[Pain therapy for children and adolescents with hemophilia : Recommendations by an expert panel]. / Schmerztherapie bei Kindern und Jugendlichen mit Hämophilie : Handlungsempfehlungen einer Expertengruppe.

BACKGROUND: Children and adolescents with severe hemophilia commonly suffer from acute and chronic pain as a consequence of hemophilia-related bleeding. Intervention-related pain also plays a major role. Despite its high prevalence in this patient group, hemophilia-related pain is not always adequately addressed and sufficiently treated. OBJECTIVES: This paper discusses how to improve pain management for children and adolescents (0-18 years) with hemophilia and which specific features in this population should influence decisions in pain management. MATERIALS AND METHODS: An expert panel discussed challenges in pain treatment in children and adolescents with hemophilia. Recommendations are based on evidence and clinical experience. RESULT: Pain management in children with hemophilia needs improvement. Children with hemophilia are at risk of developing chronic pain and of suffering traumatization due to insufficient pain management. Pain therapy can be challenging in these children as both their age and the underlying disease limit the options in particular in pain medication. The expert panel developed recommendations to improve pain management in children with hemophilia.

Arteriovenous shunts as venous access in children with haemophilia.

INTRODUCTION: Venous access is essential in patients with haemophilia for administration of factor concentrates. Peripheral venipuncture may be challenging, particularly in young children or during immune tolerance induction (ITI). Central venous access devices (CVADs) carry a significant risk for complications. An alternative for venous access is peripheral arteriovenous shunts (AVSs), but there is sparse documentation in the literature. The aim of this study was to document our experience with AVS over 12 years in 27 boys with severe haemophilia. METHODS: For AVS creation, a subcutaneous vein is connected end-to-side with an artery at the wrist (Cimino) or at the forearm (Gracz shunt). Factor concentrates were substituted as for intermediate size surgery. To prevent shunt occlusion, heparin (5 units/kg/h) was given during the first 3 days. RESULTS: Indications for AVS creation were prophylaxis start (n = 20) and ITI (n = 7). Age at shunt insertion was median 1.5 years (minimum 8 months; maximum 11.7 years). Shunt maturation was achieved within a median of 3 weeks after surgery (1.5 weeks; 18 weeks). Age when home treatment was established was median 2.1 years (9 months; 11.7 years). Four patients required AVS revisions due to stenosis, but 26 of 27 patients (96%) achieved good long-term shunt function. There were few other complications. CONCLUSION: Arteriovenous shunts provide a good alternative to CVAD and carry a lower risk of complications. AVSs allow earlier start of prophylaxis and home therapy with an improved quality of life for patients and families.

The burden of pneumococcal meningitis in Austrian children between 2001 and 2008.

UNLABELLED: The present study was conducted to evaluate the burden of pneumococcal meningitis in Austrian children between 2001 and 2008. Clinical outcome was retrospectively analyzed both on discharge and on follow-up investigations. This study was based on a prospective multicentre surveillance study on hospitalized invasive pneumococcal infections in Austrian children with a total annual "study population" of about 399,000 children aged below 5 years per year. Between 2001 and 2008, 74 cases of pneumococcal meningitis were identified in children aged below 5 years. The mean annual incidence rate for pneumococcal meningitis was 2.3 per 100,000 children in this age group. In 57/74 children (mean age on admission 14.5 ± 13.3 months), outcome data on hospital discharge were available: 5 deaths (8.8%), 20 children (35.1%) with sequelae and 32 children (56.1%) without sequelae were observed. Sequelae on discharge included motor impairment in 8 children (14.0%), hearing impairment in 9 children (15.8%) and/or other complications in 14 children (24.6%). In 7/8 children with motor deficits, matching cerebral lesions were identified by neuroimaging: cerebral infarction in five children, cerebral vasculitis and cerebral abscess in one child each. In 40/57 children, long-term outcome (18.9 ± 20.2 months after discharge) could be assessed: 1 child (2.5%) died 9 months after hospital discharge, 11 children (27.5%) had one or two long-term sequelae and 28 children (70.0%) had no sequelae. Long-term sequelae included motor impairment in three children (7.5%), hearing impairment in nine children (22.5%) and other deficits in two children (5.0%). CONCLUSION: Our study confirms that pneumococcal meningitis causes high mortality and severe long-term sequelae. On long-term follow-up, we observed improvements of motor impairment, but not of hearing impairment.

