QTc Interval Prolongation and Its Association With Electrolyte Abnormalities and Psychotropic Drug Use Among Patients With Eating Disorders.

Background: Eating disorders (EDs) often develop during adolescence with high mortality rates. Sudden cardiac death in these patients has been associated with corrected QT (QTc) interval prolongation. The significance of extrinsic factors on QTc prolongation in populations with EDs remains controversial. This study assessed the relationship between QTc prolongation in paediatric patients with EDs and extrinsic factors, such as QTc-prolonging medications and electrolyte abnormalities to investigate whether an ED alone is associated with an increased prevalence of QTc prolongation. Methods: Electrocardiograms, electrolytes, and psychopharmaceutical usage were retrospectively analysed from the charts of 264 paediatric patients with EDs. Descriptive statistics were used to assess QTc prolongation and its relationship with electrolyte abnormalities and psychopharmaceuticals. Results: Of 264 patients, 227 had normal QTc intervals (<440 ms), whereas 37 had borderline prolonged (440-460 ms) or prolonged (>460 ms) intervals. The prevalence of QTc intervals exceeding 440 ms in patients with normal electrolytes and not using QTc-prolonging psychotropics mirrored that of the general population (P = 0.59). Of the 23 patients taking psychotropics, 8 had abnormal QTc intervals. The average QTc was greater for patients using QTc-prolonging psychotropics (P = 0.05) with a correlation between interval length and psychotropic usage (P < 0.01). Average potassium (P = 0.08), calcium (P = 0.18), and magnesium (P = 0.08) levels did not significantly differ between those with normal and abnormal QTc intervals. Conclusions: This study suggests that EDs alone may not prolong QTc intervals in paediatric patients with EDs, but psychotropics appear to be a salient external factor in QTc prolongation.

Contexte: Les troubles des conduites alimentaires (TCA) surviennent surtout au cours de l'adolescence et entraînent un taux de mortalité élevé. Chez ces patients, la mort subite d'origine cardiaque a été associée à un allongement de l'intervalle QT corrigé (QTc). La portée des facteurs extrinsèques sur l'allongement de cet intervalle chez les patients atteints de TCA demeure un sujet controversé. La présente étude visait à évaluer la relation entre l'allongement de l'intervalle QTc chez les enfants atteints de TCA et des facteurs extrinsèques, comme la prise de médicaments causant l'allongement de l'intervalle QTc et les anomalies électrolytiques, pour déterminer si la présence d'un TCA est à elle seule associée à une prévalence élevée d'allongement de l'intervalle QTc. Méthodologie: Nous avons analysé rétrospectivement les électrocardiogrammes, les valeurs d'électrolytes et l'utilisation de médicaments psychotropes dans les dossiers de 264 enfants atteints de TCA. Des techniques de statistique descriptive ont été utilisées pour analyser l'allongement de l'intervalle QTc et les liens avec les anomalies électrolytiques et les médicaments psychotropes. Résultats: Parmi les 264 patients, 227 présentaient un intervalle QTc normal (< 440 ms) et 37 présentaient des résultats limites (440 à 460 ms) ou un allongement de l'intervalle (> 460 ms). La prévalence d'un intervalle QTc de 440 ms ou plus chez les patients présentant des taux d'électrolytes normaux et non traités par des médicaments psychotropes causant l'allongement de l'intervalle QTc était semblable à la prévalence dans la population générale (p = 0,59). Huit des 23 patients traités par des médicaments psychotropes présentaient un intervalle QTc anormal. La moyenne des intervalles QTc était supérieure dans le groupe des patients recevant des médicaments psychotropes causant un allongement de l'intervalle QTc (p = 0,05), et il existait une corrélation entre la durée de l'intervalle et de l'usage de médicaments psychotropes (p < 0,01). Les taux moyens de potassium (p = 0,08), de calcium (p = 0,18) et de magnésium (p = 0,08) ne différaient pas de façon significative entre les groupes présentant des intervalles QTc normaux et anormaux. Conclusions: Les résultats de notre étude donnent à penser que le TCA à lui seul ne provoque pas l'allongement de l'intervalle QTc chez les enfants qui en sont atteints, mais que l'utilisation de médicaments psychotropes constitue un facteur externe important dans l'allongement de l'intervalle QTc.

Sex-stratified reference values for the life-space assessment in the Canadian longitudinal study on aging.

