Percentiles of fasting serum insulin, glucose, HbA1c and HOMA-IR in pre-pubertal normal weight European children from the IDEFICS cohort.

OBJECTIVES: The aim of this study is to present age- and sex-specific reference values of insulin, glucose, glycosylated haemoglobin (HbA1c) and the homeostasis model assessment to quantify insulin resistance (HOMA-IR) for pre-pubertal children. METHODS: The reference population consists of 7074 normal weight 3- to 10.9-year-old pre-pubertal children from eight European countries who participated in at least one wave of the IDEFICS ('identification and prevention of dietary- and lifestyle-induced health effects in children and infants') surveys (2007-2010) and for whom standardised laboratory measurements were obtained. Percentile curves of insulin (measured by an electrochemiluminescence immunoassay), glucose, HbA1c and HOMA-IR were calculated as a function of age stratified by sex using the general additive model for location scale and shape (GAMLSS) method. RESULTS: Levels of insulin, fasting glucose and HOMA-IR continuously show an increasing trend with age, whereas HbA1c shows an upward trend only beyond the age of 8 years. Insulin and HOMA-IR values are higher in girls of all age groups, whereas glucose values are slightly higher in boys. Median serum levels of insulin range from 17.4 and 13.2 pmol l(-1) in 3-<3.5-year-old girls and boys, respectively, to 53.5 and 43.0 pmol l(-1) in 10.5-<11-year-old girls and boys. Median values of glucose are 4.3 and 4.5 mmol l(-1) in the youngest age group and 49.3 and 50.6 mmol l(-1) in the oldest girls and boys. For HOMA-IR, median values range from 0.5 and 0.4 in 3-<3.5-year-old girls and boys to 1.7 and 1.4 in 10.5-<11-year-old girls and boys, respectively. CONCLUSIONS: Our study provides the first standardised reference values for an international European children's population and provides the, up to now, largest data set of healthy pre-pubertal children to model reference percentiles for markers of insulin resistance. Our cohort shows higher values of Hb1Ac as compared with a single Swedish study while our percentiles for the other glucose metabolic markers are in good accordance with previous studies.

High cardiorespiratory fitness is inversely associated with incidence of overweight in adolescence: a longitudinal study.

To assess the association of baseline cardiorespiratory fitness (CRF) with incidence of overweight over a 4.6-year period in adolescence. In a cohort of 4878 adolescents, we assessed body mass index in years 2001-2003 and 2007. CRF was assessed at baseline as maximal oxygen consumption (VO2max , mL/kg/min) using the 20-m shuttle run test and was examined against incidence of overweight at follow-up. Estimated VO2max at baseline was higher in males than in females, P < 0.001, and was lower in overweight and obese than in non-overweight subjects. The incidence of overweight at follow-up among non-overweight participants at baseline was 15.5% [95% confidence interval (CI) 13.7% to 17.3%] in males and 5.6% (95% CI 4.9% to 7.0%) in females, P < 0.001. Adjusted odds ratio for incidence of overweight in participants in the fourth quartile of VO2max was 0.40 (95%CI 0.26 to 0.61) in males and 0.57 (95% CI 0.33 to 0.99) in females in comparison with participants in the first quartiles of VO2max . Incidence of overweight was three times more frequent in males than in females. Among non-overweight at baseline, high fitness levels were inversely associated with incidence of overweight at follow-up, suggesting that interventions aiming to increase CRF in early childhood might help reverse increasing trends in obesity.

Low serum high-density lipoprotein cholesterol in childhood is associated with adolescent asthma.

BACKGROUND: Whilst emerging evidence from animal and cell experiments has shown high-density lipoprotein cholesterol to have anti-inflammatory effects consistent with a protective role in asthma, human studies investigating the relationship of high-density lipoprotein cholesterol with asthma have produced conflicting results. OBJECTIVE: To examine the association between serum lipids among Cypriot children aged 11-12 years and prevalence of asthma at age 15-17 years. METHODS: In 3982 children, we assessed serum lipids, body mass index and maximal oxygen consumption at baseline (2001-2003) and explored associations with respiratory health at follow-up (2007) using multiple logistic regression models. RESULTS: Lower levels of high-density lipoprotein cholesterol at age 11-12 years were found in subjects who reported ever asthma (58.2 vs. 60.0 mg/dL, P = 0.005) and active asthma (57.5 vs. 59.9 mg/dL, P = 0.010) in adolescence, in comparison with their respective reference groups. Total cholesterol, low-density lipoprotein and triglycerides had no association with any of the asthma outcomes. In contrast, with estimated odds ratios of 1.89 (95% CI 1.19-3.00) and 1.89 (95% CI 1.02-3.53), ever asthma and active asthma respectively appeared particularly pronounced among those who at baseline had high-density lipoprotein cholesterol <40 mg/dL, even after adjusting for potential confounders including body mass index and maximal oxygen consumption. CONCLUSIONS & CLINICAL RELEVANCE: Low-serum high-density lipoprotein cholesterol in childhood is associated with an increased risk for asthma in adolescence, suggesting a potential role of this lipoprotein in the pathogenesis of paediatric asthma.

