RESUMO
OBJECTIVES: Inherited amino-acid metabolism disorders (IAAMDs) require lifelong protein-restricted diet. We aimed to investigate: 1/ whether IAAMDs was associated with growth, pubertal, bone mineral apparent density (BMAD) or body composition impairments; 2/ associations linking height, amino-acid mixture (AAM), plasma amino-acids and IGF1 concentrations. DESIGN: Retrospective longitudinal study of 213 patients with neonatal-onset urea cycle disorders (UCD,n = 77), organic aciduria (OA,n = 89), maple syrup urine disease (MSUD,n = 34), or tyrosinaemia type 1 (n = 13). METHODS: We collected growth parameters, pubertal status, BMAD, body composition, protein-intake, and IGF1 throughout growth. RESULTS: Overall final height (n = 69) was below target height (TH): -0.9(1.4) vs. -0.1(0.9) SD, p < 0.001. Final height was ≤ TH-2SD in 12 (21%) patients. Height ≤ - 2SD was more frequent during puberty than during early-infancy and pre-puberty: 23.5% vs. 6.9%, p = 0.002; and vs. 10.7%, p < 0.001. Pubertal delay was frequent (26.7%). Height (SD) was positively associated with isoleucine concentration: ß, 0.008; 95%CI, 0.003 to 0.012; p = 0.001. In the pubertal subgroup, height (SD) was lower in patients with vs. without AAM supplementation: -1.22 (1.40) vs. -0.63 (1.46) (p = 0.02). In OA, height and median (IQR) isoleucine and valine concentrations(µmol/L) during puberty were lower in patients with vs. without AAM supplementation: -1.75 (1.30) vs. -0.33 (1.55) SD, p < 0.001; and 40 (23) vs. 60 (25) (p = 0.02) and 138 (92) vs. 191 (63) (p = 0.01), respectively. No correlation was found with IGF1. Lean-mass index was lower than fat-mass index: -2.03 (1.15) vs. -0.44 (0.89), p < 0.001. CONCLUSIONS: In IAAMDs, growth retardation worsened during puberty which was delayed in all disease subgroups. Height seems linked to the disease, AAM composition and lower isoleucine concentration, independently of the GH-IGF1 pathway. We recommend close monitoring of diet during puberty.
Assuntos
Erros Inatos do Metabolismo dos Aminoácidos , Doença da Urina de Xarope de Bordo , Recém-Nascido , Humanos , Estudos Longitudinais , Estudos Retrospectivos , Isoleucina , Transtornos do Crescimento , Erros Inatos do Metabolismo dos Aminoácidos/genética , Aminoácidos , EstaturaRESUMO
Mutations in the LPIN1 gene constitute a major cause of severe rhabdomyolysis (RM). The TLR9 activation prompted us to treat patients with corticosteroids in acute conditions. In patients with LPIN1 mutations, RM and at-risk situations that can trigger RM have been treated in a uniform manner. Since 2015, these patients have also received intravenous corticosteroids. We retrospectively compared data on hospital stays by corticosteroid-treated patients vs. patients not treated with corticosteroids. Nineteen patients were hospitalized. The median number of admissions per patient was 21 overall and did not differ when comparing the 10 corticosteroid-treated patients with the 9 patients not treated with corticosteroids. Four patients in the non-corticosteroid group died during a RM (mean age at death: 5.6 years). There were no deaths in the corticosteroid group. The two groups did not differ significantly in the number of RM episodes. However, for the six patients who had RM and occasionally been treated with corticosteroids, the median number of RM episodes was significantly lower when intravenous steroids had been administered. The peak plasma creatine kinase level and the area under the curve were or tended to be higher in patients treated with corticosteroids-even after the exclusion of deceased patients or focusing on the period after 2015. The median length of stay (10 days overall) was significantly longer for corticosteroid-treated patients but was similar after the exclusion of deceased patients. The absence of deaths and the higher severity of RM observed among corticosteroid-treated patients could suggest that corticotherapy is associated with greater survival.
