Rapid increase in the prevalence of obesity in elementary school children.

OBJECTIVE: Three critical periods have been suggested for the development of obesity during childhood: fetal, ages 4-6 y, and adolescence. The prevalence of obesity in elementary school children is increasing in Japan, and the present study examines whether this rising prevalence occurs during the elementary school period (age 6-11 y) or is occurring prior to entry into elementary school. DESIGN: Repeated cross-sectional sampling of cohorts of children for the prevalence of obesity. SETTING AND PARTICIPANTS: The data from 81 264 first grade and 87 849 seventh grade children (94 and 87% of the total populations, respectively) between 1989 and 2002 in Kagoshima City were analyzed. Data were also obtained from nationwide surveys published by the Ministry of Japan between 1989 and 2001. MEASUREMENTS: Obesity was defined by the body mass index for an age- and sex-specific 95th percentile cutoff point in Japanese children. Trends in obesity and odds ratios of the prevalence of obesity were also determined. RESULTS: The period 1989-2001/2 showed significant increases in the prevalence of obesity for both genders, in both first and seventh grades, and in both Kagoshima City and nationwide. The odds ratios for the prevalence of obesity of 12-y-old children calculated against the prevalence of obesity within the same cohort at 6 y old revealed that a significant risk for development of obesity during the elementary school years applied only to boys from around 1993 onward in Kagoshima City and applied throughout the study period in nationwide Japan. CONCLUSION: Obesity prevalence increases for boys during elementary school years but does not significantly increase for girls. A rising trend for becoming obese before starting elementary school was present for both boys and girls over the period 1989-2001. Educational programs to improve nutrition and physical activity, especially for boys, are becoming increasingly necessary.

Who is becoming overweight during the elementary school years?

OBJECTIVE: To determine the risk of becoming overweight for every first grader during the elementary school years and to determine whether the overall risk of becoming overweight for first graders is increasing. STUDY DESIGN: A descriptive study using school-based surveys of 12,588 boys and 12,264 girls who entered elementary school between 1989 and 1994. Six years later, the follow-up survey was conducted. Overweight was defined using the BMI percentile cut-off points. MEASUREMENTS: For every 5th percentile rank of first graders, the odds ratio for becoming overweight at seventh grade was calculated. A hockey stick regression analysis and the yearly trend of the risk for becoming overweight at 7th grade were also investigated. RESULTS: For overweight children in first grade, the odds ratio for staying at the same level was extremely high in both boys (35.0) and girls (63.9). The threshold effects of the BMI percentile value at first grade for becoming overweight were the 81st and 87th percentiles for boys and girls, respectively, according to the hockey stick model. The overall risk for becoming overweight significantly increased in boys during the study period (P=0.009). CONCLUSION: The present study determined the exact level of the risk for becoming overweight for every first grader at a different BMI percentile rank. The risk of overweight children in first grade who stayed at the same level at seventh grade was higher in girls than in boys. On the other hand, the trend of the entire population for becoming overweight presents only in boys. The different pattern of the trend of population for becoming overweight by sex during elementary school period may provide evidence to understand and predict overweight in adolescents and adults.

Risk factors for persistence of pulmonary arterial branch stenosis in neonates and young infants.

BACKGROUND: Pulmonary arterial branch stenosis (PBS) in neonates is considered to be transient. However, PBS has been found not only in neonates, but also in young infants. Among these patients, we encountered several patients whose PBS was still present after the age of 1 year. METHODS: To clarify the natural history of PBS in neonates and young infants, we retrospectively reviewed the records of 103 patients diagnosed with PBS in the neonatal period and early infancy. RESULTS: The PBS findings were improved in all patients. Pulmonary arterial branch stenosis disappeared in 94 patients by the age of 1 year (group A), but persisted after I year of age in nine patients (group B). Group B patients had a significantly lower mean birth weight and greater deltavelocity (the difference in the peak flow velocity between the main pulmonary artery and stenotic branch) at diagnosis than group A patients. Incidences of low birth weight (< 2,500 g) and deltavelocity above 1.2 m/s were significantly higher in group B than group A patients. There was no significant difference in the frequency of premature infants (gestational age < 36 weeks) between the groups, suggesting that intrauterine growth retardation may be related to developmental abnormalities of the pulmonary arterial branch. CONCLUSIONS: All cases of PBS in neonates and young infants were improved. However, PBS persisted in some patients after the age of 1 year. Low birth weight and deltavelocity above 1.2 m/s are risk factors for persistent PBS. Pulmonary arterial branch stenosis was not present after the age of 1 year in 62 of 63 patients without either of these risk factors.

Face immersion in cold water induces prolongation of the QT interval and T-wave changes in children with nonfamilial long QT syndrome.