Efficacy of combined treatment with growth hormone and gonadotropin releasing hormone analogue in children with poor prognosis of adult height.

OBJECTIVE: This study was conducted to study the role of combination therapy of growth hormone and Gonadotropin-releasing hormone (GnRH) analogues in girls with idiopathic central precocious puberty (CPP) or idiopathic short stature (ISS). METHODS: Five girls with CPP (median age 9.1 y, pubertal stage 2-3) (3 of them previously treated with GnRH analogue (GnRHa) for 16.2 +/- 0.3 months) and 8 girls with ISS (median age 11.4 y, pubertal stage 2-3) (previously treated with GH for 10.95 +/- 1.42 months), were treated with recombinant human GH (0.33 mg/kg/week) and GnRHa (3.75 mg/28 days) for 22 months. RESULTS: Height of girls with CPP improved from - 1.3 to - 0.2 SDS and height for BA from - 2.1 to - 0.6 SDS (P = 0.042). Predicted adult height (PAH) improved from - 3.1 to - 0.6 SDS (P = 0.042). In girls with ISS only PAH improved from - 3.0 to - 1.5 SDS (P = 0.025). CONCLUSION: Combined treatment improves height and PAH in CPP. Height in ISS is also improved however not significantly.

Policy options for responding to the growing challenge from obesity: Cyprus national findings.

A multifaceted public health policy approach is required for reversing the current obesity epidemic. The Policy Options for Responding to the Growing Challenge of Obesity Research Project aimed to explore the consistency and/or variability of the perspectives of key stakeholders towards a range of different options to respond to the growing challenge of obesity among nine participating European member states. The multi-criteria mapping technique was used. Cyprus national data, when analysed in the public health and public policy context of Cyprus, collectively indicate that no single policy option appears to be unique in combating obesity, but rather need to be combined with other policy options. Specifically, measures are needed to improve levels of knowledge and understanding regarding food, diet, health and fitness beginning from early childhood with health professionals having an important role in this regard. These measures should be coupled with informational initiatives emphasizing the improvement of nutritional information labelling system, and the control of food and drink advertising. There was also a consensus regarding the need for modifying the supply of and demand for foodstuffs, but not via economic instruments. Practical feasibility, social acceptability, efficacy and social benefits but not the economic costs of the options were deemed the most important criteria for a successful implementation.

Prevalence and socio-demographic associations of undernutrition and obesity among preschool children in Cyprus.

OBJECTIVE: To estimate the prevalence of undernutrition and obesity in preschool children in Cyprus and identify possible associations. DESIGN: Cross-sectional study. SETTING: Private and public nursery schools. SUBJECTS: A representative sample (n=1412) stratified by age, gender, district and area of residence. INTERVENTIONS: Weight (kg) and height (cm) were obtained and BMI (kg/m2) was calculated. Z scores for weight-for-age, height-for-age, and weight-for-height were calculated using the cutoffs from the CDC/WHO 1978 reference. Socio-demographic associations with nutritional status were examined in a logistic regression analysis. RESULTS: The prevalence of undernutrition (WHO definition, Z-scores <-2) was low. Specifically the prevalence of underweight was 2.3%, wasting 2.8%, and stunting 1.1%. Undernutrition was associated with a low birth weight (LBW); odds ratio (OR) for underweight 4.1 (95% CI: 1.4, 12.2), P=0.012, stunting 5.2 (95% CI: 1.1, 23.3), P=0.033, and wasting 4.2 (95% CI: 1.3, 14.3), P=0.021. The prevalence of obesity (IOTF definition) was higher than undernutrition, and increased with age: 1.3% in 2 y olds to 10.4% in 6 y olds. Overweight and obesity prevalence were higher in rural (16.1%) than urban children (12.8%; P=0.046). Obesity in preschool children was associated with paternal obesity, OR 3.24 (95% CI: 1.59, 6.61), P=0.001, and maternal obesity 3.91 (95% CI: 1.78, 8.59), P=0.001. A birth weight (BW)> or =4000 g was associated with obesity compared to a BW between 2501 and 3000 g, OR 7.63 (95% CI: 1.91, 30.52), P=0.004. CONCLUSIONS: The prevalence of undernutrition among preschool children in Cyprus was low but obesity prevalence was higher. Parental obesity and high BW were significantly associated with obesity while LBW was associated with undernutrition in preschool children.

