Relationship between body mass index and sexual development in Chinese children / 中华儿科杂志

Objective: To investigate the relationship between body mass index (BMI) and sexual development in Chinese children. Methods: A nationwide multicenter and population-based large cross-sectional study was conducted in 13 provinces, autonomous regions and municipalities of China from January 2017 to December 2018. Data on sex, age, height, weight were collected, BMI was calculated and sexual characteristics were analyzed. The subjects were divided into four groups based on age, including ages 3-<6 years, 6-<10 years, 10-<15 years and 15-<18 years. Multiple Logistic regression models were used for evaluating the associations of BMI with sexual development in children. Dichotomous Logistic regression was used to compare the differences in the distribution of early and non-early puberty among normal weight, overweight and obese groups. Curves were drawn to analyze the relationship between the percentage of early puberty and BMI distribution in girls and boys at different Tanner stages. Results: A total of 208 179 healthy children (96 471 girls and 111 708 boys) were enrolled in this study. The OR values of B2, B3 and B4+ in overweight girls were 1.72 (95%CI: 1.56-1.89), 3.19 (95%CI: 2.86-3.57), 7.14 (95%CI: 6.33-8.05) and in obese girls were 2.05 (95%CI: 1.88-2.24), 4.98 (95%CI: 4.49-5.53), 11.21 (95%CI: 9.98-12.59), respectively; while the OR values of G2, G3, G4+ in overweight boys were 1.27 (95%CI: 1.17-1.38), 1.52 (95%CI: 1.36-1.70), 1.88 (95%CI: 1.66-2.14) and in obese boys were 1.27 (95%CI: 1.17-1.37), 1.59 (95%CI: 1.43-1.78), and 1.93 (95%CI: 1.70-2.18) (compared with normal weight Tanner 1 group,all P<0.01). Analysis in different age groups found that OR values of obese girls at B2 stage and boys at G2 stage were 2.02 (95%CI: 1.06-3.86) and 2.32 (95%CI:1.05-5.12) in preschool children aged 3-<6 years, respectively (both P<0.05). And in the age group of 6-10 years, overweight girls had a 5.45-fold risk and obese girls had a 12.54-fold risk of B3 stage compared to girls with normal BMI. Compared with normal weight children, the risk of early puberty was 2.67 times higher in overweight girls, 3.63 times higher in obese girls, and 1.22 times higher in overweight boys, 1.35 times higher in obese boys (all P<0.01). Among the children at each Tanner stages, the percentage of early puberty increased with the increase of BMI, from 5.7% (80/1 397), 16.1% (48/299), 13.8% (27/195) to 25.7% (198/769), 65.1% (209/321), 65.4% (157/240) in girls aged 8-<9, 10-<11 and 11-<12 years, and 6.6% (34/513), 18.7% (51/273), 21.6% (57/264) to 13.3% (96/722), 46.4% (140/302), 47.5% (105/221) in boys aged 9-<10, 12-<13 and 13-<14 years, respectively. Conclusions: BMI is positively correlated with sexual development in both Chinese boys and girls, and the correlation is stronger in girls. Obesity is a risk factor for precocious puberty in preschool children aged 3-<6 years, and 6-<10 years of age is a high risk period for early development in obese girls.

Efficacy and safety of human chorionic gonadotropin combined with human menopausal gonadotropin and a gonadotropin-releasing hormone pump for male adolescents with congenital hypogonadotropic hypogonadism / 中华医学杂志(英文版)