Comorbidities in overweight children and adolescents: do we treat them effectively?

OBJECTIVE: The aim was to analyze the effectiveness of treatment concerning obesity-associated comorbidities in clinical practice. METHODS: A total of 11,681 overweight children with ≥ 6-month follow-up treated at 175 centers specialized in pediatric obesity care in Central Europe were included in this analysis (mean body mass index (BMI) 29.0 ± 5.6 kg m(-)(2), standard deviation score body mass index (SDS-BMI) 2.48 ± 0.54, 45% boys, age 11.4 ± 2.8 years). The changes of weight status, blood pressure, fasting lipids and glucose, and oral glucose tolerance tests were documented by standardized prospective quality documentation software (APV). RESULTS: After follow-up of in median 1.2 (interquartile range 0.9-2.2) years, a mean reduction of -0.15 SDS-BMI was achieved. The prevalence of prehypertension (37->33%) and hypertension (17->12%) decreased, while prevalences of triglycerides >150 mg dl(-1) (22->21%), low-density-lipoprotein-cholesterol >130 mg dl(-1) (15->14%), impaired fasting glucose (6->6%) and impaired glucose tolerance (9->8%) remained stable. Drug treatment according to cutoffs recommended in European obesity guidelines were not frequently indicated (hypertension: 10%; dyslipidemia: 1%, type 2 diabetes <1%). None of the children with dyslipidemia received lipid-lowering drugs and only 1.4% of the children with hypertension were treated with antihypertensive drugs. CONCLUSIONS: Achieving sufficient weight loss to improve obesity associated comorbidities was difficult in clinical practice. Drug treatment of hypertension, dyslipidemia and type 2 diabetes was rarely performed even if it was indicated only in a minority of the overweight children. Future analyses should identify reasons for this insufficient drug treatment of comorbidities and analyze whether the benchmarking processes of APV improve medical care of childhood obesity.

Decrease of Lp(a) during weight reduction in obese children is modified by the apo(a) kringle-IV copy number variation.

BACKGROUND: Lipoprotein(a) [Lp(a)] is considered an independent risk factor for cardiovascular disease. Its concentration is mainly determined by the kringle-IV repeat copy number variation (CNV) at the apolipoprotein(a) [apo(a)] locus. OBJECTIVE: We aimed to investigate the immediate effect of weight reduction on plasma Lp(a) levels and its dependency on the apo(a) CNV in obese children. DESIGN: We performed a prospective longitudinal intervention study of a low-fat hypocaloric diet conducted in a 3-week dietary camp for obese children. In all, 140 obese participants (54 boys and 86 girls) with a mean age of 12.5+/-1.6 years and a mean relative body mass index (BMI) before treatment of 165.6+/-24.7% were included. Body weight and plasma levels of Lp(a), lipids, apolipoproteins A-I and B, insulin, and C-reactive protein were determined before the onset and after the end of the intervention. In addition, the number of apo(a) kringle-IV repeats were determined using sodium dodecyl sulfate agarose gel electrophoresis. RESULTS: The mean loss of body weight was 5.0+/-1.3 kg (-6.6%), resulting in a mean decrease of the relative BMI of 6.6%. Blood chemistry revealed significant changes in all parameters, especially in Lp(a), with a decrease from 24.4+/-30.6 to 17.9+/-22.6 mg per 100 ml or -19% (P<0.001). The decrease of Lp(a) levels was higher in the group with low compared with high molecular weight apo(a) phenotypes (-23.9 vs -16.6%). CONCLUSIONS: Weight reduction in obese children is associated with significant changes in Lp(a) levels, especially in subjects with high pre-treatment Lp(a) concentrations. This effect is markedly influenced by the molecular phenotype at the copy-number variable apo(a) locus.

Thrombin generation in haemophilia A patients with factor VIII inhibitors after infusion of recombinant factor VIIa.