Assuntos
Rabdomiólise , Humanos , Pré-Escolar , Estudos Retrospectivos , Rabdomiólise/tratamento farmacológico , Rabdomiólise/induzido quimicamente , Glucocorticoides , Doença Aguda , Fosfatidato Fosfatase/genéticaRESUMO
BACKGROUND: The Mediterranean diet (MD) has known health benefits, but its specific impact on allergy development is unclear. As part of the PARIS birth cohort follow-up, we aimed to investigate the adherence of 8-year-old children to the MD and its association with allergic/respiratory morbidity at school age. METHODS: Diet was assessed using a food frequency questionnaire completed by the parents. Adherence to the MD was assessed based on two scores: the KIDMED index and the Mediterranean Diet Score (MDS). Current allergic diseases (asthma, rhinitis, eczema), lung function indices (FEV1 and FVC), FeNO and specific IgE levels were determined during a health check-up at 8 years. Associations between levels of adherence to the MD and respiratory/allergic morbidity were studied using multivariable logistic and linear regression models adjusted for potential confounders. RESULTS: A total of 975 children were included in the present study, 35.6% with low adherence to the MD, 55.7% with moderate adherence and 8.7% with high adherence according to the KIDMED index. High family socioeconomic status, any breastfeeding at 6 months and consumption of organic food were associated with higher adherence to the MD. Compared with low adherence, high adherence was associated with lower risk of asthma and sensitization at 8 years, as well as higher FEV1 and FVC. CONCLUSION: This study suggests a protective effect of high adherence to the MD on allergic and respiratory morbidity at school age. These results need to be confirmed by further longitudinal analyses. A healthy diet may prevent allergic and respiratory morbidity in school-aged children.
Assuntos
Asma , Dieta Mediterrânea , Asma/epidemiologia , Criança , Feminino , Humanos , Pulmão , Instituições Acadêmicas , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Associations between early traffic-related air pollution (TRAP) exposure and respiratory and allergic morbidity in adolescents are inconsistent. However, sub-groups might be more vulnerable to the health effects of this exposure. OBJECTIVES: We investigated associations between early exposure to TRAP and respiratory and allergic morbidity at age 13 years in the PARIS birth cohort, and potential modifying effects of sex, parental allergy, stressful family event and lower respiratory tract infections (LRTI). METHODS: This study deals with data from 732 children of the PARIS birth cohort followed up using repeated questionnaires until 13 years of age. Prenatal TRAP exposure was assessed by measuring daily concentrations of nitrogen dioxide at the nearest station to mother's home. Early postnatal TRAP exposure was calculated for each child during the first year of life by a nitrogen oxides (NOx) air dispersion model taking into account both residence and daycare. Associations between TRAP exposures and asthma, rhinitis and related symptoms were assessed using multivariable logistic regression models adjusted for potential confounding factors. Effect modification was explored by testing multiplicative interactions. RESULTS: An increase in interquartile range (17.0 µg/m3) of early postnatal NOx exposure was positively related to current asthma (adjusted odds ratio aOR = 1.21; 95% confidence interval CI: 1.02, 1.43), severe wheeze (aOR = 1.23; 95% CI: 1.02, 1.47) and persistent asthma at 13 years old (aOR = 1.26; 95% CI: 1.03, 1.55) and tended to be associated with asthma ever. Parental history of allergy, asthma, early stressful family event and LRTI modified these associations with TRAP exposure. No relationship with rhinitis was found. Prenatal TRAP exposure did not show any association with respiratory and allergic morbidity. DISCUSSION: This study is one of the first to show several modifiers of the association between early postnatal TRAP exposure and asthma at adolescence. Not all adolescents seem equally affected by early postnatal TRAP exposure: those presenting parental history of allergy, especially asthma, those with early stressful family event or LRTI appear to be more vulnerable.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , Asma , Poluição Relacionada com o Tráfego , Adolescente , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Asma/induzido quimicamente , Asma/epidemiologia , Criança , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Poluição Relacionada com o Tráfego/efeitos adversosRESUMO
Previous studies have related early postnatal growth with later lung function but their interpretation is limited by the methods used to assess a child's growth. We aimed to assess the association of early childhood growth, measured by body mass index (BMI) trajectories up to 4â years, with lung function at 7â years.We included 1257 children from the Spanish Infancia y Medio Ambiente population-based birth cohort. Early childhood growth was classified into five categories based on BMI trajectories up to 4â years previously identified using latent class growth analysis. These trajectories differed in birth size ("lower", "average", "higher") and in BMI gain velocity ("slower", "accelerated"). We related these trajectories to lung function (forced expiratory volume in 1â s (FEV1), forced vital capacity (FVC), FEV1/FVC and forced expiratory flow at 25%-75% of FVC (FEF25-75%)) at 7â years, using multivariable mixed regression.Compared to children with average birth size and slower BMI gain (reference), children with higher birth size and accelerated BMI gain had a higher FVC % pred (3.3%, 95% CI 1.0%-5.6%) and a lower FEV1/FVC % pred (-1.5%, 95% CI -2.9%--0.1%) at 7â years. Similar associations were observed for children with lower birth size and accelerated BMI gain. Children with lower birth size and slower BMI gain had lower FVC % pred at 7â years. No association was found for FEF25-75%Independently of birth size, children with accelerated BMI gain in early childhood had higher lung function at 7â years but showed airflow limitation. Children with lower birth size and slower BMI gain in early childhood had lower lung function at 7â years.
