Gestational Weight Gain and Offspring Bone Mass: Different Associations in Healthy Weight Versus Overweight Women

Weight management strategies during pregnancy reduce child cardiometabolic risk. However, because maternal weight has an overall positive correlation with offspring bone mass, pregnancy weight management could adversely affect child bone health. We aimed to estimate associations between gestational weight gain (GWG) and bone mineralization in the offspring at 7 years of age, and test early pregnancy body mass index (BMI) as an effect modifier. We analyzed prospective data from 2167 mother-child pairs from the Generation XXI birth cohort who underwent whole-body dual-energy X-ray absorptiometry at 7 years of age. GWG was analyzed as a continuous measure and using the Institute of Medicine categories. In the whole sample and for each early pregnancy BMI category (under/normal weight and overweight/obese), relationships between GWG and offspring bone measures (bone mineral content [BMC], bone areal density [aBMD], size-corrected BMC [scBMC], and height) at 7 years were fitted through local polynomial regression and smoothing splines. The magnitude of associations was estimated through linear regression coefficients (95% CIs), crude and adjusted for maternal age, height, educational level, and child gestational age. In under/normal weight mothers, GWG was associated with slightly increased bone measures at 7 years (per 5 kg of GWG, BMC: 0.07 SD [95% CI, 0.01 to 0.12]; aBMD: 0.10 SD [95% CI, 0.05 to 0.15], scBMC: 0.11SD [95% CI, 0.06 to 0.16], and height: 0.05 SD [95% CI, 0.00 to 0.10]), while in overweight/obese mothers no effect of GWG on bone was observed (BMC: 0.02 SD [95% CI, -0.04 to 0.09]; aBMD: 0.02 SD [95% CI, -0.04 to 0.08], scBMC: 0.01 SD [95% CI, -0.06 to 0.08], and height: 0.02 SD [95% CI, -0.04 to 0.08]). Also, no advantageous effect of gaining weight above the Institute of Medicine recommendations was observed in either early pregnancy BMI group. Our results suggest that adherence to Institute of Medicine recommendations for pregnancy weight gain is unlikely to have a negative repercussion on offspring bone health, particularly in women with excess weight in early pregnancy.info:eu-repo/semantics/publishedVersio

Bone formation and resorption markers at 7 years of age: relations with growth and bone mineralization

Purpose We aimed to describe bone formation and resorption markers in generally healthy prepubertal children using total alkaline phosphatase (tALP), osteocalcin (OC) and β-isomerized C-terminal telopeptides of type I collagen (β-CTx) serum concentrations and to estimate markers’ correlations with anthropometric growth (height, weight, body mass index and trajectories of weight gain) as well as bone mineral content (BMC) and areal density (aBMD). Methods We assessed 395 7-year-old children from the Generation XXI cohort with tALP, OC and β-CTx concentrations determined from a fasting venous blood sample and BMC/aBMD measured by dual-energy X-ray absorptiometry. Gender-specific reference intervals for tALP, OC and β-CTx in 7-year-old children were established by calculating the 2.5th and 97.5th percentiles. Pearson and partial correlation coefficients (controlling for sex, age, body size and season) between bone markers and growth measures were computed. Results tALP increased with height (rpartial controlled for sex = 0.26, 95%CI: 0.17, 0.35), was higher in overweight than in healthy weight children, and in children who gained weight above average during infancy. No correlations were found between OC or β-CTx and growth. In girls, OC was slightly correlated with subtotal BMC (rpartial = 0.22, 95%CI: 0.08, 0.35), subtotal aBMD (rpartial = 0.20, 95%CI: 0.06, 0.33) and lumbar spine aBMD (rpartial = 0.23, 95%CI: 0.09, 0.36). tALP and β-CTx were not correlated with any of the DXA-derived bone measures. Conclusion This study contributed to the description of bone turnover at 7 years of age and suggested that bone metabolism markers measured in a single point in time have limited ability to describe anthropometric growth and overall bone status in generally healthy prepubertal children.info:eu-repo/semantics/publishedVersio

Upregulation of Inflammatory genes and downregulation of sclerostin gene expression are key elements in the early phase of fragility fracture healing

Peer reviewe

Do bone mineral content and density determine fracture in children? A possible threshold for physical activity

