Dual-energy computed tomography to detect early pulmonary vascular changes in children with sickle cell disease: a pilot study.

Introduction: Pulmonary hypertension (PH) is a rare but fatal complication of sickle cell disease (SCD) that is possibly reversible if treated early. Dual-energy computed tomography (DECT) is a valuable tool for diagnosing PH. We attempted to determine if DECT can detect early signs of PH in children with SCD. Methods: This prospective observational pilot study was conducted at the Geneva University Hospitals and was approved by the local human ethics committee (CCER 2019-01975). A written informed consent was obtained from the patients and/or their legal guardian. Eight children (consisting of five girls and three boys) with homozygous SCD were included in the study. They underwent full cardiological workup using transthoracic echocardiography (TTE) and cardiopulmonary exercise test (CPET), as well as DECT. Results: The median age of the children was 11 years old (range 8-12). All patients exhibited a normal biventricular systo-diastolic function using the TTE. The median tricuspid regurgitant jet velocity value was 2.24 m/s (range 1.96-2.98). Four children were found to have signs of vasculopathy detected on DECT. Of them, two had abnormal screening test results. They both had an increased VE/VCO2 slope during CPET and an increased TVR of >2.5 m/s on TTE. Conclusion: DECT is capable of identifying early signs of pulmonary vascular disease in children with SCD. Further studies are needed to understand the correlation between DECT abnormalities and hemodynamic pulmonary circulation better.

Home Respiratory Polygraphy and Spirometry in Normal Weight and Children with Obesity Suspected for Obstructive Sleep Apnea Syndrome: Are There Any Associations?

Aim: It is known that children and adolescents with obesity are more prone to obstructive sleep apnea syndrome (OSAS) and that their lung function may show some disturbance. Literature is scarce about potential associations; therefore, we aimed to study the relationship between OSAS, lung function, and adiposity in a population of children suspected of OSAS. Material and Methods. We performed home respiratory polygraphy and spirometry in all subjects. The relationships between body mass index z-score (zBMI), polygraphy, and spirometry data were analyzed. Results: We recruited 81 subjects aged between 5 and 16 years, 63% being obese. 43.2% of subjects were diagnosed with OSAS (32.1% mild, 4.9% moderate, and 6.2% severe). We found no correlation between respiratory polygraphy and the zBMI. The mean spirometric value FEV1, FVC, and FEV1/FVC ratio z's were normal in all subjects, whereas FVC z's and FEV1/FVC ratio z's were significantly positively related for obesity and negatively for normal weight (p < 0.05). FEV1 z's was inversely correlated to the percentage of analyzed time passed below 90% of SpO2 (r = -0.224, p = 0.044). All subjects with FEV1 (n = 8) and/or FVC (n = 9) z's below the lower limit for normal (LLN) had an AHI ≥ 1 (FEV1: p = 0.001; FVC: p < 0.001), especially subjects with normal weight (FEV1: p = 0.003; FVC: p = 0.010). Conclusion: When comparing normal-weight children and adolescents with obesity, the prevalence of OSAS but not spirometric values was strongly related to BMI z-score, probably because obesity engenders advanced puberty and an accelerated growth spurt. FEV1 was more frequently

Evaluation of the impact of the COVID-19 lockdown on BMI in children and adolescents with or without obesity.