BACKGROUND: Development of factor VIII inhibitors is a serious complication in haemophilia A patients. Recombinant factor VIIa (rVIIa) is clinically effective, but its effects on haemostatic system need still to be fully elucidated. MATERIAL AND METHODS: In an open controlled study, we measured thrombin generation (peak thrombin) in venous blood and prothrombin fragment F1 + 2 (F1 + 2) and D-dimer in venous and in shed blood in five haemophilia A patients with inhibitors before and after rVIIa infusion. A total of five healthy individuals who did not receive rVIIa served as controls. RESULTS: At baseline, patients had lower mean (min-max) peak thrombin levels than controls [0.12 (0.0-0.6) vs. 186.9 (116.0-254.4) nM, P = 0.001]. After infusion, peak thrombin levels increased in average to 40.7 (28.3-51.6) nM, which translates into 80.2% (95% CI 65.4-88.6%) lower levels compared to that of controls. Mean (min-max) F1 + 2 levels in venous blood did not differ significantly between patients and controls [160.7 (89.8-331.3) vs. 160.8 (104.4-242.3) pmol L(-1)], but increased in average (min-max) by 39.4% (14.1-58.5%) after infusion. In blood emerging from incisions made to determine the bleeding (shed blood), F1 + 2 levels were lower in patients than controls [1383.3 (906.4-2044.6) vs. 2981.7 (1610.0-4539.6) pmol L(-1); P = 0.04], but were not affected by rVIIa; D-dimer levels were significantly higher in haemophiliacs than in controls and remained unchanged after infusion. CONCLUSIONS: Haemophilia A patients with factor VIII inhibitors have low thrombin generation. After rVIIa, the extent of coagulation activation as measured by levels of F1 + 2 is increased, but thrombin generation is restored to only 20%. Peak thrombin levels could reflect the effects of rVIIa on coagulation mechanisms, and their relevance with regard to the clinical coagulation defect of haemophilia A patients with factor VIII inhibitors might be evaluated.

Decrease of plasma apolipoprotein A-IV during weight reduction in obese adolescents on a low fat diet.

OBJECTIVE: Apolipoprotein (apo) A-IV is an antiatherogenic apolipoprotein, which may be involved in the regulation of food intake. Plasma apoA-IV is elevated in human obesity and apoA-IV polymorphisms have been associated with the extent of obesity. Our aim was to determine the effects of weight loss on plasma apo-IV in obese adolescents and to examine the relation of apoA-IV with the degree of obesity. DESIGN: Longitudinal intervention study of a low fat hypocaloric diet conducted in a dietary camp. SUBJECTS: Two groups of obese adolescents (n=47 and n=29), age: 12.7+/-1.7 and 11.7+/-2.6 y, relative body mass index (RBMI): 168+/-24 and 175+/-34%, respectively. MEASUREMENTS: Plasma total apoA-IV, apoA-I, apoB, plasma distribution of apoA-IV, leptin, lipids, and lipoproteins before and after 3 weeks of weight reduction. RESULTS: Plasma apoA-IV decreased from 11.5+/-4.1 mg/dl before to 6.7+/-2.2 mg/dl after weight reduction in the first group (P<0.001) and to a similar extent in the second group. The relative amount of lipid-free apoA-IV and apoA-IV associated with apoA-I increased slightly, whereas apoA-IV associated with lipoproteins devoid of apoA-I decreased. ApoA-IV levels before and after weight reduction and the changes in plasma apoA-IV did not independently correlate with RBMI, weight loss, or plasma leptin. CONCLUSION: Plasma apoA-IV decreases markedly in overweight adolescents undergoing short-term weight reduction. The decrease is not directly related to the degree of weight loss and the mechanisms underlying this reduction remain to be clarified.

Prevention and treatment of overweight and obesity in children and adolescents.

UNLABELLED: Increasing numbers of obese children and adolescents all over the world demand an investment in the primary and secondary prevention of obesity and overweight in this age group. The goal of preventive measures in children is to avoid the negative short- and long-term health problems associated with obesity. Primary prevention aims at establishing a healthy, active lifestyle and keeping children and adolescents within a range of body weight which is considered to be healthy. Constant availability and affordability of palatable and energy-dense food in the affluent society of the western world demands preventive strategies. Universal or public health prevention seems to be the most suitable form because several other cofactors of morbidity and mortality of affluent societies can also be prevented. However, in most European countries there is a lack of awareness of the necessity of prevention programmes, not only among the general population but also among the medical society. More awareness and consciousness to the problem of obesity must be generated in order to lead to effective therapeutic programmes. For those children and adolescents who are already obese, secondary prevention is mandatory. Therapeutic intervention programmes for the obese aim at long-term weight maintenance and normalisation of body weight and body fat. They have to modify eating and exercise behaviour of the obese child and establish new, healthier behaviour and lifestyle. Treatments programmes must include behavioural components in order to permanently change nutrition and physical exercise of the obese children and adolescents. However, long-term results of treatment programmes in European countries are scarce and the reported results, even of multidisciplinary regimens, are not impressive. CONCLUSION: In most European countries there is an urgent need not only for a growing awareness of the problem of obesity in children and adolescents but also for development of new comprehensive approaches in treating this group.