Short-term predictors of overweight in early adolescence.

OBJECTIVE: To identify short-term predictors of risk for overweight in early adolescence in a sample of Caucasian origin subjects, in Cyprus. SUBJECTS: A total of 357 subjects (178 males) with baseline age 11.5+/-0.4 y were re-evaluated after a mean of 1.6+/-0.5 y. MEASUREMENTS: Body weight and height, calculated body mass index (BMI), and blood pressure at baseline and follow-up. Serum lipids were determined at baseline. Obesity and overweight were defined at baseline and follow-up, according to the International Obesity Task Force data set. Socioeconomic class was determined. Self-reported parental weight and height were used to calculate the parental BMI. BMI tracking and changes in BMI categories were calculated (with 95% confidence interval (CI)). The future risk of overweight in baseline normal weight subjects was predicted using logistic regression analyses, where only normal weight subjects at baseline were included. RESULTS: More males remained in the overweight or obese category than females: 86.7% (95% CI: 73.2, 94.9) vs 71.8% (95% CI: 55.1, 85.0), respectively, P=0.03. The identified predictors for future overweight were paternal obesity, odds ratio (OR): 7.1 (95% CI: 1.3, 38.0), systolic blood pressure >95th percentile, OR: 8.9 (95% CI: 1.9, 41.7), high triglyceride levels, OR: 4.2 (95% CI: 1.0, 16.9) and low HDL-cholesterol levels, OR: 7.6 (95% CI: 1.7, 34.3). CONCLUSIONS: Triglycerides and HDL-cholesterol levels have been proved predictors for overweight in early adolescence for the first time. The different sex pattern in BMI tracking observed, and also the different environmental influences on future overweight risk compared to other studies, indicate that local circumstances should be considered when implementing national intervention strategies for the prevention of obesity.

Prevalence and risk factors associated with specialized intestinal metaplasia at the esophagogastric junction.

BACKGROUND/AIMS: Specialized intestinal metaplasia around the esophagogastric junction is considered to be premalignant. The aim of this study was to examine prospectively the prevalence of metaplasia and to correlate its presence with clinical, endoscopic and histological findings. METHODOLOGY: In 101 symptomatic patients (40 women, 61 men; mean age: 55 yr, range: 20-79 yr), biopsies were taken from gastric type mucosa just distal to the esophagogastric junction. They were stained with hematoxylin and eosin and alcian blue-periodic acid Schiff for the detection of specialized intestinal metaplasia and inflammation of the cardiac mucosa (carditis) and with Warthin-Starry for H. pylori presence. RESULTS: Metaplasia was detected in 27 patients (26.7%). Multiple logistic regression analysis revealed that metaplasia was associated significantly with age (odds ratio, 2.8; 95% confidence interval, 1.2-6.6), endoscopic suspicion of short segment Barrett's esophagus (odds ratio, 3.6; 95% confidence interval 2.2-6.9), detection of H. pylori (odds ratio, 2.8; 95% confidence interval, 1.1-7) and presence of carditis (odds ratio, 6.4; 95% confidence interval, 2.8-16.8). CONCLUSIONS: The prevalence of specialized intestinal metaplasia around the esophagogastric junction is high in symptomatic patients. Age, endoscopic evidence of short segment Barrett's esophagus and histological presence of H. pylori and carditis are independent risk factors associated with its presence.

Obesity in children and adolescents in Cyprus. Prevalence and predisposing factors.

