High birth weight in a suburban hospital in Cameroon:An analysis of the clinical cut-off, prevalence, predictors and adverse outcomes

BACKGROUND AND AIMS: High birth weight (HBW) increases the risk of maternal and fetal morbidity and mortality. Its prevalence and adverse outcomes may be reduced if risk factors are identified and managed during pregnancy. The cut-off value for HBW remains debatable. The objectives of this study were to identify the optimal cut-off value and determine the prevalence, predictors and adverse outcomes of HBW in a suburban area of Cameroon. DESIGN: A 6-year retrospective register analysis and a 3-month prospective phase. SETTING: A secondary care level (regional) hospital in the city of Buea (southwest region of Cameroon). PARTICIPANTS: Women who delivered in this hospital over a 6-year period (retrospective phase) and consenting pregnant mothers and their infants (singletons, born at >28 weeks gestation) (prospective phase). OUTCOME MEASURES: 90th centile of birth weights; prevalence of HBW defined as birth weight above the 90th centile; sociodemographic, maternal and obstetrical factors associated with HBW; maternal and neonatal adverse outcomes of HBW. RESULTS: Of the 4941 newborns reviewed in registers, the 90th centile of birth weights was 3850 g. Using this new cut-off, we obtained a prevalence of 14.0% for HBW in the 200 newborns included in the prospective phase. This was significantly higher than the prevalence (9.5%) yielded when the traditional cut-off of 4000 g was used (p=0.003). None of the factors assessed was independently associated with HBW. Newborns with HBW were more likely to have shoulder dystocia (p<0.01), and their mothers more likely to suffer from prolonged labour (p=0.01) and postpartum haemorrhage (p<0.01). CONCLUSIONS: The results of this study suggest that the cut-off for HBW in this population should be 3850 g. Thus, 3 of every 10 babies born with HBW in this hospital are likely not receiving optimal postnatal care because 4000 g is currently used to qualify for additional support

What change in body mass index is needed to improve metabolic health status in childhood obesity:protocol for a systematic review

PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 checklist: recommended items to address in a systematic review protocol*. PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. (DOC 80.5 kb

A study of volatile compounds in the breath of children with type 1 diabetes

A pilot study of exhaled volatile compounds and their correlation with blood glucose levels in eight children with type 1 diabetes is reported. Five paired blood and breath samples were obtained from each child over a 6 hour period. The blood glucose concentration ranged from 41.4 to 435.6 mg/dL. Breath samples were collected in Tedlar bags and immediately evacuated through thermal desorption tubes packed with Carbopack B and C. The VOCs were later recovered by thermal desorption and analysed using gas chromatography mass spectrometry. The study identified 74 volatile compounds present in at least 10% of the patient samples. Of these 74 volatiles 36 were found in all patient samples tested. Further analysis of the 36 compounds found that none showed significant overall correlation with blood glucose levels. Isoprene showed a weak negative correlation with blood glucose levels. Acetone was found to have no correlation with blood glucose levels for the patients studied. Some patients showed significant individual correlation between the relative peak areas of certain compounds and blood glucose levels. However, there was no consistent pattern observed within these results across all 8 patients. Additional breath samples were collected in Tedlar bags and analysed using SIFTMS for 3 of the patients and a healthy control. The levels of 24 volatiles are reported and were found to be generally consistent with previously reported SIFT-MS data. In agreement with the GCMS data, no compounds exhibited a significant overall correlation with blood glucose level

Clinical and Molecular Characterisation Of Hyperinsulinaemic Hypoglycaemia In Infants Born Small-For-Gestational Age

OBJECTIVE: To characterise the phenotype and genotype of neonates born small-for-gestational age (SGA; birth weight <10th centile) who developed hyperinsulinaemic hypoglycaemia (HH). METHODS: Clinical information was prospectively collected on 27 SGA neonates with HH, followed by sequencing of KCNJ11 and ABCC8. RESULTS: There was no correlation between the maximum glucose requirement and serum insulin levels. Serum insulin level was undetectable in five infants (19%) during hypoglycaemia. Six infants (22%) required diazoxide treatment >6 months. Normoglycaemia on diazoxide <5 mg/kg/day was a safe predictor of resolved HH. Sequencing of KCNJ11/ABCC8 did not identify any mutations. CONCLUSIONS: Serum insulin levels during hypoglycaemia taken in isolation can miss the diagnosis of HH. SGA infants may continue to have hypofattyacidaemic hypoketotic HH beyond the first few weeks of life. Recognition and treatment of this group of patients are important and may have important implications for neurodevelopmental outcome of these patients

Diabetes induced by gain-of-function mutations in the Kir6.1 subunit of the KATP channel