BACKGROUND: The Life-Space Assessment (LSA) can compliment traditional physical performance measures of mobility by accounting for the interaction between individuals and their environment. However, there are no studies that have generated percentile curves showing sex-stratified reference values in a large population-based sample of community-dwelling adults, making its interpretation difficult. Therefore, this study aimed to establish sex-stratified reference values for the LSA in middle-aged and older Canadians. METHODS: Baseline data for participants aged 45-84 years old from the Canadian Longitudinal Study on Aging (CLSA) were used (n = 22,154). Quantile regression was used to estimate specific percentiles, with age as the independent variable and LSA scores as the dependent variable. Models were run for the whole sample, then separately for males and females. The models were cross-validated to assess their reliability. CLSA inflation and analytic weights were applied. RESULTS: On average, the sample was 62.5 ± 10.0 y.o. (51.1% males), with a weighted mean LSA score of 89.2 ± 17.0. There was also a decrease in LSA scores with age, where scores were lower for older age groups compared to younger groups, and LSA scores were lower for females relative to males. DISCUSSION AND CONCLUSIONS: Reference data will aid in interpreting, comparing, and making inferences related to LSA scores obtained in clinical and research settings for Canadian adults.

Make Bayley III Scores Comparable between United States and German Norms-Development of Conversion Equations.

AIM: Bayley Scales of Infant and Toddler Development (Bayley-III) determines scaled scores and converts these into composite scores. It was shown that applying the German and the U.S. manual leads to different results. This study aims to systematically analyze the differences between the U.S. and German Bayley-III version and to develop conversion equations. METHODS: This simulation study generated a dataset of pairs of U.S. and German Bayley-III composite scores (cognitive: n = 4,416, language: n = 240,000, motor: n = 314,000) by converting the same number of achievable tasks for 48 age groups. Bland-Altman plot and regression analyses were performed to develop conversion equations for all age groups. RESULTS: German and US Bayley-III scores demonstrate distinct slope and interception for cognitive, language, and motor composite scores. Lower developmental performance leads to higher composite scores with U.S. norms compared with German norms (up to 15 points). These differences varied between age groups. With newly developed conversion equations, the results can be converted (R 2 > 0.98). INTERPRETATION: This study confirms systematic differences between U.S. and German Bayley test results due to different reference cohorts. Our data consider the full age range and add conversion equations. These findings need to be acknowledged when comparing Bayley Scores internationally.

Age-appropriate BMI cut-points for cardiometabolic health risk: a cross-sectional analysis of the Canadian Longitudinal Study on Aging.

OBJECTIVES: Body composition changes that occur with aging pose unique health risks to older adults. The current World Health Organization (WHO) body mass index (BMI) cut-points may not accurately reflect health risks in older adults (65+). Prior findings suggest those classified as overweight may be conferred survival advantages. This study aims to define age-specific BMI cut-points for adults (45-64, 65-74, and 75-85 years) associated with cardiometabolic outcomes, and compare the performance of these thresholds to the WHO BMI thresholds using cardiometabolic conditions and frailty as outcomes. METHODS: Using baseline data from the comprehensive cohort of the Canadian Longitudinal Study on Aging (N = 30,097), a classification and regression tree cross-sectional analysis was conducted to derive age-specific BMI cut-points based on cardiometabolic health risk. The area under the receiver operating curve (AUC), sensitivity, and specificity were estimated. Agreement with waist circumference was conducted. RESULTS: For older adults (65-74 and 75+ years old), the BMI threshold for identifying overweight increased to 26.9 and 26.6, respectively, from the WHO definition of 25.0 kg/m2. For obesity, the thresholds were revised to 29.0 and 30.9, respectively, from 30.0. The largest improvements to AUC occurred in older adults (65+). Across all age-sex stratifications, the new overweight threshold demonstrated lower sensitivity and higher specificity compared to the traditional threshold. Age-specific BMI thresholds demonstrated higher agreement with waist circumference for some age-sex stratifications and poor performance with hearing. CONCLUSIONS: Age-appropriate BMI thresholds for older adults may improve classification by health risk compared to standard WHO cut-points. A higher overweight threshold but lower obesity cut-points may be best suited to this demographic.

Individualized Target Fortification of Breast Milk: Optimizing Macronutrient Content Using Different Fortifiers and Approaches.

