Evolution of GH secretion in urine during an in-patient slimming course in obese children.

OBJECTIVE: To estimate the change in GH excretion in urine (GH-U) during a slimming course, and if increased, to assess the components of the course related to the increase in obese children. DESIGN: Observational follow-up study of patients admitted for primary obesity to an in-patient slimming course lasting at least 10 weeks. SUBJECTS: 48 complete observations out of 54 consecutive pre-pubertal patients admitted to a paediatric centre for treatment of primary obesity (BMI greater than the 90th percentile of the national reference curves). MEASUREMENTS: GH excretion in urine by immunoradiometric assay, at entry and after 10 weeks, various anthropometric measurements, nutritional intake and departure from the prescribed diet, time spent in physical activity, sleep duration. RESULTS: A mean decrease of 0.90 standard deviations for BMI was accompanied by a 34% increase of GH-U. Time spent in physical activity was the only component of the course found to be related to the magnitude of GH-U increase. CONCLUSION: The results of this observational study confirm that GH-U is increased after a slimming course in children, and suggest that physical activity is a major contributor to the restoration of normal GH-U levels.

[Growth curves from birth to 6 years of age: growth in weight, height and cranial circumference according to sex]. / Courbes de croissance de la naissance à 6 ans: croissance en poids, taille et périmètre crânien selon le sexe.

UNLABELLED: The growth supervision of children using growth curves is a widespread and useful tool in general pediatric practice. In France the latest reference curves are rather ancient, therefore it seemed to us interesting to re-examine some growth parameters and to compare them to the current reference data. PATIENTS AND METHODS: The studied sample was composed of 7,000 children from the Rhône-Alpes region in France who were seen for a school health check-up. Anthropometric measurements (35,000) related to weight, height and cranial circumference of these children aged from 0 to 6 were selected from their health booklets. Centile curves for these three variables were drawn from these measurements using the LMS method, which is specifically suited to these types of data. RESULTS: If height and cranial circumference can be considered as normally distributed, weight is markedly skewed to the right, reflecting a high prevalence of children with heavy weight. Comparison with current references data shows more or less similar results for weight, height and cranial circumference: the medians and the 2.5 centile are constantly higher in our sample than those of the reference data (the discrepancy increasing with age). The differences are more important regarding the part of the distribution which concerns the highest values: overall, the 90th centile of our distribution corresponds rather closely to the 97.5th one of the current reference data. Thus, at 6 years of age, the 97.5th centile of the reference weight distribution for girls is 23,400 kg, while it is estimated at 27,770 kg in our sample. One should take in account the different characteristics of the two studies to interpret these differences. CONCLUSION: The aim and use of such growth curves is discussed, together with recent computer applications in this field.

[Is it possible to improve sleep in children? A research on health education in nursery schools]. / Peut-on améliorer le sommeil des enfants? Une recherche en éducation pour la santé à l'école maternelle.

An educational project in nursery schools was carried out with the aim to improve children's sleep. Its effectiveness was tested in terms of awareness of families and length of sleep of children. The method was a prevention trial based on the random division of classes of 3-year old into two groups (intervention group and control group) comprising children enrolled in nursery schools in the Rhône region (France) in 1992. The project, lasting 2 years, relied on physicians from the community (Maternal, Child Health Service and School Health Service), their role being to mobilise the teaching teams, distribute specific teaching tools and raise awareness of families to respect the sleep patterns of children, during routine medical examinations. The study was carried out in 140 nursery schools with 1,500 children in each group. The evaluation was based on the application of a logistical regression model taking potentially confounding factors into account, and an analysis in sub-groups in order to demonstrate the effectiveness of intervention on particularly exposed groups. The results show: 1) the feasibility of such an intervention among nursery school children on a large scale, 2) the effectiveness of the action, with a reduction of the risk of "poor knowledge" among parents (OR = 0.76), particularly in urban areas, and a reduction in the risk "short nights" in the sub-group of children who had " little sleep at 3 years" in low social class families (OR = 0.50).

