1 732例儿童血清维生素K2临床分析及其与骨代谢标志物关系的研究

目的 分析儿童血清维生素K₂（vitamin K₂,VitK₂）临床特征及其与骨钙素（osteocalcin,OC）、Ⅰ型前胶原氨基端前肽（type Ⅰ procollagen amino-terminal peptide,PINP）、Ⅰ型胶原交联羧基末端肽（type Ⅰ collagen carboxy-terminal peptide,CTX）的相关性。 方法 前瞻性选取2020年10月至2021年10月门诊常规体检儿童1 732例,测定血清VitK₂、25羟维生素D［25-hydroxyvitamin D,25(OH)D］水平,按年龄段分为<1岁组、1~3岁组、>3~6岁组、>6~14岁组,进行血清VitK₂相关临床分析。筛选出25(OH)D≥50 nmol/L的儿童共309例,测定血清OC、PINP、CTX水平,分析不同年龄段水平及其与血清VitK₂的相关性。 结果 血清VitK₂缺乏率为52.31%（906/1 732）。VitK₂缺乏组超重/肥胖、生长痛（≥3岁）发生率均高于VitK₂正常组（P<0.05）;1~3岁组和>6~14岁组血清VitK₂缺乏率（P<0.0083）、血清VitK₂水平（P<0.05）差异有统计学意义。<1岁组儿童血清CTX水平高于>3~6岁组和>6~14岁组,而<1岁组儿童血清PINP水平低于>3~6岁组和>6~14岁组（P<0.05）;<1岁组血清OC水平低于>6~14岁组（P<0.05）。血清VitK₂与OC呈正相关（r_s=0.347,P<0.01）,CTX与PINP呈负相关（r_s=-0.317,P<0.01）。 结论 VitK₂缺乏可能与超重/肥胖有关;血清VitK₂可影响OC水平进而影响骨骼健康。     

青少年抑郁情绪及自杀意念与父母教养方式之间的关联研究

目的 研究青少年抑郁情绪及自杀意念与父母教养方式之间的关系。 方法 采用整群抽样法,于2014~2018年抽取河南省新乡市6 195名初高中生进行调查研究。调查工具包括一般社会资料问卷、父母教养方式问卷及Kutcher青少年抑郁量表（11项）。采用多因素logistic回归分析评估青少年抑郁情绪及自杀意念与父母教养方式之间的关联。 结果 有效问卷为6 194份,其中男性2 586名（41.75%）,女性3 608（58.25%）;年龄（16.4±1.9）岁（范围：11~20岁）。在6 194名青少年中,1 333名（21.52%）青少年有抑郁情绪,508名（8.20%）青少年有自杀意念。青少年的抑郁情绪与母亲的控制（OR=1.059,P<0.001）和父亲的控制呈明显正关联（OR=1.061,P<0.001）,而与母亲的关爱（OR=0.937,P<0.001）和父亲的关爱（OR=0.917,P<0.001）呈明显负关联。青少年的自杀意念与母亲的控制（OR=1.110,P<0.001）和父亲的控制（OR=1.076,P<0.001）呈明显正关联,而与母亲的关爱（OR=0.895,P<0.001）和父亲的关爱（OR=0.914,P<0.001）呈明显负关联。 结论 父母的关爱可降低青少年抑郁情绪的发生风险,而父母控制性可增加青少年抑郁情绪及自杀意念的发生风险。 引用格式:     

运动康复训练对支气管哮喘儿童运动能力和生活质量干预效果的系统评价

目的 系统评价运动康复训练对支气管哮喘儿童运动能力和生活质量的干预效果。 方法 检索PubMed、Cochrane Library、Web of Science、EBSCO、中国知网、维普数据库、万方数据库等数据库从建库至2021年2月关于运动康复训练对支气管哮喘儿童影响的随机对照试验。采用RevMan 5.3软件进行Meta分析。 结果 共纳入14项研究,共计990例受试者。Meta分析结果显示：（1）运动康复组运动能力优于常规治疗组：6 min步行试验的步行距离（MD=108.13,P<0.01）、自我疲劳感觉值（MD=-2.16,P<0.001）、峰值功率（MD=0.94,P=0.001）均显著优于常规治疗组;（2）在儿科哮喘生活质量问卷中,运动康复组生活质量总评分（SMD=1.28,P=0.0002）显著高于常规治疗组,活动受限评分（SMD=1.38,P=0.0002）、症状评分（SMD=1.02,P<0.001）、情感功能评分（SMD=0.86,P<0.001）均显著高于常规治疗组。 结论 运动康复训练对支气管哮喘儿童运动能力和生活质量具有一定的改善作用,但受纳入研究数量和质量的限制,作为指导临床应用还需进一步研究和验证。     