Assuntos
Pulmão , Criança , Pré-Escolar , Volume Expiratório Forçado , Humanos , Estudos Prospectivos , Testes de Função Respiratória , Capacidade VitalRESUMO
PURPOSE: We aimed to identify prognostic factors for survival and long-term intellectual and developmental outcome in neonatal patients with early-onset urea cycle disorders (UCD) experiencing hyperammonaemic coma. METHODS: We retrospectively analysed ammonia (NH3) and glutamine levels, electroencephalogram and brain images obtained during neonatal coma of UCD patients born between 1995 and 2011 and managed at a single centre and correlated them to survival and intellectual and developmental outcome. RESULTS: We included 38 neonates suffering from deficiencies of argininosuccinate synthetase (ASSD, N = 12), ornithine transcarbamylase (OTCD, N = 10), carbamoylphosphate synthetase 1 (CPSD, N = 7), argininosuccinate lyase (ASLD, N = 7), N-acetylglutamate synthase (NAGS, N = 1) or arginase (ARGD, N = 1). Symptoms occurred earlier in mitochondrial than in cytosolic UCD. Sixty-eight percent of patients survived, with a mean (standard deviation-SD) follow-up of 10.4 (5.3) years. Mortality was mostly observed in OTCD (N = 7/10) and CPSD (N = 4/7) patients. Plasma NH3 level during the neonatal period, expressed as area under the curve, but not glutamine level was associated with mortality (p = .044 and p = .610). 62.1% of the patients had normal intellectual and developmental outcome. Intellectual and developmental outcome tended to correlate with UCD subtype (p = .052). No difference in plasma NH3 or glutamine level during the neonatal period among developmental outcomes was identified. EEG severity was linked to UCD subtypes (p = .004), ammonia levels (p = .037), duration of coma (p = .043), and mortality during the neonatal period (p = .020). Status epilepticus was recorded in 6 patients, 3 of whom died neonatally, 1 developed a severe intellectual disability while the 2 last patients had a normal development. CONCLUSION: UCD subtypes differed by survival rate, intellectual and developmental outcome and EEG features in the neonatal period. Hyperammonaemia expressed as area under the curve was associated with survival but not with intellectual and developmental outcome whereas glutamine was not associated with one of these outcomes. Prognostic value of video-EEG monitoring and the association between status epilepticus and mortality should be assessed in neonatal hyperammonaemic coma in further studies.
Assuntos
Argininossuccinato Sintase/metabolismo , Carbamoil-Fosfato Sintase (Amônia)/metabolismo , Deficiências do Desenvolvimento/epidemiologia , Mortalidade Infantil/tendências , Deficiência Intelectual/epidemiologia , Ornitina Carbamoiltransferase/metabolismo , Distúrbios Congênitos do Ciclo da Ureia/mortalidade , Idade de Início , Amônia/sangue , Deficiências do Desenvolvimento/enzimologia , Deficiências do Desenvolvimento/patologia , Feminino , França/epidemiologia , Humanos , Lactente , Recém-Nascido , Deficiência Intelectual/enzimologia , Deficiência Intelectual/patologia , Masculino , Estudos Retrospectivos , Distúrbios Congênitos do Ciclo da Ureia/enzimologia , Distúrbios Congênitos do Ciclo da Ureia/patologiaRESUMO
Rationale: Body composition changes throughout life may explain the inconsistent associations reported between body mass index and lung function in children. Objectives: To assess the associations of body weight and composition trajectories from 7 to 15 years with lung function at 15 years and lung function growth between 8 and 15 years. Methods: Sex-specific body mass index, lean body mass index, and fat mass index trajectories were developed using Group-Based Trajectory Modeling on data collected at least twice between 7 and 15 years from 6,964 children (49% boys) in the UK Avon Longitudinal Study of Parents and Children birth cohort. Associations of these trajectories with post-bronchodilation lung function parameters at 15 years and with lung function growth rates from 8 to 15 years were assessed using multivariable linear regression models, stratified by sex, in a subgroup with lung function data (n = 3,575). Measurements and Main Results: For all body mass measures we identified parallel trajectories that increased with age. There was no consistent evidence of an association between the body mass index trajectories and lung function measures. Higher lean body mass index trajectories were associated with higher levels and growth rates of FVC, FEV1, and forced expiratory flow, midexpiratory phase in both sexes (e.g., boys in the highest lean body mass index trajectory had on average a 0.62 L [95% confidence interval, 0.44-0.79; P trend < 0.0001] higher FVC at 15 yr than boys in the lowest trajectory). Increasing fat mass index trajectories were associated with lower levels and growth rates of FEV1 and forced expiratory flow, midexpiratory phase only in boys and lower levels of FEV1/FVC in both sexes. Conclusions: Higher lean body mass during childhood and adolescence is consistently associated with higher lung function at 15 years in both sexes, whereas higher fat mass is associated with lower levels of only some lung function parameters.