Background: Native breast milk composition displays significant inter- and intra-individual variation which persists after standard fortification with fixed doses and challenges target fortification. This study aims to analyze the macronutrient composition of different commercially available fortifiers and the effect of different fortification strategies on nutritional intake of preterm infants. Methods: In 103 preterm infants, native breast milk samples were collected from 24-h feeding batches (n = 3,338) and fat, protein and carbohydrate contents were analyzed. Nutrient content was compared for breast milk that had undergone either (i) standard fortification, (ii) targeted fortification, (iii) selective batching according to breast milk composition, or (iv) partial lyophilization. For (i) eight commercially available standard fortifiers were tested. Targeted fortification (ii) involved the addition of single component modulars of either protein, fat or carbohydrates to standard fortified breast milk. Using a mathematical growth model, the combined effect of protein, fat and carbohydrate intake on growth was assessed. The best composition of standard fortifiers as the initial step for target fortification was explored assuming three clinical scenarios for milk analysis. Results: Macronutrient content was highly variable between native breast milk samples, and this variation was still present after standard fortification, however at elevated macronutrient levels. Standard fortification, breast milk batching, as well as partial lyophilization of human milk resulted in deficient and imbalanced enteral intakes in a significant proportion of infants. Target fortification reduced this variation in a, respectively, higher percentage of samples. The effect size was dependent on the number of measurements per week. The optimum composition of standard fortifiers was dependent on the clinical scenario (measurement frequency) for target fortification. Conclusions: To provide precise and accurate intakes of macronutrients, breast milk should be target fortified. Standard fortified breast milk can result in excess above recommended intakes of some macronutrients which limits the efficiency of target fortification. Standard fortifiers with improved composition are needed for target fortification.

Individualized target fortification of breast milk with protein, carbohydrates, and fat for preterm infants: A double-blind randomized controlled trial.

BACKGROUND & AIMS: In preterm infants, natural variation of breast milk composition makes it difficult to achieve recommended macronutrient intakes with standard fortification. Evidence suggests that nutritional deficiency induces poor postnatal growth. This study investigates impacts of target fortification on preterm growth and metabolism by adjusting breast milk macronutrients. METHODS: This study was conducted as a single-centre, double-blind, randomized controlled trial for infants <30 gestational weeks. The control group received standard fortification and the intervention group received standard plus target fortification adding modular protein, lipids, and carbohydrates. Breast milk content was measured 3x/week using a validated near-infrared bedside spectrometer (NIRS). Modulars were added to achieve recommended values. To assess total nutrient intake, all 2810 native breast milk samples were analyzed - protein and fat using bedside-NIRS, lactose using tandem mass spectrometry (UPLC-MS/MS). Body composition was measured using air displacement plethysmography. Primary outcome was weight gain during the first 21 days of intervention. RESULTS: Baseline characteristics, morbidities, and total fluid intake were not different between groups (intervention n = 52, control n = 51). The intervention group infants had higher macronutrient intakes, weight gain (21.2 ± 2.5 vs 19.3 ± 2.4 g/kg/d, mean difference: 1.9 g/kg/d, 95% CI: 0.9 - 2.9), and body weight. Infants in the intervention group from mothers with below-average breast milk protein content showed greatest impact on weight at 36 weeks (2580 ± 280 g vs 2210 ± 300 g), length, head circumference, fat, and fat-free mass. Also, feeding intolerance was less frequent, blood urea was higher, and triglycerides were lower. CONCLUSIONS: This study provides evidence that target fortification of breast milk with low macronutrient content enhances the quality of nutrition and growth and is feasible in clinical routine.

Individualized birth length and head circumference percentile charts based on maternal body weight and height.

Objectives Measurement of birth length and birth head circumference is part of the newborn assessment. Both measurements aid in distinguishing between proportionate and disproportionate small and large for gestational age newborns. It had been shown that birth weight is related to maternal height and weight. This study aims to analyze birth length and birth head circumference percentiles based on maternal stature. Methods This observational study analyzed birth length and birth head circumference percentiles of 2.3 million newborns stratified by maternal height and weight from the first obstetric assessment. Percentiles were calculated for sex and 22-43 gestational weeks for all infants. Eighteen subgroups based on six maternal height and three weight strata were defined and percentiles calculated from 32 to 42 gestational weeks using GAMLSS package for R. Results Newborns of mothers with height <158 cm and weight <53 kg (short stature) had a rate of preterm birth of 9%, compared to 5% in the tall stature group (height >177 cm, weight >79 kg). Small stature mothers were 1.7 years younger. Birth length differed by several centimeters for the same percentiles between groups of short and tall stature mothers, whereas birth head circumference differed up to 1.2 cm. The largest deviation of birth length was between the 97th percentiles. For male newborns born at term, birth length at the 97th percentile differed by 3.2 cm, at the 50th percentile by 2.7 cm and at the third percentile by 2.5 cm. Conclusions Birth length and birth head circumference are related to maternal height and weight. To more completely assess newborns, the maternal size should be considered.