BACKGROUND: In Switzerland, from March 15th to May 11th 2020, schools and most shops were closed nationwide due to the COVID-19-related lockdown. This cessation of activities may have impacted weight gain in children and adolescents. The aims of our study were to evaluate the effects of the COVID-19 lockdown on the BMI of children and adolescents in treatment for obesity, and to compare its evolution to that of the previous year at the same time, as well as to that of normal-weight children. METHODS: This retrospective study gathered demographic and anthropometric data from subjects aged 6-18 years both with normal weight and with obesity, who attended our hospital clinics at four time points: before and after the lockdown period in 2020, and at the same times of the year in 2019. We used paired t-tests to assess weight, BMI and BMI z-score changes, linear and standard multiple regressions, independent Student's t-tests or Chi-square tests to compare groups, and Pearson correlation coefficient when appropriate. RESULTS: Forty-seven children with obesity and 18 normal-weight subjects had complete data for the 4 visits. The mean BMI increased in both groups during the lockdown (obese: + 0.96 ± 1.5 vs. control: + 0.51 ± 0.1), however the increase was significantly more important in the subjects with obesity compared to the same period in 2019 (2019: + 0.33 ± 1.0; mean difference between 2019 and 2020: + 0.63 ± 2.0 p = 0.034). CONCLUSION: The COVID-19 lockdown had a negative impact on the BMI of youth with obesity. Interestingly we observed extreme changes in this population, which was not the case in normal-weight children. Therefore, families with a child with obesity must be actively supported during these stressful and obesogenic periods of confinement.

Home respiratory polygraphy in obstructive sleep apnea syndrome in children: Comparison with a screening questionnaire.

OBJECTIVES: The prevalence of obstructive sleep apnea syndrome (OSAS) in children referred for sleep-disordered breathing reaches up to 59%. We aimed to test the adequacy of a questionnaire compared to home respiratory polygraphy (HRP), in 45 subjects (5-16 years-old), without maxillofacial malformations nor other comorbidities, presenting with symptoms compatible with OSAS. METHODS: All children passed a 12-items questionnaire (Obstructive Airway Child test: OACT) and the HRP. OSAS was classified in severity according to the apnea-hypopnea index (AHI). RESULTS: With HRP, 60% and 15% children were detected to have at least mild (AHI ≥1) and moderate (AHI >5) OSAS, respectively. The sensitivity of the questionnaire to detect mild and moderate OSAS was good (93% and 71%, respectively) but the specificity was very low (11% and 34%). However, an OACT score under 61 showed a very good negative predictive value for moderate and severe OSAS (87%). With the questionnaire, we could have avoided a complementary PSG or HRP in 25/45 (56%) of our subjects as in children with mild OSAS and without comorbidities only clinical observation is usually advised. CONCLUSIONS: The OACT questionnaire has shown to be a good and quick instrument to exclude moderate and severe OSAS in our population of children without maxillofacial malformations. Indeed children scoring under 61 could avoid a constraining and expensive sleep exam. However, if the score is above this cut-off, the performance to recognize OSAS is low and the child's evaluation must be completed by a HRP or PSG.

Reliable Detection of Intrapulmonary Shunts Using Contrast-Enhanced Echocardiography in Children With Portal Hypertension or Portosystemic Shunt.

OBJECTIVES: The aim of this study was to analyze if contrast-enhanced echocardiography (CEE) is as reliable as lung perfusion scintigraphy (LPS) to detect intrapulmonary shunting (IPS) in children with portal hypertension (PHTN) or congenital/surgical portosystemic shunts (PSS) and to define the number of cardiac cycles required to exclude intrapulmonary shunting. METHODS: Inclusion criteria for this cross-sectional study were: (1) presence of PHTN or PSS diagnosed on abdominal ultrasound, (2) technically valid saline contrast echocardiography, (3) lung perfusion scintigraphy within 6 months of CEE. The number of cardiac cycles between right atrial opacification and the arrival of contrast in the left atrium were counted. We analyzed our CEE data at three and five cardiac cycles and compared them with LPS results. RESULTS: The study population was composed of 78 children (38 girls, 49%) ages 2.1-18.8 years (mean 9.8). Sixty-nine patients had PHTN (88%), and nine had a PSS (11%). Eleven subjects (14%) presented evidence of IPS on LPS. Peripheral oxygen saturation was lower in the subjects with IPS detected on LPS (95.3 ±â€Š1.7% vs 99.0 ±â€Š1.4%; P < 0.01). Comparison of LPS with CEE before three and five cardiac cycles showed that CEE is highly specific (95.7%) as early as three cardiac cycles with markedly better sensitivity (72.7%) when using five cardiac cycles. Furthermore, a negative study using five cardiac cycles ruled out IPS with a 95% negative predictive value. The cardiac cycle at which the bubbles appeared in the left atrium was inversely correlated to the shunt index measured using LPS (r = -0.563; P = 0.001). CONCLUSION: CEE is sufficient for the screening of IPS in children with PHTN or congenital/surgical PSS, obviating the need for LPS.

