An improved algorithm to harmonize child overweight and obesity prevalence rates

BACKGROUND: Prevalence rates of child overweight and obesity for a group of children vary depending on the BMI reference and cut-off used. Previously we developed an algorithm to convert prevalence rates based on one reference to those based on another. OBJECTIVE: To improve the algorithm by combining information on overweight and obesity prevalence. METHODS: The original algorithm assumed that prevalence according to two different cut-offs A and B differed by a constant amount dz $$dz$$ on the z-score scale. However the results showed that the z-score difference tended to be greater in the upper tail of the distribution and was better represented by b × dz $$b\times dz$$ , where b $$b$$ was a constant that varied by group. The improved algorithm uses paired prevalence rates of overweight and obesity to estimate b $$b$$ for each group. Prevalence based on cut-off A is then transformed to a z-score, adjusted up or down according to b × dz $$b\times dz$$ and back-transformed, and this predicts prevalence based on cut-off B. The algorithm's performance was tested on 228 groups of children aged 6-17 years from 20 countries. RESULTS: The revised algorithm performed much better than the original. The standard deviation (SD) of residuals, the difference between observed and predicted prevalence, was 0.8% (n = 2320 comparisons), while the SD of the difference between pairs of the original prevalence rates was 4.3%, meaning that the algorithm explained 96.7% of the baseline variance (88.2% with original algorithm). CONCLUSIONS: The improved algorithm appears to be effective at harmonizing prevalence rates of child overweight and obesity based on different references

Exploring an algorithm to harmonize International Obesity Task Force and World Health Organization child overweight and obesity prevalence rates

BACKGROUND: The International Obesity Task Force (IOTF) and World Health Organization (WHO) body mass index (BMI) cut-offs are widely used to assess child overweight, obesity and thinness prevalence, but the two references applied to the same children lead to different prevalence rates. OBJECTIVES: To develop an algorithm to harmonize prevalence rates based on the IOTF and WHO cut-offs, to make them comparable. METHODS: The cut-offs are defined as age-sex-specific BMI z-scores, for example, WHO +1 SD for overweight. To convert an age-sex-specific prevalence rate based on reference cut-off A to the corresponding prevalence based on reference cut-off B, first back-transform the z-score cut-offs z A and z B to age-sex-specific BMI cut-offs, then transform the BMIs to z-scores z B , A and z A , B using the opposite reference. These z-scores together define the distance between the two cut-offs as the z-score difference dz A , B = 1 2 z B - z A + z A , B - z B , A . Prevalence in the target group based on cut-off A is then transformed to a z-score, adjusted up or down according to dz A , B and back-transformed, and this predicts prevalence based on cut-off B. The algorithm's performance was tested on 74 groups of children from 14 European countries. RESULTS: The algorithm performed well. The standard deviation (SD) of the difference between pairs of prevalence rates was 6.6% (n = 604), while the residual SD, the difference between observed and predicted prevalence, was 2.3%, meaning that the algorithm explained 88% of the baseline variance. CONCLUSIONS: The algorithm goes some way to addressing the problem of harmonizing overweight and obesity prevalence rates for children aged 2-18

How can we best chart children’s growth in the paperless age? The UK experience

Growth charts have played an integral part in the monitoring and assessment of children’s health for the past 50 years, but their use is now under threat as paperless electronic systems become more widely used. While the obvious solution is to adopt electronic charting systems, this can prove challenging in practice. This article describes the key issues to consider in planning this transition and the charting options available, ranging from bespoke local systems to commercial packages and a new initiative by the Royal College of Paediatrics and Child Health

Promotion of faster weight gain in infants born small for gestational age - Is there an adverse effect on later blood pressure?

Background - Being born small for gestational age is associated with later risk factors for cardiovascular disease, such as high blood pressure. Promotion of postnatal growth has been proposed to ameliorate these effects. There is evidence in animals and infants born prematurely, however, that promotion of growth by increased postnatal nutrition increases rather than decreases later cardiovascular risk. We report the long-term impact of growth promotion in term infants born small for gestational age ( birth weight < 10th percentile).Methods and Results - Blood pressure was measured at 6 to 8 years in 153 of 299 ( 51%) of a cohort of children born small for gestational age and randomly assigned at birth to receive either a standard or a nutrient-enriched formula. The enriched formula contained 28% more protein than standard formula and promoted weight gain. Diastolic and mean ( but not systolic) blood pressure was significantly lower in children assigned to standard compared with nutrient-enriched formula ( unadjusted mean difference for diastolic blood pressure, - 3.2 mm Hg; 95% CI, - 5.8 to - 0.5; P = 0.02) independent of potential confounding factors ( adjusted difference, - 3.5 mm Hg; P = 0.01). In observational analyses, faster weight gain in infancy was associated with higher later blood pressure.Conclusions - In the present randomized study targeted to investigate the effect of early nutrition on long-term cardiovascular health, we found that a nutrient-enriched diet increased later blood pressure. These findings support an adverse effect of relative "overnutrition" in infancy on long-term cardiovascular disease risk, have implications for the early origins of cardiovascular disease hypothesis, and do not support the promotion of faster weight gain in infants born small for gestational age