Assuntos
Composição Corporal , Trajetória do Peso do Corpo , Pulmão/fisiologia , Tecido Adiposo , Adolescente , Índice de Massa Corporal , Criança , Feminino , Volume Expiratório Forçado , Humanos , Modelos Lineares , Estudos Longitudinais , Pulmão/fisiopatologia , Masculino , Fluxo Máximo Médio Expiratório , Análise Multivariada , Reino Unido , Capacidade VitalRESUMO
Propionic acidemia is the result of a deficiency in propionyl-CoA carboxylase activity. Chronic neurologic and cognitive complications frequently occur, but the psychiatric evolution of the disorder is not well documented. We conducted a pedopsychiatric evaluation of 19 children, adolescents and young adults, aged between 2 and 25 years, using ADI-R, CARS-T, as well as ADOS when autism spectrum disorder was suspected. Previous psychometric examinations were also taken into consideration. Thirteen patients had an IQ < 80. Two patients presented with autism and two additional patients with other autism spectrum disorders. Five patients did not fulfill diagnostic criteria for autism spectrum disorder but showed difficulties indicative of a broader autism phenotype (BAP). Four other patients had severe anxiety manifestations related to their disease. Two patients presented with acute psychotic episodes. The number of decompensations in the first 3 years of life was lower in patients with autism spectrum disorder or related symptoms. These patients were also older when they were assessed (median age of 15 years old versus 11 years old). There was no significant correlation between 3-hydroxypropionate levels during the first 6 years of life and autism spectrum disorder diagnosis. In conclusion, autism spectrum disorder is frequent in patients with propionic acidemia. These patients should undergo in-depth psychiatric evaluation and be screened for autism spectrum disorder. Further studies are needed to understand the underlying mechanisms.
Assuntos
Transtorno do Espectro Autista/diagnóstico , Acidemia Propiônica/diagnóstico , Adolescente , Adulto , Transtorno do Espectro Autista/genética , Criança , Pré-Escolar , Feminino , Humanos , Deficiência Intelectual/etiologia , Ácido Láctico/análogos & derivados , Ácido Láctico/metabolismo , Masculino , Metilmalonil-CoA Descarboxilase/genética , Acidemia Propiônica/genética , Adulto JovemRESUMO
A considerable proportion of European adults report little or no interest in physical activity. Identifying individual-level and environmental-level characteristics of these individuals can help designing effective interventions and policies to promote physical activity. This cross-sectional study additionally explored associations between level of interest and physical activity, after controlling for other individual and environmental variables. Measures of objective and perceived features of the physical environment of residence, self-reported physical activity and other lifestyle behaviors, barriers towards physical activity, general health, and demographics were obtained from 5205 European adults participating in the 2014 online SPOTLIGHT survey. t-Tests, chi-square tests, and generalized estimating equations with negative binomial log-link function were conducted. Adults not interested in physical activity reported a higher BMI and a lower self-rated health, were less educated, and to a smaller extent female and less frequently employed. They were more prone to have less healthy eating habits, and to perceive more barriers towards physical activity. Only minor differences were observed in environmental attributes: the non-interested were slightly more likely to live in neighborhoods objectively characterized as less aesthetic and containing more destinations, and perceived as less functional, safe, and aesthetic. Even after controlling for other individual and environmental factors, interest in physical activity remained a significant correlate of physical activity, supporting the importance of this association. This study is among the first to describe characteristics of individuals with reduced interest in physical activity, suggesting that (lack of) interest is a robust correlate of physical activity in several personal and environmental conditions.
Assuntos
Exercício Físico/psicologia , Estilo de Vida , Motivação , Características de Residência , Índice de Massa Corporal , Estudos Transversais , Europa (Continente) , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários , População BrancaRESUMO
BACKGROUND: Maple syrup urine disease (MSUD) is a rare disease that requires a protein-restricted diet for successful management. Little is known, however, about the psychosocial outcome of MSUD patients. This study investigates the relationship between metabolic and clinical parameters and psychosocial outcomes in a cohort of patients with neonatal-onset MSUD. METHODS: Data on academic achievement, psychological care, family involvement, and biochemical parameters were collected from the medical records of neonatal MSUD patients treated at Necker Hospital (Paris) between 1964 and 2013. RESULTS: Thirty-five MSUD patients with a mean age of 16.3 (2.1-49.0) years participated. Metabolic decompensations (plasma leucine >380 µmol/L) were more frequent during the first year of life and after 15 years, mainly due to infection and dietary noncompliance, respectively. Leucine levels increased significantly in adulthood: 61.5% of adults were independent and achieved adequate social and professional integration; 56% needed occasional or sustained psychological or psychiatric care (8/19, with externalizing, mood, emotional, and anxiety disorders being the most common). Patients needing psychiatric care were significantly older [mean and standard deviation (SD) 22.6 (7.7) years] than patients needing only psychological follow-up [mean (SD) 14.3 (8.9) years]. Patients with psychological follow-up experienced the highest lifetime number of decompensations; 45% of families had difficulty coping with the chronic disease. Parental involvement was negatively associated with the number of lifetime decompensations. CONCLUSION: Adults had increased levels of plasma leucine, consistent with greater chronic toxicity. Psychological care was associated with age and number of decompensations. In addition, parental involvement appeared to be crucial in the management of MSUD patients.