A 13-Year-Old Male With Diagnosed Idiopathic Pulmonary Hypertension: Is it Really Idiopathic?

CASE PRESENTATION: A 13-year-old male was referred after incidental finding of cardiomegaly on chest radiograph and signs of pulmonary hypertension on subsequent cardiology consult. He was diagnosed with idiopathic pulmonary hypertension, and came to our center for a second opinion. He was born from consanguineous parents. He reported to be asymptomatic in his daily life. He was not on medications. Family history was not contributive.

Recovery of Bone Mineral Mass After Upper Limb Fractures in Children and Teenagers.

BACKGROUND: Loss of bone mineral mass and muscle atrophy are predictable consequences of cast-mediated immobilization following wrist and forearm fractures. This study aimed to prospectively determine whether previously reported lower bone mineral mass following immobilization for wrist and forearm fractures in children and teenagers had recovered at 6- and 18-month follow-up. METHODS: We recruited 50 children and teenagers who underwent a cast-mediated immobilization for a forearm or wrist fracture. Dual-energy x-ray absorptiometry scans of different skeletal sites were performed at the time of fracture, at cast removal, at 6 and at 18-month follow-up. Injured patients were paired with healthy controls according to sex and age. Dual-energy x-ray absorptiometry values were compared between groups and the injured and uninjured forearms of the patients. RESULTS: At the time of fracture, injured and healthy subjects showed no differences between their bone mineral density (BMD) and bone mineral content (BMC) z-scores at the lumbar spine, or between their BMDs at the peripheral wrist. At cast removal, upper limb bone mineral variables were significantly lower in the injured group (except for the ultradistal radius) than in the uninjured group, with differences ranging from 3.8% to 10.2%. No residual decrease in bone mineral variables was observed at any upper limb site at 6- and 18-month follow-up (28 injured patients). Significant residual increases in the BMDs and BMCs were observed for the injured group's ultradistal radius and whole wrists (+4.8% to +5.2%). CONCLUSIONS: A rapid bone mass reversal occurs by resumption of mobilization, with full bone recovery 6 months after a forearm or wrist fracture. Finally, healing bone callus could introduce a bias into the interpretation of BMD and BMC data at the fracture site, not only at cast removal but also 18 months after the fracture.

What is the real impact of upper limb cast immobilisation on activity-related energy expenditure in children?

BACKGROUND: Upper limb fractures and subsequent cast immobilisation constitute a potential cause of reduction in childhood levels of physical activity (PA), with subsequent decrease of energy consumption. The main objective of this study was thus to quantify the decrease of activity-related energy expenditure (AEE) due to upper limb cast immobilisation. METHODS: We conducted a longitudinal matched case-control study that included 35 children and teenagers with a first episode of upper limb fracture and 35 healthy cases. PA was assessed during cast immobilisation by accelerometer. AEE was the calculated using an equation based on the total counts per day measured by accelerometers. RESULTS: AEE in children and teenagers with upper limb fractures was estimated to be 7.4 % lower than healthy controls. The mean difference corresponded to 1.35 kcal/kg per mean valid recorded time (750 min), that is, the waking hours. When converted in kcal per mean subjects' weight, the difference in AEE amounted 63.5 kcal/day, which corresponds approximately to 26 min of walking at a speed of 4 km/hours. In comparison with the mean AEE in healthy controls (18.2 kcal/kg), the noted decrease (1.35 kcal/kg) represents only 7.4 % of AEE. CONCLUSION: Reduction of AEE in children and teenagers with upper limb fractures may lead to a slight positive energy balance, as there is usually no compensatory reduction of energy intake. An increase of light PA has to be counselled in this situation or patients should be advised to reduce their energy intake during the immobilisation period. LEVEL OF EVIDENCE: Level I: high-quality prospective study (all patients were enrolled at the same point in their disease with ≥80 % follow-up of enrolled patients).

