Hypertension and obesity in Italian school children: The role of diet, lifestyle and family history.

BACKGROUND AND AIMS: In Italy, the prevalence of hypertension, obesity and overweight in paediatric patients has increased in the past years. The purpose of this study was to analyse the relationship between obesity and hypertension and related factors in Italian students. METHODS AND RESULTS: We studied 2007 healthy individuals between the ages of 6 and 17 years of age (998 males and 1009 females) attending schools in the cities of Varese (northern Italy), Rome (central Italy) and Catanzaro (southern Italy). The blood pressure, weight and height of the students were measured. We also assessed their daily intake of foods and the amount of physical activity they performed. A questionnaire was administered to the parents of the subjects to obtain information on the child's medical history and family lifestyle. Of the students, 27.2% were overweight, and 6.6% were obese, with the highest percentages in southern Italy. A total of 6.2% of students had hypertension, and the region with the highest percentage was found to be northern Italy. Obese students had a risk of developing hypertension that was four times greater than those subjects who were of normal weight. CONCLUSION: Overweight and obese children/adolescents were more frequently found in southern Italy as opposed to northern and central Italy, and hypertensive children were more prevalent in the north. An unhealthy diet might explain the more widely spread obesity among children living in the south; an excess use of salt could explain the greater rate of hypertension found among children/adolescents living in the north.

Growth trend during the first six months of life in male infants with different type of feeding.

AIM: The aim of the study was to assess the differences in the growth trend of male infants fed with human milk (HM), formula feeding (FF) and both (HM+FF), focusing the attention on weight increase in the first six months of life. METHODS: We enrolled 146 healthy male infants born from a spontaneous delivery; exclusion criteria were all conditions that required parenteral nutrition; the follow-up visits were at 1, 2, 3, 4, 5, 6 months of life. All infants were subsequently divided into three groups depending on the three feeding type (HM, FF, HM+FF) and then in other three subgroups depending on birth weight and gestational age (A, B, C). RESULTS: The three feeding type groups appeared homogeneous for gestational age and birth weight at every time of follow-up. The weight differences between subgroup A, B, C were not statistically significant, showing a regular growth trends. CONCLUSION: It is possible to assess the nutritional balance and the adequacy in composition of formula. This suggests that, in our population, the possible factors that could influence the rapid weight gain, characterized by a peak in the growth trend profile, do not concern the nutrition during the first six months of life but at most the weaning.

[Donors' personal profile in Tuscany's network of milk banks]. / Il profilo personale delle donatrici nella rete toscana delle banche del latte umano donato.

AIM: An investigation on human milk donors among the milk banks of Tuscany's network was carried out. Milk banks select, collect, check, process, store and deliver human milk, whose donors should have certain physical and psychological well-being features. The aim of the study was to describe a personal and social profile of milk donors. METHODS: The study included a sample of 100 milk donors and a sample of 100 non-milk donor mothers; a questionnaire that collected data about mothers' general information, clinical history, pregnancy and delivery, weight variations, state of health, lifestyle, breastfeeding and knowledge about milk banks was administered to all of them. Then information about food history of mothers has also been collected. RESULTS: First the samples of donors were analysed for all variables considered. Subsequently the samples of donors were compared with the samples of non-donors: statistical analysis was carried out with χ2 test and documented significant differences between donors and non-donors for the majority of variables considered in the questionnaire and for food history. CONCLUSION: Milk donors have a good state of health, and the integration in milk donation initiative headed towards a healthier lifestyle. It is necessary to promote an advertising campaign to integrate social and sanitary politics, fitting to local socio-economical contest. Furthermore, the improvement of milk banks of public hospitals is necessary, as hospitals are places of major stream both of potential donors and newborns.

Causes of accidents in pediatric patients: what has changed through ages.

