Claudia Banzato

Waist-to-Height Ratio, a Useful Index to Identify High Metabolic Risk in Overweight Children

OBJECTIVE To determine whether using a combination of body mass index (BMI) and waist circumference (WC) or waist-to-height ratio (W/Hr) is clinically helpful in identifying children with high metabolic and cardiovascular risks. STUDY DESIGN Caucasian children (M/F: 740/739; n = 1479; ages 5 to 15 years) were studied. Anthropometry, blood pressure, and venous fasting blood samples tested for triacylglycerol, HDL cholesterol, and glucose were measured. RESULTS Overweight children with a large waist (>90(th) percentile) or high W/Hr (>0.5) but not obese or normal-weight children had significantly greater chances of being at high metabolic and cardiovascular risk than normal-weight children (OR: 7; 95% CI: 3.63-13.48; P < .001, OR: 8.16; 95% CI: 3.87-17.23; P < .001, respectively) with a low waist measurement (</=90(th) percentile) or W/Hr (</=0.5). Interestingly, waist and W/Hr cutoffs (90(th) percentile and 0.5, respectively) were both able to identify children with the highest metabolic and cardiovascular risks among those who were overweight. However, contrary to waist circumference, W/Hr has the advantage of not requiring population specific reference tables as well as age and sex specific cutoffs. CONCLUSIONS Waist circumference and W/Hr are helpful in detecting, among overweight children, those with a higher likelihood of having metabolic and cardiovascular risks.

Prevalence of overweight and obesity in 2- to 6-year-old Italian children

Objective: To assess the prevalence of overweight and obesity in 2‐ to 6‐year‐old Italian children and to compare the prevalence between the north and the south of the country.

Fasting Plasma Glucose (FPG) and the Risk of Impaired Glucose Tolerance in Obese Children and Adolescents

A timely diagnosis of impaired glucose tolerance (IGT) is desirable in obesity. The oral glucose tolerance test (OGTT), the gold standard to diagnose this condition, may not be realistically performed in all patients due to discomfort, labor, and cost. The aim of this study was to assess whether one or more biochemical indexes measured in fasting conditions could be used to identify obese children at risk of IGT. A cohort of 563 white obese children and adolescents (M/F: 315/248; aged 4–17 years) was recruited and underwent anthropometric evaluation and OGTT. Anthropometric parameters, fasting plasma glucose (FPG), fasting serum insulin (FSI), and homeostasis model assessment of insulin resistance (HOMAIR) were tested in pursuit of a possible threshold to be used as a predictor of IGT. Thirty‐seven children (6.9%) had IGT and one child (0.1%) had type 2 diabetes (T2D). FPG, FSI, and HOMAIR were all significantly higher in children with IGT than in children without IGT. Receiver‐operating characteristic (ROC) curve analyses run for gender and puberty‐adjusted FPG, FSI, and HOMAIR were all significant: area under the curve (95% confidence interval) equaled 0.68 (0.59–0.76), 0.66 (0.56–0.76), and 0.68 (0.59–0.78), respectively. The three parameters did not show significantly different sensitivity/specificity in the pooled population or in the gender/puberty subgroups. Thresholds varied among gender/puberty subgroups for FSI and HOMAIR, but not for FPG, which showed a fixed threshold of 86 mg/dl. A gender/puberty independent cutoff of FPG may be considered a screening tool to narrow clinical indication to OGTT in obese white children and adolescents.

The Relationship between Body Size and Depression Symptoms in Adolescents

OBJECTIVE To evaluate the relationship between body size and depressive symptoms, as well as the moderating effects of age, sex, and socioeconomic status (SES), in a sample of young adolescents. STUDY DESIGN The study group comprised 678 young adolescents (age 11 to 14 years). Body mass index (BMI) z scores were used to estimate body size. Depression symptoms were assessed using the Childrens Depression Inventory (CDI). The spline function was used to examine the shape of the relationship between BMI z score and depressive symptoms. RESULTS In the total sample, CDI scores were lowest for BMI z scores between -1 and -0.5. CDI scores increased progressively for BMI z scores > 0. In boys, CDI scores increased for BMI z scores > 2, whereas in girls, CDI scores increased for BMI z scores > -0.5 and < -1. Age did not have a significant moderating effect. SES had a moderating effect only in boys (P = .011). CONCLUSIONS The relationship between body size and depressive symptoms in young adolescents is curvilinear and is moderated by sex. Heavier-than-average and underweight girls, as well as obese boys, had the highest depression scores.

