Caesarean section and childhood obesity at age 3 years derived from the Japan Environment and Children's Study.

Caesarean section (CS) birth is widely reported to be a risk factor for childhood obesity. Although susceptibility to childhood obesity is influenced by race and ethnicity, it is unclear whether this risk of childhood obesity with CS birth also applies in the Japanese population. We investigated the impact of CS birth on obesity at 3 years of age in Japanese children. We obtained data from 60,769 mother-toddler pairs in the Japan Environment and Children's Study, a large-scale birth cohort study. Obesity was determined by body mass index measured at 3 years of age. Analysis revealed that 11,241 toddlers (18.5%) had a CS birth and that 4912 toddlers (8.1%) were obese. The adjusted risk ratio for obesity at 3 years of age when born by CS compared with vaginal delivery, estimated using inverse probability of treatment weighting, was 1.16 (95% confidence interval 1.08-1.25). These results suggest that CS birth modestly increases the risk of obesity at 3 years of age in Japanese children.

Glucokinase maturity-onset diabetes of the young as a mimicker of stress hyperglycemia: a case report.

Febrile seizures are frequently accompanied by stress-induced hyperglycemia. Herein, we report the case of a 1.5-yr-old girl with hyperglycemia during febrile seizures who was subsequently diagnosed with glucokinase (GCK) maturity-onset diabetes of the young (MODY), considering its distinction from stress hyperglycemia. Following the development of febrile seizures owing to adenovirus infection, the patient presented a casual blood glucose level was 185 mg/dL. She had a multigenerational family history of diabetes and a hemoglobin A1c (HbA1c) level of 6.4%. Owing to the persistent glucose intolerance until the age of 5 years, genetic testing was performed, which revealed a heterozygous mutation in GCK, and the patient was diagnosed with GCK-MODY. Precise diagnosis of GCK-MODY individuals is important to avoid administering unnecessary antidiabetic medications. Even during hyperglycemia under stress, multigenerational diabetes and mildly elevated HbA1c levels can suggest GCK-MODY.

Longitudinal study on the effectiveness of vitamin D supplements in exclusively breast-fed infants.

Vitamin D deficiency is a common health problem in infancy. Breast-fed infants are at a higher risk of rickets than formula-fed infants. We observed fluctuations in vitamin D levels in infancy (phase I, 2009-2010) and considered the benefits of vitamin D supplementation specifically in exclusively breast-fed infants in Japan (phase II, 2015). Infants born at our hospital were enrolled in this study. In phase I, we measured 25-hydroxyvitamin D [25(OH)D] levels at 1- to 6-mo intervals from birth. In phase II, we measured 25(OH)D levels before and after supplementation. Vitamin D deficiency was defined as 25(OH)D levels of < 20 ng/mL. All 38 infants in phase I were deficient at birth, and none of the exclusively breast-fed infants achieved 25(OH)D sufficiency by 5 mo of age. Formula-fed infants achieved 25(OH)D sufficiency earlier. The majority of the 71 infants in phase II were deficient at birth. We recommended an oral vitamin D supplement at a daily dose of 4.0 µg for the 15 exclusively breast-fed infants, starting at 1 mo of age; 14 (93.3%) of them achieved 25(OH)D sufficiency by 5 months of age. Exclusively breast-fed infants are at a high risk of vitamin D deficiency; adequate supplementation is an effective preventative strategy.