Relation of plasma leptin to lipoproteins in overweight children undergoing weight reduction.

BACKGROUND: In obese children, plasma leptin is elevated and correlates with the body mass index (BMI). In obese adults, plasma leptin decreases during weight reduction. Since the leptin system changes dynamically in puberty, we asked whether weight reduction in obese adolescents has similar consequences for plasma leptin as in overweight adults. In plasma, a portion of leptin is bound to several as yet uncharacterised proteins. We therefore studied the possible association of leptin with plasma lipoproteins. SUBJECTS AND METHODS: We measured plasma leptin, lipoprotein cholesterol and apolipoproteins (apo) A-I and B in 34 obese children (age 12.5+/-1.9 y, relative BMI 165.0+/-28.1%) before and after three weeks of weight reduction in a dietary camp. Lipoprotein binding of endogenous and exogenously radiolabelled leptin was studied by preparative ultracentrifugation. RESULTS: Plasma leptin was higher in obese children than in normal weight controls and fell from 16.5+/-9.8 ng/ml to 10.0+/-8.6 ng/ml after weight reduction (P < 0.001). In multivariate regression, relative BMI and apoA-I were significant predictors of baseline leptin and accounted for 38% (P = 0.003) and 15% (P = 0.006) of the variance of baseline leptin concentrations in obese children. Only the difference in plasma high-density lipoprotein (HDL)-cholesterol independently predicted the change of plasma leptin that was associated with weight reduction, explaining 29% of the variance of leptin changes (P = 0.0032). A substantial portion of both endogenous and exogenously labelled leptin was recovered with HDL isolated by ultracentrifugation. CONCLUSIONS: We conclude that plasma leptin decreases in overweight children undergoing short term weight reduction. In obese children, plasma apoA-I and HDL-cholesterol are independent predictors of leptin concentrations during weight loss, respectively. In addition, HDLs transport a variable portion of leptin in the circulation.

[Therapy of obesity in childhood and adolescence]. / Therapie der Adipositas im Kindes- und Jugendalter.

Major therapeutic goal of the treatment of childhood obesity is to prevent immediate and long-term adverse health consequences. In obese adults weight loss is always necessary to achieve normal or tolerable weight. During infancy and childhood keeping body weight constant while body height increases can be acceptable. If substantial body weight loss in children and adolescents is mandatory, it is necessary to consider the special physiological peculiarities of the growing organism during weight reduction. The main cornerstones of therapeutic regimens for long-term weight reduction in childhood obesity are: eating behaviour modification resulting in changes in food selection, dietary fat intake and caloric restriction, instruction to increase physical activity in everyday life and guidance to an active life style. Integrated therapeutic programs including these components based on behaviour modification have been shown to be the most successful in long-term effect on body weight. Treatment of obesity is most successful if realistic goals are set, if parental support is strong and if behaviour therapy is provided during the course of treatment to help both child and parent achieve these goals.

The effect of weight reduction on the surface electrocardiogram: a prospective trial in obese children and adolescents.

OBJECTIVE: Controversial data exist on the effect of obesity and weight reduction on surface electrocardiographic parameters. The purpose of this study was to analyze electrocardiograms of obese children in the course of short-term weight reduction. DESIGN: Prospective trial over a period of three weeks with a conventional low calorie diet containing a mean of 525 +/- 109 kcal. SUBJECTS: Thirty-three children, 17 girls and 16 boys with a mean age of 12.2 +/- 1.7 y and an overweight of 25.4-102%, mean 54.2 +/- 15.6%. MEASUREMENTS: Before the onset of therapy and thereafter, body weight, blood chemistry and 12 lead electrocardiographic evaluations were performed. RESULTS: The mean loss of body weight was 5.7 +/- 1.6 kg resulting in a mean decrease in overweight of 13.5 +/- 3.4%. Blood chemistry analyses revealed no significant changes except for cholesterol, triglycerides and uric acid. All electrocardiograms were within normal limits, however, a change in the electrocardiographic pattern was noted after weight loss. Heart rate (84 +/- 14 vs 64 +/- 11 beats per min, P < 0.0001) and QT interval (418 +/- 20 msec vs 391 +/- 22 msec, P < 0.0001) decreased and there was a tendency towards a rightward shift of the frontal plane QRS axis and a leftward shift of the horizontal plane QRS axis. CONCLUSION: Weight reduction in obese children and adolescents is associated with significant changes in the electrocardiographic pattern. These changes may only be detected by intraindividual comparison. Reduction of heart rate and shortening of the QT interval in the course of weight reduction may be of clinical significance by reducing the cardiovascular risk profile, including the risk of potentially fatal arrhythmias in obese subjects.

