girls the anti-atherogenic lipoproteins and apolipoproteins, such as HDLC and apoA-I, showed a stronger correlation with both the triceps and the subscapular skinfold thicknesses. In girls the relationships between the BMI and the degree of obesity and the thickness of the subscapular skinfold (S) thickness were similar to the relationships between those parameters and the triceps skinfold (T) thickness. In boys, these parameters showed a stronger correlation with the subscapular skinfold thickness than with the triceps skinfold thickness. The correlation coefficients for the relationships between skinfold thickness and lipid and apolipoprotein levels were similar to the coefficients for the relationships between skinfold thicknesses and the severity of obesity and the BMI. The distribution of central-type fat accumulation, which is indicated by the thickness of the subscapular skinfold, the S/T ratio and S-T value, was inversely correlated with the HDLC level in both boys and girls. The degree of obesity was strongly correlated with the atherogenic lipoprotein profile in boys, in part because the subscapular skinfold thickness was strongly correlated with the degree of obesity and the BMI. In girls, the correlations between indices of central-type obesity and atherogenic lipid and apolipoprotein profiles were stronger than in boys. These data suggest that childhood obesity may be an early cardiovascular risk factor.

Aim To investigate the relationship between the clustering of metabolic syndrome (MetS) components and non-high-density lipoprotein cholesterol (non-HDL-C) levels in Japanese obese boys. Methods Subjects were 58 obese boys aged 12.0±2.6 years, which were categorized into three subgroups: abdominal obesity, pre-MetS (abdominal obesity＋1 component), and MetS (abdominal obesity＋2 or more components). Results Sixteen (27.6%) and 32 (55.2%) of the obese boys were diagnosed as pre-MetS and MetS, respectively. The mean non-HDL-C level in total subjects was 139.0±36.4 mg/dl and that in boys with abdominal obesity, pre-MetS, and MetS were 112.9±34.4, 135.4±37.9, and 149.0±32.6 mg/dl, respectively (p=0.0183, ANOVA). Conclusions Japanese obese boys with MetS exhibited elevated non-HDL-C levels, suggesting that they may have a higher risk for the development of atherosclerotic diseases.

Background: Non-responders to primary intravenous immunoglobulin (IVIG) therapy with aspirin are at risk of coronary artery lesions in Kawasaki disease (KD). A randomized controlled trial (the RAISE study) indicated that prednisolone + primary IVIG improves responsiveness to treatment and coronary artery outcomes in non-responders to IVIG predicted on the basis of Kobayashi score. The present study aimed to verify the efficacy and safety of prednisolone + primary IVIG in predicted non-responders to IVIG. Methods: We conducted a multicenter, prospective cohort study at 30 hospitals in Japan from July 2012. All KD patients received primary IVIG therapy (2 g/kg/24 h) and, if febrile at diagnosis, oral aspirin (30 mg/kg/day) and were stratified by Kobayashi score into non-responders (score [[Unable to Display Character: ]]5) and responders (score ≤4). The required sample size to reach statistical significance was 1,500 for KD patients and 500 for non-responders. Results: We enrolled 868 patients with KD by the end of 2013, including 545 (63%) predicted responders and 323 (37%) predicted non-responders. Within the non-responder group, 256 patients received IVIG + prednisolone and 67 patients IVIG alone. The non-response rate to IVIG was significantly lower (17% vs. 55%, p Conclusion: Like the RAISE study, our study suggests that prednisolone added to IVIG therapy with oral aspirin reduces the non-response rate and incidence of coronary artery lesions in predicted non-responders to IVIG with KD.