OBJECTIVE: To estimate the prevalence of childhood and adolescent obesity in Cyprus and define possible associated risk factors. STUDY DESIGN: Cross-sectional study of a representative sample of children 6-17 y of age performed during October 1999 to June 2000. METHODS: Anthropometric data were taken using standard methods, from 2467 children. Certain diet and physical activities as well as other socioeconomic family parameters were assessed with the aid of a questionnaire. Obesity and overweight were defined using both the National Health and Nutrition Examination Survey (NHANES) I definition and the newer International Obesity Task Force (IOTF) definition. Logistic regression analyses were performed to estimate the influence of various parameters. RESULTS: The prevalence of obesity in males was 10.3% and in females 9.1% using the NHANES I definition and 6.9 and 5.7%, respectively, using the IOTF definition. The percentages presented a decreasing trend with age. There were an additional 16.9% of males and 13.1% of females defined as overweight with the NHANES I definition and 18.8 and 17.0%, respectively, using the IOTF definition. The most significant associated factor for obesity was parental obesity status. The odds ratio for offspring obesity when both parents were obese ranged from 11.34 (95% CI 1.83-75.50) in females 6 to 11-y-old to 18.09 (95% CI 2.06-158.81) for males 12 to 17-y-old. CONCLUSIONS: The prevalence of childhood and adolescent obesity was estimated for the first time in a representative sample from Cyprus, and this rate is comparable to that observed in North America. These results indicate the need for individual and population measures for the treatment and prevention of pediatric obesity. The rate of obesity differs significantly depending on the method of estimation.

Reference growth curves for cypriot children 6 to 17 years of age.

OBJECTIVE: The purpose of the study was to present smoothed percentiles for body weight and height, waist circumference, and body mass index (BMI) in Cypriot children and to compare their BMI 85th and 95th percentiles with those of children in other countries. RESEARCH METHODS AND PROCEDURES: The study was a cross-sectional study, including a representative sample of 2472 healthy children (49.1% boys) in Cyprus ages 6 to 17 years, who were evaluated during the 1999-2000 school year. Body weight and height and waist circumference were measured using standard procedures. BMI was calculated as weight in kilograms per height in square meters. Smoothed, sex-specific percentiles for these variables were calculated using polynomial regression models. Crude weight, height, waist, and BMI percentile values are presented in sex-specific tables and smoothed percentile curves are presented in charts. The 85th and 95th percentiles for BMI were compared with measurements from other countries, because of the concern of the upper limits of BMI in respect to the evaluation of obesity. RESULTS: The 85th and 95th BMI percentile values are higher in Cypriot boys than in Swedish and Iranian boys through all ages and in girls ages 6 to 15 years, whereas after the age of 15 years, both Swedish and Iranian girls' percentiles are equalized with their Cypriot peers. DISCUSSION: Weight, height, waist circumference, and BMI values and charts are presented for the first time for Cypriot children and adolescents. Much concern should be addressed to the observation that for the majority of the Cypriot sample, the upper BMI limits are higher than the peers of developing and developed countries.

Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index.

BACKGROUND: Visceral adipose tissue is associated with increased risk for cardiovascular disease risk factors and morbidity from cardiovascular diseases. Waist measurement and waist-to-height ratio (WHtR) have been used as proxy measures of visceral adipose tissue, mainly in adults. OBJECTIVE: To validate body mass index (BMI), waist circumference and WHtR as predictors for the presence of cardiovascular disease risk factors in children of Greek-Cypriot origin. SUBJECTS AND METHODS: A total of 1,037 boys and 950 girls with mean age 11.4+/-0.4 y were evaluated. Dependent variables for the study were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholestrol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and systolic (SBP) and diastolic (DBP) blood pressure. RESULTS: When children were divided into two groups according to the 75th percentile for BMI, waist circumference and WHtR, all dependent variables had higher mean values in the highest percentile groups in WHtR groups and almost all variables in BMI and waist circumference groups. Adjusted odds ratios for predicting pathological values of cardiovascular disease risk factors were slightly higher for the highest WHtR group for predicting lipid and lipoprotein pathological values and for the highest BMI groups in predicting high blood pressure measurement. Using stepwise multiple regression analysis to explain the variance of the dependent variables, waist circumference was the most significant predictor for all variables both for boys and girls, whereas BMI had the lowest predictive value for the detection of cardiovascular disease risk factors. CONCLUSION: Waist circumference and WHtR are better predictors of cardiovascular disease risk factors in children than BMI. Further studies are necessary to determine the cutoff points for these indices for an accurate prediction of risk factors.