Assessment of vitamin D status and parathyroid hormone during a combined intervention for the treatment of childhood obesity

Background: Obesity is associated with vitamin D deficiency. The aim of this work is to analyze the changes in vitamin D status and PTH levels in a group of children with obesity receiving combined intervention program in order to get BMI status reduction. Methods: Longitudinal study in 119 children with obesity, aged 9.1–13.9 years, included in a 1-year combined dietarybehavioral-physical activity intervention. Anthropometric measurements (weight, height, BMI and fat mass index) were registered every 3 months and blood testing (calcium, phosphorous, 25(OH)D and PTH) were collected at the beginning and after 12 months of follow-up. A control group was recruited (300 healthy children, aged 8.1–13.9 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. Results: Vitamin D deficiency was significantly higher in obesity group (31.1 vs. 14%). There was negative correlation between 25(OH)D and fat mass index (r = −0.361, p = 0.001). Patients with BMI reduction throughout combined intervention were 52 (43.7%). There was a significant increase in the prevalence of hypovitaminosis D in patients without BMI reduction at the end of follow-up, but in those patients with BMI reduction there was no changes of vitamin D status. Conclusions: Obesity increases the prevalence of suboptimal vitamin D status, and a BMI status reduction in children with obesity may be required to at least stabilize vitamin D status

Hypovitaminosis D and cardiometabolic risk factors in adolescents with severe obesity

Background/Objectives. Obesity is associated with cardiometabolic risk factors and with Vitamin D deficiency. The aim of this study was to examine the relationship between 25(OH)D concentrations and cardiometabolic risk factors in adolescents with severe obesity. Subjects/Methods. A cross-sectional clinical assessment (body mass index, fat mass index, fat-free mass index, waist-to-height ratio, and blood pressure) and metabolic study (triglycerides, total cholesterol, HDL-C, LDL-C, glucose, insulin, HOMA-IR, leptin, calcium, phosphorous, calcidiol, and PTH) were carried out in 236 adolescents diagnosed with severe obesity (BMI z-score > 3.0, 99th percentile), aged 10.2–15.8 years. The criteria of the US Endocrine Society were used for the definition of Vitamin D status. Results. Subjects with Vitamin D deficiency had significantly elevated values (p < 0.05) for BMI z-score, waist circumference, waist z-score, body fat percentage, fat mass index, systolic and diastolic blood pressure, total cholesterol, triglycerides, LDL-C, insulin, HOMA-IR, leptin, and PTH than subjects with normal Vitamin D status. There was a significant negative correlation (p < 0.05) of serum 25(OH)D levels with body fat percentage, FMI, systolic BP, total cholesterol, triglyceride, LDL-C, glucose, insulin, HOMA-IR, leptin, and PTH. Conclusions. Low Vitamin D levels in adolescents with severe obesity were significantly associated with some cardiometabolic risk factors, including body mass index, waist circumference, fat mass index, high blood pressure, impaired lipid profile, and insulin resistance

Effects of the application of a prolonged combined intervention on body composition in adolescents with obesity

Background: The aim of this study is to describe the effects of a prolonged dietary-behavioral-physical activity intervention (24 months) on body composition in a group of adolescents with obesity. Methods: Longitudinal study in 196 individuals with obesity (86 boys and 110 girls) aged 10.1–14.9 years that completed a prolonged combined intervention (24 months). Values for weight, height, skinfold thickness, waist circumference, BMI, body fat, fat mass index (FMI) and fat-free mass index (FFMI) were registered or calculated. A good response to treatment was reported when a BMI z-score reduction of greater than or equal to 0.5 units of the initial value occurred after 24 month of follow up. Results: A good response after 24 months of follow-up reached 58.2% (n = 114). In boys with obesity and BMI status improvement, weight z-score, BMI z-score, body fat, and FMI significantly decreased (p < 0.05). In girls with obesity and BMI status improvement, weight z-score, BMI z-score, waist circumference, waist z-score, body fat and FMI significantly decreased (p < 0.05). In both sexes the height and FFMI increased significantly (p < 0.05). The multiple logistic regression analysis showed that girls and younger age were associated with BMI status improvement; concurrently, the place of residence (urban or rural) and degree of obesity were not associated with BMI status improvement. Conclusion: The application of long-term combined strategies in the treatment of childhood obesity seems to be effective. As BMI decreases, a reduction in fat mass is also detected, with evident sexual dimorphism, in the absence of changes in fat-free mass and, consequently, in longitudinal growing

Clinical characteristics and complications of rotavirus gastroenteritis in children in east London: A retrospective case-control study.