BACKGROUND@#Compared to adult studies, studies which involve the treatment of pediatric congenital hypogonadotropic hypogonadism (CHH) are limited and no universal treatment regimen is available. The aim of this study was to evaluate the feasibility of human chorionic gonadotropin (hCG)/human menopausal gonadotropin (hMG) therapy for treating male adolescents with CHH.@*METHODS@#Male adolescent CHH patients were treated with hCG/hMG (n = 20) or a gonadotropin-releasing hormone (GnRH) pump (n = 21). The treatment was divided into a study phase (0-3 months) and a follow-up phase (3-12 months). The testicular volume (TV), penile length (PL), penis diameter (PD), and sex hormone levels were compared between the two groups. The TV and other indicators between the groups were analyzed using a t-test (equal variance) or a rank sum test (unequal variance).@*RESULTS@#Before treatment, there was no statistical difference between the two groups in terms of the biochemistry, hormones, and other demographic indicators. After 3 months of treatment, the TV of the hCG/hMG and GnRH groups increased to 5.1 ± 2.3 mL and 4.1 ± 1.8 mL, respectively; however, the difference was not statistically significant (P > 0.05, t = 1.394). The PL reached 6.9 ± 1.8 cm and 5.1 ± 1.6 cm (P  0.05, t = 0.314). After 9 to 12 months of treatment, the T level was higher in the hCG/hMG group. Other parameters did not exhibit a statistical difference.@*CONCLUSIONS@#The hCG/hMG regimen is feasible and effective for treating male adolescents with CHH. The initial 3 months of treatment may be a window to optimally observe the strongest effects of therapy. Furthermore, results from the extended time-period showed positive outcomes at the 1-year mark; however, the long-term effectiveness, strengths, and weaknesses of the hCG/hMG regimen require further research.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT02880280; https://clinicaltrials.gov/ct2/show/NCT02880280.

Prevalence of hypertension and relationship between hypertension and obesity in children and adolescents in Nanning of Guangxi Province / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the prevalence of hypertension and the relationship between hypertension and obesity in children and adolescents aged 6-18 years in Nanning, Guangxi Province, China.</p><p><b>METHODS</b>A stratified cluster random sampling method was adopted in Nanning to select 7 893 children and adolescents aged 6-18 years as research subjects. Questionnaire surveys were conducted, and blood pressure, height, weight, and other indicators of growth and development were measured.</p><p><b>RESULTS</b>An increasing trend with age for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) was observed. Detection rates of hypertension, high SBP (HSBP) and high DBP (HDBP) were 6.58%, 4.02% and 3.81%, respectively. The detection rates of hypertension and HSBP in boys were significantly higher than in girls (P<0.05). The detection rates of hypertension in normal, overweight and obesity groups were 3.87%, 9.84% and 19.23%, respectively. The obesity group showed the highest detection rates for hypertension, HSBP and HDBP, followed by the overweight group and normal group. Compared with that in the normal group, the odds ratios (95% CI) for hypertension in the overweight and obesity groups were 2.71 (1.69-5.96) and 5.91 (3.46-7.63), respectively. Blood pressure showed a positive correlation with age, height, weight and BMI (P<0.01).</p><p><b>CONCLUSIONS</b>The present study provides with the current information and characteristics of blood pressure of children and adolescents aged 6-18 years in Nanning, Guangxi. Blood pressure is correlated with gender, age, height, weight and BMI. Obesity is positively correlated with the prevalence of hypertension and the risk of hypertension increases with body weight.</p>

Analysis of chromosomal abnormalities and a report of eight new karyotypes among children in genetic counseling / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the relationship between abnormal karyotypes and clinical phenotypes among children in genetic counseling in Guangxi Zhuang Autonomous Region, China.</p><p><b>METHODS</b>We studied 601 children who visited Guangxi Zhuang Autonomous Region Women and Children Care Hospital for genetic counseling between January 2009 and July 2012. Blood samples were cultured routinely for karyotype analysis with G banding as well as clinical analysis.</p><p><b>RESULTS</b>Out of 601 patients, 329 (54.7%) had chromosomal abnormalities, and 8 new abnormal human karyotypes were found. Among 329 children with abnormal karyotypes, 317 (96.4%) had an abnormal number of chromosomes, and 12 (3.6%) had abnormal chromosomal structure. Abnormal karyotypes were clinically manifested by Down's syndrome (74.5%), growth retardation (10.9%), and mental retardation (3.0%).</p><p><b>CONCLUSIONS</b>Eight rare abnormal karyotypes were found in the study, providing new resources for the genetic studies and etiological analysis of growth retardation, mental retardation, gonadal dysgenesis, and multiple congenital anomalies in children.</p>

