Adaptation, reliability and validity of health-related quality of life questionnaires: Disabkids chronic and specific diabetes disease in children and adolescents with diabetes mellitus type 1.

INTRODUCTION: It is recommended to periodically evaluate the health-related quality of life (HRQoL) in children and adolescents with type 1 diabetes mellitus (DM1). Despite this, no specific paediatric HRQoL instrument for DM1 has been validated in Spanish. OBJECTIVES: Multicentre, prospective descriptive study in children and adolescents with DM1 with the aim of carrying out cross-cultural adaptation to Spanish and evaluating the reliability and validity of the DISABKIDS chronic disease and diabetes-specific HRQoL questionnaires, using reverse translation. MATERIAL AND METHODS: Sociodemographic variables were compiled together with the most recent capillary glycated haemoglobin (HbA1c) value and HRQoL questionnaires were handed out to 200 Spanish children and adolescents with DM1 aged between 8 and 18 years of age under evaluation in 12 different hospitals. RESULTS: The mean score on the HRQoL questionnaire (patient version) for chronic disease was 80.32 (13.66), being significantly lower (P = .04) in patients with a shorter duration of the disease (≤5 years): 78.34 (13.70) vs. 82.60 (13.36). The mean score of the DM1-specific modules was: 60.81 (16.23) for disease impact and 65.59 (26.19) for treatment impact. The mean HbA1c value was 7.08 (0.79), with no differences (P > .05) noted in the mean score of the HRQoL instruments in patients with HbA1c ≤7% vs. HbA1c >7%. The Cronbach α value varied between 0.72 and 0.90. CONCLUSIONS: The Spanish versions of the DISABKIDS HRQoL instruments meet the proposed objectives of semantic equivalence and internal consistency, making it possible to periodically assess HRQoL in these patients. The good average glycaemic control presented by the patients may explain why no difference was found in the HRQoL instruments based on the HbA1c value.

Clinical practice guidelines for transsexual, transgender and gender diverse minors.

Some people, including minors, have a gender identity that does not correspond to the sex assigned at birth. They are known as trans* people, which is an umbrella term that encompasses transgender, transsexual, and other identities not conforming to the assigned gender. Healthcare units for trans* minors require multidisciplinary working, undertaken by personnel expert in gender identity, enabling, when requested, interventions for the minor and their social-familial environment, in an individualized and flexible way during the gender affirmation path. This service model also includes hormonal treatments tailored as much as possible to the individual's needs, beyond the dichotomic goals of a traditional binary model. This guide addresses the general aspects of professional care of trans* minors and presents the current evidence-based protocol of hormonal treatments for trans* and non-binary adolescents. In addition, it details key aspects related to expected body changes and their possible side effects, as well as prior counselling about fertility preservation.

Are there any seasonal variations in 25-hydroxyvitamin D and parathyroid hormone serum levels in children and adolescents with severe obesity?

The objective of this study was to analyze the prevalence of hypovitaminosis D in children with severe obesity. We hypothesized that severe obesity could modify the seasonal variations in 25(OH)D and PTH serum levels throughout the year. A cross-sectional clinical and blood testing (calcium, phosphorus, 25(OH)D, and PTH) was carried out in 282 patients with severe obesity, aged 7.2-15.2 years. A control group was recruited (348 healthy children, aged 7.1-14.9 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. Vitamin D deficiency and hyperparathyroidism were more frequent (p < 0.05) in the obesity group (44.5 vs. 11.5% and 22.4 vs. 3.9%, respectively). There were seasonal variations in 25(OH)D levels in the obesity group, but they were lower (p < 0.05) with respect to the control group. In contrast, PTH levels were higher (p < 0.05) in the obesity group with respect to the control group, but there were no significant seasonal variations in PTH levels.Conclusion: Suboptimal vitamin D status and high levels of PTH are a common feature in pediatric population with severe obesity. In these patients, the seasonal variations in 25(OH)D were not modified, and PTH levels remained increased throughout the year, but without any seasonal variations. What is Known: • Obesity has been associated with lower 25(OH)D and higher PTH levels. • Relation among vitamin D and PTH through a natural year in children with obesity is partially known. What is New: • Seasonal variations in 25(OH)D are maintained in children with severe obesity, but PTH levels remained increased throughout the year, without seasonal variations. • -PTH levels in obesity are independent of vitamin D status and do not appear to represent secondary hyperparathyroidism.

Effects of the application of a prolonged combined intervention on body composition in adolescents with obesity.

