Accuracy and capability of tri-ponderal mass index in assessing cardio-metabolic risk factors in Chinese children and adolescents aged 3 to 17 years, compared with body mass index / 中华医学杂志(英文版)

BACKGROUND@#Tri-ponderal mass index (TMI) has been reported to be a more accurate estimate of body fat than body mass index (BMI). This study aims to compare the effectiveness of TMI and BMI in identifying hypertension, dyslipidemia, impaired fasting glucose (IFG), abdominal obesity, and clustered cardio-metabolic risk factors (CMRFs) in 3- to 17-year-old children.@*METHODS@#A total of 1587 children aged 3 to 17 years were included. Logistic regression was used to evaluate correlations between BMI and TMI. Area under the curves (AUCs) were used to compare discriminative capability among indicators. BMI was converted to BMI- z scores, and accuracy was compared by false-positive rate, false-negative rate, and total misclassification rate.@*RESULTS@#Among children aged 3 to 17 years, the mean TMI was 13.57 ± 2.50 kg/m 3 for boys and 13.3 ± 2.33 kg/m 3 for girls. Odds ratios (ORs) of TMI for hypertension, dyslipidemia, abdominal obesity, and clustered CMRFs ranged from 1.13 to 3.15, higher than BMI, whose ORs ranged from 1.08 to 2.98. AUCs showed similar ability of TMI (AUC: 0.83) and BMI (AUC: 0.85) in identifying clustered CMRFs. For abdominal obesity and hypertension, the AUC of TMI was 0.92 and 0.64, respectively, which was significantly better than that of BMI, 0.85 and 0.61. AUCs of TMI for dyslipidemia and IFG were 0.58 and 0.49. When 85th and 95th of TMI were set as thresholds, total misclassification rates of TMI for clustered CMRFs ranged from 6.5% to 16.4%, which was not significantly different from that of BMI- z scores standardized according to World Health Organization criteria.@*CONCLUSIONS@#TMI was found to have equal or even better effectiveness in comparison with BMI in identifying hypertension, abdominal obesity, and clustered CMRFs TMI was more stable than BMI in 3- to 17-year-old children, while it failed to identify dyslipidemia and IFG. It is worth considering the use of TMI for screening CMRFs in children and adolescents.

The influence of hematopoietic stem cell transplant on pulmonary involvement in pediatric type B Niemann-Pick disease: high resolution CT findings / 中华放射学杂志

Objective:To analyze the pulmonary high resolution CT (HRCT) images before and after hematopoietic stem cell transplantation (HSCT) in 6 children with Niemann-Pick disease(NPD) type B, and to investigate the effect of HSCT on lung lesions.Methods:Data of 6 children who were diagnosed with NPD type B and underwent HSCT treatment in Children′s Hospital Affiliated to Capital Institute of Pediatric from March 2019 to June 2021 were retrospectively enrolled, including 5 males and 1 female, with ages ranging from 1 year and 2 months to 5 years, and a median age of 2 years and 1month. The follow-up time of HRCT after HSCT was 7-20.5 months, the median time was 5 months, and the number of follow-up was 2-7 per patients, a total of 27 times. The pulmonary lesions (including interstitial lung disease, airway lesions and alveolar lesions) on aortic arch level, tracheal carina level and right diaphragmatic surface level were evaluated and scored respectively by two experienced pediatric radiologists, and the average score between them would be the final score. The Kruskal-Wallis H test was used to compare the scores of the three kinds of lung lesions before HSCT. The linear regression method was used to analyze the impact of HSCT duration on the degree of different lesions. To control possible confounding factors in the study, a generalized linear mixed model was used to evaluate the effects of HSCT duration, age, gender and whether co-infection on different types of lesions after HSCT. Results:Before HSCT treatment, all of the 6 children had different degree of airway, interstitial and alveolar lesions, with a median score of 3.0, 14.0 and 5.8 points, respectively (χ2=11.95, P=0.003). Interstitial disease was the most extensive and serious lesion among those three pulmonary involvements in pediatric NPD type B. After HSCT treatment, the scores of interstitial and airway lesions in all of the 6 children reduced, in varying degree, with the increase of time after HSCT. Except case 4, the alveolar lesion in 5 patients also showed a decreasing trend over time. The linear regression equation between the score of airway, interstitial, alveolar lesions and the HSCT duration was: airway lesion, Y=1.94-0.15X; interstitial lesion, Y=12.73-0.78X; and alveolar lesion, Y=3.31-0.27X. The results of the generalized linear mixed model showed that the main effect of HSCT duration significantly affected on the three kinds of lung lesions, and the scores of interstitial lesions, airway lesions and alveolar lesions were decreased by 0.688, 0.245, and 0.338 points for each 1 month increase of HSCT duration (all P<0.05). The alveolar lesion score decreased by 1.135 points for each 1 year increase in age at presentation ( P=0.012). The main effects of gender and co-infection were not statistically significant in all of the pulmonary lesions (both P>0.05). Conclusion:HSCT alleviates pulmonary lesions of children with NPD type B significantly and consistently, with interstitial lesions were the most prominent.

