Maternal weight, smoking, and diabetes provided early predictors of longitudinal body mass index growth patterns in childhood.

AIM: The aim of this study was to identify factors affecting overweight growth development using extended body mass index (BMI) data combined with birth and maternal records from Finnish national registries. METHODS: The longitudinal data consist of growth measurements of 7372 from six birth cohorts in Finland: 1974 (n = 1109), 1981 (n = 983), 1991 (n = 607), 1994-1995 (n = 829), 2001 (n = 821), and 2003-2004 (n = 3023). Anthropometric data were collected from birth to age 15 years from the health records. Pregnancy health data were included for the four most recent birth cohorts (n = 2810). A statistical method called trajectory analysis was used to identify different BMI development trajectories. Factors associated with abnormal growth tracks were analysed using logistic regression models. RESULTS: High pre-pregnancy BMI, gestational diabetes mellitus, maternal smoking, and greater gestational weight gain than the Institute of Medicine (United States) recommendations were associated with the overweight growth track. Two of the trajectories didn't seem to follow the normal growth pattern: overweight growth track appeared to lead to overweight, while low birth BMI track showed accelerating growth after the adiposity rebound point of BMI growth. CONCLUSION: These findings suggest that maternal overweight before pregnancy, excessive gestational weight gain, gestational diabetes mellitus, and smoking could potentially be associated with the risk of obesity in children.

Payments for Improved Ecostructure (PIE): Funding for the Coexistence of Humans and Wolves in Finland.

The gray wolf (Canis lupus) is a source of concern and a cause of damage to people's livelihoods. In Finland, as in most countries, actual damages are compensated according to the real lost value. However, often, the suffered damages are larger than what is compensated, and worries and fears are not accounted for at all. The purpose of our transdisciplinary action research is to contribute to the process of modifying the scientific, administrative, and everyday habits of mind in order to meet the practical prerequisites of living with the wolf. In 2014, we planned and participated in a process designed to update Finland's wolf population management plan. During our study, we applied e-deliberation, conducted a national wolf survey, and organized solution-oriented workshops in wolf territory areas around Finland. By applying abductive reasoning, we illustrate the basic features of an economic scheme that would help finance and coordinate practical modifications to the ecological, economic, and institutional circumstances and settings in wolf territory areas. The potential economic instrument is based on payments for improved ecostructures. In our paper, we describe the organization, functioning, and financing of this instrument in detail.

Transcription factor GATA-4 is abundantly expressed in childhood but not in adult liver tumors.

OBJECTIVES: Transcription factor GATA-4 is expressed in early fetal liver and essential for organogenesis. It is also implicated in carcinogenesis in several endoderm-derived organs. Hepatoblastoma (HB), the most common malignant pediatric liver tumor, has features of fetal liver including extramedullary hematopoiesis. We investigated the expression of GATA-4 and its purported target gene erythropoietin (Epo) in liver tumors and the role of GATA-4 in HB pathogenesis. PATIENTS AND METHODS: Immunohistochemistry, Western blotting, and reverse transcription-polymerase chain reaction were used for liver samples from patients with HB or hepatocellular carcinoma. To further investigate the role of GATA-4 in pediatric liver tumors, we used adenoviral transfections of wild-type or dominant negative GATA-4 constructs in the human HB cell line, HUH6. RESULTS: We found abundant GATA-4 expression in both types of liver tumors in children, whereas it was absent in adult hepatocellular carcinoma. A close family member GATA-6 was expressed in a minority of childhood but not adult liver tumors. Epo, present in the fetal liver, was also expressed in childhood liver tumors. Moreover, cell line HUH6 was GATA-4 positive and produced Epo. We found that altering the amount of functional GATA-4 in HUH6 cells did not significantly affect either proliferation or apoptosis. CONCLUSIONS: GATA-4 is abundant in pediatric liver tumors, but unraveling its exact role in these neoplasms requires further investigation.

Change in prevalence of overweight and obesity in Finnish children - comparison between 1974 and 2001.