Serum cardiovascular risk biomarkers in pre-pubertal obese children.

BACKGROUND: Childhood obesity is associated with premature cardiovascular complications. However, little is known about the effect of a family-based behavioural intervention on the relationship between arterial function, blood pressure and biomarkers in pre-pubertal children with obesity. DESIGN: This was a single centre randomized controlled trial (RCT) including 74 children randomized to a 6-month behavioural intervention to treat obesity. In 48 children (13 controls and 35 interventions), we assessed: serum level of cytokine (CCL2), adiponectin, and neutrophil product (MMP-8), as well as carotid intima-media thickness, flow-mediated dilation (FMD), nitroglycerin-mediated dilation; arterial stiffness (incremental elastic modulus, Einc), pulse wave velocity (PWV), resting and 24-hour blood pressure (BP). RESULTS: At baseline, resting systolic BP was positively associated with MMP-8 levels which was significantly higher in children with hypertension (P = 0.033). Biochemical markers were not related to endothelial function at baseline, but they globally increased after 6 months in the intervention group. The significant increase of CCL2 levels in the intervention group was associated with a decrease in diastolic BP. Furthermore, adiponectin change was positively related to a change in FMD and negatively to change in Einc and PWV. CONCLUSIONS: The usefulness of serum biomarkers for the detection of cardiovascular diseases is not well established in children. In our population, MMP-8 concentration was higher in hypertensive children. Furthermore, behavioural interventions resulted in a paradoxical increase in some biomarkers in children, with potentially beneficial effects detected with CCL2 changes. Caution should be taken when using nonspecific serum biomarkers for the clinical monitoring of children with obesity.

Identifying Reservoirs of Infections Caused by Kingella kingae: A Case-Control Study of Oropharyngeal Carriage of K. kingae Among Healthy Adults.

BACKGROUND: Kingella kingae is currently recognized as a significant pathogen of the pediatric population. Nevertheless, the possibility for adults to serve as a reservoir of healthy carriers has not been studied. METHOD: We conducted a monocentric transversal study on 228 healthy adults to define the carriage rate. Participants were recruited among the staff of a children's hospital, a population exposed to aerosolized droplets from children. A secondary analysis using a case-control method was conducted to assess risk factors for carriage. RESULTS: We demonstrated an oropharyngeal carriage rate of 2.2% in this population. However, there was a striking similarity in the carriage rate among children younger than 4 years of age and adults living with children of that age group (8.8%). Use of day-care facilities for their own children was also demonstrated as a risk factor for adult carriage. CONCLUSIONS: We were able to demonstrate the existence of adult carriage of K. kingae but our results point to transmission from children to adults. Our results do not allow us to conclude that professional exposure in a hospital setting is a risk factor for oropharyngeal carriage.

Insulin secretion response during oral glucose tolerance test is related to low cardiorespiratory fitness in obese adolescents.

BACKGROUND: The obesity paradox refers to a category of subjects who may be less prone to develop co-morbidities, such as type 2 diabetes. Cardiorespiratory fitness (CRF) has been identified as one of the key factors. We aimed at exploring the difference in insulin metabolism between fit and unfit obese adolescents. METHODS: We recruited 22 obese adolescents and assessed CRF during an incremental treadmill test. According to a cut-off at 80% of predicted maximal oxygen consumption (VO2max), subjects were separated into low or normal CRF. Body composition was determined by densitometry. Serum levels of insulin were measured sequentially during an oral glucose tolerance test and insulin secretion responses were calculated. RESULTS: Compared to adolescents with normal CRF, the ones with low CRF had higher insulin resistance indices (p=0.023) and insulin secretion response (p=0.010), independently of the body mass index z-score. CONCLUSIONS: Interventions in obese adolescents should focus on the maintenance or improvement of CRF to at least 80% of predicted VO2max. Indeed, this cut-off was significantly related to insulin secretion responses, independently of the adiposity level. A CRF above the proposed cut-off may prevent the development of insulin resistance.