The purpose of this study was to screen for FCHL in children using serum lipid phenotypes. The subjects were 1190 (599 male, 591 female) children who participated in a screening and care program for life style-related diseases in school children. Total cholesterol, high-density lipoprotein cholesterol and triglyceride were determined, and information on the family history of parents was obtained by questionnaire. Candidates for FCHL were screened by the following criteria; type IIb hyperlipidemia, type IIa hyperlipidemia with positive family history of CHD, hyperlipidemia or both. We informed them of the results by mail. A second series of examinations to diagnose FCHL was performed on volunteer participants, including their parents. The candidates consisted of 9 children with type IIb and 27 with type IIa hyperlipidemia, 11 of whom participated, in the second series of examinations, in which 5 children were diagnosed with FCHL. The prevalence was 0.4%, suggesting that at least half of all individuals with FCHL already demonstrate hyperlipidemia in childhood.

A 13-year-old girl with Graves' disease, whose younger sister had systemic lupus erythematosus, developed polyarthralgia, fever, neutropenia, hypergammaglobulinemia, and microscopic hematuria after treatment with propylthiouracil (PTU) for 2 years. Myeloperoxidase-anti-neutrophil cytoplasmic antibodies were strongly positive. Anti-single- and anti-double-stranded DNA antibodies were positive, whereas LE cells and anti-Sm antibodies were negative. PTU was discontinued and all symptoms subsided gradually. Two years later, the microscopic hematuria had disappeared completely. Both patients had the identical HLA-DR alleles (HLA-DR9). These present two cases in siblings suggest that both sisters had lupus diathesis, and that the elder sister developed a PTU-induced lupus-like syndrome.

In adults, visceral fat accumulation is an important indicator for cardiovascular disease risk. This relationship is not fully understood in children. To determine the best predictor of cardiovascular disease risk factors among anthropometric indices such as body mass index (BMI), percent body fat (%Fat), waist-to-hip ratio (WHR), waist circumference, and waist-to-height ratio (W/Ht ratio) in Japanese schoolchildren. This study included 880 children (447 boys and 433 girls), 9-13y of age. Dependent variables were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), atherogenic index (AI), life style related disease prevention score, and systolic (SBP) and diastolic (DBP) blood pressure. The strongest correlation was found between W/Ht ratio and the score by Pearson's correlation analysis. Multiple regression analysis showed that significant independent correlates for the score included W/Ht ratio and %Fat. Among the anthropometric indices, W/Ht ratio was the most significant predictor for TC, TG, LDLC, AI, and the score. W/Ht ratio is the best predictor of cardiovascular risk factors in Japanese schoolchildren. We propose using W/Ht ratio for detecting cardiovascular disease risk in children.

The aim of this preliminary study was to investigate the clinical use of acute-stage susceptibility-weighted imaging (SWI) in children with prolonged convulsive disorder.Ten children with prolonged convulsive disorder who underwent SWI within 2 h after termination of seizure (acute-stage SWI group) and 15 control children who underwent SWI2 h after their seizures terminated or for other purposes were enrolled. The cerebral venous vasculature was compared between the groups. The acute-stage SWI group was further divided into three subgroups: normal group, those with regional low signals in the cerebral veins (regional group) and those with diffuse low signals in the cerebral veins (generalized group). Inter-ictal electroencephalography (EEG) and venous blood gas findings during seizure activity were compared between these subgroups.All patients in the acute-stage SWI group had low cerebral vein signal. Four patients were assigned to the regional group and six patients to the generalized group. Decrease of venous pH and the increase of venous pCO2 during seizure activity was more prominent in the regional group than in the generalized group. In the regional group, low-signal areas in the cerebral veins were consistent with abnormal areas on EEG; these low-signal areas resolved completely in all patients on follow-up SWI. Ten patients in the control group had normal SWI, and five had a generalized low signal.Acute-stage SWI may be a useful alternative for identifying lateralization of seizures in children with prolonged convulsive disorder.