The Relationship between Body Mass Index and Body Size Dissatisfaction in Young Adolescents: Spline Function Analysis

This study assessed how body size dissatisfaction (BSD) varies in relationship to specific body mass index (BMI) values in a sample of preadolescents. A novel statistical approach based on spline function, suitable to assess in detail how two variables are related, was used. The study was conducted between December 2004 and March 2005. Students (aged 11 to 14 years) from seven selected secondary schools in Verona, Italy, were invited to participate. The final study group included 678 subjects. BSD was assessed using the Body Image Assessment Procedure. BMI values were expressed as z scores. It was found that, in the total sample, slightly underweight subjects (BMI z scores=-0.5) had no BSD. BSD progressively increased (current body size > ideal body size) for BMI z scores >-0.5 and became negative (ideal body size > current body size) for BMI z scores <-0.5. In boys, average weight subjects had no BSD. BSD progressively increased for BMI z scores >0 and became negative for BMI z scores <0. In girls, moderately underweight subjects (BMI z scores=-1) had no BSD. BSD progressively increased for BMI z scores >-1 and became negative for BMI z scores <-1. Although sex significantly moderated the relationship between BMI and BSD (P<0.001), socioeconomic status did not (P=0.459). Because average weight and slightly underweight young girls desired a thinner body, our study suggests that these subgroups should receive particular attention in public health programs as well as in dietetics clinical practice.

Metastatic Crohn's disease in childhood.

Metastatic Crohn’s disease (mCD) is a rare cutaneous manifestation of Crohn’s disease (CD). The diagnosis may be a challenge, especially when there is no history of intestinal CD. We present the case of a child with mCD, and review the published childhood cases. A 10–year–old white boy presented with a 2–month history of an erythematous infiltrated painless plaque on the mons pubis (Figure 1). The patient had a 5–year history of CD with duodenal and colorectal involvement. Previous treatment with mesalazine, azathioprine, and corticosteroids had resulted in insufficient disease control. In parallel to the onset of the skin lesion, gastrointestinal symptoms worsened. A skin biopsy of the plaque showed superficial and deep noncaseating granulomas rich in epithelioid histiocytes, Langhans type giant cells, and foreign body cells. There was a perivascular, periadnexal, and interstitial infiltrate with lymphocytes and plasma cells. Superficial lymph vessels were dilated (Figure 2). Given that gastrointestinal symptoms were not responding to corticosteroids, infliximab 5 mg/kg bw was initiated. After the third infliximab infusion, a marked improvement of both gastrointestinal and cutaneous symptoms was noted. However, after seven months, the patient experienced a recurrence of cutaneous manifestations. He developed penile edema only partially responding to topical corticosteroids, and his gastrointestinal symptoms subsequently also deteriorated. The infliximab dose was increased (10 mg/kg bw) and then stopped after two infusions because of loss of response. Neither the presence of antidrug neutralizing antibodies nor infliximab serum levels could be tested. The patient subsequently entered a clinical trial with thalidomide. Crohn’s disease is a chronic, relapsing disorder characterized by segmental granulomatous inflammation of the gastrointestinal tract and frequently associated with extraintestinal manifestations. Skin and mucosal lesions are the most frequent, occurring in more than 40 % of patients. These include mCD, which is defined as granulomatous lesions occurring at sites separate from the gastrointestinal tract [1]. Metastatic CD often begins between the second and fourth decade of life. In children, mCD most frequently presents at the age of 10 to 14. In adults, metastatic CD usually occurs in the setting of well–documented intestinal disease. By contrast, in 50–86 % of pediatric cases, it precedes the diagnosis of CD [2, 3]. In general, CD takes a more aggressive course in children than in adults. There is

Lung Function in Women with Idiopathic Central Precocious Puberty: A Pilot Study

Background: Studies have reported that women with early menarche (≤10 years) have lower lung function. Aim: To investigate lung function in women with a history of idio pathic central precocious puberty (ICPP) treated during childhood with gonadotropin-releasing hormone agonist (GnRHa). Methods: ICPP women (n = 23) were compared with healthy age-matched controls (n = 23). Subjects were clinically evaluated by means of a questionnaire, baseline and post-β2 agonist spirometry, impulse oscillometry (a measure of airway resistance), and measurement of fractional exhaled nitric oxide (FeNO). Results: Patients had lower lung function values than controls: forced expiratory volume in 1 s (FEV1) (median 97.90 vs. 109.45; p = 0.011), FEV1 after β2 agonist (100.80 vs. 114.10; p = 0.013), peak expiratory flow (92.90 vs. 97.95; p = 0.031), and maximum mid-expiratory flow (MMEF) (80.80 vs. 106.30; p = 0.008). FeNO was significantly lower in the patients (p < 0.001). Significant reversibility of FEV1 after β2 agonist was observed in 8.7% of the patients. FEV1/forced vital capacity and MMEF after β2 agonist correlated negatively with hysterometry at diagnosis (p = 0.009 and p = 0.03, respectively). There was a negative correlation between age at diagnosis and airway resistance. Conclusions: Women with ICPP seem to have lower lung function despite treatment with GnRHa. Further research on the effects of sex hormones on the airways should take into account potential interplay with factors affecting the start of puberty.