学龄前儿童颈围与体重指数的相关性

目的 探讨学龄前儿童颈围与体重指数的相关性及颈围对学龄前儿童超重/肥胖的诊断价值。 方法 采用分层整群抽样的方法抽取乌鲁木齐市10所幼儿园3 719名7岁以下儿童,收集儿童一般资料并进行体格测量,采用Pearson相关分析法评估颈围与体重指数的相关性,采用受试者工作特征（receiver operating characteristic,ROC）曲线分析颈围判断超重/肥胖的准确性,采用Kappa一致性检验评价颈围与体重指数判断超重/肥胖的一致性。 结果 各年龄阶段的男童、女童颈围与体重指数均呈正相关（r ≥0.50,均P<0.001）。以体重指数作为判断超重/肥胖的标准分为超重/肥胖组与非超重/肥胖组,各年龄阶段的超重/肥胖组颈围均大于非超重/肥胖组（P<0.001）。ROC曲线分析显示,男童和女童颈围判断超重/肥胖的曲线下面积均大于0.7。Kappa一致性检验显示,各年龄阶段男童、女童的颈围和体重指数判断超重/肥胖的Kappa值均大于0.40。 结论 学龄前儿童颈围与体重指数呈正相关;颈围可较好地判断学龄前儿童超重/肥胖。 ［中国当代儿科杂志,2022,24（9）：1042-1046］     

极低出生体重儿发生肺出血的危险因素及其临床转归

目的 研究极低出生体重儿（very low birth weight infant,VLBWI）发生肺出血的高危因素及其临床转归。 方法 病例来源于2020年1月1日至2021年12月31日江苏省妇幼保健院和南京医科大学附属儿童医院收治的所有活产VLBWI（胎龄<35周）,符合纳入和排除标准的574例VLBWI进入研究,其中肺出血组44例,无肺出血组530例。收集2组临床资料进行比较分析,采用多因素logistic回归分析探讨肺出血的危险因素。 结果 肺出血组和无肺出血组母亲年龄、正压通气复苏率、气管插管复苏率和生后1 h内最低体温的比较差异有统计学意义（P<0.05）。肺出血组Ⅲ~Ⅳ级呼吸窘迫综合征和早发型败血症的比例高于无肺出血组（P<0.05）。生后1 h内毛细血管再充盈时间>3 s和生后24 h内最大呼气末正压（positive end-expiratory pressure,PEEP）<5 cm H₂O的患儿在肺出血组更常见（P<0.05）。多因素logistic回归分析显示,母亲年龄30~<35岁为肺出血的保护因素（OR=0.115,P<0.05）,而生后1 h内最低体温<34℃、生后24 h内最大PEEP<5 cm H₂O和早发型败血症是肺出血发生的危险因素（OR值分别为11.609、11.118和20.661,均P<0.05）。在所有病例中,肺出血组有创通气总时间长于无肺出血组（P<0.05）,病死率高于无肺出血组（P<0.05）;在存活病例中,肺出血组支气管肺发育不良的发生率高于无肺出血组（P<0.05）。 结论 VLBWI生后注意保温、给予合适PEEP和早期识别败血症可减少肺出血的发生,从而有助于减少支气管肺发育不良的发生和降低病死率。     