The small FNR regulon of Neisseria gonorrhoeae: comparison with the larger Escherichia coli FNR regulon and interaction with the NarQ-NarP regulon

BACKGROUND: Neisseria gonorrhoeae can survive during oxygen starvation by reducing nitrite to nitrous oxide catalysed by the nitrite and nitric oxide reductases, AniA and NorB. The oxygen-sensing transcription factor, FNR, is essential for transcription activation at the aniA promoter, and full activation also requires the two-component regulatory system, NarQ-NarP, and the presence of nitrite. The only other gene known to be activated by the gonococcal FNR is ccp encoding a cytochrome c peroxidase, and no FNR-repressed genes have been reported in the gonococcus. In contrast, FNR acts as both an activator and repressor involved in the control of more than 100 operons in E. coli regulating major changes in the adaptation from aerobic to anaerobic conditions. In this study we have performed a microarray-led investigation of the FNR-mediated responses in N. gonorrhoeae to determine the physiological similarities and differences in the role of FNR in cellular regulation in this species. RESULTS: Microarray experiments show that N. gonorrhoeae FNR controls a much smaller regulon than its E. coli counterpart; it activates transcription of aniA and thirteen other genes, and represses transcription of six genes that include dnrN and norB. Having previously shown that a single amino acid substitution is sufficient to enable the gonococcal FNR to complement an E. coli fnr mutation, we investigated whether the gonococcal NarQ-NarP can substitute for E. coli NarX-NarL or NarQ-NarP. A plasmid expressing gonococcal narQ-narP was unable to complement E. coli narQP or narXL mutants, and was insensitive to nitrate or nitrite. Mutations that progressively changed the periplasmic nitrate sensing region, the P box, of E. coli NarQ to the sequence of the corresponding region of gonococcal NarQ resulted in loss of transcription activation in response to the availability of either nitrate or nitrite. However, the previously reported ligand-insensitive ability of gonococcal NarQ, the "locked on" phenotype, to activate either E. coli NarL or NarP was confirmed. CONCLUSION: Despite the sequence similarities between transcription activators of E. coli and N. gonorrhoeae, these results emphasise the fundamental differences in transcription regulation between these two types of pathogenic bacteria

Longitudinal Height Growth in Children and Adolescents with Type-1 Diabetes Mellitus Compared to Controls in Pune, India

Background: Height growth is affected by longterm childhood morbidity.// Objectives: To compare the growth curves of Indian children diagnosed with Type-1 diabetes mellitus (T1DM) and a control group of children without diabetes, and to see how parental height and disease severity affect the growth pattern. // Subjects and Methods: The data came from: (i) the Sweetlings T1DM (STDM) study with 460 subjects aged 4–19 years, previously diagnosed with T1DM and followed for 2–6 (median 3) years, with repeat measurements of height and glycated hemoglobin (HbA1c), and (ii) the Pune School-Children Growth (PSCG) study with 1,470 subjects aged 4–19 years, and height measured annually for median 6 years. Height growth was modeled using SuperImposition by Translation and Rotation (SITAR), a mixed effects model which fits a cubic spline mean curve and summarizes individual growth in terms of differences in mean size, and pubertal timing and intensity.// Results: SITAR explained 99% of the variance in height, the mean curves by sex showing that compared to controls, the children with diabetes were shorter (by 4/5 cm for boys/girls), with a later (by 1/6 months) and less intense (−5%/−10%) pubertal growth spurt. Adjusted for mean height, timing and intensity, the diabetic and control mean curves were very similar in shape. SITAR modeling showed that mean HbA1c peaked at 10.5% at age 15 years, 1.0% higher than earlier in childhood. Individual growth patterns were highly significantly related to parental height, age at diabetes diagnosis, diabetes duration, and mean HbA1c. Mean height was 3.4 cm more per + 1 SD midparental height, and in girls, 2 cm less per + 1 SD HbA1c. Conclusion. The results show that the physiological response to T1DM is to grow more slowly, and to delay and extend the pubertal growth spurt. The effects are dose-related, with more severe disease associated with greater growth faltering

Imposed faster and slower walking speeds influence gait stability differently in Parkinson fallers

