Relation of chemokines to BMI and insulin resistance at ages 18-21.

OBJECTIVE: In obesity, adipose tissue becomes a significant source of chemokines and inflammatory cytokines that are associated with chronic systemic low-grade inflammation and may lead to insulin resistance. Studies in children have mainly focused on inflammatory cytokines and there are limited data for chemokines in adolescents and young adults. We studied the relation of chemokines to cardiovascular (CV)-risk factors, insulin resistance and adipocytokines in 18-21-year-old individuals. SUBJECTS AND DESIGN: Cross-sectional data collected in a cohort originally enrolled at mean age 13, with data for the present study obtained from 252 examined at age 18.7±0.1 years. METHODS: Multiple linear regression models were used to analyze the associations among chemokines (monocyte chemotactic protein-1, macrophage inflammatory protein-1ß (MIP-1ß), visfatin and interleukin-8 (IL-8)) and between chemokines and body mass index (BMI), glucose, lipids, blood pressure (BP), insulin resistance (euglycemic hyperinsulinemic clamp) and adipocytokines (IL-6, TNF-α and adiponectin). RESULTS: Chemokine levels were significantly intercorrelated. Significant associations (P<0.05) with adjustment for age, race and sex included: MIP-1ß with waist circumference and IL-6, IL-8 with systolic BP and visfatin with IL-6. No other significant relations were found between the chemokines and the other variables. Further adjustment for BMI did not alter these conclusions. CONCLUSION: Considered in the context of prior studies in children and adults, these results suggest that in large part, the association between chemokines and CV risk or inflammatory factors does not appear to develop until adult life.

Development of associations among central adiposity, adiponectin and insulin sensitivity from adolescence to young adulthood.

OBJECTIVE: To examine associations of central adiposity, serum adiponectin and clamp-derived insulin sensitivity in a single longitudinal cohort from early adolescence to young adulthood. METHODS: The cohort was examined three times at mean ages 15 years (n = 308), 19 years (n = 218) and 22 years (n = 163). Insulin sensitivity was measured with the euglycaemic hyperinsulinaemic clamp. Circulating adiponectin was measured by enzyme-linked immunosorbent assay. Computed tomography scans were used at mean age 22 to compute subcutaneous and visceral abdominal fat volume. Partial Pearson correlations and linear regression were used to examine cross-sectional associations at each examination. RESULTS: The moderate negative correlation between waist circumference and adiponectin was significant and essentially unchanged from mean age 15 (-0.32, P < 0.0001) to mean age 22 (-0.29, P < 0.002), whereas the negative correlation between waist circumference and insulin sensitivity and the positive correlation between adiponectin and insulin sensitivity increased steadily in magnitude to mean age 22 (-0.29, P = 0.0002; and 0.32, P < 0.0001, respectively). In regression models including both visceral and subcutaneous fat, only visceral fat was significantly associated with insulin sensitivity, while only subcutaneous fat was nearly significantly associated with adiponectin. CONCLUSIONS: This study shows that the significant negative relationship between waist circumference and adiponectin predated the development of significant relationships between insulin sensitivity and both waist circumference and adiponectin. It also shows that adiponectin is more closely related to subcutaneous fat and insulin sensitivity is more closely related to visceral fat in young adults.

Maternal diabetes and fetal cardiac output.

BACKGROUND: The intrauterine environment is a key determinant for long-term health outcomes. Adverse fetal environments, such as maternal diabetes, obesity and placental insufficiency are strongly associated with long-term health risks in children. Little is known about differences in fetal cardiac output hemodynamics of diabetic mothers (DM) vs. non-diabetic mothers (NDM). Our study aims to investigate the left-sided, right-sided, and combined cardiac output (CCO) in fetuses of DM vs. NDM. METHODS: Retrospective data were collected in fetuses of DM (N = 532) and NDM (103) at mean gestational age 24 weeks. Examination included 2D echo and pulse wave Doppler. Wilcoxon rank sum tests and Chi-square tests were used to test for distribution difference of maternal and fetal continuous and categorical measures respectively between DM and NDM. Intraclass correlation coefficients were calculated to assess intra-observer reliability of fetal cardiac measurements. RESULTS: DM mothers had higher mean weight (89.7±22.2 kg) than NDM (76.8±19.8 kg), p < 0.0001 and higher mean BMI (33.4±7.5) than NDM (28.3±5.8), p < 0.0001. C-section delivery occurred in 66% of DM vs. 35% of NDM fetuses. Fetuses of DM mothers had significantly larger semilunar valve diameter, higher left ventricular (LV) output, higher combined cardiac output and lower right ventricle /left ventricle ratio compared to NDM. CONCLUSION: The greater CCO (adjusted for fetal weight), left sided cardiac output in the fetuses of DM, compared to NDM, represent differences in cardiac adaptation to the diabetic environment.