BACKGROUND: Rotavirus is the leading cause of acute gastroenteritis in children and is associated with neurological complications such as seizures and encephalopathy. The aim of this study was to investigate the presentation and complications of rotavirus compared to non-rotavirus gastroenteritis in UK children. METHODS: This was a retrospective, case-control, hospital-based study conducted at three sites in east London, UK. Cases were children aged 1 month to 16 years diagnosed with acute gastroenteritis between 1 June 2011 and 31 December 2013, in whom stool virology investigations confirmed presence of rotavirus by PCR. They were matched by age, gender and month of presentation to controls with rotavirus-negative gastroenteritis. RESULTS: Data were collected from 116 children (50 cases and 66 controls). Children with rotavirus gastroenteritis tended to present more frequently with metabolic acidosis (pH 7.30 vs 7.37, P = 0.011) and fever (74% versus 46%; P = 0.005) and were more likely to require hospitalisation compared to children with non-rotavirus gastroenteritis (93% versus 73%; P = 0.019). Neurological complications were the most common extra-intestinal manifestations, but did not differ significantly between children with rotavirus-positive gastroenteritis (RPG) and rotavirus-negative gastroenteritis (RNG) (24% versus 15%, respectively; P = 0.24). Encephalopathy occurred only in children with rotavirus infection (n = 3, 6%). CONCLUSION: Rotavirus causes longer and more severe disease compared to other viral pathogens. Seizures and milder neurological signs were surprisingly common and associated with multiple pathogens, but encephalopathy occurred only in children with rotavirus gastroenteritis. Rotavirus vaccination may reduce seizures and presentation to hospital, but vaccines against other pathogens causing gastroenteritis are required.AJP receives funding from the Wellcome Trust (grant 108065/Z/15/Z)

Presión asistencial, frecuentación y morbilidad pediátrica en un centro de salud. Diferencias etarias y estacionales

ObjetivoContribuir a un mayor conocimiento de la demanda asistencial pediátrica en atención primaria que permita plantear oportunidades de mejora en la calidad asistencial.DiseñoEstudio retrospectivo, observacional.EmplazamientoCentro de Salud de Estella (Navarra).PacientesLa totalidad de pacientes atendidos en el año 1999 en una de las 2 consultas pediátricas del centro de salud. Por edades, se dividieron en lactantes (0-12 meses), preescolares (1-5 años), escolares (6-9 años) y adolescentes (10-14 años).MedicionesDe las 6.611 consultas atendidas se registraron fecha, sexo, edad, tipo de consulta (demanda/programada) y problema de salud (CIPSAP-2), y se calcularon la frecuentación y presión asistencial en relación con la edad y tipo de consulta, así como la distribución estacional.ResultadosLas consultas a demanda fueron 4.600 (69,6%) y las programadas 2.011 (30,4%). La frecuentación total fue de 5,46, en las consultas a demanda fue mayor en los preescolares (6,4) y en las programadas en los lactantes (13,3). La presión asistencial total fue de 28,2, siendo menor (p < 0,05) en los meses de verano. En las consultas a demanda los problemas de salud más prevalentes fueron: enfermedades respiratorias (52,8%), infecciosas (7,5%), neurosensoriales (6,8%), accidentes (6,0%) y digestivas (4,7%). Existía una correlación negativa (p < 0,05) entre la edad y la prevalencia de las enfermedades respiratorias, mientras que la edad era directamente proporcional (p < 0,05) a la prevalencia de accidentes y enfermedades del aparato locomotor. La prevalencia de las enfermedades respiratorias e infecciosas era mayor (p < 0,05) en los meses de otoño e invierno.ConclusionesLa pediatría en un centro de salud está sometida a una sobrecarga asistencial, siendo las enfermedades agudas del aparato respiratorio el motivo de consulta más frecuente y, en menor grado, las enfermedades infecciosas. Los exámenes de salud están adquiriendo progresivamente una mayor relevancia. Convendría mayor coordinación entre los EAP para unificar criterios diagnósticos y terapéuticos, ya que cuanto más rigurosa sea la pediatría extrahospitalaria mayor será su repercusión sobre la mejora de la calidad de la salud infantil.ObjectiveTo inform on the demand for primary care paediatric services, with a view to improving health care delivery.DesignObservational retrospective study.SettingEstella Health Centre (Navarra).PatientsAll patients attended during 1999 at one of the two paediatric clinics at the health centre. They were divided by ages into breast-feeders (0-12 months), pre-school (1-5 years old), primary school (6-9) and adolescents (10-14).MeasurementsThe date, sex, age, type of consultation (on demand/scheduled) and health problem (CIPSAP-2) of the 6611 consultations were recorded. Frequency of visits, care pressure and seasonal distribution, related to age and type of consultation, were calculated.ResultsThere were 4600 on-demand consultations (69.6%) and 2011 scheduled ones (30.4%). Total frequency of attendance was 5.46, which was greater in on-demand pre-school children (6.4) and scheduled breast-feeders (13.3). Overall patient pressure was 28.2, though less (p < 0.05) in the summer months. The most common health problems in on-demand consultations were respiratory illnesses (52.8%), infectious diseases (7.5%), neuro-sensory problems (6.8%), accidents (6.0%) and digestive problems (4.7%). There was negative correlation (p < 0.05) between age and the prevalence of respiratory diseases, whereas age was directly proportional (p < 0.05) to the prevalence of accidents and locomotive illnesses. Respiratory and infectious diseases were more common (p < 0.05) in the autumn and winter months.ConclusionsPaediatrics at a health centre suffers patient overload, with acute illnesses of the respiratory apparatus, and to a lesser extent infectious diseases, the main causes of consultation. Health check-ups are becoming steadily more important. There needs to be better coordination between PC teams in order to unify diagnostic and therapeutic criteria, for the more thorough non-hospital paediatrics becomes, the greater its effect on improving child health quality