Background and Objectives: Recently, the prevalence of obese children is declining in Japan; however, longitudinal studies showed that the prevalence of obesity is still increasing during elementary school periods. Therefore, the present study aimed to evaluate the effect of lifestyles of children and their parents on the levels of cardiovascular (CV) risk factors in elementary school children. Subjects: The study have conducted since 2012 and announced through the local boards of education in seven areas in Japan. The study was included 1114 healthy volunteers (540 boys, 574 girls) aged from 6 to 12 years with a medical examination and a questionnaire. The medical examination included the measurement of height, weight, waist circumference, and blood pressures, and blood sampling for CV risk factors. The questionnaire collected data on the lifestyles of the subjects and their parents. Screen time included time spent watching TV and playing games. The subjects were asked to walk with pedometer for 7 days. Obesity in the present study was defined using the age- and sex-specific International Obesity Task Force standard. Results: Multivariate regression analyses showed that number of steps by pedometer measurement, screen time, sleeping time, and parental BMI were significantly and independently associated with the levels of one or more CV risk factors in elementary school children. Among these, screen time had a profound adverse effect on CV risk factor levels. Number of steps was positively associated with sleeping time and negatively associated with screen time. Screen time in children was strongly associated with parental screen time. The risk of obesity in boys was associated with paternal obesity (p=0.000), but not with maternal obesity (p=0.95). On the other hand, the risk of obesity in girls was associated with both paternal and maternal obesity (both p=0.000). Conclusions: Increase in number of steps and sleeping time and decrease in screen time may be the first-line approach for elementary school children to maintain favorable CV risk factor levels. An association between childhood obesity and paternal or maternal obesity and differs between genders in Japan; thus, approaches focusing on parents should take the gender of children into consideration.

Background Fatty acid metabolism has a close relationship with metabolic syndrome. Saturated very long-chain fatty acid (hexacosanoic acid; C26:0) was recently reported to be associated with cardiovascular risk factors in adults. Methods Eighty-eight children (47 male, 41 female; average age, 10.9 y) participated in this study. Concentrations of C26:0 in whole blood were measured. Results Compared with reported concentrations in the whole blood of adults, children had lower C26:0 concentrations, which had a close relationship with abdominal obesity, increased concentrations of low-density lipoprotein cholesterol and high blood pressure. C26:0 concentrations increased with increasing number of risk factors. Conclusions Elevation of C26:0 concentrations may be one of the metabolic features of children with cardiovascular risk factors.

Background: In order to know whether the changes in indexes of overweight, body mass index (BMI; kg/m2) and percentage of overweight (POW) (%), really represent the tendency toward obesity, we examined longitudinal individual changes in these indexes, and the change in body composition in boys during early pubertal period. Methods: The subjects were 50 school boys who lived in Shizuoka, Japan. Standing height and weight were measured, and BMI and POW were obtained. Body fat percentage (BF%), fat mass (FM) and lean body mass (LBM) were estimated by bioelectrical impedance method. The influence of predictive variables (LBM, FM) on the changes in BMI and POW was investigated by multiple regression analysis. We examined the 3-year changes in BMI, POW and predictive variables in each individual, from 9 to 12 years of age. Results: The mean change of BMI was 1.7 ± 0.3 (mean ± SEM) kg/m2 and that of POW was 2.2 ± 1.9%. The influence of predictive variables on the changes in BMI and POW was determined. The variance of the change in POW could be explained by that in FM (r2 = 0.737, P

With the object of clarifying the features of body conposition of infant case of allergy, % body fat was determined by the impedance method, expressed as a SD score of % body fat based on a standard value, and a heght SD score was also examined in 63 cases of allergy.1. In case of bronchial asthma, a SD score of body fat rate tended to decline with an advance of the disease serverity.2. In case of atopic dermatitis, a hight SD score significantly declined with an advance of the disease severity, and a SD score of body fat rate showed an increasing tendency in advanced cases.In case of atopic dermatitis, body height tends to decrease with an advance of the disease, and % body fat tends to increase in advanced cases. It is suspected that such physical features as seen in cases of atopic dermatitis are more strongly caused by abnormal secretion of growth homone due to stress of sleeplessness, or effect of external steroid preparations rather than by nutritional disorders due to elimination diet or absorption disorder in the intestinal tract. Therefore, patients, paticularly in advanced case of atopic dermatitis, comprehensive treatment is needed with paying attention to the above points.