OBJECTIVE: To analyse the possible changes in the prevalence of overweight and obesity comparing birth cohorts from four different decades in Finland. DESIGN: A retrospective longitudinal growth study. METHODS: The subjects representing five birth cohorts: 1974 (n = 1109), 1981 (n = 987), 1991 (n = 586), 1995 (n = 856) and 2001 (n = 766) in the city of Tampere and three rural municipalities in Finland. Data included five consecutive height and weight measurements from 2 to 15 years of age. Normal weight, overweight and obesity at the time points were classified by body mass index (BMI, kg/m(2) ) according to international age- and gender-specific BMI cut-off points. The chi-square test was used to analyse the differences in the between birth cohorts. RESULTS: The combined prevalence of overweight and obesity decreased significantly in 2-year-old boys (p = 0.009) and girls (p = 0.002) from 1974 to 2001. Insignificant fluctuation was seen in 5- and 7-year-old children. Both the prevalence of obesity and the combined prevalence of overweight and obesity showed a significant increase in 12- (p = 0.031 and p < 0.001) and 15-year-old boys (p < 0.001 in both) from the 1970s to 2000s. In girls, the prevalence of obesity as well as the combined prevalence of overweight and obesity increased significantly in the age group of 12 years (p = 0.023), but not in that of 15 years. CONCLUSIONS: During the last three decades, overweight and obesity have become clearly more prevalent in Finnish young adolescents. This trend has been more obvious in boys than in girls. At the same time, 2-year-old children have shown an opposite trend.

Toddlers get slimmer while adolescents get fatter--BMI distribution in five birth cohorts from four decades in Finland.

AIM: To investigate the trends in the size of Finnish children in five birth cohorts from four decades. METHODS: This is a retrospective longitudinal growth pattern study on children representing five birth cohorts: 1974, 1981, 1991, 1995 and 2001 from the city of Tampere and three rural municipalities. Growth data were collected from birth to 15 years of age, except in birth cohorts 1995 and 2001 until 12 and 5 years. Body mass index (BMI, kg/m²) was calculated. Pearson's chi-square test was used in analysis. RESULTS: The 50th percentile of BMI at birth varied between the 1970's and 2000's (boys: p<0.001, girls: p=0.02), with increase seen in girls. The 50th BMI percentile remained unchanged in 6-month-aged boys, whereas in girls, it varied inconsistent (p=0.04). At 1 and 2 years of age, the 15th, 50th, 85th and 95th BMI percentiles decreased (p=0.26 to <0.001). The 50th BMI percentile remained fairly constant at 5 and 7 years of age. In 12- and 15-year-old boys, the 50th, 85th and 95th percentiles of BMI showed a marked increase (p=0.01 to <0.001). In 12-year-old girls, only the 85th BMI percentile increased (p=0.03). CONCLUSIONS: During the last three decades, Finnish toddlers have become markedly slimmer. Concurrently, an opposite change has taken place in adolescent boys.

Risk of hyperammonemic coma in the puerperium: two cases of women with diagnosed and undiagnosed deficiency of urea cycle enzymes.

Deficiencies of urea cycle enzymes are rare metabolic disorders. Inadequate function of these enzymes may in worst cases lead to hyperammonemic encephalopathy and death. The danger of urea cycle enzyme deficiencies is that previously healthy adults with no prior medical history suggesting these deficiencies may suddenly develop life-threatening complications during prolonged catabolic situations such as delivery or surgery. Since most of the metabolic disorders are diagnosed during childhood, it may sometimes be difficult to bear in mind these rare diseases as a cause of unconsciousness in adulthood. However, early diagnosis and prompt initiation of ammonia-lowering treatment are essential for survival of these patients. We present two pregnant women with urea cycle disorders: one with a known deficiency and an uncomplicated outcome, and another with a previously undiagnosed disorder and life-threatening course of the postpartum period.

Parents underestimate their child`s overweight.

AIM: The aim of this study was to evaluate parents' ability to perceive the weight status of their children. METHODS: This cross-sectional study was performed on 5 (n = 310) and 11-year-old (n = 296) children. The height, weight and waist circumference were measured. Body mass index (BMI, kg/m²) was calculated. The International Obesity Task Force criteria and the British cut-off points were used to classify BMI and waist circumference. Parents filled out a questionnaire concerning their perception of the weight class of their child. The parents and the 11-year-old children estimated their own weight class. For analysis, the measured and perceived weight classes were divided into two categories; normal weight (including underweight) and overweight or obese. To measure the agreement cross-tabulation with Cohen's Kappa was used. Explanatory variables associated with misclassification of overweight children as normal weight were examined by logistic regression modelling. RESULTS: The prevalence of overweight (including obese) was 17.4% and 21.6% in 5- and 11-year-old children in this study. Only a few parents misclassified their normal weight children as overweight. By contrast, a majority of parents to the 5-year-old children and about half of the parents to the 11-year-old children misclassified them as normal weight. Using waist circumference for body size classification did not improve parents' performance. Mothers performed best when estimating own weight class. CONCLUSION: A majority of parents fail to recognize overweight or obesity in their 5- and 11-year-old children. The underestimation of overweight may impair the motivation of the parents to adopt weight control.