What do we learn from neutrinos?

Each type of particle, by definition, is special. The special property of neutrinos is that they are penetrating. This has made their discovery and the understanding of their properties elusive, but it has also made them a useful tool in the study of particles and their interactions. In astrophysics, on account of this property, neutrinos provide an important means for energy transfer and permit insight into the interior of stars hidden to other radiation. The special conditions in space permit, in turn, the study of neutrino properties not possible in the laboratory.

Experiments with high-energy neutrino beams.

Experiments in which high-energy neutrinos were used as projectiles have made substantial contributions to our understanding of both weak and strong interactions, as well as the structure of hadrons. This article offers some illustrations. It recalls the discovery of the neutral weak current and some experiments on its nature. The sections on charged-current inclusive scattering recall the important role of these experiments in the understanding of the quark structure of the nucleon and the validity of quantum chromodynamics. The section on dimuon production illustrates the role of neutrino experiments in establishing the Glashow-Iliopoulos-Maiani current as well as the measurement of the structure function of the strange quark in the nucleon.

Serum phospholipid and cholesteryl ester fatty acids and estimated desaturase activities are related to overweight and cardiovascular risk factors in adolescents.

AIM/HYPOTHESIS: The objective of this study was to describe the relation of serum fatty acids and desaturase activity (DA) to overweight, insulin sensitivity and cardiovascular disease (CVD) risk factors in adolescents. METHODS: The relations of % serum phospholipid (PL) and cholesteryl ester (CE) fatty acids and estimated DA with CVD risk factors were examined in 264 adolescents (average age 15 years). Fatty acids were determined by gas liquid chromotography. Surrogate measures of DA were expressed as ratios of serum fatty acids: Delta9 DA=16:0/16:1; Delta6 DA=20:3,n6/18:2,n6 (PL) or 18:3,n6/18:2,n6 (CE); and Delta5 DA=20:4,n6/20:3,n6. Spearman partial correlations of fatty acids (%) and DA ratios with CVD risk factors were reported, adjusting for age, sex, race, Tanner stage, energy intake and physical activity. RESULTS: Overweight adolescents compared to normal weight had more adverse levels of CVD risk factors, composition of PL and CE fatty acids in serum, and Delta6 DA and Delta5 DA ratios. Linoleic acid was inversely related to body mass index (BMI), waist circumference and triglycerides (P

The pediatric metabolic syndrome.

The metabolic syndrome is a frequent subject of attention, discussion, and debate in medical research, because of its linkages to the growing problem of obesity on the one hand and both diabetes mellitus and cardiovascular disease on the other. It is also the grounds for contention, as respected researchers disagree on its definition and even on its validity as a construct. This clustering of obesity, dyslipidemia, elevated blood pressure, impaired glucose metabolism, and acute phase reactants can be seen in children as well as in adults. There are at least five definitions of adult metabolic syndrome promulgated by different societies and organizations, and as many as 40 different definitions of the syndrome have been used in pediatric studies. In 2007, the International Diabetes Federation published a definition of pediatric metabolic syndrome; whether it unifies the field remains to be seen. In addition, long term cohort studies have furnished data showing that clusters of the factors used to identify metabolic syndrome do predict the presence of type 2 diabetes and cardiovascular disease defined as myocardial infarction, stroke, coronary artery bypass graft, and/or positive angiogram. In addition, longitudinal studies have demonstrated compromised vascular function in young adults with metabolic syndrome, variously defined, as children and adolescents. This review discusses the background and development of the concept of a metabolic syndrome, the inter-relationships among its constitutive elements, the debates surrounding the uses of the concept and possible treatment avenues.

Insulin resistance during puberty: results from clamp studies in 357 children.