Medical and non-medical complications among children and adolescents with excessive body weight.

BACKGROUND: The burden of disease from childhood obesity is considerable worldwide, as it is associated with several co-morbidities, such as dyslipidemia, hypertension, type 2 diabetes (T2DM), orthopedic and psychosocial problems. We aimed at determining the prevalence of these complications in a population of children and adolescents with body weight excess. METHODS: This is a cohort study including 774 new patients (1.7 - 17.9 yrs, mean 11.1 ± 3.0) attending a pediatric obesity care center. We assessed personal and family medical histories, physical examination, systemic blood pressure, biochemical screening tests. RESULTS: We found that the great majority of the children suffered from at least one medical complication. Orthopedic pathologies were the most frequent (54%), followed by metabolic (42%) and cardiovascular disturbances (31%). However, non-medical conditions related to well-being, such as bullying, psychological complaints, shortness of breath or abnormal sleeping patterns, were present in the vast majority of the children (79.4%). Family history of dyslipidemia tends to correlate with the child's lipids disturbance (p = .053), and ischemic events or T2DM were correlated with cardiovascular risk factors present in the child (p = .046; p = .038, respectively). CONCLUSIONS: The vast majority of obese children suffer from medical and non-medical co-morbidities which must be actively screened. A positive family history for cardiovascular diseases or T2DM should be warning signs to perform further complementary tests. Furthermore, well-being related-complaints should not be underestimated as they were extremely frequent.

High bone density in adolescents with obesity is related to fat mass and serum leptin concentrations.

OBJECTIVES: Obesity has been associated with increased bone mass, but the mechanisms involved are still poorly understood. We aimed to explore the relation between bone mineral density and factors known to influence bone formation in obese and lean adolescents. METHODS: We recruited 24 obese and 25 lean adolescents in a case-control study. Total body bone mineral density (TB-BMD) z scores and body composition were determined using dual-energy x-ray absorptiometry. We measured 25-hydroxyvitamin D (25-OH-D), glucose, insulin, and leptin concentrations. Physical activity (PA) level was quantified using accelerometer. RESULTS: TB-BMD z score was higher, whereas 25-OH-D and PA levels were lower in obese compared with lean subjects (TB-BMD z score 1.06 ±â€Š0.96 vs 0.26 ±â€Š0.91, P = 0.004; 25-OH-D 9.9 ±â€Š6.4 vs 18.5 ±â€Š7.4 ng mL, P < 0.001; PA level 308.3 ±â€Š22.1 vs 406.8 ±â€Š29.2 count min, P = 0.01). TB-BMD z score was not related to 25-OH-D or PA levels, but was positively correlated with leptin concentration and fat mass (P < 0.05). Vitamin D concentration was negatively correlated with fat mass (P < 0.001). CONCLUSIONS: Despite lower serum vitamin D and PA levels, BMD was higher in adolescents with obesity and associated with higher serum leptin concentrations. Furthermore, adolescents with obesity have lower vitamin D serum concentrations than lean controls, probably owing to its distribution in adipose tissue.

BMI changes in children and adolescents attending a specialized childhood obesity center: a cohort study.