Vitamin D status and parathyroid hormone assessment in girls with central precocious puberty

Purpose The objective of this study was to analyze vitamin D status and PTH concentrations in 6- to 8-year-old girls with central precocious puberty. Methods A cross-sectional clinical and blood testing study (calcium, phosphorus, 25(OH)D and PTH) was carried out in 78 girls with central precocious puberty (CPP group), aged 6.1–7.9 years. A control group was recruited (137 prepubertal girls, aged 6.1–8.2 years). The criteria of the US Endocrine Society were used for the defnition of hypovitaminosis D. Results There were no signifcant diferences in vitamin D status between both groups. There were no signifcant diferences in 25(OH)D concentrations between CPP (25.4±8.6 ng/mL) and control groups (28.2±7.4 ng/mL). In contrast, PHT concentrations in CPP group (44.8±16.3 pg/mL) were higher (p<0.05) with respect to control group (31.0±11.9 ng/mL). In CPP group, there was a positive correlation (p<0.05) between PTH concentrations and growth rate, bone age, and basal estradiol, basal FSH, basal LH and LH peak concentrations. Conclusion Vitamin D status in 6- to 8-year-old girls with CPP is similar to that in prepubertal girls. PTH concentrations were signifcantly higher in girls with CPP, and this could be considered as a physiological characteristic of puberty and, in this case, of pubertal precocit

Dental caries in children and vitamin D deficiency: a narrative review

Dental caries represents one of the most prevalent health problems in childhood. Numerous studies have assessed that vitamin D deficiency is highly related to dental caries in primary and permanent teeth in children. The aim of this study is to elaborate a narrative review about proposed mechanisms by which vitamin D deficiency interacts with dental caries process in children. Vitamin D deficiency during pregnancy may cause intrauterine enamel defects, and through childhood is accompanied by insufficient activity of antibacterial peptides, decreased saliva secretion, and a low level of calcium in saliva. Conclusion: In conclusion, vitamin D deficiency would increase the risk of caries in the primary and/or permanent dentition. Relationship between vitamin D deficiency and dental caries is evident enough for vitamin D deficiency to be considered as a risk factor for dental caries in children. Optimal levels of vitamin D throughout pregnancy and childhood may be considered an additional preventive measure for dental caries in the primary and permanent dentition