ADCY9基因与儿童支气管哮喘的易感性及环境交互作用分析

目的 研究腺苷酸环化酶9（adenylyl cyclase Ⅸ,ADCY9）基因rs1967309、rs2230739、rs2601814、rs2601825、rs2601796和rs2283497位点单核苷酸多态性（single nucleotide polymorphisms,SNPs）及基因-环境交互作用与儿童支气管哮喘（简称哮喘）的关系。 方法 选取2019年3月至2021年9月就诊的哮喘儿童123例作为哮喘组,其中急性发作为轻中度84例（68.3%）,重度39例（31.7%）;124例健康体检儿童作为对照组。分析ADCY9基因6个位点SNPs及单倍型与儿童哮喘易感性的关系。同时采用广义多因子降维法分析基因-环境交互作用。 结果 哮喘组和对照组儿童ADCY9基因6个位点存在多态性,其中rs1967309位点基因型及等位基因在哮喘组和对照组间的分布差异有统计学意义（P<0.05）。单倍型TA、GG在哮喘组和对照组的分布差异无统计学意义（P>0.05）。广义多因子降维法分析显示,rs1967309位点与变应原接触间存在交互作用（P<0.05）,该位点与变应原接触的交互作用使哮喘患病风险增加（OR=1.585,P<0.05）。 结论 ADCY9基因rs1967309位点与儿童哮喘易感性相关,且该位点和变应原接触具有协同致哮喘的作用。 ［中国当代儿科杂志,2022,24（9）：1027-1035］     

儿童碳青霉烯类耐药肺炎克雷伯菌医院感染的危险因素分析：单中心配对病例-病例-对照研究

目的 调查儿童专科医院住院患儿碳青霉烯类耐药肺炎克雷伯菌（carbapenem-resistant Klebsiella pneumonia,CRKP）感染及死亡的危险因素,为该类细菌的感染防治提供参考依据。 方法 采用配对病例-病例-对照研究的方法。回顾性纳入昆明市儿童医院2019年1月至2021年10月的81例CRKP感染患儿,81例碳青霉烯类敏感肺炎克雷伯菌（carbapenem-sensitive Klebsiella pneumonia,CSKP）感染患儿,及162例对照儿童（住院期间未分离出CRKP及CSKP的患儿）,比较分析各组儿童的基础疾病、既往住院暴露及该次住院暴露情况与CRKP感染及死亡的关联性。 结果 与对照组比较,既往3个月内有住院史与CRKP、CSKP感染存在较高关联强度（分别OR=14.25、10.07,P<0.01）;CRKP感染患儿特异的危险因素包括既往3个月内有碳青霉烯药物治疗史（OR=16.54,P<0.01）及该次住院接受中心静脉置管（OR=33.03,P<0.01）。而既往3个月内有碳青霉烯药物治疗史（OR=28.33,P<0.01）及该次住院抗生素经验性用药（OR=14.50,P<0.01）是导致CRKP患儿死亡的危险因素。 结论 患儿既往3个月内有住院史、碳青霉烯类药物治疗史,以及入院后接受侵入性操作是影响CRKP感染及预后的主要原因。儿童专科医院有必要开展入院时CRKP主动筛查,规范使用抗生素,并加强医院感染监测,以控制CRKP感染的发生。 ［中国当代儿科杂志,2022,24（9）：1008-1013］     

单胎濒死儿发生的围生期危险因素分析

目的 探讨单胎濒死儿发生的围生期危险因素,为濒死儿综合诊治提供依据。 方法 该研究为病例对照研究。选取2006年1月—2015年12月在复旦大学附属妇产科医院出生的154例胎龄≥28周、1 min Apgar评分为0~1分的单胎新生儿为病例组（濒死组）,按1∶4比例随机选取616例同期出生的单胎非濒死儿（1 min Apgar评分>1分）为对照组,采用单因素分析和多因素logistic回归分析评估濒死儿发生的围生期危险因素。 结果 濒死组胎龄和出生体重均显著低于对照组（P<0.05）。濒死组胎儿水肿、脐带脱垂、羊水Ⅲ度污染、胎盘早剥、臀位、重度子痫前期、母亲产时全麻、产前胎心监护异常、产前胎动减少发生比例显著高于对照组（P<0.05）。多因素logistic回归分析显示母亲产时全麻（OR=34.520）、产前胎动减少（OR=28.168）、胎盘早剥（OR=15.641）、羊水Ⅲ度污染（OR=6.365）、产前胎心监护异常（OR=5.739）、臀位（OR=2.614）是濒死儿发生的危险因素（P<0.05）,胎龄较大（OR=0.686）是濒死儿发生的保护因素（P<0.05）。 结论 临床需对产前胎心监护异常、胎动减少、早产、胎盘早剥、臀位、羊水Ⅲ度污染、全麻手术的产妇引起重视,做好新生儿复苏准备,防范濒死儿的发生。     