BACKGROUND: Multidisciplinary group therapies for obese children and adolescents are effective but difficult to implement. There is a crucial need to evaluate simpler management programs that target the obese child and his family. This study aimed to determine changes in body mass indexes (BMI) after individual family-based obesity intervention with a pediatrician in a specialized obesity center for child and adolescent. METHODS: This cohort study included 283 patients (3.3 to 17.1 years, mean 10.7 ± 2.9) attending the Pediatric Obesity Care Program of the Geneva University Hospitals. Medical history and development of anthropometric were assessed in consultations. Pediatricians used an integrative approach that included cognitive behavioral techniques (psycho-education, behavioral awareness, behavioral changes by small objectives and stimulus control) and motivational interviewing. Forty five children were also addressed to a psychologist. RESULTS: Mean follow-up duration was 11.4 ± 9.8 months. The decrease in BMI z-score (mean: -0.18 ± 0.40; p < .001) was significant for 49.5% of them. It was dependent of age, BMI at baseline (better in youngest and higher BMI) and the total number of visits (p = .025). Additional psychological intervention was associated with reduced BMI z-score in children aged 8 to 11 years (p = .048). CONCLUSIONS: Individual family obesity intervention induces a significant weight reduction in half of the children and adolescents, especially in the youngest and severely obese. This study emphasizes the need to encourage trained pediatricians to provide individual follow up to these children and their family. Our study also confirms the beneficial effect of a psychological intervention in selected cases.

Serum resistin and inflammatory and endothelial activation markers in obese adolescents.

OBJECTIVES: To assess the level of serum resistin in obese and lean children and to establish a relationship with circulating inflammatory and vascular markers. STUDY DESIGN: This is a cross-sectional study including 67 obese and 62 lean children (mean age 10.9 ± 2.8 years, age range 5.4-16.6 years). We assessed circulating hormones (insulin, leptin, insulin-like growth factor 1), markers of inflammation (resistin, high sensitivity C-reactive protein, interleukin-6, chemokine ligand 2), and endothelial cell activation (vascular and intercellular adhesion molecules: vascular cell adhesion molecule 1 and intercellular adhesion molecule; E-selectin; P-selectin; endothelin 1). RESULTS: Body weight, body mass index (BMI), insulin, leptin, high-sensitivity C-reactive protein, vascular adhesion molecule 1, and E-selectin levels were significantly higher in obese than in lean subjects. Resistin was similar among the groups in the prepubertal period, but increased significantly in the obese adolescents (18.6 ± 24.9) compared with lean subjects (7.9 ± 10.7 ng/mL; P = .038). Resistin was not associated with BMI z score (P > .05). Subjects with resistin levels above 9 (ng/mL) had higher concentration of interleukin-6, chemokine ligand 2, endothelin-1, and insulin-like growth factor 1 but not of leptin, insulin, or BMI. CONCLUSION: Resistin was increased in obese adolescents independently of the quantity of the adipose tissue. In this population, increased resistin levels were related to inflammation and endothelial activation. We may hypothesize that interventions aiming to diminish resistin expression may slow down atherogenesis in adolescents.

Physical activity increases bone mineral density in children with type 1 diabetes.

INTRODUCTION: Osteoporosis is a growing health problem in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to determine the effects of a 9-month weight-bearing physical activity program on bone mineral density (BMD) and bone biomarkers in T1DM compared with healthy children. METHODS: This was a randomized controlled trial including 27 diabetic and 32 healthy children (mean age = 10.5 ± 2.5 yr). Both T1DM and healthy participants were randomized to either an exercise or a control group (i.e., four groups). At baseline and 9 months, total body (TB), lumbar spine (LS2-LS4), femoral neck, and greater trochanter areal BMD (aBMD) and serum bone biomarkers (osteocalcin, type 1 collagen cross-linking) were measured. The intervention consisted of two 90-min sessions per week of weight-bearing physical activity (ball games, jumping, rope skipping, and gymnastics). RESULTS: Baseline variables were similar among groups. At 9 months, changes in TB (T1DM = 0.035 ± 0.022 g·cm(-2), healthy = 0.031 ± 0.017 g·cm(-2)) and LS2-LS4 (T1DM = 0.046 ± 0.038 g·cm(-2), healthy = 0.063 ± 0.034 g·cm(-2)) aBMD were statistically significant in the intervention groups and of similar magnitude between T1DM and healthy subjects. The level of type 1 collagen cross-linking (T1DM = -0.12 ± 0.32 ng·mL(-1), healthy = -0.36 ± 0.11 ng·mL(-1)) decreased in the intervention groups but was not associated with TB aBMD changes. CONCLUSIONS: Regular weight-bearing physical activity (180 min·wk(-1), including ball games, jumping activities, and gymnastics) improves total and LS2-LS4 bone mineral accretion in children with T1DM, in a similar magnitude to healthy subjects. We conclude that children with T1DM should be encouraged to practice regular physical activity to enhance peak bone mass and prevent osteoporosis later in life.