Effect of daytime on resting energy expenditure and thermic effect of food in obese adolescents.

The aim of this study was to investigate the effect of daytime on resting energy expenditure (REE) and thermic effect of food (TEF), REE and TEF were measured in 11 obese boys (mean age +/- SD 11.9 +/- 1.6 years; body mass index 30.1 +/- 4.0 kg/m2) by indirect calorimetry (SensorMedics 2900) on two consecutive days: early in the morning (7:30 a.m.) on one day and at 12 noon on the other day or vice versa. REE was measured for 30 minutes and TEF for 180 minutes after a 600 kcal liquid meal containing 13% protein, 39% fat and 48% carbohydrates. REE measured in the morning was not statistically different from that measured at noon (2191 +/- 358 vs 2223 +/- 319 kcal/24 hours) and morning values were highly correlated with afternoon values (r2 = 0.805). Therefore we conclude that the effect of daytime is negligible for measurements of REE if the patients are in a postabsorptive state and avoid physical activity and stress 10-12 hours prior to measurements. The thermic effect of food calculated in the morning also was not statistically significantly from values found in the afternoon (8.2 +/- 8.8% in the morning and 6.6 +/- 7.5% in the afternoon). However, because of very high within-patient variability the correlation between morning and afternoon values was weaker than for REE (r2 = 0.289).

Cardiovascular risk factors in obese children in relation to weight and body fat distribution.

To assess the relationship between obesity and body fat distribution with cardiovascular risk factors in children, various measures of obesity and waist-to-hip circumference ratio (WHR) were related to serum lipids, lipoproteins, apolipoproteins, glucose, insulin, uric acid, systolic (SBP) and diastolic blood pressure (DBP). In boys univariate analysis revealed an association of triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB), the ratio ApoAI/ApoB, cholesterol/HDL-C, glucose and insulin to WHR. SBP and DBP and serum uric acid correlated with all measures of obesity [body mass index (BMI), percent overweight, percent body fat, skinfolds], but not with WHR. In girls lipid parameters (triglycerides, LDL-C, HDL-C, HDL2, ApoAI, ApoB) and atherogenic ratios correlated with measures of obesity and WHR. Glucose, insulin, SBP and DBP showed the highest correlation with WHR (r = 0.598, p less than 0.001 and r = 0.713, p less than 0.001). Multivariate analysis in girls revealed a first step dependency of ApoAI, the ratio cholesterol/ApoAI, insulin, SBP and DBP on WHR, triglycerides, HDL-C, LDL-C and the ratio ApoAI/ApoB, a first step dependency on percent body fat mass. In boys triglycerides, ApoB and the ratio ApoAI/ApoB were related to WHR for insulin, SBP and DBP, but a positive association with the WHR was found, explaining 33, 21.8, and 22.6% of the variance. This study demonstrates that cardiovascular risk factors in obese children are related to obesity and body fat distribution. Obese children with predominantly abdominal fat mass show a risk profile that is less favorable than gluteal-femoral fat distribution. Evaluation of body fat distribution in obese children, therefore, may help to identify persons most susceptible to cardiovascular risk in adulthood.

Resting metabolic rate in obese children before, during and after weight loss.

Resting metabolic rate (RMR) and body composition were measured by indirect calorimetry and body impedance analysis in 14 obese children before weight loss, during weight reduction for 3 weeks with a conventional hypocaloric diet (730 kcal/3050 kJ) and 12 months after weight loss. The initial weight reduction (5.8 +/- 1.2 kg) resulted in a decrease in RMR and fat free mass (FFM) of 17 +/- 10 per cent (P less than 0.001) and 3.1 +/- 2.3 kg (P less than 0.001), respectively. Prior to weight loss (r2 = 0.89, P less than 0.001) and after 12 months follow up (r2 = 0.88, P less than 0.001) RMR correlated positively with FFM. Changes in RMR after 3 weeks weight loss and throughout the follow-up were positively correlated with changes in FFM (r2 = 0.29, P less than 0.05 and r2 = 0.90, P less than 0.001). Our data indicate that RMR in obese children considerably decreased during a 3 weeks weight reduction, but no sustained depression of the metabolic rate after 12 months was found.