We investigated the distribution of abdominal fat accumulation in obese children to know whether a clustering of coronary risk factors was demonstrated in visceral fat obesity as reported in adults. The relative indicator of intra-abdominal fat accumulation was obtained from computed tomography scans at the umbilicus level in 36 obese subjects (24 males, 12 females). There was no visceral fat obesity in this study by reported criteria. All metabolic variables except triglyceride did not correlate significantly with intra-abdominal fat accumulation. We conclude that visceral fat obesity is a rare status and has no close relationship to coronary risk factors in childhood.

Summary Background Abdominal obesity alters the composition of plasma and tissue long chain fatty acids and thus affects a number of important physiological functions relating to the development of cardiometabolic diseases. The fatty acid composition is modulated by desaturases; stearoyl-CoA desaturase (SCD), delta-6 desaturase (D6D) and delta-5 desaturase (D5D). Therefore, we examined the relationship between the desaturase activities and abdominal adiposity. Methods One hundred eighty-one children (98 males, 83 females), including 42 children with abdominal obesity having waist to height ratio (WHtR) >0.5, were recruited. Fatty acid composition in plasma phospholipids was analyzed by gas chromatography after overnight fast, and SCD activity was estimated by 18:1/18:0 ratio. Results In children without abdominal obesity, WHtR correlated positively with D6D activity ( r =0.252, p =0.0027) and negatively with SCD activity ( r =−0.289, p =0.0006), but not with D5D activity ( r =−0.159, p =0.0607). While in children with abdominal obesity, WHtR had a positive association with SCD activity ( r =0.332, p =0.0315), but not with D6D ( r =0.267, p =0.0847) or D5D activity ( r =0.008, p =0.9600). Conclusion The relationship between the desaturase activities and abdominal adiposity altered in children with abdominal obesity. Especially, SCD activity demonstrated a U-shaped association with WHtR.

Fatty acid composition, which is altered in patients with abdominal obesity, is influenced not only by dietary intake but also by the desaturating enzymes stearoyl-CoA desaturase (SCD), delta-6 desaturase (D6D) and delta-5 desaturase (D5D). We investigated desaturase activities and their associations with metabolic risk factors, C-reactive protein levels (CRP) and insulin resistance in Japanese children. There were 237 school children in this study; 115 were boys. The fatty acid composition of plasma phospholipids was analyzed, and the following desaturase activities were estimated: SCD (16:1n-7/16:0 and 18:1n-9/18:0), D6D (20:3n-6/18:2n-6) and D5D (20:4n-6/20:3n-6). D6D and D5D activities, but not SCD activity, were significantly associated with triglyceride levels, high-density lipoprotein cholesterol levels and insulin resistance in both sexes, and with CRP levels in boys. In addition, increased abdominal adiposity was significantly associated with increased D6D activity, and decreased D5D activity and insulin resistance in both sexes, and with increased CRP levels in boys. The n-6 polyunsaturated fatty acid desaturation pathway may be associated with metabolic risk factors, insulin resistance and increased inflammation in children with abdominal obesity, especially in boys.