Increased pancreatic fat fraction is present in obese adolescents with metabolic syndrome.

OBJECTIVES: Little is known about pancreatic fat accumulation and its possible associations with metabolic syndrome (MetS) and glucose metabolism. The aim of the present study was to quantify pancreatic fat fraction (PFF) in lean and obese adolescents and explore its relation to metabolic parameters. METHODS: We recruited 25 lean and 24 obese adolescents. PFF and visceral adipose tissue (VAT) were determined using magnetic resonance imaging. We measured blood pressure, fasting glucose, insulin, liver enzymes, leptin, and lipid levels. Obese subjects underwent an oral glucose tolerance test. RESULTS: PFF was significantly higher in obese than in lean subjects (4.8±1.2 vs 3.6±0.9; P<0.001) and was associated with VAT, γ-glutamyltransferase, triglycerides, high-density lipoprotein cholesterol, leptin concentrations, and MetS (P<0.05 for all). None of the obese subjects had glucose intolerance, but when adjusted for VAT, the following 3 parameters correlated negatively with PFF: fasting and 30- minute and 120-minute insulin levels. We divided subjects into 3 groups: group I, lean without MetS; group II, obese without MetS; and group III, obese with MetS, and observed that PFF increased gradually among groups (I: 3.56%±0.88%; II: 4.70%±1.06%; III: 5.34%±1.49%; P<0.001). CONCLUSIONS: Obese adolescents accumulate fat in the pancreas. PFF correlates with the presence of MetS. Even in the absence of glucose intolerance, pancreatic fat deposition is associated with impaired insulin response to glucose overload. This suggests that ß-cell dysfunction may already be present in nondiabetic obese adolescents, mirroring what has been shown in adults, and that pancreatic fat accumulation may participate in obesity-associated pancreatic endocrine dysfunction.

Elevated E-selectin and diastolic blood pressure in diabetic children.

BACKGROUND: Cardiovascular risk markers are related to micro-angiopathy in children with type 1 diabetes (T1DM), but there is no information about their relationship with blood pressure (BP) and endothelial function. MATERIALS AND METHODS: This was a case-control study including 29 children with T1DM (mean age 10·5 ± 2·7 years, disease duration: 3·8 ± 2·2 years) and 39 healthy controls (mean age: 9·8 ± 2·7 years). We assessed 24-h ambulatory BP, vascular function and serum level of lipids, vascular cell adhesion molecule-1 (VCAM-1; ICAM) and selectins (E-selectin; P-selectin). RESULTS: The subject groups had similar physical characteristics and lipids level, except body mass index (BMI) which was higher in T1DM than in healthy children (18·6 ± 2·6 vs. 16·7 ± 2·5 kg/m(2), P = 0·003). Children with T1DM had increased 24 h diastolic BP z-score (0·62 ± 0·9 vs. -0·65 ± 0·8, P < 0·001), even after adjustment for BMI, as well as higher VCAM-1 concentration (492 ± 346 vs. 340 ± 225 ng/mL, P = 0·039) compared to healthy subjects. Diastolic BP z-scores were associated with disease duration, E-selectin and triglyceride levels in the T1DM group (P < 0·05). E-selectin was also related to triglycerides, otherwise there were no relationships between vascular function, markers and BP. CONCLUSION: E-selectin, an early atherosclerosis biomarker, is positively associated with diastolic BP values in children with T1DM, despite relatively short disease duration.

