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BACKGROUND: Children with Down syndrome (DS) have a higher prevalence of obesity than other children. Whether this increased risk for obesity is due to a lower resting energy expenditure (REE) is controversial. Our study assessed whether (1) the REE of children with DS adjusted for fat-free mass (FFM) was lower than that of sibling controls, and (2) the changes in fat mass (FM) over 3 years were associated with FFM-adjusted baseline REE. METHODS: This study used cross-sectional and prospective cohort designs. Four annual measurement visits were conducted with 28 children with DS and 35 sibling controls aged 3-10years. REE and serum thyroxine (T4) were measured at baseline. Anthropometry, skinfold thickness measures, and, in a subsample, dual-energy x-ray absorptiometry (DXA) were used at each visit to calculate FM. RESULTS: Children with DS had significantly lower REE adjusted for FFM (- 78kcal/day, 95% CI: - 133 to - 27, P = 0.003). The difference remained significant after adjustment for FM, sex and African ancestry (-49kcal/day, 95% CI: - 94 to - 4, P = 0.03). In the longitudinal analysis, the baseline REE adjusted for baseline FFM was not predictive of FM accretion over time (P = 0.8). CONCLUSION: Children with DS have lower REE than sibling controls, but REE was not associated with changes in FM over time. The results suggest that the lower REE of children with DS does not explain their increased risk for obesity. European Journal of Clinical Nutrition (2013) 67, 1087-1091; doi: 10.1038/ejcn.2013.137; published online 31 July 2013 Keywords: obesity; fat-free mass; fat mass, INTRODUCTION Down syndrome (DS), or trisomy 21, is associated with intellectual disability and many medical conditions. (1-3) Up to 30% of children with DS are obese (BMI-for-age ≥ 95th percentile), [...]

Arch Dis Child 2004;89:342-346. doi: 10.1136/adc.2003.030072 Aims: To evaluate linear growth assessment and the effect of an intervention on measurement accuracy in primary care practices (PCP) within eight US geographical [...]

Background: Extreme prematurity is a risk factor for both candidemia and threshold retinopathy of prematurity (ROP) and may confound the reported association between these conditions. Objective: To determine if candidemia is an independent risk factor for threshold ROP. Methods: A cohort study was conducted of infants with birth weight [is less than or equal to] 1000 g using a prospectively maintained neonatal database. The study included infants admitted to the NICU [is less than or equal to] 3 days of age between 1/93 and 12/97. We excluded infants not screened for ROP, because they died, were discharged or transferred. Threshold ROP, i.e. requiring ablative therapy within 72 hours of diagnosis, was defined by the criteria of the American Academy of Pediatrics Section on Ophthalmology ROP subcommittee. Candidemia was defined as Candida species growth from at least one blood culture. Cox proportional hazards regression was used to determine independent risk factors for threshold ROP. Results: Six hundred fourteen infants had birth weight [is less than or equal to] 1000 g, of which 165 were excluded: 120 died before ROP screening, 40 were admitted [is greater than] 3 days of age, and 5 were discharged or transferred prior to ROP screening. A total of 449 infants were included in the study; 58 (13%) developed threshold ROP. Candidemia occurred in 58 (13%) infants prior to developing the worst stage of ROP. Candidemia occurred in 27 of 73 (37%) at 23-24 weeks gestational age (GA), 25 of 197 (13%) at 25-26 weeks GA, and 6 of 129 (5%) at 27-28 weeks GA, 0 of 50 [is greater than] 28 weeks GA (P [is less than] .001). Similarly, threshold ROP occurred in 25 of 73 (34%) at 23-24 weeks GA, 26 of 197 (13%) at 25-26 weeks GA, and 6 of 129 (5%) at 27-28 weeks GA, and 1 of 50 (2%) [is greater than] 28 weeks GA (P [is less than] .001). Threshold ROP developed in 19 of 58 (33%) infants with a history of candidemia and 39 of 391 (10%) without candidemia (P [is less than] .001). Proportional hazards analysis indicated that GA in weeks (hazard ratio = 0.75; 95% CI 0.61, 0.93; P [is less than] .01) and non-black ethnicity (hazard ratio = 1.8; 95% CI 1.05, 3.08; P = .03) were significantly associated with threshold ROP. After controlling for GA and other factors, candidemia did not remain significantly associated with threshold ROP (hazard ratio = 1.6; 95% CI 0.89, 2.9; P = .12). Conclusion: Candidemia may not be an independent risk factor for threshold ROP in extremely low birth weight infants. The magnitude of the previously reported association between candidemia and threshold ROP ([is greater than] 5 fold) is unlikely and much of the clinically observed association appears to be mediated by gestational age., PETER J. GIANNONE, MD, M. G. KARLOWICZ, MD, FAAP, J. PESTIAN, PHD, A.L. MORROW, PHD, J. SHULTS, PHD; DEPARTMENT OF PEDIATRICS, EASTERN VIRGINIA MEDICAL SCHOOL, NORFOLK, [...]