AIM: Accidents are the main cause of death and disability in children and adolescents aged 1-15 years and cause more than one sixth of all infant admissions to hospital. In Italy, about 400 children and adolescents are involved in domestic accidents and more than 200 in road accidents. The aim of the study was to determine the number and type of accidents involving children and adolescents in the area of Siena and to compare present results with those obtained 20 years ago in order to assess the effectiveness of preventive measures evolving in the period. METHODS: Two groups of patients were admitted to the hospital of Siena for accidents between 1980-1985 and 2000-2006; age, gender, type of accident, frequency distribution in the study period and age of highest frequency of accidents were analysed. RESULTS: The most frequent cause of admission to hospital in the earlier period was limb trauma with and without fracture, whereas in the later period it was head injury without fracture followed by limb trauma with and without fracture, and fracture of the skull, spine and trunk in boys and girls. Some variation in the course of the years was observed in both study period, however a constant, gradual reduction in admissions is evident. CONCLUSION: Comparison of these data with those collected 20 years earlier revealed a general reduction in the number of hospital admissions. This encouraging result suggests that what has been done so far is effective and should be continued, and that it is also worthwhile taking measures to further reduce the toll of accidents.

Asthma and allergy in young athletes in Siena Province. Preliminary results.

AIM: The aim of the study was to assess the prevalence of asthma and related respiratory symptoms in a sample of the Siena pediatric population that engages in sport. METHODS: The subjects were 460 young athletes, age 7-14 years, enrolled in 23 sporting clubs in 10 municipalities of Siena Province. Subjects and their parents answered a questionnaire on life style and the children underwent basal spirometric tests at their respective training centers. RESULTS: A total of 352 questionnaires (76.6%) were returned; 80% of responders performed the spirometric test. The lifetime prevalences of asthma, allergic rhinitis and atopic dermatitis were found to be 17.33%, 22.16% and 11.08%, respectively. About 33.2% of subjects had also experienced symptoms compatible with exercise-induced bronchospasm (EIB) during sport and 4.2% of them had had to stop activity at least once. CONCLUSION: The results suggest that EIB is a major phenomenon in our province and that this disorder interferes with, or even limits, physical activity of young athletes.

A 2.6 Mb deletion of 6q24.3-25.1 in a patient with growth failure, cardiac septal defect, thin upperlip and asymmetric dysmorphic ears.

We report a female patient with neurodevelopmental delay and peculiar facial features. She has postnatal growth failure and an atrial septal defect. Patent duct arteriosis and tricuspidal insufficiency were also noted at birth. Characteristic facial features include medial flare eyebrows, dysmorphic helix of the right ear, cupshaped left ear, anteverted nares, long and smooth philtrum, thin upper lip, high vaulted palate. Array-CGH analysis demonstrated the presence of a 2.6 Mb deletion in 6q24.3-25.1. The phenotypic features of this case are very similar to those previously reported in a patient with a 7Mb overlapping deletion, pointing to a specific new syndrome. Twenty-two genes are present in the common critical deleted region. Among them, there is the PPP1R14C gene that encodes for KEPI, a PKC-potentiated inhibitory protein for type-1 Ser/Thr protein phosphatase. Its selective distribution in brain and heart well correlates with developmental delay and cardiac anomalies observed in the patient.

Pediatricians' advices on timing of solid food introduction: two Italian experiences.

AIM: The aim of the study was to evaluate and compare methods of weaning suggested by pediatricians in two Italian regions with different geographical and cultural characteristics, Tuscany and Apulia. METHODS: Questionnaires were sent to 30 pediatricians, 15 in Tuscany and 15 in Apulia. Questions regarded prevalence and duration of breastfeeding, timing and manner of introducing other foods, and use of commercial baby food or food prepared at home. RESULTS: The pediatricians advised beginning weaning between the 4(th) and the 6th months. In Tuscany, 60% of pediatricians advised breastfeeding for 6 months and 40% for 12 months. In Apulia the same figures were 86.7% and 13.3%. All pediatricians advised differentiated introduction of foods. The percentages of Tuscany pediatricians suggesting late introduction of certain foods were 31.70% for eggs, 19.51% for cow's milk, fish and tomato, 4.87% for vegetables and 2.44% for citrus and gluten. Foods introduced with caution by Apulia pediatricians were egg white (41.37%), gluten (31.03%) and fish (27.58%). The percentages of Tuscany and of Apulia pediatricians recommending home cooked food were 77.7% and 31.21%, respectively; 22.3% and 68.75% respectively recommended commercial baby food. CONCLUSIONS: Pediatricians in both regions are aware of the importance of nutritional quality in the first year of life and provide indications about the timing and manner of introducing foods in line with international scientific guidelines.