Prevalence of overweight and obesity in 5- and 12-year-old Finnish children in 1986 and 2006.

OBJECTIVE: To investigate the prevalence and the trends of overweight and obesity in Finnish 5- and 12-year-old children in 1986 and 2006. DESIGN: Retrospective cross-sectional study. SUBJECTS AND METHODS: Anthropometric data were collected retrospectively from health examinations in Tampere and in three rural municipalities. The size of the 5- and 12-year-old cohorts were 2108 in 1986 and 4013 in 2006, respectively. The body mass index (BMI) was calculated. Overweight and obesity was estimated using the International Obesity Task Force cutoff values (ISO BMI). RESULTS: The prevalence of overweight (ISO BMI >25) and obesity (ISO BMI >30) in 5-year-old boys in 2006 was 9.8% and 2.5% and in girls 17.7% and 4.3%, [corrected] respectively. At the age of 12 years, the corresponding figures in boys were 23.6% and 4.7% and in girls 19.1% and 3.2%. Between 1986 and 2006, the prevalence of overweight in 12-year-old children had increased 1.8 fold in boys (p < 0.001) and 1.5 fold in girls (p = 0.008). Overweight was significantly more common in rural than in urban areas. CONCLUSION: During the last 20 years the prevalence of overweight has markedly increased in 12-year-old Finnish children, but remained nearly unchanged in 5-year-old children.

Tropical timber rush in Peruvian Amazonia: spatial allocation of forest concessions in an uninventoried frontier.

Land-use allocation has important implications for the conservation and management of tropical forests. Peru's forestry regime has recently been reformed and more than 7 million ha has been assigned as forest concessions. This potentially has a drastic impact on the land-use practices and species composition of the assigned areas. Nevertheless, the environmental variation found within the concessions and the process applied to delimit them are poorly studied and documented. Thus, it is difficult to estimate the biological impacts of forestry activities in concessions or plan them sustainably. This paper reveals the characteristics of the current concession allocation in Loreto, Peruvian Amazonia, using environmental and access-related variables and compares the concessions to other major land-use assignments. The work draws on a number of data sets describing land-use, ecosystem diversity, and fluvial network in the region. According to our data, certain environment types such as relatively fertile Pebas soils are overrepresented in the concessions, while others, like floodplain forests, are underrepresented in comparison to other land-use assignments. Concessions also have less anthropogenic disturbance than other areas. Furthermore, concessions are located on average further from the river network than the other land-use assignments studied. We claim that forest classification based on productivity, soil fertility, accessibility, and biodiversity patterns is an achievable long-term goal for forest authorities in Peru, and in many other tropical countries. We present a rough design of a geographic information system incorporating environmental, logging, and access-related data that could be applied to approach this goal in Peru.

Experiences from harvest-driven conservation: Management of Amazonian river turtles as a common-pool resource.

Understanding what causes variability in the outcomes of common-pool resources management and governance has important policy implications for biodiversity conservation, in particular for the conservation of wild plants and animals subject to harvest. We report an exploratory study focusing on Amazonian river turtles as a common-pool resource under harvest-driven conservation and management efforts in Peru. Based on document analysis, literature review and a series of interviews, we describe the management program as a social process and identify the most important governance and management outcomes achieved (increased turtle abundance and benefits for harvesters, harvester formalization), factors hindering and facilitating the program implementation (four natural and three societal factors), and key governance actions behind the program outcomes (awareness and capacity building, crafting and enforcing rules). We then highlight the existing knowledge gaps and the needs and possible means to address particular risks related to turtle management on a harvest-driven setting.

Cholesterol absorption and synthesis in pediatric kidney, liver, and heart transplant recipients.