Assuntos
Doença da Urina de Xarope de Bordo/metabolismo , Doença da Urina de Xarope de Bordo/psicologia , Adolescente , Adulto , Criança , Pré-Escolar , Dieta com Restrição de Proteínas/métodos , Feminino , Seguimentos , Humanos , Leucina/sangue , Masculino , Doença da Urina de Xarope de Bordo/sangue , Pessoa de Meia-Idade , Doenças Raras/sangue , Doenças Raras/metabolismo , Doenças Raras/psicologia , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Obesity-related lifestyle behaviors usually co-exist but few studies have examined their simultaneous relation with body weight. This study aimed to identify the hierarchy of lifestyle-related behaviors associated with being overweight in adults, and to examine subgroups so identified. METHODS: Data were obtained from a cross-sectional survey conducted across 60 urban neighborhoods in 5 European urban regions between February and September 2014. Data on socio-demographics, physical activity, sedentary behaviors, eating habits, smoking, alcohol consumption, and sleep duration were collected by questionnaire. Participants also reported their weight and height. A recursive partitioning tree approach (CART) was applied to identify both main correlates of overweight and lifestyle subgroups. RESULTS: In 5295 adults, mean (SD) body mass index (BMI) was 25.2 (4.5) kg/m2, and 46.0 % were overweight (BMI ≥25 kg/m2). CART analysis showed that among all lifestyle-related behaviors examined, the first identified correlate was sitting time while watching television, followed by smoking status. Different combinations of lifestyle-related behaviors (prolonged daily television viewing, former smoking, short sleep, lower vegetable consumption, and lower physical activity) were associated with a higher likelihood of being overweight, revealing 10 subgroups. Members of four subgroups with overweight prevalence >50 % were mainly males, older adults, with lower education, and living in greener neighborhoods with low residential density. CONCLUSION: Sedentary behavior while watching television was identified as the most important correlate of being overweight. Delineating the hierarchy of correlates provides a better understanding of lifestyle-related behavior combinations which may assist in targeting preventative strategies aimed at tackling obesity.
Assuntos
Exercício Físico , Obesidade/etiologia , Comportamento Sedentário , Televisão , Adulto , Idoso , Índice de Massa Corporal , Estudos Transversais , Dieta , Europa (Continente)/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Sono , Fumar , Fatores Socioeconômicos , População Urbana , Adulto JovemRESUMO
BACKGROUND: Sedentary behaviour has been associated with obesity and related chronic diseases. Disentangling the nature of this association is complicated due to interactions with other lifestyle factors, such as dietary habits, yet limited research has investigated the relation between domain-specific sedentary behaviours and dietary habits in adults. The aim of this paper was to examine the association between domain-specific sedentary behaviours and dietary habits in adults and to test the moderating effect of age and gender on this association. METHODS: A total of 6,037 participants from five urban regions in Europe completed an online survey, of which 6,001 were included in the analyses. Multilevel mixed-effects logistic regression analyses were used to examine main associations and interaction effects. RESULTS: All domain-specific sedentary behaviours, except transport-related sitting time, were significantly related to dietary habits. In general, having a higher sitting time was related to having less healthy dietary habits, especially for television viewing. Gender did not moderate any of the relations, and age was only a significant moderator in the relation between other leisure sitting time and alcohol consumption. CONCLUSION: Domain-specific sitting behaviours were related to unhealthy dietary behaviours. However, the small effect sizes suggest that individual level behavioural interventions focusing on sedentary behaviour will not be sufficient to improve dietary habits. The fact that almost none of the associations were moderated by age or gender suggests that these associations, and possibly also the effects of interventions targeting both behaviours, may hold across age and gender groups.