BackgroundRelations between bone parameters, physical exertion, and childhood fractures are complex. We aimed to estimate the associations between fracture history and bone mineral content (BMC) and areal bone mineral density (aBMD) at 7 years of age, by levels of physical activity, as a proxy for trauma frequency.MethodsWe used data collected from 2,261 children of the Generation XXI birth cohort, assembled in 2005/6 in Porto, Portugal. At the age of 7 years (2012/4), fracture history, time spent per week in active play, and sports practice were reported by parents. Subtotal and lumbar spine (LS) BMC and aBMD were measured using whole-body dual-energy X-ray absorptiometry.ResultsBoys and girls in the highest categories of time spent in sports practice or active play generally had higher BMC and aBMD. Among girls, BMC and aBMD were protective of fracture only in the highest quarter of active play (>660 min/week)-odds ratios (OR; 95% confidence interval (95% CI)) for subtotal BMC=0.27 (0.11-0.67), subtotal aBMD=0.18 (0.06-0.49), and LS aBMD=0.41 (0.22-0.75). For boys in the highest quarter of sports practice (>240 min/week), subtotal and LS BMC were protective of fracture-OR=0.39 (0.16-0.98) and 0.51 (0.27-0.96), respectively.ConclusionIn prepubertal children, BMC and aBMD predicted fracture history only in the highest levels of physical activity.info:eu-repo/semantics/publishedVersio

Avaliação dos lanches escolares de crianças do 1.º ano do Ensino Básico de escolas de Matosinhos : trabalho de investigação : School snack evaluation of the first grade children from elementary schools in Matosinhos

Contém um relatório de estágio curricular realizado no Serviço de Nutrição e Alimentação da Unidade Local de Saúde de Matosinhos, no âmbito da licenciatura em Ciências da Nutrição pela Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto. O exemplar do relatório de estágio existe apenas em formato papel e está disponível para consulta na Biblioteca da FCNAUPTese de licenciatura em Ciências da Nutrição apresentada à Faculdade de Ciências da Nutrição e Alimentação da Universidade do PortoResumo da tese: Na criança em idade escolar a alimentação possui um papel fundamental no desenvolvimento das suas capacidades motoras e competência intelectual. Os lanches escolares bem como o pequeno-almoço (PA) são fundamentais para o melhor desempenho cognitivo das crianças e para a adequação nutricional da sua alimentação. Objectivos: Caracterizar qualitativa e quantitativamente os lanches escolares e identificar razões da sua omissão; determinar o contributo energético e nutricional do lanche escolar; caracterizar qualitativamente o consumo do PA e identificar as razões da sua omissão; caracterizar o consumo de leite escolar (LE). Amostra: Participaram no estudo 372 crianças do 1º ano de escolaridade de Escolas Básicas públicas do 1ºciclo do concelho de Matosinhos. Métodos: Este trabalho consistiu num estudo observacional transversal. A recolha dos dados foi feita através de um questionário de informação da escola, de um questionário com dados relativos ao pequeno-almoço e lanche dos alunos, de uma grelha de descrição dos alimentos disponíveis para lanche e respectivas fotografias. A análise descritiva consistiu na determinação de medidas de tendência central e de dispersão, dos extremos e das frequências categoriais. O teste do Qui-quadrado foi utilizado para verificar a independência variáveis categóricas e a comparação de médias entre dois grupos independentes foi efectuada a partir do teste de Mann-Whitney. Resultados: Os produtos alimentares mais disponíveis para consumo aos lanches foram o grupo do pão e equivalentes. O valor energético médio dos lanches foi de 300,8kcal. A maioria dos lanches provinha de casa e era preparado pelos pais ou avós, o que determinava positiva e significativamente a qualidade alimentar do lanche. A principal razão para a omissão do lanche foi o esquecimento. (...)Thesis abstract:Nutrition plays a key role in the development of physical and mental skills of school aged children. School snacks as well as breakfast are essencial for children cognitive performance and nutricional adequacy of their diets. Objectives: Characterize both quality and quantity of the school snacks and identify the reasons for their missing; determine energetic and nutritional contribution of the school snacks; characterize the quality of breakfast and identify its skipping reasons; characterize school milk consumption. Population: 372 first grade children from public elementary schools of Matosinhos. Methods: A observational cross sectional study was conduted. Data was obtained by a school information questionnaire, another questionnaire about students’ breakfast and snack, a grid containing the available foods for snacks and pictures of them. The descriptive analysis consisted in the determination of central tendency, dispersion measures and category frequencies. Qui-square test was used to verify the nominal variables independence. The comparison of averages between two independent groups was made according Mann-Whitney test. Results: The most available foods for snacks consumption was bread and equivalents. The average energetic intake in snacks was 300,8kcal. The majority of snacks came from home and were prepared by parents or grandparents, which determines significantly and positively the nutritional quality of snacks. The main reason for snack missing was forgetting. (...