Blood pressure in the small-for-gestational age newborn.

AIM: The aim of the paper is to verify the existence of an inverse correlation between birth weight and blood pressure (BP) in neonates, infants and adolescents. METHODS: BP was measured at 7 days, 3, 6, 9, 12 months and 7-18 years in 432 subjects born at term at the Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena; 228 of these subjects were small for gestational age (SGA) and 204 appropriate for gestational age (AGA). For small babies, BP was measured with a DYNAMAP oscillometer which provides digital visualisation of systolic, diastolic and mean arterial pressure and heart rate. In older children, a mercury sphygmomanometer was used. Statistical analysis was carried out with SPSS 8.01 software using the Kolmogorov-Smirnov test for normality of populations. RESULTS: Statistical analysis did not reveal any significant differences between SGA and AGA subjects in the various age classes of the first 12 months of life. Significant correlation was found between 7 and 18 years with differences in the various age classes for systolic pressure. Subjects with normal birthweight had lower systolic and diastolic BP. SGA males had higher risk of high systolic and diastolic pressure, whereas SGA females were only at higher risk for elevated diastolic pressure. CONCLUSIONS: SGA subjects should be monitored for BP and life-style between 7 and 18 years to risk of cardiovascular disease.

Homocystinuria with transverse sinus thrombosis.

A case of cerebral venous thrombosis caused by undiagnosed homocystinuria is reported. The pitfalls regarding the diagnosis of a potentially medically treatable condition are discussed. Cerebral venous thrombosis in children has a variable type of onset and a multiplicity of causes. This type of pathology, although not frequent, is more common than previously thought. Among the different etiologies, undiagnosed homocystinuria is not routinely considered. We report a case of venous thrombosis of the left transverse cerebral sinus in a girl with drug-resistant partial epilepsy and homocystinuria. This diagnosis was considered and confirmed after the appearance of acute cerebral symptoms caused by venous thrombosis.

Biologic monitoring of exposure to organophosphorus pesticides in 195 Italian children.

One hundred ninety-five 6- to 7-year-old children who lived in the municipality of Siena (Tuscany, Italy), underwent biologic monitoring to evaluate urinary excretion of several alkylphosphates that are metabolites of organophosphorus pesticides. We evaluated dimethylphosphate (DMP), dimethylthiophosphate (DMTP), dimethyldithiophosphate (DMDTP), diethylphosphate (DEP), diethylthiophosphate (DETP), and diethyldithiophosphate (DEDTP). We obtained urine samples taken in the children's schools, and each sample was accompanied by a questionnaire about lifestyle and dietary habits. We found DMP and DMTP in detectable concentrations in the greatest number of samples (96 and 94%, respectively). The DMP values were geometric mean (GM) 116.7, [geometric standard deviation (GSD) 2.5], and a range of 7.4-1,471.5 nmol/g creatinine. The corresponding DMTP values were GM 104.3 (GSD 2.8) and a range of 4.0-1,526.0 nmol/g creatinine. DMDTP, DEP, DETP, and DEDTP concentrations were GM 14.1, (GSD 3.0), and a range of 3.3-754.6 nmol/g creatinine in 34% of the children; GM 33.2, (GSD 2.4), and a range of 5.1-360.1 nmol/g creatinine in 75% of the children; GM 16.0, (GSD 2.9), and a range of 3.1-284.7 in 48% of the children; and GM 7.7, (GSD 2.1), and a range of 2.3-140.1 in 12% of the children, respectively. The significant variable for urinary excretion of these metabolites in children was pest control operations performed inside or outside the house in the preceding month; however, the presence of a vegetable garden near the house rarely emerged. The urinary excretion of alkylphosphates in children was significantly higher than in a group of the adult population resident in the same province.