Assuntos
Dieta/normas , Comportamento Alimentar , Comportamento Sedentário , Adulto , Fatores Etários , Idoso , Estudos Transversais , Metabolismo Energético , Europa (Continente) , Exercício Físico , Feminino , Humanos , Atividades de Lazer , Masculino , Pessoa de Meia-Idade , Obesidade/etiologia , Postura , Fatores Sexuais , Inquéritos e Questionários , Televisão , TrabalhoRESUMO
Although formaldehyde is a common indoor pollutant, its impact on respiratory symptoms in childhood remains unclear. The aim of this study was to examine the relation between domestic formaldehyde exposure and occurrence of coughing, one of the most prevalent respiratory symptoms during the first year of life of infants from the PARIS birth cohort involving 3840 healthy full-term babies. The presence of respiratory symptoms, including dry cough at night apart from a cold or chest infection in the past 12 months was reported on a standardized health questionnaire. Formaldehyde exposure was estimated for all infants using a predictive model established from data (both repeated measurements and information about determinants of levels) collected in a random sample of infants from the cohort. An unconditional logistic regression was fitted to study the relation between annual domestic formaldehyde exposure and dry cough at night, adjusting for all potential risk factors/confounders. The prevalence of dry cough at night was 14.9%. Parental history of allergy was found to modify the relation between environmental factors and dry cough. Cockroaches, used mattresses, and family stressor events were associated with dry cough in infants with parental allergy history. Conversely, domestic formaldehyde exposure tended to increase occurrence of dry cough at night only among babies without parental history of allergy (adjusted OR per 10 µg/m(3) increase in levels, single imputation approach: 1.45, 95% CI: 1.08-1.96, and Bayesian approach: 1.12, 0.91-1.36). This study suggests that the impact of indoor environmental exposure on dry cough at night in infancy is different depending on the presence or not of parental history of allergy.
Assuntos
Tosse/epidemiologia , Formaldeído/efeitos adversos , Substâncias Perigosas/efeitos adversos , Hipersensibilidade/epidemiologia , Adulto , Tosse/etiologia , Feminino , Humanos , Lactente , Estilo de Vida , Masculino , Pais , Paris/epidemiologia , PrevalênciaRESUMO
There is growing public health concern about indoor air quality. Tetrachloroethylene (PERC), a chlorinated volatile organic compound widely used as a solvent in dry cleaning facilities, can be a residential indoor air pollutant. As part of an environmental investigation included in the PARIS (Pollution and asthma Risk: an Infant Study) birth cohort, this study firstly aimed to document domestic PERC levels, and then to identify the factors influencing these levels using standardized questionnaires about housing characteristics and living conditions. Air samples were collected in the child's bedroom over one week using passive devices when infants were 1, 6, 9, and 12 months. PERC was identified and quantified by gas chromatography/mass spectrometry. PERC annual domestic level was calculated by averaging seasonal levels. PERC was omnipresent indoors, annual levels ranged from 0.6 to 124.2 µg/m3. Multivariate linear and logistic regression models showed that proximity to dry cleaning facilities, do-it-yourself activities (e.g.: photographic development, silverware), presence of air vents, and building construction date (<1945) were responsible for higher domestic levels of PERC. This study, conducted in an urban context, provides helpful information on PERC contamination in dwellings, and identifies parameters influencing this contamination.
Assuntos
Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Tricloroetileno/análise , Poluição do Ar em Ambientes Fechados/análise , Estudos de Coortes , Habitação/estatística & dados numéricos , Humanos , Lactente , Lavanderia , ParisRESUMO
BACKGROUND: Adolescents may not all have reacted similarly to the COVID-19 lockdown. This study aimed to identify subgroups of perceptions in adolescents from the PARIS cohort during the first French lockdown, and to investigate whether adolescent behaviors differed according to these subgroups. METHODS: Online questionnaires were sent to 1,549 PARIS adolescents aged 13-17 years who reported on possible infection with SARS-CoV-2, their perceptions, and behaviors during lockdown. Ascending hierarchical clustering was performed on the perception variables. Associations of behaviors with perception clusters were analyzed using multivariable multinomial logistic regression. RESULTS: Three perception clusters were identified among 791 adolescents (response rate 51%). One cluster "happy" (39%) had good mental health and did not feel stressed during lockdown. Another cluster "unhappy" (19%) was mainly unhappy, felt stressed, suffered from overcrowded living conditions, and experienced deteriorating relationships with family members. A further cluster "intermediate" (42%) experienced moderate well-being and stress, felt more supported by family, and worried about the health of their relatives. Compared with the "happy" cluster, the unhappy adolescents were more affected by COVID-19, had difficulty doing school activities, spent more time on social networks and less time on video games, slept less, and reported a deterioration in their diet. Adolescents "intermediate" with moderate well-being were more often girls, spent more time on social networks, were more physically active, slept less, and more often reported eating fruit and vegetables and drinking alcohol. CONCLUSIONS: Not all adolescents experienced lockdown in the same way. This study highlighted subgroups that differed in terms of well-being and health-related behaviors. These results should motivate public authorities to consider the benefit/risk ratio of implementing strict lockdowns by taking into account family disparities and inequities among adolescents.
