上海市闵行区儿童青少年非酒精性脂肪肝病7年患病率横断面调查

背景：儿童非酒精性脂肪肝病（NAFLD）导致成年后心血管病发病风险明显增加,而目前我国儿童青少年一般人群NAFLD患病率研究十分有限,长期变化趋势亦不明确。目的：描述儿童青少年NAFLD患病流行趋势。设计：横断面调查。方法：以上海市闵行区2014至2020年参加健康体检的住校学生为调查对象。将ALT水平高于一般人群性别和年龄别P97.5水平定义为疑似NAFLD,依此估计疑似NAFLD患病率（简称患病率）。根据全国标准分别以BMI和腰围定义一般性肥胖和腹型肥胖。通过计算平均年度变化百分比（AAPC）及其95%CI行描述NAFLD患病率逐年变化幅度,趋势性检验Logistic回归分析,并校正BMI和腰围。主要结局指标：NAFLD患病率。结果：NAFLD总体患病率为5.1%,从2014年至2020年上升了2.5倍（2.1%到7.4%）,NAFLD患病率逐年上升（Ptrend<0.001）,AAPC为0.9%（95%CI：0.1%~1.7%）,且男孩高于女孩（6.3% vs 3.7%）。在体重正常人群中NAFLD患病率为1.9%,7年中呈逐年上升趋势（Ptrend<0.001）。调整BMI和腰围后,NAFLD患病率逐年上升的趋势仍显著（Ptrend<0.001）。结论：上海儿童青少年人群NAFLD患病率呈现每年上升近1.0%的趋势,调整BMI和腰围因素后,NAFLD患病率逐年上升的趋势仍然存在。提示除肥胖外,儿童人群防控NAFLD需进一步关注其他可干预危险因素的作用。     

母亲糖尿病及UCP2基因多态性与子代先天性心脏病关联的病例对照研究

目的 探讨母亲糖尿病、解偶联蛋白2基因（UCP2）多态性及两者的交互作用与子代先天性心脏病（CHD）的关系。方法 采用以医院为基础的病例对照研究,选择2018年3月至2019年8月在湖南省儿童医院确诊的464例单纯CHD患儿的母亲为病例组,选择同期住院、无先天畸形的504例患儿的母亲为对照组。通过问卷调查,收集相关暴露信息,同时采集母亲静脉血5 mL,用于UCP2基因多态性检测。采用多因素logistic回归分析探讨母亲糖尿病、UCP2基因多态性及两者交互作用与子代CHD的关联性。结果 多因素logistic回归分析显示,在控制混杂因素后,患有妊娠期糖尿病（OR=2.96,95% CI：1.57~5.59）、有妊娠期糖尿病史（OR=3.16,95% CI：1.59~6.28）和妊娠前患有糖尿病（OR=4.52,95% CI：2.41~8.50）均显著增加子代CHD的风险（P < 0.05）。母亲UCP2基因两个位点rs659366（T/C vs C/C：OR=1.49,95% CI：1.02~2.16;T/T vs C/C：OR=2.77,95% CI：1.67~4.62）和rs660339（A/A vs G/G：OR=2.19,95% CI：1.34~3.58）的多态性与子代CHD的风险存在关联（P < 0.05）。交互作用分析显示,UCP2基因两个位点（rs659366和rs660339）的多态性与母亲糖尿病在子代CHD发生中存在交互作用（P < 0.05）。结论 母亲糖尿病、UCP2基因多态性及其交互作用与子代CHD发病相关。     