BACKGROUND: Hypercholesterolemia after organ transplantation is common. Previously, we observed higher serum total cholesterol (TC) concentrations in our pediatric kidney than liver or heart transplant recipients. To find an explanation to the observed difference, our kidney recipients' cholesterol synthesis and absorption efficiency was compared to those of liver and heart recipients. METHODS: Serum noncholesterol sterol ratios (10 x mmol to the mol of TC, surrogate estimates of hepatic cholesterol synthesis and intestinal absorption) were studied in 50 pediatric kidney, 25 liver and 12 heart transplant recipients without diabetes or cholestasis, and in 29 controls. RESULTS: The kidney recipients had lower Delta-cholesterol (P=0.031), similar lathosterol and higher desmosterol ratios (markers of cholesterol synthesis) (P=0.020), and similar campesterol and sitosterol ratios (markers of cholesterol absorption) when compared to the controls. The liver recipients had lower campesterol ratios than the kidney recipients and controls (P=0.002). Glomerular filtration rates were not associated with the ratios of noncholesterol sterols. Multivariate analysis showed markers of cholesterol synthesis to be lower and absorption to be higher in the kidney than the liver or the heart transplant recipients. Weight-adjusted dosages of immunosuppressive agents were associated with some ratios of noncholesterol sterols and cholestanol though these varied between the transplant recipient groups. CONCLUSIONS: Serum TC concentration in kidney recipients was not significantly associated with absorption efficiency or synthesis of cholesterol, though kidney transplantation was associated with low synthesis and high absorption efficiency of cholesterol. Immunosuppressive therapy with cyclosporine and methylprednisolone may modulate absorption efficiency and synthesis of cholesterol.

Current strategies for the treatment of hereditary tyrosinemia type I.

Hereditary tyrosinemia type I (HT-I) is the most common of the three known diseases caused by defects in tyrosine metabolism. This type of tyrosinemia is caused by a mutation in the gene coding for fumarylacetoacetate hydrolase; several mutations in this gene have been identified. The main clinical features of HT-I are caused by hepatic involvement and renal tubular dysfunction. Dietary intervention with restriction of phenylalanine and tyrosine together with supportive measures can ameliorate the symptoms, but given the high risk for hepatocellular carcinoma, a cure for these patients has so far been possible only with liver transplantation. Pharmacologic treatment with nitisinone, a peroral inhibitor of the tyrosine catabolic pathway, offers an improved means of treatment for patients with HT-I. However, longer follow-up periods are needed to establish the role of this drug in ultimately protecting patients from end-stage organ involvement and hepatocellular carcinoma. Experimental work in mice has provided some promise for the future management of tyrosinemia with gene therapy.

Studies of LDL particle size and susceptibility to oxidation and association with glucose metabolism in children after heart transplantation.

BACKGROUND: Increased concentrations of serum triglyceride and low-density lipoprotein (LDL) cholesterol are common after heart transplantation (HTx). These abnormalities may promote transplant vascular disease and atherosclerosis, especially if LDL is small, dense, and oxidized. There have been no previous studies of LDL particle size and LDL susceptibility to oxidation in children after HTx. METHODS: Twenty-three HTx recipients (aged 3-19 years) who received triple-drug immunosuppression therapy after HTx and 181 controls within the same age range participated in the study. Total, high-density lipoprotein, and LDL-cholesterol concentrations; triglyceride concentration, and glucose and insulin concentrations during oral glucose tolerance tests were determined an average of 3 years after HTx (range, 1-7 years). Moreover, we determined serum lipoprotein (a) concentration, apolipoprotein E phenotype, LDL particle size, and indices of LDL susceptibility to copper-induced oxidation in 12 HTx recipients. RESULTS: We found hypertriglyceridemia in 56.5% and hyperinsulinemia in 30.4% of patients. Triglyceride concentration and body mass index were associated significantly with insulin concentration (p < 0.008 for both). Low-density lipoprotein particle size, LDL susceptibility to in vitro oxidation, and lipoprotein (a) concentrations did not differ significantly between HTx patients and controls. Low-density lipoprotein particle size was associated inversely with cyclosporine through level (Neoral, r = -0.59, p = 0.045), whereas weight-adjusted dosage of cyclosporine correlated positively with longer lag time of LDL oxidation (r = 0.69, p = 0.013). CONCLUSIONS: Hypertriglyceridemia and hyperinsulinemia were common in children receiving triple-drug immunosuppression therapy after HTx. Increased cyclosporine through concentration was associated with small LDL particle size but did not increase LDL susceptibility to oxidation.

Allocating logging rights in Peruvian Amazonia--does it matter to be local?

BACKGROUND: The fate of tropical forests is a global concern, yet many far-reaching decisions affecting forest resources are made locally. We explore allocation of logging rights using a case study from Loreto, Peruvian Amazonia, where millions of hectares of tropical rainforest were offered for concession in a competitive tendering process that addressed issues related to locality. METHODOLOGY/PRINCIPAL FINDINGS: After briefly presenting the study area and the tendering process, we identify and define local and non-local actors taking part in the concession process. We then analyse their tenders, results of the tendering, and attributes of the concession areas. Our results show that there was more offer than demand for concession land in the tendering. The number of tenders the concession areas received was related to their size and geographic location in relation to the major cities, but not to their estimated timber volumes or median distances from transport routes. Small and Loreto-based actors offered lower yearly area-based fees compared to larger ones, but the offers did not significantly affect the results of the tenders. Local experience in the form of logging history or residence near the solicited concession areas, as well as being registered in the region of Loreto, improved the success of the tenders. CONCLUSIONS/SIGNIFICANCE: The allocation process left a considerable number of forest areas under the management of small and local actors, and if Peru is to reach its goal of zero deforestation rate by safeguarding 75 per cent of its forests by 2020, the small and the local actors need to be integrated to the forest regime as important constituents of its legitimacy.