RESUMO
Background: Few studies have examined the overall experience of adolescents and their families during COVID-19 lockdowns. This study describes COVID-19-related morbidity in the PARIS birth cohort families during the first lockdown in France and identifies family profiles in terms of morbidity, perception, behaviors, and attitudes. Methods: Online questionnaires were sent to adolescents of the PARIS birth cohort and their parents. Possible COVID-19 was defined by symptoms using the ECDC definition. Household transmission was estimated by calculating the observed clinical secondary attack rates. Perception, behaviors and attitudes were assessed by levels of stress, degree of satisfaction regarding levels of information about COVID-19, degree of agreement with the lockdown and preventive measures. COVID-19 morbidity in adolescents and parents was compared using chi-squared or Student's t-tests. Within each family, perception, behaviors, and attitudes were compared between adolescents and parents using matched-pairs tests. To identify contrasting family profiles, a K-means cluster analysis was implemented. Results: Of 1,549 families contacted, 1,051 (68%) participated. Adolescents were less affected by possible COVID-19 than their parents (138.7 vs. 192.7 per 1,00,000 person-days). Household transmission of possible COVID-19 was higher when possible COVID-19 came from adults than from adolescents. Most families implemented preventive measures. Adolescents and parents generally shared the same attitudes, but adolescents were less compliant with restrictive measures. Four family profiles were identified which differed mainly regarding family stress, COVID-19 in the household, and compliance with preventive measures. Conclusion: Improving information dissemination to parents and adolescents, including dedicated adolescent messages, would increase adherence to preventive measures.
Assuntos
COVID-19 , Adolescente , Adulto , Atitude , Coorte de Nascimento , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Humanos , Morbidade , PercepçãoRESUMO
BACKGROUND AND OBJECTIVES: We previously showed in a 6-month randomized controlled trial that resistance training and protein supplementation after bariatric surgery (Roux-en-Y gastric bypass, RYGB) improved muscle strength without significant effect on weight loss and body composition changes. We performed a 5-year follow-up study in these subjects with the aim 1) to assess the long-term effect of this exercise training intervention and 2) to analyze associations between habitual physical activity (PA) and weight regain at 5 years. METHODS: Fifty-four out of 76 initial participants (follow-up rate of 71%) completed the 5-year follow-up examination (controls, n = 17; protein supplementation, n = 22; protein supplementation and resistance training, n = 15). We measured body weight and composition (DXA), lower-limb strength (leg-press one-repetition maximum) and habitual PA (Actigraph accelerometers and self-report). Weight regain at 5 years was considered low when <10% of 12-month weight loss. RESULTS: Mean (SD) time elapse since RYGB was 5.7 (0.9) y. At 5 years, weight loss was 32.8 (10.1) kg, with a mean weight regain of 5.4 (SD 5.9) kg compared with the 12-month assessment. Moderate-to-vigorous PA (MVPA) assessed by accelerometry did not change significantly compared with pre-surgery values (+5.2 [SD 21.7] min/d, P = 0.059), and only 4 (8.2%) patients reported participation in resistance training. Muscle strength decreased over time (overall mean [SD]: -49.9 [53.5] kg, respectively, P<0.001), with no statistically significant difference between exercise training intervention groups. An interquartile increase in MVPA levels was positively associated with lower weight regain (OR [95% CI]: 3.27 [1.41;9.86]). CONCLUSIONS: Early postoperative participation in a resistance training protocol after bariatric surgery was not associated with improved muscle strength after 5 years of follow-up; however, increasing physical activity of at least moderate intensity may promote weight maintenance after surgery. PA may therefore play an important role in the long-term management of patients with obesity after undergoing bariatric procedure.
Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Obesidade Mórbida , Exercício Físico , Seguimentos , Derivação Gástrica/métodos , Humanos , Obesidade Mórbida/cirurgia , Aumento de Peso , Redução de PesoRESUMO
BACKGROUND: Children are sensitive to indoor environmental pollution. Up until now there has been a lack of data on air quality in child day care centers. OBJECTIVES: The aim of this study is to document the indoor environment quality of Paris child day care centers by repeated measurements, and to compare pollutant levels in child day care centers with levels in Paris dwellings. METHODS: We selected 28 child day care centers frequented by a random sample of babies who participated in the PARIS birth cohort environmental investigation, and visited the child day care centers for one week twice in one year. Biological contaminants assessed were fungi, endotoxin, dust mite allergens, and chemical pollutants: aldehydes, volatile organic compounds and nitrogen dioxide (NO2). Relative humidity, temperature, and carbon dioxide levels were measured simultaneously. A standardized questionnaire was used to gather information about the buildings and their inhabitants. RESULTS: Airborne endotoxin levels in child day care centers were higher than those found in Paris dwellings. Dust mite allergens in child day care centers were below the threshold level for sensitization in the majority of samples, and in common with dwelling samples. Penicillium and Cladosporium were the most commonly identified genera fungi. The child day care center indoor/outdoor ratio for most chemical pollutants was above unity except for NO2, the levels for NO2 being significantly higher than those measured in homes. CONCLUSION: Chemical and biological contamination in child day care centers appears to be low, apart from endotoxin and NO2. Failure to take child exposure in child day care centers into account could result in an overestimation of children's exposure to other pollutants.