儿童嗜酸性粒细胞性胃肠炎糖皮质激素治疗的预测因素分析

目的 分析儿童嗜酸性粒细胞性胃肠炎临床特点和治疗方案的关系，探讨糖皮质激素治疗的适用情况，为儿科医师选择治疗方案提供依据。 方法 回顾性收集广州市妇女儿童医疗中心2012年1月至2020年12月收治的182例嗜酸性粒细胞性胃肠炎患儿的临床资料。根据治疗方案中是否使用糖皮质激素分为激素组和对照组，比较分析两组患儿年龄、过敏史、临床症状、实验室检查结果、内镜下表现和胃肠黏膜病理结果，对差异有统计学意义的结果进一步行logistic回归分析。 结果 182例患儿中，36例使用糖皮质激素治疗，占总人数的19.8%。激素组患儿出现血便、贫血，内镜下出现黏膜溃疡/管腔狭窄的比例，以及黏膜嗜酸性粒细胞浸润计数均明显高于对照组（n=146，P<0.05）；激素组血清白蛋白水平明显低于对照组（P<0.05）。多因素logistic回归分析结果显示，内镜下见黏膜溃疡/管腔狭窄（OR=10.830，95%CI：3.090~37.961，P<0.001）和黏膜嗜酸性粒细胞浸润计数升高（OR=0.967，95%CI：0.941~0.993，P=0.015）可提示使用糖皮质激素治疗儿童嗜酸性粒细胞性胃肠炎。 结论 内镜下见到黏膜溃疡/管腔狭窄，病理显示黏膜嗜酸性粒细胞浸润计数明显升高，均提示儿童嗜酸性粒细胞性胃肠炎的治疗方案中可采用糖皮质激素治疗。 引用格式:     

基于动脉自旋标记成像技术探讨支气管肺发育不良对早产儿脑血流量影响的前瞻性研究

目的 探讨儿童高超二倍体（high hyperdiploid,HHD）急性淋巴细胞白血病（acute lymphoblastic leukemia,ALL）的临床特征及预后。 方法 回顾性分析2011年4月—2020年12月福建省5家医院收治的1 414例ALL初诊患儿的临床资料。根据染色体核型,分为伴HHD组（172例）和不伴HHD组（1 242例）,比较两组的临床特征及疗效,并进一步探讨HHD ALL的预后影响因素。 结果 在1 414例ALL初诊患儿中,172例（12.16%）检出HHD。伴HHD组初诊有不良预后危险因素（起病年龄≥10岁或<1岁、初诊白细胞计数≥50×10⁹/L、T细胞表型）、常见融合基因（TEL-AML1、BCR-ABL1、E2A-PBX1、MLL基因重排）阳性的患儿比例均低于不伴HHD组（均P<0.05）,而诱导化疗后微小残留病（minimal residual disease,MRD）<0.01%的患儿比例高于不伴HHD组（P<0.05）。伴HHD组预期10年无事件生存（event-free survival,EFS）率及总生存率均高于不伴HHD组（P<0.05）。单因素分析显示,染色体数目58~66、10号染色体三体、17号染色体三体、诱导化疗第15天或第19天骨髓MRD<1%、诱导化疗第33天或第46天骨髓MRD<0.01%是高EFS率的影响因素（均P<0.05）;10号染色体三体与高总生存率有关（P<0.05）。Cox比例风险回归模型分析显示,17号染色体三体与高EFS率密切相关（P<0.05）。 结论 儿童HHD ALL初诊时不良预后危险因素较少,总体预后佳;染色体数目及特定染色体三体与预后相关。     

Obesity and type 2 diabetes mellitus: a population-based study of adolescents

A cross-sectional, population-based study was conducted on 1,647 Turkish adolescents to determine the prevalence of obesity, impaired fasting glucose (IFG) and type 2 diabetes mellitus (DM2), and to determine whether the recent increase in DM2 prevalence in some countries is applicable to this population. Information was gathered through a questionnaire. All children were screened with physical examination and fasting plasma glucose. 10.7% of adolescents were overweight (BMI 85-95th percentile) and 3.6% were obese (BMI > or =95th percentile). Mean BMI was 20.25 +/- 3.31 kg/m2 with maximum BMI 35.88 kg/m2. No child was diagnosed with DM2; 1.96% had IFG (110-126 mg/dl). No significant relationship was found between IFG and obesity, socio-economic status (SES) or family history of DM. The risk of obesity was increased among children with family history of DM or obesity, and among those who had low physical activity and were of high SES level. This analysis represents the population-based data upon which future studies will be based.     