A 19-year-old Japanese man visited our department presenting with glycosuria that had been detected during a routine school urinalysis. The patient had undergone cardiac surgery at the age of 4 years for atrial and ventricular septal defects, and pulmonary artery stenosis. He denied any history of abdominal trauma, drug or alcohol intake, or gastrointestinal problems. His maternal grandmother had mild diabetes that began in middle age; whereas, his parents had no significant medical history including diabetes. The physical examination revealed an emaciated young man with a body mass index of 19.3, but otherwise a normal examination. Laboratory studies were: fasting hyperglycaemia of 19.7 mmol/l (354 mg/dl) without ketosis. The HbA1c was 12.1%, urinary excretion of C-peptide 43.9 lg/day (normal range 50–100 lg/day). The anti-islet cell and anti-glutamic acid decarboxylase antibodies were negative. The serum total amylase level was normal, 49 U/l (normal range 40–180 U/l); whereas, the levels of serum pancreatic enzymes p-type amylase, lipase, trypsin and phospholipase A2 were decreased to 8 U/l (normal range 17–50 U/l), 10 U/l (13–49 U/l), 50 U/l (100–550 U/l) and 100 U/l (130–400 U/l), respectively. Ultrasonography (US) of the abdomen could not identify the body of the pancreas, although the head and uncus were clearly visible. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed that most of the body and the tail of the pancreas were absent, and that the pancreatic head was slightly enlarged (Fig. 1). Magnetic resonance cholangiopancreatography (MRCP) revealed that the dorsal pancreatic duct was absent. Based on these findings, a diagnosis of agenesis of the dorsal pancreas was made. Insulin replacement therapy was initiated, and currently, the diabetes is well controlled with 4 U of insulin per day. There are no signs of any diabetes-related renal, retinal or neurological changes. His blood glucose levels have improved after beginning insulin therapy, and he is being followed up as a hospital outpatient.

Bioelectrical impedance methods have been found to be a valid and reliable way of estimating per cent body fat (%BF) in adults. We applied them to healthy children and compared them with conventional anthropometry methods. One thousand two hundred and sixteen children participated in this study. Impedance and skinfold thickness were measured, and %BF was estimated using these values. Bodyweight and height were measured, and per cent obesity (%OB) and body mass index (BMI) were obtained. The values of %BF by the bioelectrical impedance method (%BFi) were 8.6 +/- 4.0% in the junior male group, 14.2 +/- 2.8% in the junior female group, 7.9 +/- 4.7% in the senior male group and 16.1 +/- 2.9% in the senior female group. The %BFi correlated strongly with skinfold thickness, %OB and BMI. Thus %BFi correlated strongly with variables from conventional methods. It was concluded that it is a reliable way of assessing lipid storage in children.

AIM Mice lacking apolipoprotein A-V (apoA-V) displayed an increase in serum triglyceride (TG) levels; however, the correlation of apoA-V levels with TG levels in humans is controversial, and the exact mechanism by which apoA-V affects TG levels is unclear. The aim of the present study was to clarify the impact of apoA-V on the lipoprotein subclass profile in preadolescent children, which has not been studied. METHOD The study subjects were 178 (89 male, 89 female) 4th grade elementary school children (mean+/-SD: 9.5+/-0.5 years old). ApoA-V levels were determined by an enzyme-linked immunosorbent assay, and the lipid component of each lipoprotein fraction and their particle sizes were measured by HPLC. RESULTS Levels of apoA-V showed no gender difference in preadolescent children, and were not affected by anthropometric variables. ApoA-V had a negative association with serum TG levels and TG levels in each lipoprotein fraction, and a positive association with HDL-C. In particular, apoA-V appears to contribute to the increase in cholesterol levels in the larger HDL fraction. CONCLUSIONS It was suggested that apoA-V is a potent modulator of HDL and VLDL components in preadolescent children.

We isolated methicillin-resistant Staphylococcus aureus (MRSA) from a 3-month-old Indian girl who was born in the United States, moved to Japan, and suffered from subcutaneous abscesses in 2007. The MRSA (strain NN36) belonged to multilocus sequence type (ST) 8, exhibited agr1, staphylococcal cassette chromosome mec (SCCmec) type IVa, and coagulase type III, and was positive for Panton-Valentine leukocidin (PVL) and the arginine catabolic mobile element (ACME), just like the USA300 clone, which is the predominant community-acquired MRSA (CA-MRSA) in the United States. Strain NN36 shared an identical pulsed-field gel electrophoresis (PFGE) pattern with the USA300 clone. Although the USA300 clone is of spa1, strain NN36 possessed spa985. Strain NN36 was resistant to erythromycin and kanamycin, in addition to beta-lactam agents (e.g., oxacillin). The data suggest that the USA300 clone has emerged in Japan. Because the USA300 clone has recently spread to European countries, surveillance of the USA300 clone should be actively performed in Japan.

