Metabolic risk associated with liver enzymes, uric acid, and hemoglobin in adolescents.

BACKGROUND: The associations of renal, hepatic, and hematologic markers with metabolic risk (MR) have already been shown in adolescents. However, it is still controversial which marker best predicts metabolic changes in youth. The aim of this study was to verify the association of MR with alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid, and hemoglobin (Hb) in adolescents. METHODS: We evaluated 1713 Brazilian adolescents aged 10 to 17 years. MR was calculated using a continuous metabolic risk score, including the sum of Z-scores of waist circumference, systolic blood pressure, fasting glucose, high-density lipoproteins, triglycerides, and cardiorespiratory fitness. Cutoff points were set for MR prediction for five metabolic components (ALT, AST, AST/ALT ratio, uric acid, and Hb). RESULTS: MR was strongly associated with increased uric acid (odds ratio [OR]: 2.50; 95% confidence interval [CI]: 1.74-3.59), ALT (OR: 2.64; 95% CI: 1.63-4.27), and AST levels (OR: 2.53; 95% CI: 1.24-5.18). Uric acid was shown to be the best predictor for MR (sensitivity: 55.79%; specificity: 61.35%; area under the curve: 0.616). CONCLUSION: Elevated hepatic, renal, and hematological markers were associated with MR in adolescents, especially ALT, AST, and uric acid levels. IMPACT: Elevated hepatic, renal, and hematological markers were associated with metabolic risk in adolescents, especially ALT, AST, and uric acid levels. It is still controversial which marker best predicts metabolic changes in adolescents. In addition, association of Hb with metabolic risk is under-studied in this population. It is important to further investigate the relationship between elevated Hb and hepatic markers, since there are key aspects not addressed yet. Our results highlight the importance of creating public health policies aimed to child and adolescent population, to prevention of metabolic disorders from an early age.

Difference between Methods for Estimation of Basal Metabolic Rate and Body Composition in Pediatric Patients with Osteogenesis Imperfecta.

BACKGROUND/AIMS: Osteogenesis Imperfecta (OI) is a bone disease characterized by bone fragility, deformities, and multiple fractures. The aim of this study was to compare the different methods of measuring the basal metabolic rate (BMR) and body composition (BC) in pediatric patients with OI. METHODS: This cross-sectional study included 52 individuals with a median age of 9 (5.25-12.7) years. BMR was calculated by bioelectrical impedance analyses (BIA), predictive values according to age from the World Health Organization (WHO), a kcal/cm formula, and indirect calorimetry (IC). BC was assessed using the anthropometric calculation of percentage body fat (%BF) and lean mass (kg), BIA, and dual-energy X-ray absorptiometry (DEXA). Agreement among the methods was assessed using the Bland-Altman technique. RESULTS: IC estimates of BMR were greater than BIA and lower than values obtained using the WHO and kcal/cm methods. Better agreement was observed using the WHO values for mild forms of OI and the kcal/cm formula for moderate-to-severe forms. For BC, DEXA estimates of %BF were higher and the lean mass was lower than the values obtained using BIA and anthropometry. Neither method agreed with the DEXA method results. CONCLUSIONS: Significant differences exist among the various methods used for measuring BMR and BC with regard to phenotypic differences between OI types.

Assessment of drinking water fortification with iron plus ascorbic Acid or ascorbic Acid alone in daycare centers as a strategy to control iron-deficiency anemia and iron deficiency: a randomized blind clinical study.

OBJECTIVE: Assess drinking water fortification with iron and/or ascorbic acid as a strategy to control iron-deficiency anemia and iron deficiency. METHODS: Randomized blind clinical study, fortifying drinking water to 153 pre-school children during 3 months, with iron and ascorbic acid (A), ascorbic acid (B) or plain water (C). Hemoglobin (Hb), mean corpuscular volume (MCV) and ferritin were measured. RESULTS: Within the groups, Hb raised in all three groups, MCV in A and B and ferritin in A. The difference between time points 0 and 1 was significant between A and B for Hb, when A and B were compared with C for MCV and when A was compared with either B or C for ferritin. CONCLUSIONS: Water fortification is efficient in controlling iron deficiency and anemia. Iron stores' recovery depends on a more effective offer of iron. Water fortification must be preceded by a careful assessment of the previous nutritional status.

Association between eating behavior, anthropometric and biochemical measurements, and peptide YY (PYY) hormone levels in obese adolescents in outpatient care.

Objective To evaluate the eating behavior of obese adolescents and its association with biochemical, anthropometric and peptide YY (PYY) measures. Methods Fifty-one obese adolescents received counseling for weight management at 12 monthly appointments. Fasting serum PYY levels, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), insulin and glucose levels, waist circumference (WC) and results from the Three-Factor Eating Questionnaire (TFEQ-21) were assessed. Results Over one year there was a significant increase in PYY levels (p = 0.026), reduction in TC (p = 0.003), TG (p = 0.022), BMI (p = 0.002), BMI z-score (p < 0.001) and WC (p = 0.003). During this period there was a decrease in the uncontrolled eating score (UE), illustrating that adolescents displayed more self-control (p = 0.008) at the end of the study; however, this result was independent of BMI and BMI z-score (p = 0.407). The reduction in UE was associated with a significant improvement in insulin levels (rs = 0.326; p = 0.020). The reduction in UE was also associated with lower levels of blood glucose (r = 0.332; p = 0.017), and the increase of cognitive restriction, with the reduction of insulin insulin (rs = -0.294; p = 0.036) and TG (r = -0.368; p = 0.008) and an increase in Cognitive Restraint. Conclusions Our results show that after a year of monitoring weight loss, adolescents had more controlled eating behaviors, increased PYY levels, and reduced weights.

Validation of a new method developed to measure the height of adult patients in bed.