母亲糖尿病及UCP2基因多态性与子代先天性心脏病关联的病例对照研究

目的 探讨母亲糖尿病、解偶联蛋白2基因（UCP2）多态性及两者的交互作用与子代先天性心脏病（CHD）的关系。方法 采用以医院为基础的病例对照研究，选择2018年3月至2019年8月在湖南省儿童医院确诊的464例单纯CHD患儿的母亲为病例组，选择同期住院、无先天畸形的504例患儿的母亲为对照组。通过问卷调查，收集相关暴露信息，同时采集母亲静脉血5 mL，用于UCP2基因多态性检测。采用多因素logistic回归分析探讨母亲糖尿病、UCP2基因多态性及两者交互作用与子代CHD的关联性。结果 多因素logistic回归分析显示，在控制混杂因素后，患有妊娠期糖尿病（OR=2.96，95% CI：1.57~5.59）、有妊娠期糖尿病史（OR=3.16，95% CI：1.59~6.28）和妊娠前患有糖尿病（OR=4.52，95% CI：2.41~8.50）均显著增加子代CHD的风险（P < 0.05）。母亲UCP2基因两个位点rs659366（T/C vs C/C：OR=1.49，95% CI：1.02~2.16；T/T vs C/C：OR=2.77，95% CI：1.67~4.62）和rs660339（A/A vs G/G：OR=2.19，95% CI：1.34~3.58）的多态性与子代CHD的风险存在关联（P < 0.05）。交互作用分析显示，UCP2基因两个位点（rs659366和rs660339）的多态性与母亲糖尿病在子代CHD发生中存在交互作用（P < 0.05）。结论 母亲糖尿病、UCP2基因多态性及其交互作用与子代CHD发病相关。     

幼儿园儿童肺炎链球菌携带的聚集性及影响因素分析

目的 探讨幼儿园儿童肺炎链球菌携带的聚集性及影响因素，为肺炎链球菌性疾病的预防提供科学依据。方法 采用多阶段分层整群抽样的方法，对柳州市1 702名幼儿园儿童进行双侧鼻前庭拭子采样，对其家长进行问卷调查，数据分析采用卡方检验和随机效应logistic回归模型。结果 幼儿园儿童鼻部肺炎链球菌携带率为13.16%（224/1 702）。聚集性分析显示：肺炎链球菌携带在班级水平的随机效应具有统计学意义（Z=2.07，P=0.038），组内相关系数为5.9%。随机效应logistic回归分析表明，5~7岁儿童的肺炎链球菌携带风险低于2~< 5岁儿童（OR=0.55，95% CI：0.40~0.76，P=0.001）；同住人口数≥5的儿童的肺炎链球菌携带风险高于同住人口数 < 5的儿童（OR=1.34，95% CI：1.01~1.79，P=0.043）。结论 肺炎链球菌携带存在班级水平的聚集性；年龄和同住人口数是儿童肺炎链球菌携带的重要影响因素。     

中国儿童哮喘危险因素的Meta分析

目的 探讨中国儿童哮喘的主要危险因素,为哮喘的防治提供参考依据。方法 系统收集中国知网、万方数据库、中国生物医学文献数据库、维普中文科技期刊全文数据库、Web of Science和PubMed等数据库从建库至2017年9月有关中国儿童哮喘危险因素的研究。采用Stata 12.0软件进行Meta分析。结果 共纳入24篇病例对照研究,其中病例组5 309例,对照组6 404例。Meta分析显示,家族哮喘史（OR=5.246,95% CI：3.435~8.011）、家族过敏史（OR=4.627,95% CI：2.450~8.738）、特应性体质（OR=4.659,95% CI：2.511~8.644）、变应性鼻炎（OR=11.510,95% CI：6.769~19.574）、湿疹/皮炎史（OR=4.919,95% CI：3.514~6.886）、患儿过敏史（OR=4.732,95% CI：2.802~7.989）、食物过敏史（OR=5.890,95% CI：3.412~10.166）、药物过敏史（OR=4.664,95% CI：2.637~8.252）、家中有霉斑（OR=2.483,95% CI：1.671~3.690）、家中种花草（OR=1.748,95% CI：1.383~2.209）、房屋装修史（OR=2.823,95% CI：2.206~3.935）、剖宫产（OR=1.894,95% CI：1.166~3.077）是儿童哮喘的危险因素,母乳喂养是儿童哮喘的保护因素（OR=0.508,95% CI：0.396~0.653）。结论 中国儿童哮喘的发生与多种因素有关,其中家族哮喘史、家族过敏史、个体特应性体质、过敏史、过敏合并症、剖宫产出生及不良的家庭环境因素可增加儿童哮喘的患病风险,而母乳喂养可降低儿童哮喘的患病风险。     