The prevalence of impaired fasting glucose and type 2 diabetes in a population‐based sample of overweight/obese children in the Middle East

Moadab MH, Kelishadi R, Hashemipour M, Amini M, Poursafa P. The prevalence of impaired fasting glucose and type 2 diabetes in a population‐based sample of overweight/obese children in the Middle East. Background: Type 2 diabetes mellitus (T2DM) and impaired fasting glucose (IFG) are increasing in young population who are facing an escalating trend of overweight. The aim of this study was to determine the prevalence of IFG and T2DM for the first time in a population‐based sample of Iranian obese children. Methods: This cross‐sectional, population‐based study was conducted in Isfahan, the second large city of Iran. Overall, 672 overweight and obese school students, selected from 7554 students, aged 6–19 yr, were screened for IFG and T2DM. Fasting plasma glucose (FPG) and lipid profile were measured in all participants. Oral glucose tolerance test and insulin level were measured in those children with IFG. Insulin resistance was defined as homeostasis model assessment for insulin resistance (HOMA‐IR) > 3.10. Results: Among the7554 students (48.7% boys and 51.3% girls) studied, 9.34% (n = 706) were overweight and 5.3% (n = 403) were obese. A number of 672 overweight and obese students including 302 (44.9%) boys and 370 (55.1%) girls, with a mean age of 12.8 ± 3.10 yr underwent biochemical work up. Overall, the prevalence of IFG was 4.61% (n = 31), the corresponding figure was 2% (n = 4) in the 6–10 yr age group, and 5% (n = 27) in those aged 10.1–19 yr. The prevalence of T2DM was 0.1% (n = 1; age, 18.00 yr). Impaired glucose tolerance and insulin resistance were detected in three and six participants with IFG, who consisted 0.4 and 0.8% of total obese and overweight students, respectively. Conclusions: Although the prevalence of T2DM is low in Iranian obese children, IFG is not uncommon. Preventive measures and screening of FPG should be considered for these children.     

Glucose tolerance status in 510 children and adolescents attending an obesity clinic in Central Italy

Brufani C, Ciampalini P, Grossi A, Fiori R, Fintini D, Tozzi A, Cappa M, Barbetti F. Glucose tolerance status in 510 children and adolescents attending an obesity clinic in Central Italy. Childhood obesity is epidemic in developed countries and is accompanied by an increase in the prevalence of type 2 diabetes (T2DM). Aims: Establish prevalence of glucose metabolism alterations in a large sample of overweight/obese children and adolescents from Central Italy. Methods: The study group included 510 overweight/obese subjects (3–18 yr). Oral glucose tolerance test (OGTT) was performed with glucose and insulin determination. Homeostatic model assessment of insulin resistance (HOMA‐IR) and insulin sensitivity index (ISI) were derived from fasting and OGTT measurements. Beta‐cell function was estimated by insulinogenic index. Fat mass was measured by dual‐energy x‐ray absorptiometry. Results: Glucose metabolism alterations were detected in 12.4% of patients. Impaired glucose tolerance (IGT) was the most frequent alteration (11.2%), with a higher prevalence in adolescents than in children (14.8 vs. 4.1%, p < 0.001); silent T2DM was identified in two adolescents (0.4%). HOMA‐IR and glucose‐stimulated insulin levels were higher in patients with IGT than individuals with normal glucose tolerance (HOMA‐IR = 4.4 ± 2.5 vs. 3.4 ± 2.3, p = 0.001). Fat mass percentage and insulinogenic index were not different between the two groups. In multivariate analysis, age, fasting glucose, and insulin resistance influenced independently plasma glucose at 120 min of OGTT. Individuals with combined impaired fasting glucose/IGT (IFG/IGT) and T2DM were older and had reduced plasma insulin values at OGTT when compared to patients with simple IGT. Conclusions: Glucose metabolism alterations are frequently found among children and adolescents with overweight/obesity from Central Italy. Age, fasting glucose, and insulin resistance are main predictors of IGT. We suggest the use of OGTT as a screening tool in obese European adolescents.     