Analysis of clinical manifestations and genetic mutations in a child with Laron syndrome / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze clinical manifestations and gene mutations in a child with severe short stature, explore its molecular mechanism and further clarify the diagnostic procedure for short stature.</p><p><b>METHOD</b>We observed clinical characteristics of a patient with short stature and did diagnostic examinations, assessed the function of GH-IGF-1 axis, and surveyed its family members.Genomic DNA was extracted from peripheral blood, GHR, IGFALS, STAT5b and GH1 gene were amplified by PCR for sequencing, including exons and splicing areas.</p><p><b>RESULT</b>The patient presented symmetrical short stature (height -8.2 SDS) and facial features, and other congenital abnormalities.It displayed non-growth hormone deficiency. The baseline value of GH was 21 µg/L, and the peak was 57.9 µg/L. The value of IGF-1 was less than 25 µg/L, and the IGFBP-3 less than 50 µg/L. And IGF-1 generation test showed no response. There was no similar patients in the family members.Sequencing of GHR in the patient revealed a homozygous point mutation (c.Ivs6+1G>A), and her father and mother had the same heterozygous mutation. The same mutation was not identified for her sister.No other candidate gene was found.</p><p><b>CONCLUSION</b>As the result of combined clinical characteristics and lab examinations, as well as gene detection, the case was diagnosed with Laron syndrome and GHR gene mutation is the molecular mechanism.We should explicit the etiological diagnosis for short stature, and avoid missed diagnosis and misdiagnosis.</p>

Pulmonary surfactant associated gene variants in mixed ethnic population of Han and Zhuang / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the prevalence of pulmonary surfactant associated pathway genes functional variants in Chinese population.</p><p><b>METHOD</b>Using a cohort of 258 mixed ethnic population of Han and Zhuang, we pooled DNA samples from 146 term male infants and 112 term female infants and then used an Ill umina next generation sequencing platform to perform the complete exonic resequencing in 6 target genes:surfactant protein-B (SFTPB), surfactant protein-C (SFTPC), ATP-binding cassette transporter A3 (ABCA3), lysophospholipid acyltransferase 1 (LPCAT1), choline phosphotransferase 1 (CHPT1), phosphate cytidylyltransferase 1, choline, beta (PCYT1B). Collapsing methods was used to determine the functional allele frequency.</p><p><b>RESULT</b>(1) Altogether, 128 variants were found, including 44 synonymous variants, 66 nonsynonymous variants and 18 insertions-deletions. Of these, 28 variants were predicted to alter protein function. Two of these variants were seen twice, the rest variants were only seen once, for a total of 30 functional alleles; (2) ABCA3 had the most functional variants in both male and female groups with the minor allele frequencies of 0.014 (1.4%) and 0.04 (4%), respectively. The total functional allele frequencies of 6 genes were 0.041 (4.1%) and 0.08 (8%) in the two groups, respectively (P = 0.06).</p><p><b>CONCLUSION</b>(1) Functional variants in pulmonary surfactant associated pathway genes are present in the mixed Han-Zhuang population. (2) ABCA3 contained the most functional variants suggesting that ABCA3 could contribute significantly to neonatal respiratory distress syndrome and other lung disease.</p>

Study on physique index set for Chinese children and adolescents / 中华流行病学杂志

Objective To provide data as age-gender dependent mean,standard deviation and percentile on height,weight.waist circumference (WC),hip circumference (HC).body mass index (BMI),waist hip ratio (WHR),waist to height ratio (WHtR) among 7-16 year-olds Chinese children and adolescents,towards setting up diagnostic criteria on metabolic syndrome for them.Methods A representative sample involvng 22 197 children and adolescence aged 7 to 16 years were randomly surveyed and they were from 6 representative geographical areas,including Beijing.Tianjin? Hangzhou,Shanghai,Chongqing and Nanning.A total of 21858 had available data,with male/female ratio as:11460/10 398.Using the standard methods,we measured height,weight.WC,HC,BMI.WHtR and other data in all age groups.Physique indexes among different geographic regions (North.Mid-west and East) were compared.Results (1) Both male and female showed an inaeasing trend of height.weight,waist circumference,hip circumference and BMI along with the increase of age.WHR of girls decreased gradually from 0.84 to 0.76 went from 7 to 16 years old while WHR of boys changed from 0.87 to 0.81 accordingly.(2) WHtR was rarely affected by age.It fluctuated between 0.42-0.43 in all girls and 0.44-0.45 in boys less than 11 years.WHtR of boys older than 12 years showed a slight decline from 0.45 to 0.42 of WHtR.(3) The average height,weight,BMI of children and adolescents from the northem regions (Beijing,Tianjin) were significantly higher than that of the mid-western (Chongqing,Nanning) and the eastem regions (Shanghai,Hangzhou) (P＜0.001 ),while those from the mid-western region were slightly higher than that of the eastern region (P＜0.05) in each of the age group.Conclusion Reference values and percentile curves for WC and WHtR of Chinese children and adolescents were provided.For the assessment of central obesity.WHtR had the advantages of relative stability and small degree of variation and rarely affected by age and gender,when compared with WC.and could be used as an simple index to reflect the central obesity of children and adolescents.