Physical Function and Frailty for Predicting Adverse Outcomes in Older Primary Care Patients.

OBJECTIVE: To explore the predictive ability of the Short Physical Performance Battery (SPPB), Late Life Function and Disability Instrument-Function component (LLFDI-function) and frailty phenotype, for falls, hospitalizations, emergency department (ED) visits, and low self-rated health (SRH) over 1 and 2 years in older adults. DESIGN: Secondary analysis of data from a longitudinal study, the Boston Rehabilitative Impairment Study of the Elderly. SETTING: Primary care. PARTICIPANTS: Adults 65 years and older at risk for disability who completed ≥1 follow-up call (N=391). INTERVENTIONS: None. MAIN OUTCOME MEASURES: We computed separate logistic regression models using the SPPB, LLFDI-function, and frailty phenotype as independent variables and falls, hospitalizations, ED visits, and SRH over 1 and 2 years as dependent variables. Receiver operating characteristic curves were constructed and the areas under the curves calculated. RESULTS: Participants had a mean age of 76.5±7.1 years. The SPPB, LLFDI-function, and frailty phenotype all predicted hospitalizations and low SRH over a 1- and 2-year timeframe (odds ratio [OR] min-max, 1.35-1.51 and 1.67-3.07, respectively). Over 2 years, the SPPB predicted ED visits (OR, 1.28), and the LLFDI-function predicted falls (OR, 1.31). The LLFDI-function predicted low SRH better than the frailty phenotype over 1 year. There were no differences between the measures for any of the other outcomes. CONCLUSIONS: The SPPB, LLFDI-function, and frailty phenotype had similar accuracy for predicting falls, hospitalizations, ED visits, and low SRH over 1 and 2 years among older primary care patients at risk for disability. As a result, when considering the optimal screening tool for older adults, the choice between a measure of function and frailty may ultimately depend on clinical preference and context.

Fat and Fat-Free Mass of Preterm and Term Infants from Birth to Six Months: A Review of Current Evidence.

To optimize infant nutrition, the nature of weight gain must be analyzed. This study aims to review publications and develop growth charts for fat and fat-free mass for preterm and term infants. Body composition data measured by air displacement plethysmography (ADP) and dual energy X-ray absorptiometry (DXA) in preterm and term infants until six months corrected age were abstracted from publications (31 December 1990 to 30 April 2019). Age-specific percentiles were calculated. ADP measurements were used in 110 studies (2855 preterm and 22,410 term infants), and DXA was used in 28 studies (1147 preterm and 3542 term infants). At term age, preterm infants had higher percent-fat than term-born infants (16% vs. 11%, p < 0.001). At 52 weeks postmenstrual age (PMA), both reached similar percent-fat (24% vs. 25%). In contrast, at term age, preterm infants had less fat-free mass (2500 g vs. 2900 g) by 400 g. This difference decreased to 250 g by 52 weeks, and to 100 g at 60 weeks PMA (5000 g vs. 5100 g). DXA fat-free mass data were comparable with ADP. However, median percent-fat was up to 5% higher with DXA measurements compared with ADP with PMA > 50 weeks. There are methodological differences between ADP and DXA measures for infants with higher fat mass. The cause of higher fat mass in preterm infants at term age needs further investigation.

Z-score differences based on cross-sectional growth charts do not reflect the growth rate of very low birth weight infants.