Blood pressure in childhood and adolescence: the Italian normal standards. Study Group on Hypertension' of the Italian Society of Pediatrics'.

OBJECTIVES: To develop a national standard level of blood pressure (BP) for Italian children on the basis of a large sample of the population. DESIGN: We analyzed data available from 21 Italian studies conducted according to the recommendations of the American Task Force between 1988 and 1994. Percentile curves of systolic and diastolic BP were constructed by fitting a third-order polynomial model of BP on age and height using multiple regression analysis. PARTICIPANTS: BP was measured in 11 519 healthy individuals (6258 boys and 5261 girls) aged 5-17 years in various locations throughout Italy. All measurements were performed at school. RESULTS: Percentile curves (5th, 10th, 25th, 50th, 75th, 90th and 95th) of systolic and diastolic BP are reported by age and by height for males and females. CONCLUSIONS: With respect to the American standards, the levels in Italy for the 90th and 95th percentiles were 3-8 mmHg higher for systolic and diastolic BP in both sexes between 5 and 12 years of age, and 2-3 mmHg higher in older males. With respect to Northern Europe, in the lower ages, levels in Italy were quite similar, although slightly higher, whereas in late adolescence, the Northern European levels were much higher, especially in males, with differences of 4-5 mmHg for the mean values and 8-12 mmHg for the 95th percentile.

[Tables of the arterial hypertension in children in Italy (from 0 to 18 years)]. / Le tavole della pressione arteriosa infantile in Italia (da 0 a 18 anni). Gruppo Italiano Ipertensione Infantile.

For the first time in Italy, the results of a multicentre study of the Study Group into Juvenile Hypertension of the Italian Society of Paediatrics in 16.772 subjects from 0 to 18 years, are presented. Percentile charts (tables) of juvenile blood pressure (BP) levels according respectively to age and height of the subjects divided by sex, have been elaborated. Also pressure curves have been calculated and drawn that are based on standard deviations (DS). Normal levels are between + and -2DS. The relationship of BP levels with age permits the comparison with the Task force Tables, whilst the relationship with height permits comparison with the European data.

[Prognostic aspects of esophageal ph-metry in infants with reflux]. / Aspetti prognostici nella pHmetria esofagea del lattante reflussore.

Gastroesophageal reflux (g.e.r.) is a very common event in children particularly in infants. Twenty-four-hour continuous esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. It has a large sensitivity and specificity, but it does not allow a good prediction of esophagitis. The Authors show a computerized method to determine the area under the curve (a.u.c.) and the percentage of time at different pH levels. These parameters have shown the same sensitivity and specificity as DeMeester-Boix-Ochoa score. They directly relate the time of exposure and pH level in every reflux under pH 4 and so they suggest a better prognostic index. To improve this approach to g.e.r. we will need other studies with this method.

[Plasma levels of lipids and apoprotein in a group of middle-school students 11-14 years of age: preliminary data]. / Livelli plasmatici di lipidi e apoproteine in un gruppo di studenti delle scuole medie inferiori di 11-14 anni: dati preliminari.

Plasma lipids and apoprotein A and B levels were measured in 63 children, of both sexes, in the age range 11-14 years. The children have been subjected to a blood drawing after a 12 hour fast at least. Statistical analysis proves that total cholesterol (TC) is positively correlated with triglycerides (TG), HDL cholesterol (HDL) with apolipoproteins A (Apo A), apolipoproteins A (Apo A) with apoproteins B (Apo B). In the end we confirm the utility of determining plasma lipids and apoproteins to estimate lipidic risk for atherosclerosis in pediatric age.