UNLABELLED: We present the performance of a new instrument developed to measure the height of patients in bed (Luft Ruler). METHODS: Standing height was the gold standard measured in 116 hospitalized adults with a stadiometer, compared with measurements from the Luft Ruler and calculated estimates. RESULTS: Using the Luft Ruler in women, men, <60 years old, and >60 years old, the mean difference from the gold standard was, respectively, 1.5 cm (P= .02), 1.3 cm (P= .06), 1.2 cm (P= .07), and 1.6 cm (P= .02); total arm span: 6.7 cm, 7.7 cm, 5.4 cm, and 9.0 cm (P< .01 for all strata); 2x half arm span: 7.8 cm, 10.2 cm, 7.7 cm, and 10.3 cm (P< .01 for all); World Health Organization (WHO) equation: 5.5 cm, 6.2 cm, 4.7 cm, and 6.9 cm (P< .01 for all); and the Hospital de Clínicas de Porto Alegre equation: 1.9 cm (P< .01), 2.5 cm (P< .01), 1.1 cm (P= .12), and 3.3 cm (P< .01). The proportion of differences >5 cm was 0.9% (n=1) using the Luft Ruler, 62.9% using total arm span, 71.6% using 2x half arm span, 64.7% using the WHO equation, and 27.6% using the Hospital de Clínicas de Porto Alegre equation. CONCLUSIONS: The Luft Ruler was the only method that presented minor mean differences in relation to the gold standard in both gender and age strata. The other estimates are not recommended because of high frequency of relevant errors.

Overweight and Obesity in Schoolchildren: Hierarchical Analysis of Associated Demographic, Behavioral, and Biological Factors.

Studies focused on the mechanisms involved in the development of obesity in children and adolescents have reported associations between this condition and birth weight, sedentary lifestyle, and hereditary conditions. However, few studies have simultaneously evaluated these factors. This cross-sectional study aims to identify demographic, behavioral, and biological factors associated with overweight/obesity in children and adolescents. 381 schoolchildren aged seven to 17 years were included in the study to evaluate the associations between overweight/obesity and biological factors (including family history of obesity, birth weight, and the fat mass and obesity-associated (FTO) rs9939609 polymorphism), demographic variables (including gender and age), and behavioral variables (including physical activity and/or sports participation). The results of this study showed that there was a lower prevalence of obesity in schoolchildren aged 11-17 years (PR: 0.89; p=0.004). Obesity was more prevalent in children whose father (PR: 1.24; p < 0.001) and maternal grandmother (PR: 1.16; p=0.019) were obese. Higher prevalence rates of obesity were also identified in schoolchildren who were overweight at birth (PR: 1.18; p=0.002) and carriers of the obesity risk genotype (PR: 1.13; p=0.016). Biological factors, such as family history of obesity, overweight at birth, and the presence of the fat mass and obesity-associated rs9939609 polymorphism were associated with the prevalence of obesity in children and adolescents.

Hyperuricemia is associated with low cardiorespiratory fitness levels and excess weight in schoolchildren.

OBJECTIVE: To evaluate the possible association between hyperuricemia and cardiorespiratory fitness levels/nutritional profile, grouped into a single variable, in schoolchildren. METHOD: Cross-sectional study of 2335 students from Elementary schools, aged 7-17 years of both genders, stratified by conglomerates of a municipality in Southern Brazil. Body mass index (BMI) was calculated and cardiorespiratory fitness (CRF) was assessed by the 6-minute run/walk test. The BMI and CRF were grouped into a single variable, considering: (1) low and normal weight/fit; (2) low and normal weight/unfit; (3) overweight-obesity/fit; (4) overweight-obesity/unfit. The Poisson regression (prevalence ratio, PR) was used for the association between hyperuricemia and BMI/CRF ratio with 95% confidence intervals and differences were considered significant when p<0.05. RESULTS: There is an association, although subtle, between the presence of hyperuricemia with low levels of CRF and the presence of excess weight, when grouped into a single variable. Boys and girls with this condition have higher prevalence of hyperuricemia (PR: 1.07; p=0.007 for boys; PR: 1.10; p<0.001 for girls). CONCLUSION: Together, excess weight and low levels of cardiorespiratory fitness are associated with the presence of hyperuricemia in schoolchildren.

[Individual outpatient care versus group education programs. Which leads to greater change in dietary and physical activity habits for obese children?]. / Atendimento ambulatorial individualizado versus programa de educação em grupo: qual oferece mais mudança de hábitos alimentares e de atividade física em crianças obesas?

OBJECTIVE: To compare two strategies for childhood obesity management: ambulatory assistance (individual) and educational program (in group). METHOD: Children and adolescents from 7 to 13 years of age were selected at random. They were divided into two groups: individually assisted or assisted in groups. An educational program about childhood obesity was created, with monthly meetings that consisted of lectures with parents' participation and group work. Simultaneously, children and teenagers of the other group received individual ambulatory assistance. The program took place for six months. Body composition, eating habits and physical activities were assessed before and after interventions. RESULTS: The sample comprised 38 children and adolescents whose mean age was 9.9 years. The program was more effective in increasing physical activity (p = 0.003), specially walking (p = 0.003), as well as in reducing total cholesterol (p = 0.038). Reduction of body mass index, obesity index and caloric intake was similar in both groups. As for food habits, ambulatory assistance increased the intake of fruits (p = 0.033) and vegetables (p = 0.002) and reduced the amount of French fries and crisps (p = 0.041), while children participating in the program reduced the intake of soft drinks (p = 0.022), sandwiches, pizza and fast food (p = 0.006). CONCLUSIONS: Both strategies for handling childhood obesity were favorable to changes in food and physical activity habits. Group assistance was as effective as individual assistance, consolidating it as an alternative for obesity treatment.