新生儿坏死性小肠结肠炎伴发败血症的危险因素研究

目的 探讨新生儿坏死性小肠结肠炎 （NEC） 伴发败血症的危险因素。方法 回顾性研究273例NEC患儿的临床资料,分析伴发败血症的危险因素。结果 NEC伴发败血症的几率为32.2% （88/273）。Ⅲ期NEC伴发败血症的几率高于Ⅱ期 （69.0% vs 15.9%,P < 0.05）。62.5%的败血症发生在NEC诊断后3d内,37.5%发生在3d后。伴发败血症的NEC患儿与未伴发者相比,出生胎龄更小,出生体重更低 （P < 0.05）。硬肿症 （OR：9.75,95% CI：2.84~33.52,P < 0.001）、Ⅲ期NEC （OR：12.94,95% CI：6.82~24.55,P < 0.001） 及胃肠减压 （OR：2.27,95% CI：1.14~4.5,P=0.02） 为NEC伴发败血症的独立危险因素。结论 硬肿症、Ⅲ期NEC及胃肠减压为NEC伴发败血症的独立危险因素。     

CASP3基因一个新的功能性SNP rs72689236与川崎病相关性的Meta分析

目的：综合分析半胱氨酸蛋白酶3基因 (CASP3)一个新的功能性单核苷酸多态位点（SNP） rs72689236与川崎病发生发展的相关性。方法：国内外数据库中检索川崎病与CASP3基因相关性研究的文献,根据纳入与排除标准筛选文献,获取2012年11月以前公开发表的病例-对照研究与家系传递不平衡研究（TDT）的资料,结合作者的相关研究结果,评价质量后采用RevMan 5.1软件进行Meta分析。结果：川崎病患者中rs72689236的A等位基因频率显著增高（P<0.001,OR=1.34,95% CI：1.24~1.46)。rs72689236风险等位基因A的携带者（AG+AA）相较于GG个体,患病风险增加约44% （P<0.001, OR=1.44,95% CI：1.27~1.65）。该SNP的风险等位基因A增加了川崎病并发冠状动脉损伤的风险（P=0.01, OR=1.51,95% CI：1.10~2.07）,携带风险等位基因A的川崎病患者相比于非携带者,并发冠状动脉损伤的风险增加约59%（P=0.05, OR=1.59,95% CI：1.00~2.53）。未发现该SNP与川崎病患者静脉注射免疫球蛋白（IVIG）疗效相关联的证据。结论：CASP3基因功能性SNP rs72689236的A等位基因增加了川崎病的发生风险,该SNP的风险等位基因有可能作为川崎病并发冠状动脉损伤的易感遗传标记。目前还没有足够的证据提示该SNP对川崎病的重要治疗手段IVIG的疗效存在影响,需要更多的相关研究以进一步评价其应用于临床个体化治疗方案选择的可行性。     

新生儿先天性甲状腺功能减低症危险因素的Meta分析

目的 探讨新生儿先天性甲状腺功能减低症（congenital hypothyroidism,CH）的危险因素,为CH的预防提供参考依据。方法 系统收集中国生物医学文献数据库、中国知网、维普中文期刊数据库、万方数据库、PubMed、Web of Science、Embase、SpringerLink、Elsevier/ScienceDirect等数据库自建库至2020年8月1日公开发表有关新生儿CH危险因素的研究文献,采用R 3.6.2和RevMan 5.3软件进行Meta分析。结果 共纳入20篇文献,其中病例对照研究13篇,现况研究7篇。病例组3 579例,对照组7 985例,样本量合计11 564例。Meta分析显示,母亲高龄（OR=2.111,95% CI：1.275~3.493）、妊娠合并甲状腺疾病（OR=3.365,95% CI：1.743~6.500）、妊娠糖尿病（OR=2.158,95% CI：1.545~3.015）、妊娠期焦虑（OR=3.375,95% CI：2.133~5.340）、妊娠期用药（OR=2.774,95% CI：1.344~5.725）、妊娠期接触辐射（OR=3.262,95% CI：1.950~5.455）、甲状腺疾病家族史（OR=8.706,95% CI：5.991~12.653）、低出生体重（OR=2.674,95% CI：1.895~3.772）、巨大儿（OR=1.657,95% CI：1.187~2.315）、早产儿（OR=2.567,95% CI：2.070~3.183）、过期产儿（OR=2.083,95% CI：1.404~3.091）、双胎及多胎（OR=3.455,95% CI：1.958~6.096）、出生缺陷（OR=6.038,95% CI：3.827~9.525）是新生儿CH的危险因素。结论 母亲高龄、妊娠合并甲状腺疾病、妊娠糖尿病、妊娠期焦虑、妊娠期用药、妊娠期接触辐射、甲状腺疾病家族史、低出生体重、巨大儿、早产儿、过期产儿、双胎及多胎、出生缺陷可能增加新生儿CH的患病风险。     

