First results of the growth disorders related twinning programme Partners4Growth implemented at the tertiary university pediatric endocrinology clinics in Bulgaria.

OBJECTIVES: Early diagnosis of childhood growth disorders, their timely and proper treatment are important for better outcomes.The aim of the present study was to assess the results of the first 18 months of the growth disorders related twinning programme "Partners4Growth" implemented at all tertiary university pediatric endocrinology clinics in Bulgaria. METHODS: In 2019, Partners4Growth started operation at 7 centres (4 experienced and 3 twin centres) with the main aim of aligning their practices in the shortest possible time. Education of twin centres' personnel was organized, equipment and methods for growth evaluation and follow-up were standardized. The approach was tested initially at one centre. At baseline and at the 18th month a questionnaire concerning diagnosis and management of recombinant human growth hormone (rhGH) requiring disorders was applied. RESULTS: A total of 104 new patients were diagnosed compared to 30 in the previous year. Of those, 91 started rhGH treatment - 65 (64 %) GH deficient, 12 (12 %) Turner syndrome, 7 (7 %) Prader-Willi syndrome patients, and 7 (7 %) born small for gestational age without postnatal catch-up, representing 35.8 % of all currently rhGH treated Bulgarian children. A better geographical coverage and more advanced diagnostic and management practices were achieved. CONCLUSIONS: Partners4Growth facilitated the alignment of the tertiary pediatric endocrinology centres competences thus leading to an improved diagnosis and treatment of growth disorders as well as better patients' access. For its short existence, the Programme increased significantly the number of new patients in the difficult times of COVID-19 pandemic thus justifying its continuation.

Mapping of the current transition of care practice for patients with pituitary disease at Endo-ERN reference centers.

Rare endocrine conditions present specific diagnostic and management challenges for healthcare providers, one of which is the understudied transition of care. Despite the need for guidance regarding transition, consensus on structured and protocolled approaches is lacking. Therefore, we aimed to map the current clinical practice and identify unmet needs regarding transition of care for patients with pituitary disease in the reference centers (RCs) of the European Reference Network on Rare Endocrine Conditions (Endo-ERN). A survey-based, cross-sectional study using the EU Survey tool was performed and completed by 46 physicians (n) from 30 RCs (N). Transition is a common practice among RCs (n = 44/46), usually accomplished by a multidisciplinary team meeting (N = 20/30). Criteria for start and end of transition were defined in half of the RCs, with 16.7% of centers providing dissimilar answers. Transition readiness was assessed by >75% of the RCs, mostly by unvalidated means (e.g. subjective opinions, informal consultations). Pituitary-specific transition assessment tool was applied in one RC only. Transition protocols were present in only 9% of RCs, while in many RCs, transition decisions were taken in combined adult-pediatric meetings or based on clinicians' personal judgment. A minority of physicians evaluated the effectiveness of transition-related interventions (n = 11/46) or medical outcomes (n = 8/46). Patient-reported outcome measures were infrequently used (n = 4/46). Identified unmet needs included the development of guidelines (n = 5/46) and EU-wide approach (n = 2/46). This study exemplifies the unmet needs for a structural definition of the transition period and transition management for patients with rare hypothalamic and pituitary conditions from healthcare providers' perspective.

International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years.

CONTEXT: No universal waist circumference (WC) percentile cutoffs used have been proposed for screening central obesity in children and adolescents. OBJECTIVE: To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk. DESIGN AND SETTING: We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years). MAIN OUTCOME MEASURE: WC measured based on recommendation by the World Health Organization. RESULTS: We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls). CONCLUSION: The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time.

Circulating proinflammatory peptides related to abdominal adiposity and cardiometabolic risk factors in healthy prepubertal children.

OBJECTIVES: To analyze the circulating levels of proinflammatory peptides in healthy prepubertal children in relation to abdominal obesity, measured by waist circumference (WC), and to investigate their interactions with cardiometabolic risk factors. DESIGN AND METHODS: A cross-sectional study of 137 healthy prepubertal children with a mean age of 8.0±0.1 years divided into three groups according to their WC as a measure of abdominal obesity: 'normal-WC' children (25th-75th percentile, n=48), 'children at risk' (75th-90th percentile, n=39), and 'abdominally obese' (≥90th percentile, n=50) children. Auxological measurements and blood pressure (BP) were taken. Fasting levels of high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL6), tumor necrosis factor-α (TNF-α), glucose, insulin, and lipid profile were measured. Insulin resistance (IR) was assessed by homeostasis model assessment of IR (HOMA-IR). RESULTS: Abdominally obese children had significantly higher BP, insulin, HOMA-IR, total cholesterol and triglycerides (TG) compared with their normal-WC counterparts (P<0.05). HsCRP concentrations increased proportionally with the degree of abdominal obesity (r=0.443, P<0.0001), whereas IL6 and TNF-α were not significantly associated with any of the adiposity variables. After controlling for adiposity, hsCRP was significantly correlated with systolic BP (r=0.257, P=0.004), TNF-α levels were related to high-density lipoprotein cholesterol (HDL-C; r=-0.216, P=0.016) and TG (r=0.196, P=0.029), whereas the relationship between IL6 and HDL-C reduced its magnitude to an insignificant level (r=-0.173, P=0.055). CONCLUSIONS: Healthy prepubertal children with abdominal obesity have associated inflammatory and cardiometabolic alterations, interacting with each other.

Waist circumference percentile curves for Bulgarian children and adolescents aged 6-18 years.

BACKGROUND: Waist circumference (WC) is a simple, easily available anthropometric measurement, giving relevant information about fat distribution and reflecting the degree of central adiposity in children. It appears to be the main risk factor for the progress of the metabolic syndrome. Our aim was to develop age- and sex-specific WC percentile curves for Bulgarian children/adolescents and to compare them with those from other countries. METHODS: A representative cross-sectional study of 3,810 healthy Bulgarian children/adolescents (2,052 males) aged 6-18 years, conducted in 2006/07. Body weight, height and WC were measured and body mass index (BMI) was calculated. Sex- and age-specific WC percentile curves were constructed using the LMS method. RESULTS: WC increased with age in both sexes (P<0.0001), with higher values in boys at every age and percentile point. This difference became significant from age 11 years onwards (P<0.05). The boys' values continued to increase steeply after this age, while in girls we found a constant continuing increase until the age of 15. Thereafter WC began to decrease and level off. The WC percentile values in Bulgarian children were lower than in US children, higher than in British and Turkish children, and similar to those of their Cypriot peers. CONCLUSIONS: For the first time, WC percentile curves were constructed for Bulgarian children/adolescents. A unique standardized method for WC measurement in children is needed for more acceptable international comparisons.