[Birth weight and obesity at the age of 6. Study from the growth curves of a population of schoolchildren]. / Poids de naissance et obésité à 6 ans. Etude à partir de courbes de croissance d'une population d'enfants scolarisés.

The weight and height data of 9261 children from birth onwards were gathered on their admission to primary school in 1989 in the area of Lyon, and compared to French references. In comparison with the latter data, the weight and height for age were found to be higher, and there was an excess of children with a high weight for height. The weight for height was higher than the mean of the reference distribution plus two standard deviations in 6.2% of the children. Birth hypertrophy increased the risk of obesity at age six. A new criterion of neonatal hypertrophy, taking various constitutional characteristics into account, was found to be associated to a twofold risk of subsequent obesity, and was shown to be more appropriate in predicting subsequent obesity than classical definitions based on the weight or on the weight for gestational age or sex.

Risk factors of obesity in a five year old population. Parental versus environmental factors.

To be more effective, the prevention of obesity in childhood should be focused on the population at risk. The purpose of the present study is firstly to find correlations between certain environmental factors and obesity in childhood, and secondly to measure the influence of the environmental factors after taking the parental history of obesity into account. This case controlled study includes 704 controls vs. 327 cases selected in a population of five year old school children. The anthropometric assessment was completed at school. Obesity was defined as a weight for height > or = 2 s.d. using the French weight charts for French children based on sex and height. Interviews of the parents recorded parental overweight and child birth overweight as 'constitutional' factors and family structure, socio-economic level and daily lifestyle (sleep, TV viewing, after school care, etc.) as 'environmental' factors. The results show that parental overweight and birth overweight are closely related to the child's obesity at five years of age (estimated relative risks 3.1 and 2.4 respectively). The environmental factors which contribute to child obesity are: southern European origin of the mother, snacks, excessive television viewing and, more importantly, short sleep duration (estimated relative risks = 1.9, 1.3, 2.1 and 4.9 respectively). A logistic regression model, after taking parental overweight into account, shows that the relationship between obesity and short sleep duration persists independently of television viewing. The hypotheses raised by these findings are discussed.

[Life style of children and obesity in a population of 5-year-old children]. / Mode de vie de l'enfant et obésité dans une population d'enfants de cinq ans.

The increasing level of childhood obesity has prompted some research into the early risk factors likely to lead to preventive measures. A case-control study was conducted of a five year-old population in the Rhône and Isère administrative "départements" of France during the children's first visit to primary school, with the participation of 327 obese children and 704 controls. Anthropometric data on the children since birth, together with data on their lifestyles, were collected in interviews with parents. "Family obesity" and "obesity at birth" were found to be closely related to the child's obesity at five years old (adjusted OR = 2.7 and 2.1 respectively). Of the environmental factors, the hypothesis tested paid specific attention to television viewing, snacks between meals and lack of sleep. These three variables were all found to be risk factors of obesity at five years old. However after allowing for parental obesity, the only remaining significant risk factor for obesity at five was lack of sleep (adjusted OR = 1.4). The pathogenic assumptions raised by these results are discussed.

[Evaluation of campaign promoting restraint systems for children in automobiles]. / Evaluation d'une campagne de promotion des systèmes de retenue des enfants dans les automobiles.

Car collisions are a major cause of death in young children. Many of these deaths could be avoided by using child restraint systems. In May 1990, an illustrated leaflet, describing the utility for a child to be seated on the backseat and belted, was distributed to all children in the primary schools of the Rhône department. To assess the impact of this program "Ceint et sauf" (belted and safe), questionnaires were filled by teachers, once before, and twice after leaflets were distributed. These questionnaires allowed to estimate, in each classroom, the proportion of children who were seated and belted on the backseat during the last day of the preceding week. Answers to questionnaires were received from 673 out of the 5,249 classrooms of the Rhône department (12.8%). The sample was representative with regard to public-private sector, geographical area, and size of schools. Among those who were on the backseat, the proportion of children who were belted increased from 32 to 47%. The proportion of children correctly protected remained low: at the end of the program, only 39% of all children were on the backseat and belted. Despite a methodology unadequate for evaluation, this survey underlined the low level of protection of children in cars in France. Other actions, well evaluated, are needed to promote the use of child restraint systems in France.