Inverse relationship between diastolic blood pressure and urinary excretion of potassium in girls aged 8 to 9 years--a preliminary communication.

In order to investigate the association of urinary excretion of sodium and potassium with blood pressure, 72 prepubertal healthy children between 8 and 9 years were investigated in a cross sectional study. We determined anthropometric data, diastolic (DBP), and systolic blood pressure (SBP) and urinary excretion of sodium and potassium in 24-hour urine samples. No relationship was found between urinary sodium or potassium excretion and systolic or diastolic blood pressure, neither with regard to simple, nor multiple regression analysis. However, on simple linear and multiple regression analysis a significant inverse association between the excretion of potassium and diastolic blood pressure (r = -0.53; p less than 0.01 and r = -0.60; p less than 0.001) was observed in girls. From our data we conclude that in normal weight, healthy children urinary excretions of sodium and potassium are not associated with systolic blood pressure. However, a high 24-hour urinary excretion of potassium might be associated with lower diastolic blood pressure in prepubertal girls.

[External stimulus dependence in food intake of obese adolescents: studies using a food dispenser]. / Erhöhte Aussenreizabhängigkeit bei der Nahrungsaufnahme übergewichtiger Jugendlicher: Untersuchungen mit dem Food-dispenser.

According to the theories of Schachter concerning the external response of obese adults, which have been confirmed by Jung, Pudel and Nisbett, we tested these theories in obese adolescents. Eating behaviour of 16 grossly obese adolescents (8 males, 8 females, mean age 13.2 +/- 0.3 years, mean relative body weight 124 +/- 2%; mean +/- SD) and 16 normal weight age-matched adolescents (8 males, 8 females, mean age 13.4 +/- 0.2 years, mean relative body weight 97 +/- 3%) were investigated under four different test situations. 1. drinking test with vanilla-mix (790 kcal/l) 2. drinking test with vanilla-mix (1090 kcal/l) 3. drinking test with visual illusion 4. drinking test during a stress situation No significant differences were found between obese and normal weight concerning the absolute amounts of vanilla-mix consumed nor in total energy intake. However, differences in test 1, 3, and 4 concerning the amounts estimated prior and after the tests. Compared with the first drinking test in test 2, 3, and 4 the obese probands consumed significantly more vanilla-mix and total calories than the lean. In bicycle-ergometry the obese revealed significantly lower exercise values (p less than 0.02) than the normal weight probands. Furthermore, the obese adolescents showed a massive discrepancy between the subjective working ability and the objective measurement of the individual pulse rate. In our tests we could demonstrate that obese adolescents are more sensitive to external stimuli than normal weight. The theory of higher responsiveness of obese to external stimuli therefore is also valid for obese adolescents.

[Cholesterol, triglycerides and lipoproteins in the serum of healthy, normal weight children between 6 and 12 years of age]. / Cholesterin, Triglyceride und Lipoproteine im Serum gesunder, normalgewichtiger Kinder im Alter zwischen 6 und 12 Jahren.

Serum cholesterol, triglycerides and lipoproteins were investigated in 276 healthy, prepubertal children and adolescents of normal weight aged 6 to 12 years. The results were evaluated on the basis of the guidelines of the Austrian Cholesterol Consensus Conference 1988 and according to the 90th and 95th percentiles of the Lipid Research Clinics (LRC) data. A relatively high percentage of the probands revealed cholesterol concentrations which could be classified as "risk" (50% of the female and 53% male probands) or "high risk" (39% of the girls and 25% of the boys). Classifying the cholesterol data according to the LRC criteria 46% of the girls and 41% of the boys exceeded these "cut off" values of the 90th percentile. Our data show that the mean serum cholesterol concentrations in healthy children and adolescents of normal weight--like in other European countries--are in a region concomitant with the category in adults which is associated with an increased risk for cardiovascular diseases. We assume that apart from genetic factors a high fat intake might play a predominant role in causing these raised levels.