Bird diversity, birdwatching tourism and conservation in Peru: a geographic analysis.

In the face of the continuing global biodiversity loss, it is important not only to assess the need for conservation, through e.g. gap analyses, but also to seek practical solutions for protecting biodiversity. Environmentally and socially sustainable tourism can be one such solution. We present a method to spatially link data on conservation needs and tourism-based economic opportunities, using bird-related tourism in Peru as an example. Our analysis highlighted areas in Peru where potential for such projects could be particularly high. Several areas within the central and northern Andean regions, as well as within the lowland Amazonian regions of Madre de Dios and Loreto emerge as promising for this type of activity. Mechanisms to implement conservation in these areas include e.g. conservation and ecotourism concessions, private conservation areas, and conservation easements. Some of these mechanisms also offer opportunities for local communities seeking to secure their traditional land ownership and use rights. (Spanish language abstract, Abstract S1).

Hereditary urea cycle diseases in Finland.

AIM: To estimate the incidence of urea cycle diseases (UCDs) in Finland and determine the course of the various disorders as well as the outcome. METHODS: The original data were collected in the years 1998-2001. The diagnoses made after 2001, as well as the current status of the patients, were updated by surveys in the spring of 2007. RESULTS: We found a total of 55 cases of UCDs in Finland by 2007: 30 cases of ornithine transcarbamylase (OTC) deficiency, 20 of argininosuccinate lyase (ASL) deficiency, 3 of carbamyl phosphate synthetase (CPS-I) deficiency, 1 of type 1 citrullinaemia and 1 of argininaemia. The estimated total incidence of UCDs was 1:39 000. The incidences of individual disorders were: OTC deficiency 1:62 000, ASL deficiency 1:144 000, CPS deficiency 1:539 000 and citrullinaemia 1:1 616 000. Eighteen (33%) of the patients with a diagnosis of UCD have died, most during their first hyperammonaemic crisis. One patient with OTC deficiency has had a liver transplant. Neurological symptoms of varying severity are common among these patients, particularly those with ASL deficiency. CONCLUSION: The first survey on the incidence of UCDs in Finland shows some differences in the occurrence rates compared to other countries. Hyperammonaemia, and the neurological symptoms caused by it, can be avoided in most patients with late-onset UCDs with a standard treatment. However, in patients with ASL deficiency, the development of neurological symptoms seems to be inevitable in spite of careful treatment and avoidance of hyperammonaemia.

Diet does not explain the high prevalence of dyslipidaemia in paediatric renal transplant recipients.

Dyslipidaemia exists frequently after renal transplantation (RTx) and promotes atherosclerosis. In this study, we examined the association between daily intake of nutrients and serum lipids after paediatric RTx. We studied 45 children with acceptably functioning kidney grafts and adequately completed food records at a median age of 10.6 years (range 4.3-17.2 years), a median 5.2 years (range 1.0-11.0) after RTx, and 178 healthy controls at a median age of 9.0 years (range 3.2-18.7 years). Serum total cholesterol (TC), triglyceride, and apolipoprotein B concentrations were higher in the RTx patients than in the controls (P < 0.001), despite similar dietary intakes of saturated and polyunsaturated fats, and cholesterol. Both the RTx patients and controls ingested a low amount of polyunsaturated fats [mean (SD) percent of total calories (E%) 4.8 (1.3) and 4.6 (1.5), respectively] and an excessive amount of saturated fats [mean (SD) E% 14.4 (2.4) and 14.1 (2.8), respectively]. In multiple regression analyses, dietary fibre was negatively associated with serum TC concentration. The standard deviation score for body mass index was negatively associated with serum concentration of high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein diameter, and positively with serum triglyceride concentration. In addition, dietary total fat intake was positively associated with serum HDL-C. In conclusion, the higher prevalence of dyslipidaemia in our paediatric RTx patients than in the controls was not explained by the diet. However, the type of fat consumed implicates the counselling for a healthier dietary lifestyle, with an increase in the ingestion of polyunsaturated fats and a decrease in that of saturated fats.