We investigated the relation between heart rate and the QT interval using face immersion in cold water in children with long QT syndrome (LQTS) without a family history of this condition, and in control children. The face immersion test revealed that all children with high probability of LQTS had a significantly longer QT interval than control children during face immersion, and that the test could induce T-wave alternans or a notched T-wave in all children with a high probability of LQTS.

Urinary N-methylhistamine in asthmatic children receiving azelastine hydrochloride.

BACKGROUND: Histamine has a particular role in the pathogenesis of bronchial asthma, and many antiallergic drugs have been developed with antihistaminic action in mind. Recently, a sensitive and specific assay for measuring histamine and its metabolites has been developed. There are, however, no reports of the effect of antiallergic drugs on histamine levels in asthmatic patients. OBJECTIVES: To determine the relationship between clinical symptoms and histamine levels in asthmatic patients receiving an antiallergic agent. METHODS: A prospective study was designed in asthmatic children treated with azelastine hydrochloride. The evaluation of clinical symptoms was based on scores of the severity of exacerbations, activities of daily living, quality of sleep, and required therapy. Urinary excretion of N-methylhistamine, a major metabolite of histamine, was measured by double antibody radioimmunoassay. RESULTS: In the patients treated with azelastine, the improvement in clinical symptoms of bronchial asthma correlated significantly with a decrease in urinary N-methylhistamine excretion (r2 = 0.434, P < .001), while no such relationship was noted in patients receiving no antiallergic agent. Urinary N-methylhistamine excretion showed no diurnal change or influence of meals. CONCLUSIONS: Decreased urinary N-methylhistamine excretion may be a direct reflection of the antihistaminic action of azelastine in vivo. Measurement of urinary N-methylhistamine excretion can be used to evaluate the efficacy of agents with antihistaminic action in the treatment of bronchial asthma.

What are parents of obese children concerned about in their children?

We retrospectively examined the issues that concern parents of obese children to determine the most effective means of motivating them to seek treatment for obesity in their children. Children with an obesity index > or = 40%, aged six to 12 years, were screened in Kagoshima City in 1992. Parents were notified if their children needed an evaluation that included a family history and measurements of the blood pressure, total cholesterol, high density lipoprotein (HDL)-cholesterol, atherogenic index (ASI), triglycerides, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Parents were informed of the results of the evaluation and invited to attend a lecture on the treatment of obesity in children. A total of 378 obese children were evaluated. However, the parents of only 39 children attended the lecture. Children whose parents attended had higher mean total levels of cholesterol (190 +/- 25 vs 175 +/- 28, P < 0.01) and ASI values (3.2 +/- 0.9 vs 2.7 +/- 0.9, P < 0.02) than those whose parents did not attend. There were no significant differences in other factors. Only 4.2% of parents whose children showed no abnormal values, except for obesity, attended the lecture, compared with 20.3% (P < 0.01) or 16.9% (P < 0.05) of parents whose children had abnormal levels of cholesterol or abnormal ASI. Parents may be more concerned about hypercholesterolemia or arteriosclerosis than obesity per se. We should perhaps use the total cholesterol or ASI values, not just the severity of obesity, to motivate parents to enter their children into treatment programs for obesity.

[Quantitative analyses of the normal throat flora of children with upper respiratory tract infections].

Relationship between the normal throat flora and pathogenic bacteria recovered from the throat in 139 children with upper respiratory tract infections in winter were studied using quantitative analyses. Pathogenic bacteria examined include S. pyogenes, H. influenzae, S. aureus, and S. pneumoniae, and the normal floras include alpha-streptococci, gamma-streptococci, Neisseria species, and Micrococci. Children with S. pyogenes in their throats (S. pyogenes group) were examined with anti-streptococcal antibodies such as anti-streptolysin O, anti-streptokinase, and anti-deoxyribonuclease B. Eighty seven pathogenic bacteria were recovered from 72 children (51.8%) out of 139. S. pyogenes and S. pneumoniae groups showed significantly lower alpha-streptococci and gamma-streptococci in incidence of appearance when compared with children with the no pathogenic bacteria in their throats (no bacteria group). H. influenzae group showed significantly lower gamma-streptococci and higher Neisseria sp. in incidence of appearance compared with the no bacteria group. Positive cases for anti-streptococcal antibodies showed a significantly lower alpha-streptococci in number compared with negative cases for antibodies and the no bacteria group, and a significantly lower gamma-streptococci in incidence of appearance compared with the no bacteria group. These data suggest that the normal throat flora may have a role in prevention of colonization by the pathogenic bacteria in vivo, as were shown in vitro by many authors, and that the quantitative analysis of the normal flora is useful because this methodology might reveal whether the bacteria recovered from the throat show the pathogenicity.