阿奇霉素辅助治疗儿童毛细支气管炎有效性的系统回顾与Meta分析

目的 系统评价阿奇霉素（AZM）辅助治疗儿童毛细支气管炎的有效性。方法 采用RevMan 5.3软件,对截止2019年2月17日国内外发表的关于AZM用于辅助治疗毛细支气管炎的临床随机对照试验进行Meta分析。结果 共纳入14篇文献,干预组667例,对照组651例。合并效应量结果显示,AZM辅助治疗不能缩短毛细支气管炎患儿的住院时间（MD=-0.29,95% CI：-0.62~0.04,P=0.08）及用氧时间（MD=-0.33,95% CI：-0.73~0.07,P=0.10）;可以缩短患儿喘息（MD=-1.00,95% CI：-1.72~-0.28,P=0.007）及咳嗽缓解时间（MD=-0.48,95% CI：-0.67~-0.29,P < 0.00001）。菌群分析结果提示,AZM能有效减少患儿鼻咽部肺炎链球菌（OR=0.24,95% CI：0.11~0.54,P=0.0006）、嗜血杆菌属（OR=0.28,95% CI：0.14~0.55,P=0.0002）和卡他莫拉菌（OR=0.21,95% CI：0.11~0.40,P < 0.00001）的检出率。结论 AZM辅助治疗儿童毛细支气管炎一定程度上有助于缩短患儿咳嗽及喘息缓解时间,但对住院及用氧时间的影响不显著。     

维生素D受体基因多态性与维生素D缺乏性佝偻病遗传关联性Meta分析

目的:评价维生素D受体（VDR）基因多态性与维生素D缺乏性佝偻病(佝偻病)的遗传关联性。方法:制定原始文献的纳入标准及检索策略,检索PubMed、Springer、Science Direct、Web of Science、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库,收集VDR基因FokⅠ、ApaⅠ、BsmⅠ和TaqⅠ位点多态性与佝偻病相关性的病例对照研究,以佝偻病患儿为病例组。依据NHI NHGRI研究工作组2007年制定的遗传关联性研究报告规范为基础,并依据相关文献选取其中的14条标准用于评价文献偏倚。以基因型频率为指标,提取数据后先确定最佳遗传模型,采用Stata 11.0软件进行Meta分析,计算合并的OR值及其95％CI。结果:19篇病例对照研究进入Meta分析。①FokⅠ位点采用共显性模型（FF基因型 vs ff基因型;FF基因型 vs Ff基因型）分析,病例组704例,对照组596例。Meta分析结果显示,亚洲人群FF基因型较ff基因型（OR=4.59,95%CI：2.98~7.07）和Ff基因型(OR=2.58,95%CI：1.79~3.73)患佝偻病的风险显著增加;高加索人群FokⅠ位点与佝偻病无显著关联性（FF基因型 vs ff基因型,OR=2.50,95%CI：0.76~8.19;FF基因型 vs Ff基因型,OR=1.18,95%CI：0.66~2.10）;非洲人群FF基因型较ff基因型患佝偻病的风险显著增加（OR=5.81,95%CI：1.21~27.98）。②ApaⅠ位点采用显性模型（AA+Aa基因型 vs aa基因型）分析,病例组338例,对照组459例。亚洲人群和非洲人群ApaⅠ位点与佝偻病均无显著关联性,OR分别为1.04（95%CI：0.72~1.49）和0.98（95%CI：0.57~1.71）;高加索人群AA+Aa基因型患佝偻病的风险增高（OR=5.50,95%CI：1.22~24.75）。③BsmⅠ位点采用显性模型（bb基因型 vs Bb+BB基因型）分析,病例组822例,对照组736例。亚洲人群BsmⅠ位点bb基因型较Bb+BB基因型患佝偻病的风险降低(OR=0.46,95%CI：0.23~0.92),非洲人群BsmⅠ位点与佝偻病无显著关联性（OR=1.65,95%CI：0.95~2.88）。④TaqⅠ位点采用隐性模型（TT基因型 vs Tt+tt基因型）分析, 病例组519例,对照组513例。亚洲人群（OR=1.22,95%CI：0.82~1.82）、高加索人群（OR=0.91,95%CI：0.35~2.35）和非洲人群（OR=1.18,95%CI：0.68~2.05）TaqⅠ位点与佝偻病无显著关联性。结论:现有证据表明,亚洲人群FokⅠ位点FF基因型为患佝偻病的危险因素,而BsmⅠ位点bb基因型为佝偻病轻微的保护因素,尚不能认为ApaⅠ和TaqⅠ位点与佝偻病有关联性;由于高加索人群和非洲人群研究较少,VDR基因多态性与佝偻病的关联性尚不明确。     