Summary: A comparison of the association of different forms of 25-hydroxyvitamin D [25(OH)D] with parathyroid hormone (PTH) and with areal and volumetric bone mineral density (BMD) demonstrated that bioavailable and free 25(OH)D do not provide a better index of vitamin D status in terms of bone health compared to total 25(OH)D. Introduction: This study aims to compare measures of vitamin D-binding protein (DBP) using a monoclonal versus polyclonal ELISA and assess correlations of total versus estimated free and bioavailable 25(OH)D with BMD and PTH concentrations. Methods: DXA and peripheral quantitative CT (pQCT) scans were obtained in 304 adults (158 black, 146 white), ages 21-80 years. Free and bioavailable 25(OH)D were calculated from total 25(OH)D, DBP, and albumin concentrations. Multivariable linear regression with standardized beta coefficients was used to evaluate associations of bone measures and PTH with total, free, and bioavailable 25(OH)D. Results: Measures of DBP obtained using a monoclonal versus polyclonal ELISA were not correlated ( r = 0.02, p = 0.76). Free and bioavailable 25(OH)D based on the polyclonal assay were lower in black versus white participants ( p < 0.0001); this race difference was not evident using the monoclonal assay. Adjusted for age, sex, calcium intake, and race, all forms of 25(OH)D were negatively associated with PTH, but the absolute coefficient was greatest for total 25(OH)D (−0.34, p < 0.001) versus free/bioavailable 25(OH)D (−0.18/−0.24 depending on DBP assay, p ≤ 0.003). In analyses stratified on race, none of the measures of 25(OH)D were associated with BMD across DXA and pQCT sites. Conclusions: The monoclonal versus polyclonal ELISA yielded highly discrepant measures of DBP, particularly among black individuals, likely related to established race differences in DBP polymorphisms. Contrary to prior studies, our findings indicate that using DBP to estimate bioavailable and free 25(OH)D does not provide a better index of vitamin D status in terms of bone health. [ABSTRACT FROM AUTHOR]

Context: Anxiety and depression are the most commonly reported psychiatric conditions and frequently occur as comorbid disorders. While the advent of conventional drug therapies has simplified treatment, a large segment of the population goes untreated or declines conventional therapy for financial, cultural, or personal reasons. Therefore, the identification of inexpensive and effective alternative therapies for anxiety and depression is of relevance to public health.Objective: The current study explores data from a 2009 clinical chamomile trial in humans to determine if chamomile provides clinically meaningful antidepressant activity versus a placebo.Design: In the 2009 randomized, double-blind, placebo-controlled study, the research team examined the antianxiety and antidepressant action of oral chamomile (Matricaria recutita) extract in participants with symptoms of comorbid anxiety and depression.Setting: In the 2009 study, all of participants' evaluations took place at the Depression Research Unit at the University of Pennsylvania. The study drew participants from patients at the Department of Family Medicine and Community Health's primary care clinic at the University of Pennsylvania, Philadelphia.Participants: Of the 57 participants in the 2009 trial, 19 had anxiety with comorbid depression; 16 had anxiety with a past history of depression; and 22 had anxiety with no current or past depression.Intervention: The intervention and placebo groups in the 2009 trial received identically appearing 220-mg capsules containing either pharmaceutical-grade chamomile extract standardized to a content of 1.2% apigenin or a placebo (ie, lactose monohydrate NF), respectively.Outcome Measures: In the current study, the research team used generalized estimating equations analysis to identify clinically meaningful changes over time in scores from the Hamilton Depression Rating (HAM-D) questionnaire among treatment groups.Results: In the current study, the research team observed a significantly greater reduction over time in total HAM-D scores for chamomile vs placebo in all participants (P < .05). The team also observed a clinically meaningful but nonsignificant trend for a greater reduction in total HAM-D scores for chamomile vs placebo in participants with current comorbid depression (P = .062). When the team examined the HAM-D core mood item scores, it observed a significantly greater reduction over time for chamomile vs placebo in all participants (P < .05) and a clinically meaningful but nonsignificant trend for a greater reduction over time for chamomile vs placebo in participants without current or past depression (P = .06).Conclusion: Chamomile may provide clinically meaningful antidepressant activity that occurs in addition to its previously observed anxiolytic activity. [ABSTRACT FROM AUTHOR]