Insulin resistance may be an important cause of a constellation of cardiovascular risk factors in adults, and onset of this syndrome may occur in childhood. However, children normally experience transient insulin resistance at puberty. There were 357 normal children (159 girls, 198 boys) age 10-14 years who underwent euglycemic clamp studies to assess the effects of Tanner stage (T), sex, ethnicity, and BMI on insulin resistance. Insulin resistance increased immediately at the onset of puberty (T2), but returned to near prepubertal levels by the end of puberty (T5). Its peak occurred at T3 in both sexes, and girls were more insulin resistant than boys at all T stages. White boys appeared to be more insulin resistant than black boys; no difference was seen between white and black girls. Insulin resistance was strongly related to BMI, triceps skinfold thickness, and waist circumference, and this relationship was independent of Tanner stage or sex. Differences in BMI and adiposity did not, however, entirely explain the insulin resistance of puberty. These results demonstrate that 1) significant differences in insulin resistance are present between boys and girls; 2) insulin resistance increases significantly at T2, T3, and T4, but decreases to near prepubertal levels at T5; and 3) while insulin resistance is related to BMI and anthropometric measures of fatness, these factors do not completely explain the insulin resistance that occurs during the Tanner stages of puberty.

Visceral adipose tissue measured by DXA correlates with measurement by CT and is associated with cardiometabolic risk factors in children.

BACKGROUND: Visceral adipose tissue (VAT) generally demonstrates a stronger relationship with cardiometabolic risk factors than total body fat or subcutaneous adipose tissue. OBJECTIVES: The purpose of this study was to compare VAT estimated in children by total volume dual-energy X-ray absorptiometry (DXA) with a gold standard measurement, single slice (L4-L5) computed tomography (CT). METHODS: A total of 329 (152 females, 177 males) children ages 6-18 years (mean age 12.3 ± 3.6) and with average body mass index percentile of 54.9% (3-99%) had their VAT estimated by both CT and DXA. Linear association between methods was measured using Pearson's correlation. Multiple linear regressions compared the associations between cardiometabolic risk factors and both CT-VAT and DXA-VAT, respectively. RESULTS: In children, DXA-VAT was correlated significantly with CT-VAT, with a stronger relationship in overweight and obese children. Multiple regression analysis showed that both estimates of VAT were significantly associated with lipids and insulin sensitivity, measured by euglycaemic-hyperinsulinaemic clamp. Additionally, DXA-VAT was associated with diastolic blood pressure, homeostasis model of insulin resistance and fasting insulin, but CT-VAT was not. CONCLUSION: In children, total volume DXA-VAT and single slice CT-VAT are significantly correlated and each demonstrates similar associations with cardiometabolic risk factors. This suggests that DXA is a useful and valid method for estimation of VAT in children.

Echocardiographic diagnosis of heart disease in apparently healthy adolescents.

OBJECTIVE: Comprehensive data are currently unavailable on the prevalence of cardiac abnormalities in children after the newborn/infant period. The present report describes the prevalence of echocardiographically detected cardiac disease in a cohort of randomly selected healthy junior high school children. METHODS: The cohort for this report consists of 357 children (mean age: 13 years) randomly selected after blood pressure screening of 12 043 fifth through eighth grade students and having an echocardiographic examination as part of a study of insulin resistance in childhood. RESULTS: A physical examination performed by a board-certified pediatrician reported no cardiac abnormalities. However, echocardiography and Doppler studies identified 13 (3.6%) children (7 males and 6 females), with previously unknown cardiac abnormalities, as follows: abnormal mitral valve with mitral regurgitation (4), bicuspid aortic valve (2), atrial septal defect (2), coronary artery to pulmonary artery fistula (1), patent ductus arteriosus (1), pulmonary hypertension (1), cardiomyopathy (1), and pulmonary artery stenosis (1). Physical examination performed by a pediatric cardiologist detected abnormal cardiac findings in 7 (54%) of the children. Cardiac catheterization was required in 3 for additional diagnostic evaluation and in 2 for therapeutic intervention; 1 patient underwent open-heart surgery. Bacterial endocarditis prophylaxis was recommended in 8 (62%) of the 13 children. CONCLUSIONS: The results suggest that: 1) clinically significant cardiac disease in childhood is more prevalent than previously reported; and 2) improved screening methods should be considered to detect asymptomatic but significant cardiac abnormalities that may result in long-term complications. echocardiography, prevalence, incidence, heart disease, children.