Distribution curve of waist-to-height ratio and its association with blood pressure among children and adolescents: study in a large population in an eastern coastal province,China

Several studies have suggested that waist-to-height ratio (WHtR) is an accurate and easier index for evaluating abdominal obesity in both children and adults. The present study examined the distribution of WHtR and its association with blood pressure (BP) levels among children and adolescents in a large population in Shandong, China. A total of 38,810 students (19,453 boys and 19,357 girls) aged 7–17 years participated in this study. Height, waist circumference (WC), and BP of all subjects were measured, and WHtR was calculated. Abdominal obesity was defined as WHtR ≥0.5; high BP status was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥95th percentile for age and gender. Overall, 16.45 % (95%CI: 15.93–16.97) and 7.80 % (95%CI: 7.42–8.17) of boys and girls had a WHtR ≥0.5. WHtR was positively correlated with SBP and DBP in both boys and girls. The mean values of SBP and DBP for both boys and girls were all significantly higher in the WHtR ≥0.5 group than in the WHtR<0.5 group. Z-scores of BP and the prevalence of high BP increased with WHtR. The prevalence of high BP increased from 10.61 (boys) and 9.64 % (girls) in the WHtR <0.34 group to 55.11 (boys) and 51.97 % (girls) in the WHtR ≥0.58 group, an increase of 4.2- and 4.4-times. We conclude that children and adolescents with high WHtR might have an increased risk of elevated BP. These findings highlight the importance of the prevention of abdominal obesity in order to prevent future-related problems such as hypertension in children and adolescents.     

Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years

Background

Central obesity has been associated with the risk of cardiovascular and metabolic disease in children and anthropometric indices predictive of central obesity include waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR). South Asian children have higher body fat distribution in the trunk region but the literature regarding WC and related indices is scarce in this region. The study was aimed to provide age- and gender-specific WC, WHR and WHtR smoothed percentiles, and to explore prevalence and correlates of central obesity, among Pakistani children aged five to twelve years.

Methods

A population-based cross-sectional study was conducted with a representative multistage random cluster sample of 1860 primary school children aged five to twelve years in Lahore, Pakistan. Smoothed percentile curves were constructed for WC, WHR and WHtR by the LMS method. Central obesity was defined as having both age- and gender-specific WC percentile ≥90^th and WHtR ≥0.5. Chi-square test was used as the test of trend. Multivariate logistic regression was used to quantify the independent predictors of central obesity and adjusted odds ratios (aOR) with 95% CI were obtained. Linear regression was used to explore the independent determinants of WC and WHtR. Statistical significance was considered at P < 0.05.

Results

First ever age- and gender-specific smoothed WC, WHR and WHtR reference curves for Pakistani children aged five to twelve years are presented. WC increased with age among both boys and girls. Fiftieth WC percentile curves for Pakistani children were higher as compared to those for Hong Kong and British children, and were lower as compared to those for Iranian, German and Swiss children. WHR showed a plateau pattern among boys while plateau among girls until nine years of age and decreased afterwards. WHtR was age-independent among both boys and girls, and WHtR cut-off of ≥0.5 for defining central obesity corresponded to 85^th WHtR percentile irrespective of age and gender. Twelve percent children (95% CI 10.1-13.0) had a WC ≥90^th percentile and 16.5% children (95% CI 14.7-18.1) had a WHtR ≥0.5 while 11% children (95% CI 8.9-11.6) had both WC ≥90^th percentile and WHtR ≥0.5. Significant predictors of central obesity included higher grade, urban area with high socioeconomic status (SES), high-income neighborhood and higher parental education. Children studying in higher grade (aOR 5.11, 95% CI 1.76-14.85) and those living in urban area with high SES (aOR 82.34, 95% CI 15.76-430.31) showed a significant independent association. Urban area with high SES and higher parental education showed a significant independent association with higher WC and higher WHtR while higher grade showed a significant independent association with higher WC.