不同肥胖程度儿童罹患心血管代谢异常风险的横断面调查

目的 通过对肥胖学生健康评估体检,了解不同肥胖程度儿童青少年罹患高血压、高血糖和血脂异常等心血管代谢异常风险现况。方法 采用现况调查方法,对北京市西城区、海淀区和密云县17所中小学2012至2013年度参加学校常规年度体检并以BMI为评价指标筛查为肥胖的学生,进行以健康风险评估为目的的临床体检,体检内容包括体量（身高、体重及体质成分）,血压,空腹血糖,血脂（总胆固醇、三酰甘油、高密度脂蛋白和低密度脂蛋白）等指标。采用中国肥胖问题工作组（WGOC）制定的BMI超重、肥胖筛查标准判定肥胖状态;采用中国儿童青少年血压参照标准评定儿童高血压;采用儿童青少年血脂异常防治专家共识推荐的中国2岁以上儿童青少年血脂异常诊断标准判断血脂异常;以空腹血糖作为评价指标,采用美国糖尿病联盟推荐糖尿病诊断和分类标准进行评价。结果 1 809/3 227名(56.1%)肥胖学龄儿童青少年完成了现况调查且具有完整体检数据,平均年龄12.2岁。肥胖学生心血管代谢异常指标检出率分别为：高血压30.8%,血脂异常43.3%,糖尿病和空腹血糖受损66.6%,肝功能异常11.6%,脂肪肝16.0%,黑棘皮症21.9%。肥胖男生高血压、空腹血糖受损、肝功能异常、脂肪肝和2项及以上心血管代谢异常检出率均高于肥胖女生。重度肥胖占总肥胖人数的29.9%,协方差分析调整年龄和性别后,重度肥胖学生高血压、肝功能异常、脂肪肝、黑棘皮症和2项及以上心血管代谢异常检出率均高于轻中度肥胖学生。结论 肥胖儿童青少年高血压、高血糖和血脂代谢紊乱等心血管代谢异常高发,心血管代谢异常随肥胖程度增加呈上升趋势;儿童肥胖相关心血管代谢异常高发需要得到更广泛关注。     

北京市超重和肥胖学龄儿童中代谢综合征的流行特征

目的了解北京市6—18岁超重、肥胖儿童青少年中代谢综合征（MS）的流行现状和临床表型特征;比较美国国家胆固醇教育计划和国际糖尿病联盟定义的标准诊断儿童青少年MS的差异。方法以2004年北京儿童青少年MS调查中筛查出的超重和肥胖儿童为研究对象,并选取一组正常体重儿童为对照组,检测空腹血浆葡萄糖和胰岛素、血清甘油三酯和高密度脂蛋白胆固醇水平,采用稳态模式评估法计算胰岛素抵抗指数。符合以下5项指标中3项及以上者为MS：腹型肥胖（腰围≥P90）、高血压（≥P90）、低高密度脂蛋白胆固醇[〈1．03mmol／L（40mg／dl）]、高甘油三酯[≥1．24mmol／L（110mg／dl）]和空腹血糖升高[≥5．6mmol／L（100mg／dl）]。结果（1）采用美国国家胆固醇教育计划定义,MS检出率分别为,对照组0．9％,超重组7．6％,肥胖组29．8％,高于国际糖尿病联盟定义的检出率（0．1％,5．2％,28．6％）;两定义标准诊断的MS检出率均呈现随体重指数升高而增加的趋势（趋势检验,P〈0．001）;（2）肥胖儿童中MS单项异常检出率依次为：腹型肥胖81．6％,高血压47．7％,高甘油三酯35．6％,低高密度脂蛋白胆固醇16．9％,高空腹血糖13．4％;超过四分之一的超重儿童具有高血压（29．8％）、腹型肥胖（27．4％）和高甘油三酯（26．0％）;随体重指数增加,MS指标多项异常者和胰岛素抵抗者呈增加趋势（P〈0．001）。结论北京市肥胖儿童青少年中MS已呈现严重流行趋势;腹型肥胖、高血压、高甘油三酯是超重肥胖儿童最常见的代谢异常。采用美国国家胆固醇教育计划定义的儿童MS检出率高于国际糖尿病联盟定义的检出率。     