[The environment of the obese child. Comparison with a reference population]. / Etude de l'environnement de l'enfant obèse. Comparaison avec une population de référence.

Among 7300 school children aged 10 to 12 years, prevalence of obesity (+2 SD of weight for height) was found to be 7.6 +/- 0.3% without significant differences between boys and girls. Correlations between obesity and several environmental factors collected at school were studied. Segmental analysis was used to estimate risk factors. Risk factors for obesity between the age of five and ten were as follows: having only one parent; being the only child or the last-born in a two-parent family; having parents of southern European origin. At 5 years of age, children from North African countries tended to be less obese, while among the French and southern European children, the father's non-manual occupation constituted a risk factor.

[Evaluation of a nutritional education program in nursery schools]. / Evaluation d'un programme d'éducation nutritionnelle à l'école maternelle.

A study of the impact of nutrition education was carried out in 14 nursery schools of the Rhône department for one semester as part of an awareness program. The major themes used were: the need for a balanced diet, proper meal times during the day, avoidance of excesses (sugar, fats and salt), and usefulness of bread, tap-water, etc. Parents were informed of the study during meetings with the school physician. A questionnaire dealing with dietary habits was distributed before and at a distance from the educational program, using a control group. Statistical analysis of the response allowed for an evaluation of the program's impact.

[Experience in health education of children by televised messages]. / Expérience d'éducation pour la santé chez l'enfant par des messages télévisés.

A questionnaire was submitted to 394 school children aged from 9 to 12 years following a short campaign of health education using televised advertisements. Slides with a drawing and a brief comment were used and broadcasted on a regional TV network. The results of the survey showed that there is still an important need for health education among children to which television can effectively contribute.

[Educational campaign on the sleep of young children]. / Campagne d'éducation pour le sommeil du petit enfant.

An educational campaign on sleep of young children was conducted in Vénissieux, a town of 65,000 inhabitants in the suburbs of Lyons, France. The campaign was directed at the parents of 2 to 6 year-old children enrolled in nursery schools (i.e. a population of 3,863 children) and continued over one school year. The main aspects of sleep approached during the campaign were: the importance of sleep for the health of the children, the need for a pleasant and early bedtime, the importance of a nap at home or in school, the danger of a regular drug use to solve sleep disorders. In order to evaluate the effects of the campaign, two studies using questionnaires filled out by the parents were carried out, one before and one after the campaign. Comparisons of the results of the two questionnaires showed several significant positive changes after the campaign: less precocious arising, earlier evening bedtime and improved conditions of bedtime, tendency to increase overall night rest, less sleep disorders, improved conditions favouring nap at school.

Studies of growth hormone secretion in juvenile diabetes.

To further investigate the GH secretion in juvenile diabetics, blood glucose (BG) and plasma growth hormone (GH) were determined during controlled exercise performed in basal condition and under glucose infusion, in 7 controls and 22 juvenile diabetics aged 12--35 years, 10 of them with fundal vascular lesions. In controls, glucose infusion significantly lowered the exercise induced GH rise observed under basal conditions. In diabetics, under basal conditions, diabetics with low basal BG (BG less than 100 mg/100ml) had higher GH secretion than those with high basal BG (BG greater than 140 mg/100 ml; p less than 0.05). Under glucose infusion, diabetics with normal BG peak values (not different from controls: BG = 284 +/- (SK) 45 mg/100 ml) had significantly higher plasma GH levels than controls (p less than 0.01). In contrast, in diabetics with BG peak value higher than controls (BG greater than 374 ng/100 ml), plasma GH levels were not different from control values. This study indicates that exercise induced GH secretion in diabetics is mainly related to actual BG levels. Furthermore, we found no relation between the magnitude of GH secretion and the presence of retinopathy in diabetics.