Conclusions

Comprehensive worldwide reference values are needed to define central obesity and the present study is the first one to report anthropometric indices predictive of central obesity for Pakistani school-aged children. Eleven percent children were centrally obese and strong predictors included higher grade, urban area with high SES and higher parental education. These findings support the need for developing a National strategy for childhood obesity and implementing targeted interventions, prioritizing the higher social class and involving communities.     

Distributions of waist circumference and waist-to-height ratio for children and adolescents in Shandong, China

Waist circumference (WC) and waist-to-height ratio (WHtR) are useful tools which can help to identify abdominal obesity among the childhood and adolescent populations. This study assessed the distributions of WC and WHtR for Shandong children and adolescents and compared them with those from other countries and regions. Data for this study were obtained from a large cross-sectional survey of schoolchildren carried out in 2010. A total of 42,296 students (21,218 boys and 21,078 girls) aged 7–18 years participated in this study. Height and WC of all subjects were measured and WHtR was calculated. Central obesity was defined as WC ≥ 90th percentile and a WHtR ≥ 0.5, respectively. Shandong children and adolescents had a high WC level, with the 50th percentiles of WC for children and adolescents aged 7 to 18 years in Shandong is above the reference values for Chinese children and adolescents by 1.3–3.1 cm for boys and 1.2–2.0 cm for girls, respectively. The WC levels in Shandong boys and girls were higher than those from Hong Kong, Malaysian, and Turkish. Overall, 20.20 and 16.57 % of boys and girls had a WC ≥90th percentile, 15.73 and 7.38 % of boys and girls had a WHtR ≥0.5. Conclusion: The prevalence of central obesity among children and adolescents has become a serious public health problem, which would arouse special attention.     

Validating the waist-height ratio and developing centiles for use amongst children and adolescents

Aim: To assess the statistical validity of the waist-height ratio (WHtR) as an appropriate method of adjusting waist circumference (WC) for height in children and adolescents.
Introduction: Recently, WHtR has been proposed to be of greater value than body mass index (BMI), in predicting obesity-related cardiovascular co-morbidities in children. This index, however, is yet to be extensively validated within the paediatric population.
Methods: Height and WC in centimetres, were measured in 3597 children from grades 1 (5–7 years), 5 (9–11 years) and 10 (15–17 years). Log regression analyses using WC and height were performed to determine appropriate powers (p) to raise height, to completely adjust the index for height, by sex and grade. Correlations between WHtR and height were assessed.
Results: Statistically, the WHtR is only valid for use among grade 1 boys and girls (p = 1.09 [95%CI 0.95–1.23] and p = 1.07 [95%CI 0.92–1.22], respectively) and grade 10 girls p = 0.85 (95%CI 0.62–1.08). However, the error (0.25%–1.85%), associated with the use of this index, in all ages and both sexes is clinically and biologically acceptable.
Conclusion: The WHtR is a clinically and biologically valid index to use among Australian children and adolescents.     

Television, computer use, physical activity, diet and fatness in Australian adolescents.

PURPOSE: To examine sedentary behaviours (including television viewing, playing computer games and computer use), diet, exercise and fitness in relation to overweight/obesity in Australian adolescents. METHODS: Questionnaires elicited food frequency data, time spent in TV-viewing, using computers, other sedentary occupations and physical activity recall. Weight, height and fitness (laps completed in the Leger test) were measured. RESULTS: Among 281 boys and 321 girls, mean age 12 years (SD 0.9), 56 boys (20.0%) and 70 girls (23.3%) were overweight/obese. Greater fitness was associated with decreased risk of overweight/obesity in boys (Odds ratio [OR] 0.74; 95% CI 0.55, 0.99) and girls (OR 0.93; 95% CI 0.91, 0.99). TV-viewing predicted increased risk in boys (OR 1.04; 95% CI 1.01, 1.06) and decreased risk in girls (OR 0.99; 95% CI 0.96, 0.99). Computer use, video games, and other sedentary behaviours were not significantly related to risk of overweight/obesity. Vegetable intake was associated with lower risk in boys (OR 0.98; 95% CI 0.97, 0.99); greater risk was associated with lower fat intake in boys and girls, lower consumption of energy-dense snacks in boys (OR 0.74; 95% CI 0.62, 0.88) and greater intake of vegetables in girls (OR 1.02; 95% CI 1.00, 1.03), suggesting dieting or knowledge of favourable dietary choices in overweight/obese children. CONCLUSIONS: Among these adolescents, fitness was negatively related to risk for overweight/obesity in boys and girls. TV-viewing was a positive predictor in boys and a negative predictor in girls but the effect size was small; other sedentary behaviours did not predict risk.     