Evaluation of glucose intolerance in adolescents relative to adults with type 2 diabetes mellitus

AIM: There is an increasing trend in the prevalence of type 2 diabetes mellitus (DM2) in childhood and adolescence, while positive family history of DM2 and obesity are the most important risk factors. To study the influence of family history and obesity on glucose intolerance in our country was the aim of this study. STUDY DESIGN AND METHODS: A total of 105 children and adolescents aged 10-18 years (mean 13.3 +/- 2.5 years) were included in the study. All children and adolescents were divided into three groups according to positive family history of DM2 and obesity, and an oral glucose tolerance test (OGTT) was performed for all. Prediabetes was defined as impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG). Insulin secretion and insulin resistance were estimated using the insulinogenic index; and the homeostatic model assessment for insulin resistance (HOMA-IR) and Matsuda index, respectively. RESULTS: The prevalence of prediabetes was 15.2% in the whole group, while it was 25.5% in obese children who also had a positive family history of DM2. The frequency of hyperinsulinism was 57.1% in all groups. Prediabetic children had significant insulin resistance (HOMA-IR 11.5 +/- 7.1 and 4.1 +/- 6.4, respectively, p = 0.034). CONCLUSIONS: Obesity and glucose intolerance are also a problem in developing countries. The risk of prediabetes in children is highest in obese children who also have a positive family history of DM2. There is a need for a lifelong preventive program starting in childhood to avoid DM2 and decrease cardiovascular risk factors     

Prevalence of glucose intolerance in school age children. Population based cross-sectional study

AIM: The aim of the study was to determine the prevalence of glucose intolerance among school children in south-eastern Poland. METHODS: Schools were randomly selected in the area and the entire school population was studied. We examined 1083 children (510 boys and 573 girls) in the mean age 14.49 years (age range: 7.9-19 years). Their weight and height were measured and body mass index (BMI) was calculated. Patients were classified as overweight or obese based on International Obesity Task Force (IOTF) criteria. We tested fasting glucose level in randomly selected children with normal weight (N=83) in all overweight and obese subjects (N=229). In children with fasting blood glucose level higher than 5.5 mmol/L (100 mg/dL) oral glucose tolerance test (OGTT) was performed. RESULTS: About 17.8% of children were overweight and 4.6% obese. Fasting hyperglycemia was found in 16.7% obese children. The calculated prevalence of fasting hyperglycemia for entire population was 6.7/1000. Impaired glucose tolerance (IGT) was found only in obese children. The prevalence of glucose intolerance in obese children was 7.1%, in contrast the calculated prevalence of glucose intolerance for the entire population was 3.0/1000 (95% confidence interval: 0-8.4/1000). CONCLUSION: Despite relatively high number of obese children, the prevalence of IGT among schoolchildren of south-eastern Poland remains low.     

脂联素基因SNP276多态性与儿童青少年肥胖的相关性研究

目的研究脂联素（APM1）基因SNP276 G/T多态性与儿童青少年单纯性肥胖及其代谢指标的相关性。方法以2004至2006年于复旦大学附属儿科医院内分泌门诊就诊的单纯性肥胖或超重儿童青少年分别作为肥胖组和超重组;选择某中学正常体重学生作为正常对照组。分别测量身高和体重,计算体重指数（BMI）。测定血清空腹葡萄糖（FPG）、空腹胰岛素(FIns)、三酰甘油(TG)和总胆固醇(TC)水平。计算胰岛素抵抗指数（HOMA-IR）和胰岛素敏感指数（QUICKI）。抽提外周血基因组DNA,采用Taqman-MGB探针技术检测APM1基因SNP276 G/T多态性,分析不同基因型与代谢指标和BMI间的关联性。 结果肥胖组纳入227例,超重组纳入231例,正常对照组纳入216名。①肥胖+超重组的BMI、FPG、FIns、TG和HOMA-IR均显著高于正常对照组。②基因分布频率符合Hardy-Weinberg平衡。③肥胖组、超重组和正常对照组的G等位基因频率分别为71.4％、72.5％和69.7％,GG基因型频率分别为50.2％、52.4％和45.8％,GT基因型频率分别为42.3％、40.3％和47.7％;各组差异均无统计学意义（P均>0.05）。 ④SNP276 GG、GT和TT基因型的BMI、FPG、FIns、TG、TC、HOMA-IR和QUICKI差异均无统计学意义（P＝0.49~0.99）。⑤肥胖+超重组IFG儿童青少年中GG+GT型有70例,TT型4例;正常对照组IFG儿童青少年中GG+GT型有10例,TT型0例;两组差异无统计学意义（P＝0.45）。结论APM1基因SNP276 G/T多态性与青少年儿童单纯性肥胖及其代谢指标间无显著关联性,提示该SNP位点可能存在种族特异性。     