BACKGROUND: The aim of this study is to describe the effects of a prolonged dietary-behavioral-physical activity intervention (24 months) on body composition in a group of adolescents with obesity. METHODS: Longitudinal study in 196 individuals with obesity (86 boys and 110 girls) aged 10.1-14.9 years that completed a prolonged combined intervention (24 months). Values for weight, height, skinfold thickness, waist circumference, BMI, body fat, fat mass index (FMI) and fat-free mass index (FFMI) were registered or calculated. A good response to treatment was reported when a BMI z-score reduction of greater than or equal to 0.5 units of the initial value occurred after 24 month of follow up. RESULTS: A good response after 24 months of follow-up reached 58.2% (n = 114). In boys with obesity and BMI status improvement, weight z-score, BMI z-score, body fat, and FMI significantly decreased (p < 0.05). In girls with obesity and BMI status improvement, weight z-score, BMI z-score, waist circumference, waist z-score, body fat and FMI significantly decreased (p < 0.05). In both sexes the height and FFMI increased significantly (p < 0.05). The multiple logistic regression analysis showed that girls and younger age were associated with BMI status improvement; concurrently, the place of residence (urban or rural) and degree of obesity were not associated with BMI status improvement. CONCLUSION: The application of long-term combined strategies in the treatment of childhood obesity seems to be effective. As BMI decreases, a reduction in fat mass is also detected, with evident sexual dimorphism, in the absence of changes in fat-free mass and, consequently, in longitudinal growing.

Hypovitaminosis D and Cardiometabolic Risk Factors in Adolescents with Severe Obesity.

BACKGROUND/OBJECTIVES: Obesity is associated with cardiometabolic risk factors and with Vitamin D deficiency. The aim of this study was to examine the relationship between 25(OH)D concentrations and cardiometabolic risk factors in adolescents with severe obesity. SUBJECTS/METHODS: A cross-sectional clinical assessment (body mass index, fat mass index, fat-free mass index, waist-to-height ratio, and blood pressure) and metabolic study (triglycerides, total cholesterol, HDL-C, LDL-C, glucose, insulin, HOMA-IR, leptin, calcium, phosphorous, calcidiol, and PTH) were carried out in 236 adolescents diagnosed with severe obesity (BMI z-score > 3.0, 99th percentile), aged 10.2-15.8 years. The criteria of the US Endocrine Society were used for the definition of Vitamin D status. RESULTS: Subjects with Vitamin D deficiency had significantly elevated values (p < 0.05) for BMI z-score, waist circumference, waist z-score, body fat percentage, fat mass index, systolic and diastolic blood pressure, total cholesterol, triglycerides, LDL-C, insulin, HOMA-IR, leptin, and PTH than subjects with normal Vitamin D status. There was a significant negative correlation (p < 0.05) of serum 25(OH)D levels with body fat percentage, FMI, systolic BP, total cholesterol, triglyceride, LDL-C, glucose, insulin, HOMA-IR, leptin, and PTH. CONCLUSIONS: Low Vitamin D levels in adolescents with severe obesity were significantly associated with some cardiometabolic risk factors, including body mass index, waist circumference, fat mass index, high blood pressure, impaired lipid profile, and insulin resistance.

[Catch-up growth and associated factors in very low birth weight infants]. / Crecimiento recuperador y factores asociados en niños de muy bajo peso al nacer.

INTRODUCTION: The characteristics of catch-up growth in very low birth weight infants (VLBW) have not been clearly established. The aim of this study was to analyse the height catch-up and some associated factors in a cohort of VLBW (birth weight<1,500g) from birth to age 14 years. METHODS: We obtained retrospective data on weight and height at birth and ages one, 2, 3, 4, 6, 8, 10, 12 and 14 years in a cohort of 170 VLBW. We compared these anthropometric values with those documented in a control group. RESULTS: Thirty-seven children (21.8%) were born with an extremely low birth weight and 32 (18.8%) extremely preterm. At 10 years of age, 7% of VLBW (1,000-1,500g) and 35% of extremely low birth weight (<1,500g) children had short stature (P=.001). Almost all VLBW children who had a normal height at ages 2, 4 and 10 years had exhibited adequate weight catch-up in previous evaluations. We found that extremely low birth weight and extremely preterm were independent predictors for inadequate height catch-up. CONCLUSION: The growth pattern of VLBW children has specific characteristics. The catch-up in weight seems to be an important factor for catch-up in height, and therefore a thorough nutritional follow-up is recommended in these children.

Assessment of vitamin D status and parathyroid hormone during a combined intervention for the treatment of childhood obesity.