Severe refractory dermatitis and cystic fibrosis

An 80-day-old infant was admitted for severe dermatitis, resembling acrodermatitis enteropathica, characterised by erythematous scaly plaques with crusts and ulcerations, predominantly in the diaper area, perioral area and extremities (figure 1). She had generalised severe dermatitis from the first weeks of life unresponsive to conventional treatment. At admission, the patient was below the 3rd percentile for weight and …

A neonate with abdominal distension and failure to thrive

A full-term male was born after a pregnancy complicated between 22 and 31 weeks of gestation by non-immune hydrops fetalis (NIH). At 48 h of life, the physical examination revealed jaundice, which was treated successfully with conventional phototherapy for 24 h, and mild hepatomegaly, which was not promptly investigated. At 20 days of life, the patient presented with a clinical picture of failure to thrive and significant abdominal distension (figure 1). Liver and spleen were palpable at 7 and 8 cm below the costal margin, respectively. The patient was dystrophic without dysmorphic features or signs of neurological involvement. Liver enzyme levels and cholestasis indices were significantly altered (aspartate aminotransferase 126 U/L gamma glutamyl transferase 283 U/L, alkaline phosphatase 533 U/L, total bilirubin 58 mmol/L, conjugated bilirubin 41 mmol/L), while leucocyte count, haemoglobin level, coagulation parameters, albumin and serum glucose level were …

Metastatischer Morbus Crohn in der Kindheit

metastatischer Morbus Crohn ist eine seltene kutane Manifestation des Morbus Crohn (MC). Die Diagnose kann schwierig sein, insbesondere wenn in der Anamnese kein Hinweis auf intestinalen MC vorliegt. Wir stellen den Fall eines Kindes mit metastatischem MC vor und geben eine Übersicht über die publizierten Fälle, bei denen Kinder betroffen waren. Ein 10-jähriger weißer Junge stellte sich mit einem nicht schmerzenden, erythematösen, infiltrierten Plaque auf dem Schamhügel vor (Abbildung 1), der sich zwei Monate zuvor Clinical Letter entwickelt hatte. Der Patient litt seit fünf Jahren an MC mit duodenaler und kolorektaler Beteiligung. Die Behandlung mit Mesalazin, Azathioprin und Kortikosteroiden hatte zu keiner ausreichenden Kontrolle der Erkrankung geführt. Mit dem Auftreten der Hautläsion verschlimmerten sich die gastrointestinalen Symptome. In einem Hautbiopsat des Plaques zeigten sich oberflächliche und tiefe nichtverkäsende Granulome, die reich an epithelioiden Histiozyten, Langhans-Riesenzellen und Fremdkörperzellen waren. Es lag ein perivaskuläres, periadnexales und interstitielles Infiltrat von Lymphozyten und Plasmazellen vor. Die oberflächlichen Lymphgefäße waren erweitert (Abbildung 2). Da die gastrointestinalen Symptome nicht auf Kortikosteroide ansprachen, wurde eine Behandlung mit 5 mg/kg Körpergewicht (KG) Infliximab eingeleitet. Nach der dritten Infliximab-Infusion verbesserten sich sowohl die gastrointestinalen als auch die kutanen Symptome deutlich. Nach sieben Monaten trat jedoch ein Rezidiv der kutanen Manifestationen auf. Der Patient entwickelte ein Penisödem, das nur teilweise auf topische Kortikosteroide ansprach, und die gastrointestinalen Symptome verschlimmerten sich daraufhin ebenfalls. Die Infliximab-Gabe wurde mit erhöhter Dosis (10 mg/kg KG) fortgesetzt, nach zwei Infusionen jedoch beendet, da kein Ansprechen mehr beobachtet wurde. Weder das Vorliegen von neutralisierenden Antikörpern gegen das Arzneimittel noch der Infliximab-Serumspiegel konnte getestet werden. Der Patient nahm anschließend an einer klinischen Studie mit Thalidomid teil. Beim Morbus Crohn handelt es sich um eine rezidivierende chronische Erkrankung, die durch segmentale granulomatöse Entzündung des Gastrointestinaltrakts gekennzeichnet ist und häufig mit extraintestinalen Manifestationen einhergeht. Am häufigsten, bei mehr als 40 % der Patienten, treten Hautund Schleimhautläsionen auf. Dazu gehört auch der metastasierte MC, der definiert ist als granulomatöse Läsionen, die nicht den Gastrointestinaltrakt betreffen [1].