Prevalence of overweight and obesity in children and adolescents with type 1 diabetes mellitus

BACKGROUND: Information about the prevalence of obesity in children with type 1 diabetes mellitus (DM1) is inconsistent and limited. The burden of the concurrent problems of obesity and DM1 can have notable medical, psychological, and social implications for both patients and their families. AIMS: To determine prevalences of overweight and obesity in children with DM1 compared to a control population. METHODS: In a cross-sectional study, we compared the prevalence of overweight/obesity in 390 children with DM1 (males 54%) and 565 controls (CONT; males 60%) aged 6 to 16 years. Overweight and obesity were defined as body mass indices between the 85th and 95th percentiles, and greater than the 95th percentile for age, respectively. RESULTS: Overall, 29.5% DM1 and 18.1% CONT (p < 0.001) were either obese or overweight. The prevalence of obesity alone did not differ (DM1 5.4% vs CONT 8.2%), but a greater rate of overweight was seen in the DM1 group (DM 24.1% vs CONT 10.0%, p < 0.001). Rate's of overweight were higher in the DM1 than CONT across all age groups and in both genders (males: DM1 20.1% vs CONT 8.9%, p < 0.001; females: DM1 28.7% vs CONT 11.5%, p < 0.001). Only females showed an increase in overall overweight/obesity rate (DM1 34.8% vs CONT 16.4%, p < 0.001) and this was most evident in older girls. CONCLUSIONS: Children with DM1 are more overweight, but not more obese, than their nondiabetic counterparts. Additional research is warranted to evaluate the characteristics of DM1 and its management that may influence weight gain.     

Differential impact of impaired fasting glucose versus impaired glucose tolerance on cardiometabolic risk factors in multi-ethnic overweight/obese children

We aimed to investigate the prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), and their associations with cardiometabolic risk factors, according to ethnicity in a large obese paediatric cohort. A 75-g oral glucose tolerance test was performed in 1,007 overweight/obese Dutch children of multi-ethnic origin, referred to the obesity outpatient clinics of two Dutch hospitals in Amsterdam (mean age, 11.4 ± 3.2 years; 50.7% boys). Anthropometric parameters and blood samples were collected, and cardiometabolic risk factors were assessed. The cohort consisted of Dutch native (26.0%), Turkish (23.7%), Moroccan (18.8%) and children of ‘other’ (31.5%) ethnicity. The prevalence of IFG was significantly higher in Moroccan and Turkish children as compared to Dutch native children (25.4% and 19.7% vs. 11.8%, respectively, P < 0.05). IGT was most frequently present in Turkish and Dutch native children, relative to Moroccan children (6.3% and 5.3% vs. 1.6%, P < 0.05). Besides pubertal status and ethnicity, components of ‘metabolic syndrome’ (MetS) which were associated with IGT, independent of hyperinsulinaemia, were hypertension [odds ratio (OR), 2.3; 95% CI, 1.1–4.9] while a trend was seen for high triglycerides (OR, 2.0; 95% CI, 0.9–4.3). When analyzing components of MetS which were associated with IFG, only low high-density lipoprotein cholesterol was significantly associated (OR, 1.7; 95% CI, 1.2–2.5) independent of hyperinsulinaemia. In conclusion, in a Dutch multi-ethnic cohort of overweight/obese children, a high prevalence of IFG was found against a low prevalence of IGT, which differed in their associations with cardiometabolic risk factors.