What is the appropriate strategy for diagnosing NAFLD using ultrasonography in obese children?

Background:The aim of this study is to identify obese children who are candidates for a potential diagnosis of non-alcoholic fatty liver disease (NAFLD).Methods:We enrolled 242 obese children (122 boys and 120 girls) aged 7-16 years who were examined with abdominal ultrasonography in our pediatric obesity clinic.We compared patients in the normal group with those in the NAFLD group (mild disease,moderate to severe disease) and identified the optimal anthropometric parameters among height,weight,body mass index (BMI),waist circumference,hip circumference,waist to height ratio (WHtR),and waist to hip ratio to predict NAFLD using a receiver operating characteristic curve analysis.We also investigated risk factors associated with NAFLD for the anthropometric parameters and the biochemical model using logistic regression.Results:The high-and low-risk groups for hepatic steatosis relative to a WHtR of 0.56 as the standard point showed significant differences in hepatic steatosis severity grade (P＜0.001),BMI (P=0.004),hip circumference (P=0.090),aspartate aminotransferase (P＜0.001),alanine aminotransferase (P＜0.001),triglycerides (P=0.001),and the triglyceride to high-density lipoprotein (HDL) cholesterol ratio (P=0.006).Risk factors for hepatic steatosis on logistic regression analysis were male sex (odds ratio:3.68,95％ confidence interval:1.76-7.70),WHtR ＞0.56 (2.25,1.05-4.81),and waist circumference ＞90th percentile (20.22,9.21-44.36) in the anthropometric parameter model and elevated alanine aminotransferase levels (boys ＞25.8 U/L,girls ＞22.1 U/L) (6.93,2.52-19.03),hypertriglyceridemia (＞110 mg/dL) (3.80,1.23-11.75),and triglyceride to HDL cholesterol ratio ＞3 (9.23,2.95-8.83) in the biochemical parameter model.Conclusions:A diagnostic approach to hepatic steatosis is recommended as part of the proper screening and stratification of risk factors in obese children.WHtR is a simple and convenient method of effectively identifying obese children who are candidates for hepatic steatosis screening.     

不同营养状况下儿童青少年骨龄发育提前或落后的风险分析

目的 分析不同营养状况下儿童青少年的骨龄发育特点，探讨超重、肥胖及消瘦与骨龄发育提前或落后的相关性。方法 运用CHN法对2012年1月至2019年2月期间在首都儿科研究所附属儿童医院就诊的4~18岁7 062例（男3 310例，女3 752例）儿童的左手腕部骨龄进行评价，利用“儿童生长发育与营养评估系统”计算体质指数Z值（BMIZ），BMIZ＜-2为消瘦组，BMIZ＞+1和BMIZ＞+2分别为超重组和肥胖组，比较不同性别和营养状况下骨龄年龄差（BAD）的差异，并对超重、肥胖儿童骨龄提前的发生风险进行分析。结果 消瘦和正常儿童平均骨龄与年龄相符，超重、肥胖儿童骨龄提前，且女童提前幅度大于男童，超重男、女童分别提前1.10岁和1.36岁（P=0.000）；肥胖男、女童分别提前1.60岁和1.78岁（P=0.000）。与正常体重相比，超重男、女童骨龄提前的风险分别增加2.358倍（95% CI：2.759~4.086）和2.483倍（95% CI：2.928~4.144）；肥胖男、女童骨龄提前的风险分别增加5.820倍（95% CI：5.066~9.181）和7.537倍（95% CI：6.319~11.534）；消瘦男、女童骨龄落后的风险分别增加1.540倍（95% CI：1.481~4.355）和3.790倍（95% CI：2.245~10.221）（P均＜0.05）。结论 超重肥胖增加骨龄提前的风险，超重男、女童骨龄提前风险接近，肥胖女童骨龄提前风险大于男童。消瘦增加骨龄落后的风险。     

