Does physiological distribution of blood parameters in children depend on socioeconomic status? Results of a German cross-sectional study.

OBJECTIVES: In the present study, we examined the relation between socioeconomic status (SES) and the physiological distribution of iron-related blood parameters. DESIGN: This is a cross-sectional analysis of longitudinal population-based cohort study. SETTING: Based on a sample of healthy participants from a German research centre, various blood parameters and values of clinical examinations and questionnaires were collected. PARTICIPANTS: A total of 1206 healthy volunteers aged 2.5 to 19 years, one child per family randomly selected, were included. PRIMARY AND SECONDARY OUTCOME MEASURES: Associations between the SES of children by Winkler-Stolzenberg Index (WSI) and its dimensions (income, education, occupation) and iron-related blood parameters (haemoglobin, ferritin and transferrin) were analysed by linear regression analyses. Gender and pubertal stage were included as covariables. Additionally, associations between SES of children by WSI and physical activity (side-to-side jumps, push-ups) as well as body mass index (BMI) were analysed by linear regression analyses. RESULTS: Children with high WSI or family income showed significantly increased z-scores for haemoglobin (P=0.046; P<0.001). Children with increased WSI or family income showed significantly lower z-scores for transferrin (P<0.001). There was a significant correlation between haemoglobin and gender (P<0.001) and between transferrin and pubertal stage (P=0.024). Furthermore, physical activity was positively correlated and BMI was negatively correlated with WSI (P<0.001). DISCUSSION: Our data show an association between SES and the distribution of iron-dependent parameters. Lower SES is correlated with lower values for haemoglobin and higher values for transferrin. Furthermore, we demonstrate that physical activity and BMI are associated with SES. Whereas higher SES is correlated with higher values for physical activity and lower BMI. Our parameters are standardised as z-scores with the advantages that the results are comparable across different age groups and present physiological courses. TRIAL REGISTRATION NUMBER: NCT02550236; Results.

[Quality of and Attendance at Healthy Child Clinics in Germany]. / Qualität und Inanspruchnahme von Kindervorsorgeuntersuchungen in Deutschland.

Background For several years the German healthy child clinics program has been a highly appreciated preventive measure and is subject to constant development. However, attendance depends on the families' sociodemographic situation. Findings are documented in a medical checkup booklet (the so-called Gelbes Heft). Currently, there is no procedure to use the data collected for epidemiological purposes nor to evaluate the pediatric prevention measures in Germany. Methods Between 2011 and 2016, we recruited 3480 study participants for our population-based cohort study LIFE Child in Leipzig. 90.6 % submitted their check-up booklets which were subsequently scanned, the data was digitalized and transmitted to a computerized form. Furthermore, data on social status (so-called Winkler-Index) were collected for each family using a structured questionnaire. The study population consisted of the families' oldest child for whom both data sets were available. Results The transmission of data from the check-up booklets was time-consuming and cost-intensive due to large datasets, uncoded diagnoses as well as the necessity of trained employees for transferring often illegible handwriting. Early diagnostic tests for children enjoy a high level of acceptance among all social classes. With increasing age, attendance rate decreases gradually. Only 83 % of the population with a lower social status attend the U9 test. The documentation of diagnoses in the check-up booklets was implausible because the frequency fluctuated heavily between the different check-up time points. With only less than 2 %, the documentation of psychosocial difficulties in a child was particularly surprising Conclusion It is not possible to draw conclusions regarding the prevalence of target diseases from the frequency of documented findings in the check-up booklets. In order to make the data both comparable and evaluable, documentation must be digitalized in the future.

Validity and intraobserver reliability of three-dimensional scanning compared with conventional anthropometry for children and adolescents from a population-based cohort study.

BACKGROUND: Conventional anthropometric measurements are time consuming and require well trained medical staff. To use three-dimensional whole body laser scanning in daily clinical work, validity, and reliability have to be confirmed. METHODS: We compared a whole body laser scanner with conventional anthropometry in a group of 473 children and adolescents from the Leipzig Research Centre for Civilization Diseases (LIFE-Child). Concordance correlation coefficients (CCC) were calculated separately for sex, weight, and age to assess validity. Overall CCC (OCCC) was used to analyze intraobserver reliability. RESULTS: Body height and the circumferences of waist, hip, upper arm, and calf had an "excellent" (CCC ≥ 0.9); neck and thigh circumference, a "good" (CCC ≥ 0.7); and head circumference, a "low" (CCC < 0.5) degree of concordance over the complete study population. We observed dependencies of validity on sex, weight, and age. Intraobserver reliability of both techniques is "excellent" (OCCC ≥ 0.9). CONCLUSION: Scanning is faster, requires less intensive staff training and provides more information. It can be used in an epidemiologic setting with children and adolescents but some measurements should be considered with caution due to reduced agreement with conventional anthropometry.

Serum lipid levels were related to socio-demographic characteristics in a German population-based child cohort.

AIM: Socio-demographic factors affect the development and lives of children and adolescents. We examined links between serum lipids and apolipoproteins and socio-demographic factors in the Leipzig Research Centre for Civilization Diseases Child (LIFE Child) study. METHODS: The Winkler index and the Family Affluence Scale were used to define characteristics of the social status of 938 boys and 860 girls aged from birth to 19 years. We then used univariate and multivariate regression analyses to examine the socio-demographic impact on total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL), cholesterol triglycerides and apolipoproteins A1 (ApoA1) and B (ApoB). RESULTS: No significant influences on the Winkler index or the Family Affluence Scale were observed regarding the concentrations of serum lipids for total cholesterol or LDL cholesterol. However, and most importantly, children and adolescents with high social status and high family affluence showed significantly higher HDL cholesterol and ApoA1 levels than those with lower individual totals. A higher Winkler index was associated with significantly lower values for triglycerides and ApoB. CONCLUSION: Adolescents with higher family wealth and social status showed a lower cardiovascular risk profile, as measured by the concentrations of HDL cholesterol and triglycerides as well as ApoA1 and B.