BACKGROUND: Obesity is associated with vitamin D deficiency. The aim of this work is to analyze the changes in vitamin D status and PTH levels in a group of children with obesity receiving combined intervention program in order to get BMI status reduction. METHODS: Longitudinal study in 119 children with obesity, aged 9.1-13.9 years, included in a 1-year combined dietary-behavioral-physical activity intervention. Anthropometric measurements (weight, height, BMI and fat mass index) were registered every 3 months and blood testing (calcium, phosphorous, 25(OH)D and PTH) were collected at the beginning and after 12 months of follow-up. A control group was recruited (300 healthy children, aged 8.1-13.9 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. RESULTS: Vitamin D deficiency was significantly higher in obesity group (31.1 vs. 14%). There was negative correlation between 25(OH)D and fat mass index (r = -0.361, p = 0.001). Patients with BMI reduction throughout combined intervention were 52 (43.7%). There was a significant increase in the prevalence of hypovitaminosis D in patients without BMI reduction at the end of follow-up, but in those patients with BMI reduction there was no changes of vitamin D status. CONCLUSIONS: Obesity increases the prevalence of suboptimal vitamin D status, and a BMI status reduction in children with obesity may be required to at least stabilize vitamin D status.

Central precocious puberty in girls: Diagnostic study and auxological response to triptorelin treatment. / Pubertad precoz central en niñas: estudio diagnóstico y respuesta auxológica al tratamiento con triptorelina.

INTRODUCTION: There are several controversies regarding the diagnostic tests and management of central precocious puberty (CPP). The aim of this study is to present the experience acquired in a group of girls with CPP treated with triptorelin, and to analyze the auxological characteristics and diagnostic tests. MATERIAL AND METHODS: An observational, retrospective study in a group of 60 girls with CPP was conducted between January 2010 and December 2017. Sociodemographic, auxological and hormonal data were recorded at diagnosis, and pelvic ultrasound and magnetic resonance imaging of the head were performed. Girls were treated with triptorelin and monitored after treatment discontinuation until menarche. RESULTS: At treatment start, chronological age and bone age were 7.7±0.7 and 9.7±0.8 years respectively, and growth velocity was 8.3±1.6cm/year. Target height was 161.1±5.8cm. Peak LH level after stimulation was 16.6±12.1 IU/l. Ovarian volumes were greater than 3mL in 35% of cases. MRI of the head was pathological in seven girls (11.7%). At treatment completion, chronological age and bone age were 10.3±1.1 and 11.2±0.8 years respectively, and growth velocity was 4.7±1.4cm/year. At the age of menarche (11.9±0.9 years), height was 157.5±5.7cm. CONCLUSIONS: Treatment of CPP with triptorelin appears to be beneficial. The possibility to block pubertal development and slow skeletal maturation allows patients to reach their target height. However, individualized auxological monitoring would be mandatory.

[Recommendations for the diagnosis and follow up of the foetus and newborn child born to mothers with autoimmune thyroid disease]. / Recomendaciones para el diagnóstico y seguimiento del feto y del recién nacido hijo de madre con patología tiroidea autoinmune.

The objective of this document is to review the current recommendations in the management of the foetus and the newborn child born to mothers with autoimmune thyroid disease. In 2017, the American Thyroid Association published guidelines for the diagnosis and management of thyroid disease during pregnancy and post-partum. In this guide, 97 recommendations were made, and an algorithm for the diagnosis and treatment of gestational hypothyroidism was proposed. Also, in this last year, a wide review was been published on the foetal and neonatal approach of the child of a mother with Graves' disease. The importance of the determination of maternal antibodies against thyrotropin receptor in the second half of pregnancy is stressed, in order to adequately stratify the risk in the neonate.

[Prevalence of hypovitaminosis D and associated factors in Spanish population of school children and adolescents]. / Prevalencia de hipovitaminosis D y factores asociados en la edad infantojuvenil.