Survey on the levels of lipids in school-aged children of Beijing, Tianjin, Hangzhou, Shanghai,Chongqing and Nanning cities / 中华流行病学杂志

Objective To investigate the lipid levels of Han ethnicity Chinese children at school-age,to provide objective data for the formulation of prevention and management strategy regarding dyslipidemia among children and adolescents.Methods 20 191 children (with 10 669 boys and 9522 girls) aged 7 to 16 years old from 6 representative geographical areas,including Beijing,Tianjin,Hangzhou,Shanghai,Chongqing and Nanning,were surveyed in a randomly selected clustered sample in China.Data on fasting blood triglyceride (TG),total cholesterol (TC),lowdensity lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were measured.Non-high-density lipoprotein cholesterol (non-HDL-C) levels were calculated with data collection,entry,and collation were under the same criteria.Results (1) In the 7-16 year-old group,TG (P95) fluctuated between 1.26 mmol/L and 1.88 mmol/L,while TC (P95) was between 4.80 mmol/L and 5.46 mmol/L.LDL-C(P95) was between 2.67 mmol/L and 3.27 mmol/L while non-HDL-C (P95) was between 3.36 mmol/L and 3.91mmol/L,sugesting that age did not seem to be an affecting factor for the lipid level (P＞0.05).The level of HDL-C (P5) fluctuated bctwcen 1.08 mmol/L and 0.83 mmol/L,and the dependability analysis on HDL-C and age showed statistically significant difference (P＜0.01,r=-0.274).(2) In the 7-9 year-old group,the levels ofTG,TC,LDL-C and non-HDL-C of boys were lower but the HDL-C level was higher than in girls.However,in the 10-16 year-old group,the levels of five lipids of boys were all lower than in girls,with all the differences statistically significant (P＜0.05).(3) The levels of TG,TC,LDL-C and non-HDL-C in the obese group were significantly higher than those in non-obesity group,as HDL-C was significantly lower than in non-obese group(P＜0.01).Incidence rates of single and multiple dyslipidemia in obese group were significantly higher than in non-obese group (P＜0.01).(4) Grouped by region,the abnormal rates of TG were descending,with the ranking as North (10.4％),Midwest (9.7％) and East (8.3％),while the abnormal rates of TC were descending with the ranking as Midwest (6.0％),North (5.2％)and East (4.8％).The abnormal rates of LDL-C were descending as the ranking of North (3.1％),East (2.6％) and Midwest (0.9％),with the abnormal rates of non-HDL-C were descending as Midwest (6.5％),North(4.2％)and East (3.6％).The abnormal rates of HDL-C were descending as Midwess (14.2％),North(5.7％) and East(5.5％).All the differences in the above-said items were statistically significant (P＜0.05).(5) According to the standards of hyperlipidemia formulated by the American Academy of Pediatrics,the incidence rates of abnormal TG,TC,LDL-C,non-HDL-C,HDL-C were 9.4％,5.4％,2.2％,4.8％,8.6％ respectively.Conclusion (1) Levels of lipids were affected by many factors,but age was not one of them in children and adolescents.However,HDL-C was declining along with the increase of age,to some extent.(2)Girls had a relatively protective tendency through the increasing HDL-C level when they entered the puberty years.(3)Lipids levels in non-obese group were significantly better than the obese group.(4)The lipids levels of children and adolescents in the Eastern region of the country were better than that in the northern and mid-western areas.