Background: Although there have been many studies on the relationship between obesity and long-chain polyunsaturated fatty acid (LCPUFA), the results and their interpretation are controversial, especially in children. Arachidonic acid (AA), the product of n-6 LCPUFA, is reported to be related to insulin resistance. The purpose of the present paper was to investigate the LCPUFA profile in obese children and mechanisms that contribute to reduced AA content. Method: An age- and sex-matched control study was performed. The study subjects were 59 obese children (mean age, 11.8 years) and 53 healthy non-obese children (mean age, 12.5 years). The study parameters included anthropometric measurements, serum lipids, leptin and fatty acid composition in plasma. Results: Plasma fatty acids in obese children had lower linoleic acid (P < 0.0001) and higher dihomo-γ-linolenic acid (P = 0.0004) than those in non-obese children. In all subjects combined, δ-6 desaturase (D6D) index (ratios of [C 18:3n-6+C 20:2n-6]/C 20:4n-6 or C 20:4n-6/C 18: 2n-6) correlated with leptin (P < 0.0001). There was no significant difference in AA content between obese and non-obese. However, the AA content was low (

Background:Alanine-for-threonine substitution at codon 54 (A54T polymorphism) in the fatty acid-binding protein 2 gene (FABP2) has been associated with hypertriglyceridemia and insulin resistance. Impairment in the activity of delta 6 and 5 desaturases is also supposed to be a factor predisposing the development of insulin resistance syndrome.Aim: We investigated the relationship between A54T polymorphism in FABP2 and the impairment of long-chain polyunsaturated fatty acid metabolism in obese children.Methods: Thirty-two obese children participated. During the study, the children continued their habitual diet, which was documented in a 3-day food record using household measures. Anthropometry was performed, and serum lipid and fatty acid composition in plasma were analyzed. The polymorphism of codon 54 in the FABP 2 gene was analyzed.Results: The allele frequency was 0.66 and 0.34 for Ala54 and Thr54, respectively. There were no significant differences in age, body mass index, fasting serum glucose, insulin or serum lipoproteins among the three polymorphism groups. These were also no significant differences in the intake of energy, the percentage of energy nutrients or in the dietary lipid composition. The content of arachidonic acid (AA) in plasma was lowest in Thr/Thr54 (p< 0.05). The indices of delta-6 desaturase (D6D) activity in Thr/Thr54 were significantly lower than in Thr/Ala54 or Ala/Ala54 (p< 0.05, p< 0.01, respectively).Conclusions: In obese children, Thr/Thr54 of the FABP 2 gene is associated with impaired activation of D6D and reduced AA content. The results in the LCPUFA profile suggest that Thr/Thr54 may predispose the to development of insulin resistance.

Background: In order to define the diagnostic criteria for visceral adipose tissue (VAT) accumulation and abdominal obesity in Japanese youths, a cross-sectional, multicenter study was conducted. Methods: Subjects were 194 boys and 96 girls ranging in age from 6 to 15 years. Obese youths were classified according to the occurrence of abnormal values in serum triglyceride, alanine aminotransferase or insulin level. A threshold value of each criterion was calculated, using the analysis of receiver operating characteristic (ROC) curve. The areas of total abdominal adipose tissue (AT), VAT and subcutaneous adipose tissue (SAT) were estimated by single slice computed tomography at the level of umbilicus. Results: VAT area was greater in boys than it was in girls. The critical values for VAT area and waist circumference in all subjects were 54.8 cm2 and 83.5 cm, respectively. The values for the area under the ROC curves were VAT area > total AT area > waist circumference > SAT area > percentage overweight > percentage body fat. The sensitivity and specificity for VAT area were 90.5 and 79.5%, respectively. Those for waist circumference were high enough (> 70%) for clinical use. In the linear regression analysis assigning VAT area as an independent variable and waist circumference as a dependent variable, the expected value for the waist circumference was 82 cm. Conclusion: In Japanese obese youths ranging in age from 6 to 15 years, the diagnostic criteria for the waist circumference was 82 cm, and that for VAT area was 55 cm2.