Causes of sudden unexpected cardiac death in the first two decades of life.

Sudden, unexpected cardiac death in the age group 1 to 21 years usually is due to myocarditis, hypertrophic cardiomyopathy, aortic valvar stenosis, and coronary arterial abnormalities. The hearts of 70 patients <21 years of age who died suddenly were reviewed. Twenty patients were <1 year of age and 50 were 1 to 21 years old. The cardiac findings were compared with those in 68 age-matched controls with known cardiac disease who did not die suddenly. Significant cardiac abnormalities were present in 13 (65%) of the 20 infants; 10 (50%) had anomalies of the aortic origin of the coronary arteries. Among the 50 older patients, cardiac abnormalities were found in 40 (80%), among whom coronary arterial anomalies existed in 12 (24%). Anomalies of aortic origin more frequently involved the left main than the right coronary artery in both groups.

Interstitial 7q deletion [46,XY,del (7) (pter----cen::q112----qter)] in a retarded quadriplegic boy with normal beta glucuronidase.

A 14-year-old severely retarded male with deletion of chromosomal band 7 cen----q112 is described. Clinical features include short stature, microcephaly, unusual facies with narrow forehead, short nose, malar hypoplasia, protruding alveolar ridges and incisors, receding chin, relatively long philtrum, and large ears. In addition, he had bilateral inguinal herniae cryptorchidism with hypogonadism, pulmonic stenosis, and spastic quadriplegia. Normal activity of beta-glucuronidase was found in the patient's leukocytes. This finding suggests that the gene is not in the deleted region, narrowing the smallest region of overlap to 7q112----q22.

Interstitial deletion 2q14q21.

A girl with multiple congenital anomalies and a tendency to severe pyogenic infections was found to have an interstitial deletion of chromosome band 2q14----q21. Unusual facial manifestations included enophthalmos, long philtrum, micrognathia, narrow forehead, prominent glabella, and depressed nasal bridge. Unilateral corneal clouding, with Peters-like anomaly; agenesis of the corpus callosum; brain atrophy; and heart, kidney, hand, and dermatoglyphic anomalies were additional findings. Eye anomalies were observed in five of 22 patients with deletions of chromosome 2q. In comparing these cases, it seems that deletions of bands 2q21 and 2q31 are variably associated with microphthalmia, corneal clouding, cataracts, and Peters anomaly. Measurement of protein C and interleukin-1 (IL-1) did not show a gene dose effect, but the pyogenic infections and low IgA found in this patient may reflect an abnormality of IL-1 not detectable by our methods.

Monosomy 9p24-->pter and trisomy 5q31-->qter: case report and review of two cases.

Partial deletion of the short arm of chromosome 9 (p24-->pter) and partial duplication of the long arm of chromosome 5 (q32-->qter) were observed in an abnormal boy who died at age 8 weeks of a complex cyanotic cardiac defect. He also had minor anomalies, sagittal craniosynostosis, triphalangeal thumbs, hypospadias, and a bifid scrotum. Two other infants with similar cytogenetic abnormalities were described previously. These patients had severe congenital heart defect, genitourinary anomalies, broad nasal bridge, low hairline, apparently low-set ears, short neck, and triphalangeal thumbs, in common with our patient. We suggest that combined monosomy 9p23,24-->pter and trisomy 5q31,32-->qter may constitute a clinically recognizable syndrome.

Once daily cefixime compared with twice daily trimethoprim/sulfamethoxazole for treatment of urinary tract infection in infants and children.

We conducted a randomized prospective multicenter study to compare the safety and efficacy of once daily oral cefixime (8 mg/kg) to twice daily oral trimethoprim/sulfamethoxazole (TMP/SMX) (8/40 mg/kg/day) for the treatment of acute urinary tract infection in children ages 6 months to 13 years. Seventy-six patients (38 in each group) were studied. Thirty-seven percent were younger than 3 years of age. Escherichia coli was the most common isolate in both groups (85%). Eighty-five percent of all Gram-negative organisms were susceptible to TMP/SMX and all were susceptible to cefixime. Seventy-two percent of all patients were febrile at the time of diagnosis. Both groups were treated for 7 to 10 days. Peripheral white blood cell counts, erythrocyte sedimentation rate, body temperature and urinalysis returned to normal at the same rate in both groups. No failures were observed and relapse occurred in 3 cases within the 4 weeks after treatment (2 in the cefixime group and one in the TMP/SMX group). Side effects were observed in 14% of the cefixime group and 16% of the TMP/SMX group and were all mild enough not to necessitate discontinuation of therapy. We conclude that the efficacy and safety of cefixime administered once daily compared favorably with TMP/SMX administered twice daily for acute uncomplicated urinary tract infection.