Relationship between alanine aminotransferase and overweight or obesity in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the association of alanine aminotransferase (ALT) with overweight or obesity in children.</p><p><b>METHODS</b>A total of 2889 healthy children and 702 overweight or obese children aged from 7 to 18 years who had received a physical examination were enrolled. Height, body weight, waist circumference, and blood pressure were measured, and the biochemical indicators including blood glucose, blood lipids, ALT, and insulin were detected. The insulin resistance index were calculated.</p><p><b>RESULTS</b>The ALT level was significantly higher in boys than in girls. Along with the increase of BMI, the ALT level increased in the normal, overweight, and obese groups in both boys and girls. ALT was correlated with BMI, waist circumference, triglyceride, and insulin resistance index. Among the overweight or obese children, the boys with the increased ALT level had higher BMI, waist circumference, blood pressure, triglyceride, low density lipoprotein and insulin resistance index than the boys with normal ALT level (P<0.05); the girls with the increased ALT level had higher waist circumference, blood pressure and insulin resistance index and lower high density lipoprotein than the girls with normal ALT level (P<0.05).</p><p><b>CONCLUSIONS</b>ALT is correlated with overweight and obesity and metabolic disorders caused by overweight and obesity such as dyslipidemia and insulin resistance.</p>

Epidemiological study on the association between obesity with metabolic syndrome in obese children and adolescents of Nanning city, Guangxi / 中华流行病学杂志

Objective To investigate the association between obesity and prevalence of metabolic syndrome (MS) with its associated risk factors,in children and adolescents.Methods A stratified random sampling method was used to select 7893 students from 6 to 18 years of age from 14 out of 396 primary and secondary schools in Nanning city.All the students had undergone physical examination and blood tests including the following risk factors related to metabolic syndrome:fasting blood glucose (FBG),total cholesterol (TC),triglycerides (TG),high-density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),alanine amino shift enzyme (ALT),aspartic acid amine shift enzyme (AST) and fasting insulin (FINS).The homeostasis model assessment insulin resistance index (HOMA-IR) was also measured.Results (1) The prevalence rate of MS in normal group was 0.57％.In both the overweight and obesity groups,the prevalence rates of MS were 4.53％ and 26.80％,respectively.(2) These indices in obesity group were higher than other two groups (P＜0.05).The result of overweight group was higher than normal group (P＜0.05).(3) Waist circumference(OR=1.087,95％CI:1.033-1.143 ),SBP ( OR=1.073,95％CI:1.032-1.116),FBG (OR=1.394,95％CI:1.568-3.423),TG (OR=3.213,95％CI:1.410-7.319) and HDL-C (OR=0.001,95％CI:0.000-0.012)were detecting indices which had statistically significant with MS in binary logistic regression analysis.Conclusion Metabolic syndrome and obesity were closely related in children and adolescents while its prevalence and risk factors increased with the severity of obesity.

Impact of gonadotropin-releasing hormone analogs treatment on final height in girls with central precocious puberty / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effects of treatment with gonadotropin-releasing hormone analogs (GnRHa) on final height, weight and pubertal development in girls with central precocious puberty.</p><p><b>METHODS</b>Twenty-six girls with central precocious puberty were treated with GnRHa for an average of 19.2+/- 8.4 months. Pretreatment and posttreatment predicted adult heights (PAH) were evaluated based on the Bayley-Pineau table. The patients, heights and weights were measured monthly. Bone age (BA) was evaluated using Greulich-Plyle. Height standard deviation score for BA [HtSDS (BA)] was measured. After discontinuation of treatment, the patients were followed-up for the observation of height, weight, BA and menstruation.</p><p><b>RESULTS</b>Final height averaged 158.0+/- 4.0 cm in the 26 girls, which was greater than their target height (155.3+/- 4.4 cm; P< 0.01) and consistent with their posttreatment PAH (158.4+/- 5.2 cm). The final height was positively corrrelated with initial height, PAH and HtSDS(BA). There was a positive correlation in the body mass index before and after treatment (r=0.724, P< 0.01). Menarche occurred 13.2+/- 6.1 months after discontinuation of treatment, with a mean menarche age of 12.2+/- 0.7 years.</p><p><b>CONCLUSIONS</b>GnRHa may increase final height in girls with central precocious puberty. Their final heights may be correlated with their initial heights and PAH. The pubertal development after GnRHa treatment in girls with central precocious puberty may be matched with normal children.</p>