Gain-of-function (GOF) mutations in the pore-forming (Kir6.2) and regulatory (SUR1) subunits of K(ATP) channels have been identified as the most common cause of human neonatal diabetes mellitus. The critical effect of these mutations is confirmed in mice expressing Kir6.2-GOF mutations in pancreatic β cells. A second K(ATP) channel pore-forming subunit, Kir6.1, was originally cloned from the pancreas. Although the prominence of this subunit in the vascular system is well documented, a potential role in pancreatic β cells has not been considered. Here, we show that mice expressing Kir6.1-GOF mutations (Kir6.1[G343D] or Kir6.1[G343D,Q53R]) in pancreatic β cells (under rat-insulin-promoter [Rip] control) develop glucose intolerance and diabetes caused by reduced insulin secretion. We also generated transgenic mice in which a bacterial artificial chromosome (BAC) containing Kir6.1[G343D] is incorporated such that the transgene is only expressed in tissues where Kir6.1 is normally present. Strikingly, BAC-Kir6.1[G343D] mice also show impaired glucose tolerance, as well as reduced glucose- and sulfonylurea-dependent insulin secretion. However, the response to K(+) depolarization is intact in Kir6.1-GOF mice compared with control islets. The presence of native Kir6.1 transcripts was demonstrated in both human and wild-type mouse islets using quantitative real-time PCR. Together, these results implicate the incorporation of native Kir6.1 subunits into pancreatic K(ATP) channels and a contributory role for these subunits in the control of insulin secretion

Overweight and obesity in children aged 3-13 years in urban Cameroon:a cross-sectional study of prevalence and association with socio-economic status

BACKGROUND: Childhood overweight/obesity is increasing rapidly in developing countries. There is a need to provide more evidence on its burden in sub-Saharan Africa, and to identify associated factors in order to set preventive measures. We aimed to determine the prevalence of overweight/obesity and assess its association with the socioeconomic status in nursery and primary school children in urban Cameroon. METHODS: In this cross-sectional study, we included by multi-staged cluster random sampling 1343 children from high (HSES, n = 673) and low (LSES, n = 670) socioeconomic status schools in Douala. Parent/child demographic data were collected, and children’s anthropometric parameters were measured using validated methods. The World Health Organization body mass index-for-age reference curves were used. RESULTS: The prevalence of overweight/obesity was 12.5% (13.2% in girls, 11.8% in boys). The risk of overweight/obesity was 2.40 (95% CI 1.70, 3.40) higher in HSES children compared to LSES after adjusting for age and gender. However this association was attenuated to 1.18 (95% CI 0.59, 2.35) once adjustment had been made for a range of potential confounders. CONCLUSIONS: Overweight/obesity is relatively common in sub-Saharan African children and prevalence is associated with HSES. However, this association may be mediated by sweet drink consumption, passive means of travel to school and not doing sport at school. We suggest that these potentially modifiable behaviors may be effective targets for obesity prevention. Further studies should specifically focus on unhealthy behaviors that mediate overweight/obesity as well as other non communicable diseases in children. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40608-017-0146-4) contains supplementary material, which is available to authorized users

The development of a theory informed behaviour change intervention to improve adherence to dietary and physical activity treatment guidelines in individuals with familial hypercholesterolaemia (FH)

This study is funded by the National Institute for Health Research NIHR Bristol Biomedical Research Centre (Nutrition theme) at University Hospitals Bristol NHS Foundation Trust and The University of Bristol.Peer reviewedPublisher PD

Parental beliefs about portion size, not children's own beliefs, predict child BMI

Background Increases in portion size are thought by many to promote obesity in children. However, this relationship remains unclear. Here, we explore the extent to which a child's BMI is predicted both by parental beliefs about their child's ideal and maximum portion size and/or by the child's own beliefs. Methods Parent–child (5–11 years) dyads (N = 217) were recruited from a randomized controlled trial (n = 69) and an interactive science centre (n = 148). For a range of main meals, parents estimated their child's ‘ideal’ and ‘maximum tolerated’ portions. Children completed the same tasks. Results An association was found between parents' beliefs about their child's ideal (β = .34, p < .001) and maximum tolerated (β = .30, p < .001) portions, and their child's BMI. By contrast, children's self‐reported ideal (β = .02, p = .718) and maximum tolerated (β = −.09, p = .214) portions did not predict their BMI. With increasing child BMI, parents' estimations aligned more closely with their child's own selected portions. Conclusions Our findings suggest that when a parent selects a smaller portion for their child than their child self‐selects, then the child is less likely to be obese. Therefore, public health measures to prevent obesity might include instructions to parents on appropriate portions for young children