The association of lipid composition in each lipoprotein fraction with adiponectin level in relation to body fatness was investigated. The subjects were 283 children (144 boys and 139 girls) aged 11.6 years (S.D. 1.5). Cholesterol (C) and triglyceride (TG) levels in each lipoprotein fraction were measured by a combination of agarose gel electrophoresis and differential staining. Adiponectin level was not significantly different between girls and boys. In simple regression analyses, an association of adiponectin level with lipoprotein lipid profile was shown only in girls, and not in boys at all. In girls, very low-density lipoprotein (VLDL)-C, low-density lipoprotein (LDL)-C, VLDL-TG and LDL-TG were negatively correlated with adiponectin level, and high-density lipoprotein (HDL)-C and HDL-C/TG ratio were positively correlated. Multiple regression analyses including adiponectin level and body mass index (BMI) as predictors for the lipoprotein lipid profile demonstrated that adiponectin level was a significant independent predictor of VLDL-TG, LDL-C, LDL-TG, HDL-C and HDL-C/TG ratio. In conclusion, adiponectin level correlates with lipoprotein lipid profile independent of body fatness in adolescent girls.

Background: The aim of the present study was to examine the serum lipid profile in obese Chinese children, their serum lipid and apolipoprotein A-I (apoA-I) and B (apoB) levels were examined. Methods: The subjects were 153 patients (109 male and 44 female) aged 4−16 years with obesity, who attended the outpatient clinic of Beijing Children's Hospital. Percentage bodyweight (%BW) ([(bodyweight − standard weight)/standard weight]× 100) were obtained. Skinfold thickness and hip and waist circumference were measured. Percentage body fat (%BF) was estimated by bioelectrical impedance analyzer. Serum total cholesterol (TC), high density lipoprotein cholesterol (HDLC), triglyceride (TG), apoA-I and apoB levels were also measured. Results: TC showed an acceptable level in 86.8% of obese children. The prevalence of high TC levels (3.3%) or high LDLC levels (6.0%) was rather low. The HDLC level was reduced in 31.3% of obese children. Anthropometric variables had no linear relationship to TC, HDLC, TG, LDLC, apoA-I or apoB, but in the older age group (over 10 years old) %BW and %BF showed a weak correlation with HDLC (r = −0.202, r = −0.211, respectively). Conclusion: In obese Chinese children, HDLC as well as TC levels should be examined in order to assess coronary risk.

Objective: As obesity has been increasing in China, the present study examined the body composition of children to assess their fatness. Study design: A total of 532 healthy schoolchildren who lived in central Beijing were examined. Skinfold thicknesses, hip and waist circumferences, and body fat percentage were measured, as well as height and weight. Results: The prevalence of overweight (Body Mass Index (BMI) ≥ 95% for age and sex of Chinese children) was 27.7% in boys and 14.2% in girls (chi-squared; P = 0.0001). The percentages of body fat (BF%), waist/hip ratios and skinfold thicknesses ratios (subscapular/triceps) in overweight children were significantly higher than those in non-overweight children (Mann−Whitney U-test). The BF% of non-overweight boys was significantly higher than that of non-overweight girls. Conclusion: Urban Chinese overweight children have high BF% with adverse fat distribution. They may have high risk of atherogeniety. Boys in the non-overweight category may have higher fat accumulation than predicted by BMI. The establishment of an intervention program for childhood obesity is strongly recommended.

Nonlinear optically active compounds newly designed and synthesized in Frontier Research Program were reviewed: single crystal of dicyanovinyl anisole (DIVA) for blue light generation, one- or two-dimensional r -conjugated systems such as polythiophenes, polydiynes, soluble phthalocyanines and annulenes, for third order optical nonhinearities and waveguide application. As a promising technique to control the molecular orientation and assembly, the organic molecular beam epitaxy (OMBE) is proposed.