OBJECTIVE: To test whether the assessment of growth in very low birth weight infants during the hospital stay using z-score differences (Zdiff) is confounded by gestational age (GA), birth weight percentiles (BW%ile), and length of the observation period (LOP). We hypothesize that Zdiff calculated from growth charts based on birth weight data introduces a systematic statistical error leading to falsely classified growth as restricted in infants growing similarly to the 50th percentile. METHODS: This observational study included 6,926 VLBW infants from the German Neonatal Network (2009 to 2015). Inclusion criterion was discharge between 37 and 41 weeks postmenstrual age. For each infant, Zdiff, weight gain velocity, and reference growth rate (50th percentile Fenton) from birth to discharge were calculated. To account for gestational age dependent growth rates, assessment of growth was standardized calculating the weight gain ratio (WGR) = weight gain velocity/reference growth rate. The primary outcome is the variation of the Zdiff-to-WGR relationship. RESULTS: Zdiff and WGR showed a weak agreement with a Zdiff of -0.74 (-1.03, -0.37) at the reference growth rate of the 50th percentile (WGR = 1). A significant proportion (n = 1,585; 23%) of infants with negative Zdiff had weight gain velocity above the 50th percentile's growth rate. Zdiff to WGR relation was significantly affected by the interaction of GA x BW%ile x LOP. CONCLUSION: This study supports the hypothesis that Zdiff, which are calculated using birth weights, are confounded by skewed reference data and can lead to misinterpretation of growth rates. New concepts like individualized growth trajectories may have the potential to overcome this limitation.

Maternal body height is a stronger predictor of birth weight than ethnicity: analysis of birth weight percentile charts.

Background Anthropometric parameters such as birth weight (BW) and adult body height vary between ethnic groups. Ethnic-specific percentile charts are currently being used for the assessment of newborns. However, due to globalization and interethnic families, it is unclear which charts should be used. A correlation between a mother's height and her child's BW (1 cm accounts for a 17 g increase in BW) has been observed. The study aims to test differences in small for gestational age (SGA) and large for gestational age (LGA) rates, employing BW percentile charts based on maternal height between ethnic groups. Methods This retrospective study of 2.3 million mother/newborn pairs analyzed BW, gestational age, sex, maternal height and ethnicity from the German perinatal survey (1995-2000). These data were stratified for maternal height (≤157, 158-163, 164-169, 170-175, ≥176 cm) and region of origin (Germany, Central and Northern Europe, North America, Mediterranean region, Eastern Europe, Middle East and North Africa, and Asia excluding Middle East). Percentile charts were calculated for each maternal height group. Results The average BW and maternal height differ significantly between ethnic groups. On current percentile charts, newborns of taller mothers (≥176 cm) have a low rate of SGA and a high rate of LGA, whereas newborns of shorter mothers (≤157 cm) have a high rate of SGA and a low rate of LGA. When the BW data are stratified based on the maternal height, mothers of similar height from different ethnic groups show similar average BWs, SGA and LGA rates. Conclusion Maternal body height has a greater influence on BW than maternal ethnicity. The use of BW percentile charts for maternal height should be considered.

Individualized Postnatal Growth Trajectories for Preterm Infants.

BACKGROUND: Growth of preterm infants is monitored using fetal charts despite individual trajectories being downshifted postnatally by adaptational processes. The study aims to compare different approaches to create individualized postnatal trajectories. METHODS: Three approaches to achieve growth similar to healthy term infants at 42+0/7 weeks postmenstrual age (PMA) on World Health Organization growth standards (WHOGS) (target weight) were tested by comparing trajectories obtained by: 1) following birth percentiles (Birth-Weight-Percentile Approach); 2) following percentiles achieved at day of life 21 (Postnatal-Percentile Approach); 3) using day-specific fetal median growth velocities starting at day of life 21 (Fetal-Median-Growth Approach [FMGA]). The primary outcome was delta weight (ΔW), defined as difference between target weight (WHOGS) at 42+0/7 weeks and weight predicted by trajectories. The secondary outcome was ΔW vs %fat mass in a cohort of 20 disease-free surviving very low-birth-weight infants. RESULTS: Birth-Weight-Percentile and Postnatal-Percentile Approach showed high ΔW; FMGA alone reduced ΔW. Introducing a factor to FMGA to reflect the transition to extrauterine conditions (Growth-Velocity Approach [GVA]) minimized ΔW. GVA merged with target and best normalized for body composition related to ΔW. CONCLUSIONS: GVA provides an evidence-based approach for individualized growth trajectories. GVA is based on physiologic data and that healthy preterm infants adjust their postnatal trajectory below their birth percentile. GVA may reflect a biologic principle because it matches consistently with WHOGS at 42+0/7 weeks for all preterm infants from 24 to 34 weeks. This concept could become a bedside tool to aid clinicians in monitoring growth, guiding nutrition, and minimizing chronic adult disease risks as a consequence of unguided, inappropriate growth.