Impacts of hypertension on early changes of cardiovascular structure and function among children: a case-control study / 中华流行病学杂志

Objective To assess the cardiovascular structure and function in children with confirmed primary hypertension,and to explore the impact of hypertension and related risk factors on cardiovascular structure and function of children.Methods Parameters related to cardiac structure,vascular structure and function were measured in 213 hypertensive children,who were confirmed upon repeated measurements on separate occasions.A total of 197 healthy children were recruited as controls.Results 1) In hypertensive children,left ventricular end-diastolic diameter (LVEDd),left ventricular end-systolic diameter (LVESd),left ventricular mass (LVM),left ventricular mass index (LVMI),left ventricular posterior wall thickness (LVPT) and interventricular septal thickness (IVST) were all significantly higher than their counterparts (P＜0.05).No statistical differences were found in carotid intima-media thickness (cIMT),relative wall thickness (RWT) and brachial ankle pulse wave velocity (ba-PWV).2) Compared with controls,LVEDd,LVESd,LVM,LVMI were all significantly higher in hypertensive children (P＜0.05),regardless of age group or weight-status.No statistical differences were found in ccIMT and RWT,while ba-PWV was statistically higher in controls among children aged 6-12 years.3) Data from multiple linear regression analysis noticed that LVMI was associated with age,sex,BMI and hypertension while RWT was associated with age and BMI.Conclusion In children with primary hypertension,changes of vascular structure and function were not shown but left ventricular remodeling and early changes of function had been developed in children under 12 years old.

Trends on the prevalence rates of obesity and cardiometabolic among children and adolescents in Beijing, during 2004-2013 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the trends on the prevalence rates of obesity and cardiometabolic among children and adolescents in Beijing, during 2004-2013.</p><p><b>METHODS</b>Data was collected from three cross-sectional studies among children and adolescents, aged 7-17 years old in Beijing. Two studies in 2004 and 2013 were conducted in general population, and one was among obese children in 2007. Data on anthropometric measurements including weight, height, and age was collected from all the subjects. The obese children from all three studies underwent a clinic examination that containing blood pressure, fasting plasma glucose, lipid profile (TC, TG, LDL-C, HDL-C), and acanthosis nigricans. Liver transaminases detection (ALT and AST) and liver ultrasound examination were performed in obese children from surveys in 2007 and 2013.</p><p><b>RESULTS</b>The prevalence of severe obesity increased from 1.86% in 2004 to 4.17% in 2013, with an annual increase rate as 0.26%. The proportion of severe obesity in obesity increased from 18.92% in 2004 to 25.15% in 2013. After adjusting for age and gender, the prevalence of IFG, hypertriglyceridemia and low HDL-C in both obese children and adolescents increased during 2004-2013 (all P < 0.05). The prevalence rates of hypertension, dyslipidemia, hypertriglyceridemia, and acanthosis nigricans in severe obese children were higher than those in moderate obesity. The proportion of children with 2 or more cardiometabolic risk factors in severe obese children was higher than in moderate obese children.</p><p><b>CONCLUSION</b>The prevalence rates of obesity and cardiometabolic risk factors among children and adolescents in Beijing showed an increase during 2004-2013.</p>