Outcome after referral for pediatric transplantation.

Although heart, heart-lung, or lung transplantation is performed in more than 200 children annually, the number of patients referred for such procedures is considerably greater, and little is known about the outcome of those referrals. To determine the outcome of pediatric transplant referrals we reviewed the follow-up of 31 patients evaluated at our institution for heart (24), heart-lung (three), or lung (four) transplantations between January 1991 and September 1992. Indications included hypoplastic left heart syndrome (seven patients), cardiomyopathy or myocarditis (seven patients), and postoperative congenital heart disease (10 patients) for heart transplantation; Eisenmenger's syndrome (three patients) for heart-lung transplantation; and primary pulmonary hypertension (two patients), broncho pulmonary dysplasia, and cystic fibrosis for lung transplantation. Only 14 of 31 referred patients were listed for transplantation; the remaining 17 patients either improved when medical therapy was maximized (nine patients), died within days of referral (three patients), refused (two patients), chose alternate surgery (one patient), were medically unacceptable (one patient), or are currently undecided (one patient). To date 7 of 14 patients listed have undergone successful heart transplantation; the remaining seven patients either improved and did not require transplantation (two patients), refused (one patient), died waiting (one patient), are currently awaiting a donor (one patient), or underwent Norwood procedure because of donor unavailability (two patients). Thus including patients who died before listing, only 14 of 31 referrals (45%) were deemed in need of a transplant.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular function in children following bone marrow transplant: a cross-sectional study.

Sixty-three patients who had undergone a BMT at age < or = 18 years were evaluated cross-sectionally to determine cardiac function as well as the long-term prevalence, types, severity, and risk factors of cardiac abnormalities. Patients were > or = 1 year post-BMT and were evaluated by history, resting ECG, echocardiography (ECHO), exercise treadmill test, chest X-ray, pulmonary function tests and review of past cardiac studies. Patients were assigned a New York Heart Association (NYHA) class based on an activity and cardiac symptoms questionnaire. Pretransplant preparative regimens included high-dose cyclophosphamide (CY) and total body/lymphoid irradiation (n = 38), CY in combination with other chemotherapy (n = 22), and other drug combinations (n = 3). Forty patients (63.5%) had received prior anthracyclines (median 307 mg/m2). Patients' ages ranged from 1.9 to 32 years (median 10.9 years) with median follow-up of 3.3 years (range 1-16.3 years). Twenty-six patients (41.3%) had a cardiac abnormality detected at follow-up. In 21 patients the abnormal finding had not been present at the pre-BMT evaluation. Ten patients (16.4%) had resting ECG abnormalities. Left ventricular ejection fraction (LVEF) by ECHO was mildly decreased to 50-54% in three patients and markedly decreased to 40% in one patient. Only one patient (1.7%) developed a mildly abnormal shortening fraction of 27%. All patients with ECHO abnormalities were asymptomatic. Twenty-three of 31 patients > or = 9 years of age (74%) who underwent a treadmill exercise test had a borderline or abnormal response to exercise. There was no correlation between demographic factors, previous therapy, preparative regimen or length of follow-up with the post-BMT ECG, ECHO and treadmill abnormalities. Overall, eight patients (12.7%) were symptomatic and NYHA class II or III, and all had abnormal exercise tests. The presence of symptoms and NYHA class were predictors for oxygen consumption during exercise (P = 0.03 and 0.02, respectively) and tended to predict overall treadmill results also. Late cardiac abnormalities do occur following BMT in childhood and thus, there is a clear need for continued, serial long-term cardiac evaluation in transplant survivors. Evaluations should include exercise stress testing to detect inadequate cardiac output as well as oxygen consumption during exercise.

Insulin resistance and cardiovascular risk in the pediatric patient.