Assuntos
Poluição do Ar em Ambientes Fechados , Creches , Pré-Escolar , Exposição Ambiental , Humanos , Umidade , Lactente , Paris , TemperaturaRESUMO
CONTEXT: A strictly controlled diet (often involving enteral tube feeding (ETF)) is part of the treatment of many inherited metabolic diseases (IMDs). OBJECTIVE: To describe the use of ETF in a large cohort of patients with IMDs. DESIGN: A retrospective analysis of ETF in patients with urea cycle disorders (UCDs), organic aciduria (OA), maple syrup disease (MSUD), glycogen storage diseases (GSDs) or fatty acid oxidation disorders (FAODs) diagnosed before the age of 12â¯months. SETTING: The reference center for IMDs at Necker Hospital (Paris, France). RESULTS: 190 patients born between January 1991 and August 2017 were being treated for OA (nâ¯=â¯60), UCDs (nâ¯=â¯55), MSUD (nâ¯=â¯32), GSDs (nâ¯=â¯26) or FAODs (nâ¯=â¯17). Ninety-eight of these patients (52%) received ETF (OA subgroup: nâ¯=â¯40 (67%); UCDs: nâ¯=â¯12 (22%); MSUD: nâ¯=â¯9 (28%); GSDs: nâ¯=â¯23 (88%); FAODs: nâ¯=â¯14 (82%)). Indications for ETF were feeding difficulties in 64 (65%) patients, cessation of fasting in 39 (40%), and recurrent metabolic decompensation in 14 (14%). Complications of ETF were recorded in 48% of cases, more frequently with nasogastric tube (NGT) than with gastrostomy. Among patients in whom ETF was withdrawn, the mean duration of ETF was 5.9 (SD: 4.8) years (range: 0.6-19.8â¯years). The duration of ETF was found to vary from one disease subgroup to another (pâ¯=â¯0.051). While the longest median duration was found in the GSD subgroup (6.8â¯years), the shortest one was found in the UCD subgroup (0.9â¯years). CONCLUSION: ETF is an integral part of the dietary management of IMDs. The long duration of ETF and the specific risks of NGT highlights the potential value of gastrostomy.In this study at a French tertiary hospital, we documented the indications, modalities, duration and complications of enteral tube feeding in a cohort of patients with inherited metabolic diseases.
RESUMO
BACKGROUND: Although physical activity has many known health benefits, its association with lung function in childhood/adolescence remains unclear. We examined the association of physical-activity trajectories between 11 and 15 years with lung function at 15 years in 2266 adolescents. METHODS: A population-based cohort of 14 305 singleton births alive at 1 year was recruited in the UK population-based Avon Longitudinal Study of Parents and Children cohort. Physical activity (counts/minute and moderate-to-vigorous physical activity) was assessed for 7 days using an accelerometer at 11, 13 and 15 years. We identified sex-specific physical-activity trajectories applying K-means for longitudinal data in children with at least two accelerometer measurements (n = 3584). We then estimated the sex-specific associations of these trajectories with post-bronchodilation lung-function parameters using multivariable linear-regression models (n = 2266, 45% boys). RESULTS: Fewer than 7% of participants met the WHO physical-activity recommendations (i.e. daily average of at least 60 minutes of moderate-to-vigorous physical activity). Boys were substantially more active than girls. In both sexes, we identified three distinct physical-activity trajectories ('low': 39.8% boys, 45.8% girls; 'moderate': 42.9% boys, 41.4% girls; and 'high' physical activity: 17.3% boys, 12.8% girls). Girls in the moderate and high physical-activity trajectories had 0.11 L [95% confidence interval (CI): 0.04-0.19] and 0.15 L (95% CI: 0.03-0.26) higher forced vital capacity than their less-active peers. No association was observed in boys. CONCLUSIONS: Higher childhood physical activity relates to higher lung-function levels in adolescent girls. A better understanding of the mechanisms underlying this association should be pursued.