Long-term follow-up of cardiovascular risk factors after exercise training in obese children.

OBJECTIVE: We previously demonstrated beneficial effects of physical activity on cardiovascular disease (CVD) risk factors, body mass index (BMI) and fat mass in pre-pubescent obese children. The aim of this study was to determine whether these changes were maintained 2 years later. METHODS: Two years after the Randomised Controlled Trial, we performed a follow-up study with 20 of 38 subjects (11.4 ± 1.8 years). Outcomes included blood pressure (BP) by ambulatory monitoring; arterial function and structure using high-resolution ultrasound, BMI, body composition by dual-energy x-ray absorptiometry (DXA), physical activity using accelerometer, and biological markers. RESULTS: During the 2-year follow-up period, mean 24-hour diastolic BP z-score significantly decreased (1.4 ± 1.2 vs. 0.3 ± 1.4, p = 0.04), while systolic BP z-score was slightly reduced (2.4 ± 1.5 vs. 1.4 ± 1.7, p = 0.067). Blood pressure changes were greater in children who diminished their BMI z-score compared with the ones who did not. Systolic hypertension rates dropped from 50 to 28% and diastolic hypertension from 42 to 6%. In addition, arterial intima-media thickness (0.51 ± 0.03 vs. 0.51 ± 0.06, p = 0.79), BMI z-score (2.9 ± 0.8 vs. 2.9 ± 1.1 kg.cm(-2), p = 0.27), body fat (41.9 ± 6.9 vs. 42.8 ± 6.7%; p = 0.39) and physical activity count (703 ± 209 vs. 574 ± 244 cpm, p = 0.30) were stable. CONCLUSION: To our knowledge, this is the first study reporting that beneficial effects on adiposity and CVD risk factors of a physical activity centred intervention are sustained 2 years after the cessation of training in obese children. Subjects stabilized BMI z-score and maintained physical activity with further improvement of BP and stabilization of arterial wall remodelling. We conclude that it is important to encourage physical activity in this population. Effects of Aerobic Exercise Training on Arterial Function and Insulin Resistance Syndrome in Obese Children: A Randomised Controlled Trial: NCT00801645.

Reduced physical activity level and cardiorespiratory fitness in children with chronic diseases.

UNLABELLED: We aimed to compare physical activity level and cardiorespiratory fitness in children with different chronic diseases, such as type 1 diabetes mellitus (T1DM), obesity (OB) and juvenile idiopathic arthritis (JIA), with healthy controls (HC). We performed a cross-sectional study including 209 children: OB: n = 45, T1DM: n = 48, JIA: n = 31, and HC: n = 85. Physical activity level was assessed by accelerometer and cardiorespiratory fitness by a treadmill test. ANOVA, linear regressions and Pearson correlations were used. Children with chronic diseases had reduced total daily physical activity counts (T1DM 497 +/- 54 cpm, p = 0.003; JIA 518 +/- 28, p < 0.001, OB 590 +/- 25, p = 0.003) and cardiorespiratory fitness (JIA 39.3 +/- 1.7, p = 0.001, OB 41.7 +/- 1.2, p = 0.020) compared to HC (668 +/- 35 cpm; 45.3 +/- 0.9 ml kg(-1) min(-1), respectively). Only 60.4% of HC, 51.6% of OB, 38.1% of JIA and 38.5% of T1DM children met the recommended daily 60 min of moderate-to-vigorous physical activity. Low cardiorespiratory fitness was associated with female gender and low daily PA. CONCLUSION: Children with chronic diseases had reduced physical activity and cardiorespiratory fitness. As the benefits of PA on health have been well demonstrated during growth, it should be encouraged in those children to prevent a reduction of cardiorespiratory fitness and the development of comorbidities.