The insulin resistance syndrome, a cluster of potent risk factors for atherosclerotic cardiovascular disease and type 2 diabetes in adults, is composed of hyerinsulinemia, obesity, hypertension and hyperlipidemia. In addition, left ventricular hypertrophy and its precursor increased left ventricular mass, is known to be a powerful predictor of adverse cardiovascular events, both as an independent risk factor and by association with the insulin resistance syndrome. Obesity appears to have a major role in the relations between the components of the insulin resistance syndrome, and their association with increased heart mass. Of significant impact in the adult population, atherosclerotic cardiovascular disease and death are rarely seen in the young, but the pathologic processes and risk factors associated with its development have been shown to begin during childhood. Recent studies revealed the presence of components of the insulin resistance syndrome also in children and adolescents, however, their associations are not well understood. A direct link between obesity and insulin resistance has also been reported in the young, as has the link between insulin resistance and abnormal lipid profile. There is an increasing amount of data to show that being overweight during childhood and adolescence is significantly associated with insulin resistance, abnormal lipids and elevated blood pressure in young adulthood. Weight loss in these situations results in a decrease in insulin concentration and an increase in insulin sensitivity toward normalcy. Moreover, it has been determined that increased left ventricular mass is present in childhood, and is related to other risk factors, namely obesity and insulin resistance. Based on current knowledge, it is reasonable to suggest that weight control, and lifestyle modification, could alter the incidence of the syndrome of insulin resistance, and improve the risk profiles for cardiovascular disease as children make the transition toward adolescence and young adulthood.

The relative contributions of the abdominal visceral and subcutaneous fat depots to cardiometabolic risk in youth.

The aim of this study was to evaluate the association of abdominal visceral and subcutaneous fat, independent of total body fat, with cardiometabolic risk factors and insulin resistance among youth. Visceral and subcutaneous fat, percentage total body fat, insulin resistance (adjusted for lean body mass: Mlbm), blood pressure, glucose, insulin and lipids were obtained in 472 youth ages 6-18 years. Linear regression, adjusted for age, sex, race, Tanner stage and percentage total body fat, was used to evaluate associations of visceral and subcutaneous fat with cardiometabolic risk factors. Visceral fat was associated inversely with Mlbm (P = 0.003) and positively with fasting insulin (P = 0.002) and triglycerides (P = 0.002). Visceral fat levels above the mean were associated inversely with high-density lipoprotein (HDL) cholesterol (P = 0.002), and positively with systolic blood pressure (P < 0.0001) and non-HDL cholesterol (P < 0.0001). Subcutaneous fat was associated inversely with Mlbm (P = 0.003) and HDL cholesterol (P < 0.05), and positively with fasting glucose (P < 0.05), fasting insulin (P = 0.0003), systolic blood pressure (P = 0.005) and triglycerides (P = 0.003). Subcutaneous fat levels above the mean were associated with non-HDL cholesterol (P = 0.0002). These findings suggest that there may be a threshold level of visceral and subcutaneous fat (regardless of total body fat), that when exceeded in childhood, is more likely to be associated with many cardiometabolic risk factors. Triglycerides and insulin resistance appear to be associated with these fat depots at even lower thresholds of abdominal adiposity.

Bone mineral deficits in recipients of hematopoietic cell transplantation: the impact of young age at transplant.

Low bone mineral density (BMD) has been reported in recipients of pediatric hematopoietic cell transplantation (HCT), but it is unclear whether age at HCT has a role. The objective of this cross-sectional study was to determine if patients treated with HCT before the age of 10 years have long-term BMD deficits compared with patients transplanted at an older age and with sibling controls. The study included 151 HCT recipients (87 males), age at study 24.7±8.6 years treated with HCT for hematologic malignancies at age 10.9±6.4 years, and 92 healthy sibling controls (49 males), age at study 22.3±8.0 years. Dual-energy x-ray absorptiometry was performed to measure BMD Z-scores for total body BMD (TBMD), lumbar spine BMD (LBMD) and femoral neck BMD (FNBMD, for subjects 20 years at study visit). Patients <10 years at HCT had significantly lower TBMD and FNBMD Z-scores (by 0.5 and 0.8 s.d., respectively) compared with controls (P=0.003 and P=0.0001, respectively) and patients >18 years at HCT (P=0.04 and P=0.004, respectively) at an average of 14 years after HCT. In conclusion, this study identified young age at transplant as an important risk factor for bone deficits in young adulthood, suggesting that efforts to reduce bone loss should focus on this patient population.