The current status of physical activity in urban school-aged children and its association with obesity / 中华流行病学杂志

Objective To understand the current status of physical activity among urban school-aged children and its association with obesity.Methods 295 pupils,aged 9 to 13 years were selected,using the method of convenience sampling.Data on anthropometric measurements was collected,including weight and height.Questionnaire survey,clinic examination,dietary investigation of school lunch and surveillance on 7-day physical activity by pedometers,were done and Multi-linear regression was used to analyze the relationship between waist to height ratio (WHtR),fat mass percentage (FMP),body mass index (BMI) and physical activity.Single-variable and multiple non-conditional logistic regression modeling were applied to analyze data collected from obesity and physical activities.Results 15.5％ of boys and 13.1％ of girls reached 60 minutes per day of ‘ moderate-vigorous physical activities’.Compared with normal children,overweight/obesity children showed an increase of sedentary activity time,total energy expenditure,and energy expenditure of physical activity.With the increase of 1 hours daily on going to school by private car,WHtR and FMP increased by 0.01 and 2.06 units,respectively.FMP increased 0.89 units among with the increase of sedentary activity time,1 hour daily.BMI and the intake of leafy vegetables (eg.spinach,cabbage)showed a negative correlation.As the frequency of leafy vegetables consumption increased once weekly,BMI fell 0.10 units.After adjustment for sex and age,the risk of overweight/obesity was 3.82-fold (95％CI:1.17-12.47) among children who had sedentary activity time more than 120 min/ d,than those having less than 120 min/d.Conclusion Our data showed that children' s daily physical activity was not enough and measures should be taken to decrease the time of sedentary behavior and increase the energy expenditure through physical activities.

Impacts of types and degree of obesity on non-alcoholic fatty liver disease and related dyslipidemia in Chinese school-age children? / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To explore the impacts of types and degree of obesity on non-alcoholic fatty liver disease (NAFLD) and related lipids disturbance in Chinese school-age children.</p><p><b>METHODS</b>A total of 1 452 school-age Children of 7 to 17 years were recruited in Beijing with representative cluster sampling method. Data of anthropometric measurements including weight, height and waist circumference were collected from March to May of 2007. Body mass index(BMI)was calculated. Blood samples were obtained and lipid profiles including triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured, while glutamate-pyruvate transaminase (ALT) and glutamic-oxalacetic transaminase (AST) were determined to evaluate liver function. The liver was also scanned by sonography, and abnormal hepatic sonograms were documented. NAFLD was diagnosed according to the criteria recommended by the Fatty Liver and Alcoholic Liver Disease Study Group under the Chinese Liver Disease Association. Analysis of covariance (ANOVA), Chi-square test for trend and binary logistic regression analysis were performed.</p><p><b>RESULTS</b>The dyslipidemia and ultrasonographic fatty liver deteriorated with the degree of obesity defined either by BMI or waist circumference. Compared with BMI, waist circumference contributed more to the development of dyslipidemia, fatty liver and NAFLD. The highest levels of TG, TC, LDL-C, and lowest level of HDL-C were seen in the mixed obese group followed by abdominal obese, peripheral obese and non-obese ones. Adjusted for gender and age, the odds ratios (ORs) and their 95% confidence intervals of peripheral obesity, abdominal obesity and mixed obesity were 0, 10.93 (0.98-121.96) and 79.16 (10.95-572.44) for predicting NAFLD; 12.61 (1.24-127.78), 19.39 (5.23-71.85), and 93.21 (29.56-293.90) for predicting ultrasonographic fatty liver; 1.78 (0.59-5.44), 3.01 (1.91-4.77), and 4.64 (3.52-6.12) for predicting dyslipidemia, respectively compared with the non-obese control group. The trend of hazards over groups was statistically significant (P<0.01).</p><p><b>CONCLUSION</b>The levels of lipid profile and the prevalence of NAFLD and dyslipidemia increased in parallel with the degree of obesity; As compared with the non-obese control, the mixed obesity had the strongest association with NAFLD and dyslipidemia, followed by abdominal obesity and peripheral obesity in Chinese school-age Children.</p>