儿童急性白血病易感性与GS TPi基因多态性关系的研究

目的探讨谷胱甘肽硫转移酶Pi（GSTPi）基因A313G、C341 T多态性在深圳地区汉族健康儿童和急性白血病（AL）儿童中的突变情况,并分析GSTPi基因多态性与儿童AL易感性的关系。方法采用逆转录聚合酶链式反应-变性梯度凝胶电泳（RT-PCR-DGGE ）结合DNA测序技术,对108例AL患儿和121名正常对照儿童进行基因多态性筛查。结果 GSTPi313G等位基因总样本频率为16.4％;未检测到GSTPi C341 T位点突变。GSTPi 313 G等位基因在AL组、急性淋巴细胞白血病（ALL）组、急性髓细胞白血病（AML）组和急性B淋巴细胞白血病（B-ALL）组中分布频率分别为18.1％、17.9％、20.0％和19.9％,均高于对照组的14.9％（P ＞0.05）。男性患儿 GSTPi 313AG基因型及AG＋GG显性模型可显著增加B-ALL发病风险（OR＝2.26,95％CI：1.07～6.42, P＝0.04;OR＝2.49,95％CI：1.07～5.81,P＝0.04）;女性患儿GSTPi 313GG基因型似可增加AML发病风险（OR＝2.33,95％CI：0.18～30.10）,但差异无显著性（P＞0.05）。结论男性患儿GSTPi 313 AG基因型和AG＋GG显性模型可增加B-ALL发病风险。另外,GSTPi 多态性在降低女性AL患儿发病风险中的作用仍需做进一步探讨。     

TV watching modifies obesity risk linked to the 27Glu polymorphism of the ADRB2 gene in girls.

OBJECTIVE: A matched case-control study was conducted in a population of Spanish children and adolescents (5-18 years old), to assess the interaction between the Gln27Glu polymorphism of the ADRB2 and television (TV) watching on obesity risk. PATIENTS: Obese (n=165) and control subjects (n=165) matched by sex and age were recruited and classified according to Spanish reference data. Results. Using conditional logistic regression, we calculated the obesity risk linked to the polymorphism. A statistically significant association was found for 27Glu carrier allele girls (OR = 1.95; 95% CI = 1.02-3.70), but no association was apparent among boys. In the fully adjusted model, the odds ratio for obesity linked to the genotype Glu27Glu in the female population rose to 4.84 (95% CI = 1.37-17.10). Moreover, we found a significant negative interaction between hours of TV watching and the Gln27Glu polymorphism for obesity risk in girls. Surprisingly, among 27Glu carrier subjects, even girls with a low level of TV watching ( < 12.5 h/week) had a high obesity risk (OR = 4.60; 95% CI = 1.01-20.02), which was not very different to the odds ratio values for sedentary girls carrying the 27 Glu allele watching TV more than 12.5 h/week (OR = 6.05; 95% CI = 1.31-27.71). Conclusion. A higher risk of obesity was found for girls carrying the 27Glu allele of the ADRB2 gene even when they spent less than 12.5 h/week watching TV. In addition, our results suggest that the effect of sedentary lifestyle on obesity risk may depend on the genotype of the subject.     

Weight concerns and weight control behaviors of adolescents and their mothers

OBJECTIVE: To assess the association between weight concerns and weight control practices of adolescents and their mothers. DESIGN AND PARTICIPANTS: Cross-sectional study of 5331 adolescent girls and 3881 adolescent boys (age range, 11.8-18.4 years) in an ongoing cohort study and their mothers. Participants were included in the analysis if both the adolescent and his or her mother returned a questionnaire mailed in 1999 and provided information on weight, height, and weight concerns. RESULTS: More adolescent girls (33.0%) than boys (8.1%) thought frequently about wanting to be thinner. Compared with adolescent girls who accurately perceived that their thinness was not important to their mother, girls who misperceived (odds ratio [OR] = 1.9; 95% confidence interval [CI], 1.3-2.8) or accurately perceived (OR = 2.85; 95% CI, 1.0-8.4) that it was important to their mother that they be thin were significantly more likely to think frequently about wanting to be thinner. Among the adolescent boys, only those who accurately perceived that it was important to their mother that they not be fat were more likely than their peers to think frequently about wanting to be thinner (OR = 3.8; 95% CI, 2.3-6.2). Adolescents who accurately perceived that it was important to their mother to be thin or not fat were significantly more likely to be frequent dieters than their peers who accurately perceived that their weight was not important to their mother. CONCLUSION: Among adolescents, an accurate perception that weight status is important to their mother is associated with thinking frequently about wanting to be thinner and about frequent dieting.