OBJECTIVE: To analyse the prevalence of hypovitaminosisD and associated factors in school children and adolescents living in a region of northern Spain. DESIGN: Cross-sectional study (convenience sampling). SETTING: Primary Health Care. PARTICIPANTS: A total of 602 Caucasian individuals (aged 3.1 to 15.4years) were included in the study. MAIN MEASUREMENTS: Prevalence of hypovitaminosisD were calculated (dependent variable). HypovitaminosisD is defined according to the US Endocrine Society criteria: deficiency (calcidiol <20ng/mL), insufficiency (calcidiol: 20-29ng/mL), and sufficiency (calcidiol ≥30ng/mL). Gender, age, body mass index, residence, and season of the year were recorded (independent variables), and their association with hypovitaminosisD was analysed by multiple regression. RESULTS: The prevalence of hypovitaminosisD was 60.4% (insufficiency: 44.6%; deficiency: 15.8%). Multivariate analysis showed that factors associated to hypovitaminosisD were being female (OR: 1.6; 95%CI: 1.1-2.3), pubertal age (OR: 1.8; 95%CI: 1.2-2.6), autumn (OR: 9.5; 95%CI: 4.8-18.7), winter (OR: 8.8; 95%CI: 4.5-17.5) and spring time (OR: 13.2; 95%CI: 6.4-27.5), living in urban areas (OR:1.6; CI95%: 1.1-2.2), and severe obesity (OR: 4.4; 95%CI: 1.9-10.3). CONCLUSIONS: There is a high prevalence of hypovitaminosisD in juvenile populations. being female, pubertal age, autumn, winter and spring seasons, severe obesity, and living in urban areas are factors associated to hypovitaminosisD. Consideration should be given to the administration of vitamin supplements and/or the increase in the ingestion of natural vitaminD dietary sources.

[VITAMIN D DEFICIENCY AMONG CHILDREN AND ADOLESCENTS WITH NORMAL NUTRITIONAL STATUS]. / DEFICIENCIA DE VITAMINA D EN ESCOLARES Y ADOLESCENTES CON UN ESTADO NUTRICIONAL NORMAL.

OBJECTIVE: to analyze the prevalence of vitamin D deficiency throughout a natural year in a pediatric population with normal nutrition status. MATERIAL AND METHODS: cross sectional clinical and analytical study (calcium, phosphorus, alkaline phosphatase, calcidiol and parathyroid hormone) in 413 caucasian individuals (aged 3.1 to 15.4 years): 227 school children (96 males and 131 females) and 186 adolescents (94 males and 92 females), all of them in a normal nutrition status, during the year 2014. Vitamin D deficiency was defined according to the United States Endocrine Society guidelines. RESULTS: calcidiol levels were lower during spring (25.96 ± 6.64 ng/ml) and reached its maximum level in summer (35.33 ± 7.51 ng/ml); PTH levels were lower in summer (27.13 ± 7.89 pg/ml) and reached maximum level in autumn (34.73 ± 15.38 pg/ml). Vitamin D deficiency prevalence was 14.3% in summer and 75.3% in spring. PTH levels were compatible with secondary hyperparathyroidism in 8 individuals (1.9%). There was a negative correlation between calcidol and PTH levels (p < 0.01). There was not a correlation between body mass index (BMI) and calcidiol. CONCLUSION: the pediatric population in normal nutrition status shows a high prevalence of vitamin D deficiency during the months of autumn and winter and, especially, in spring; the addition of vitamin supplements and/ or an increase in the ingestion of their natural dietary sources should be considered.

Objetivo: analizar la prevalencia de la deficiencia de vitamina D a lo largo de un año natural en una población pediátrica con un estado nutricional normal. Material y métodos: estudio transversal clínico y analítico (calcio, fósforo, fosfatasa alcalina, calcidiol y hormona paratiroidea) en 413 sujetos (entre 3,1 y 15,4 años): 227 escolares (96 varones y 131 mujeres) y 186 adolescentes (94 varones y 92 mujeres), de raza caucásica y estado nutricional normal, durante el año 2014. Para definir la deficiencia de vitamina D se han aplicado los criterios de la Sociedad Americana de Endocrinología. Resultados: los niveles de calcidiol eran más bajos en primavera (25,96 ± 6,64 ng/ml) y alcanzaban su máximo nivel en verano (35,33 ± 7,51 ng/ml); mientras que los de PTH eran más bajos en verano (27,13 ± 7,89 pg/ml) y alcanzaban su máximo nivel en otoño (34,73 ± 15,38 pg/ml). La prevalencia de deficiencia de vitamina D era del 14,3% en verano y del 75,3% en primavera. En 8 casos (1,9%) existían cifras de PTH compatibles con hiperparatiroidismo secundario. Existía una correlación negativa entre calcidiol y PTH (p < 0,01). No existía correlación entre IMC y calcidiol. Conclusión: en la población pediátrica con una situacion nutricional normal existe una alta prevalencia de deficiencia de vitamina D en los meses de otoño e invierno y, especialmente, en primavera, y habría que considerar la necesidad de administrar suplementos vitamínicos y/o ingerir mayores cantidades de sus fuentes dietéticas naturales.