Objective To evaluate the effect of imposed faster and slower walking speeds on postural stability in people with Parkinson disease (PD). Design Cross-sectional cohort study. Setting General community. Participants Patients with PD (n=84; 51 with a falls history; 33 without) and age-matched controls (n=82) were invited to participate via neurology clinics and preexisting databases. Of those contacted, 99 did not respond (PD=36; controls=63) and 27 were not interested (PD=18; controls=9). After screening, a further 10 patients were excluded; 5 had deep brain stimulation surgery and 5 could not accommodate to the treadmill. The remaining patients (N=30) completed all assessments and were subdivided into PD fallers (n=10), PD nonfallers (n=10), and age-matched controls (n=10) based on falls history. Interventions Not applicable. Main Outcome Measures Three-dimensional accelerometers assessed head and trunk accelerations and allowed calculation of harmonic ratios and root mean square (RMS) accelerations to assess segment control and movement amplitude. Results Symptom severity, balance confidence, and medical history were established before participants walked on a treadmill at 70%, 100%, and 130% of their preferred speed. Head and trunk control was lower for PD fallers than PD nonfallers and older adults. Significant interactions indicated head and trunk control increased with speed for PD nonfallers and older adults, but did not improve at faster speeds for PD fallers. Vertical head and trunk accelerations increased with walking speed for PD nonfallers and older adults, while the PD fallers demonstrated greater anteroposterior RMS accelerations compared with both other groups. Conclusions The results suggest that improved gait dynamics do not necessarily represent improved walking stability, and this must be respected when rehabilitating gait in patients with PD

Is arterial stiffening associated with adiposity, severity of obesity and other contemporary cardiometabolic markers in a community sample of adolescents with obesity in the UK?

BACKGROUND: Cardiovascular disease (CVD) prediction is problematic within groups of obese adolescents as measures such as adiposity and metabolic markers lack validation. Pulse wave velocity (PWV), a proxy for arterial stiffening, is a potential way to contemporaneously capture adolescents at greater risk of CVD. OBJECTIVES: To investigate associations between PWV and 1) adiposity and 2) other conventional metabolic factors in a community sample of (>95th centile body mass index (BMI)). DESIGN AND SETTING: Cross-sectional measurement and analysis in a hospital-based research centre drawn from a community sample of adolescents recruited to an obesity intervention at baseline. PATIENTS: 174 adolescents (12-19 years) with obesity (>95th centile BMI). 37% were male, while 66 (38%) were white, 53 (30%) black, 36 (21%) South Asian, 19 (11%) mixed/other. Participants with endocrine, genetic causes of obesity and chronic medical conditions (excluding asthma) were excluded. MEASURES: BMI z-score (zBMI), waist z-score, fat mass index (FMI: measured using bioimpedance), sagittal abdominal dimension (SAD), cardiometabolic blood tests and resting blood pressure (BP) were collected. Carotid-radial PWV was measured by a single operator. RESULTS: PWV was associated with age but not pubertal stage. PWV was positively associated with adiposity (zBMI: coefficient 0.44 (95% CI 0.08 to 0.79); FMI: coefficient 0.05 (95% CI 0.00 to 0.10); waist z-score: coefficient 0.27 (95% CI 0.00 to 0.53); SAD: coefficient 0.06 (95% CI: 0.00 to 0.12)). There was no association between PWV and BP, and few associations with cardiometabolic bloods. Associations between PWV and adiposity measures were robust to adjustment in multivariable models except for SAD. Participants with zBMI >2.5 SD and >3.5 SD had greater average PWV but overlap between groups was large. CONCLUSIONS: In our sample, increasing adiposity was positively associated with arterial stiffness, however partitioning by severity was not reliable. Lack of associations between BP, cardiometabolic bloods and arterial stiffness questions the reliability of these factors for predicting CVD risk in adolescents with obesity

A combined geochemical and hydrological approach for understanding macronutrient sources

This study employed complementary geochemical techniques and distributed hydrological modelling to investigate multiple sources of catchment macronutrients and characterise their changes in contrasting storm and baseflow conditions. This approach was demonstrated for the Beult catchment in the county of Kent (England), a designated Site of Special Scientific Interest (SSSI) indentified as failing to meet water quality standards for key nutrients under the Water Framework Directive. Significant changes in nutrient stoichiometry and bioavailability are observed for surface waters under contrasting flow regimes. Soluble reactive phosphorus (SRP) concentrations are approximately twice as high during baseflow compared to high flow, while the inverse is true for particulate, colloidal and dissolved hydrolysable phosphorus, dissolved organic carbon and nitrate. Nitrogen (N):phosphorus (P) ratios are lower during baseflow for most surface waters impacted by diffuse sources of pollution. Fluorescence indices of dissolved organic matter (DOM) show that waste water inputs may be locally important sources of more complex low molecular weight DOM, particularly during baseflow. Nitrate N and O isotope signatures, combined with other dissolved chemical tracers, confirm the dominance of wastewater N inputs at sites downsteam of sewerage treatment works during baseflow, with a shift towards the soil N pool in surface waters across the catchment during high flow. Distributed hydrological modelling using the Grid-to-Grid model reveal areas with the greatest runoff also export higher N and P concentrations, and hence deliver a greater flux of macronutrients, while forested areas with low nutrient concentrations reduce runoff and nutrient fluxes. During periods of high runoff, nested sampling indicates that nutrient fluxes scale with catchment area. This combined approach enables a more thorough assessment of the macronutrient sources and dynamics, better informing management options in nutrient impacted catchments