Costs, effectiveness, and safety associated with Chimeric Antigen Receptor (CAR) T-cell therapy: Results from a comprehensive cancer center

Real world effectiveness, toxicity and costs analyses from chimeric antigen receptor (CAR)-T cell therapy are of utmost relevance to determine whether and how to offer patients highly personalized immunotherapy. In this study, we aimed at describing CAR T-cells effectiveness, safety and costs in a Portuguese Comprehensive Cancer Center. We performed a retrospective descriptive study of adult patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL), primary mediastinal B-cell lymphoma and transformed follicular lymphoma referred to CAR T-cell therapy, between May 2019 and February 2021. Rates of treatment response, toxicity and survival (Kaplan-Meier method) were analyzed by intention-to-treat. Direct medical costs stratified by inpatient-care, outpatient-care, and diagnostic-therapeutic procedures (DTP) were derived based on resources used and their respective unit costs. In twenty patients (median age 49.5y; 55%male; 70%DLBCL; 50% with primary refractory disease), best overall and complete response rates were 65.0% and 45.0%, respectively. Median overall (OS) and progression-free survivals were 9.2 and 7.3 months; 12-month OS rate was 42.6% (95%CI:23.2–78.3). Grade≥3 cytokine release syndrome and neurotoxicity occurred in 5.6% and 11.1% of patients, respectively. CAR T-cell therapy expenditure, including adverse events costs, was 7 176 196€, or 286 238€ when excluding drug cost. Median cost for treated patient was 355 165€ with CAR T-cell drug cost accounting for 97.0% of the overall expense. Excluding CAR T-cell acquisition cost, inpatient-care and DTP accounted for 57% and 38% of total cost/patient, respectively. Our findings highlight the heavy economic burden of CAR T-cell therapy driven by drug acquisition costs

Costs, effectiveness, and safety associated with Chimeric Antigen Receptor (CAR) T-cell therapy: Results from a comprehensive cancer center.

Real world effectiveness, toxicity and costs analyses from chimeric antigen receptor (CAR)-T cell therapy are of utmost relevance to determine whether and how to offer patients highly personalized immunotherapy. In this study, we aimed at describing CAR T-cells effectiveness, safety and costs in a Portuguese Comprehensive Cancer Center. We performed a retrospective descriptive study of adult patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL), primary mediastinal B-cell lymphoma and transformed follicular lymphoma referred to CAR T-cell therapy, between May 2019 and February 2021. Rates of treatment response, toxicity and survival (Kaplan-Meier method) were analyzed by intention-to-treat. Direct medical costs stratified by inpatient-care, outpatient-care, and diagnostic-therapeutic procedures (DTP) were derived based on resources used and their respective unit costs. In twenty patients (median age 49.5y; 55%male; 70%DLBCL; 50% with primary refractory disease), best overall and complete response rates were 65.0% and 45.0%, respectively. Median overall (OS) and progression-free survivals were 9.2 and 7.3 months; 12-month OS rate was 42.6% (95%CI:23.2-78.3). Grade≥3 cytokine release syndrome and neurotoxicity occurred in 5.6% and 11.1% of patients, respectively. CAR T-cell therapy expenditure, including adverse events costs, was 7 176 196€, or 286 238€ when excluding drug cost. Median cost for treated patient was 355 165€ with CAR T-cell drug cost accounting for 97.0% of the overall expense. Excluding CAR T-cell acquisition cost, inpatient-care and DTP accounted for 57% and 38% of total cost/patient, respectively. Our findings highlight the heavy economic burden of CAR T-cell therapy driven by drug acquisition costs

Effectiveness outcomes.

Effectiveness outcomes.</p