Olcay Neyzi

Body mass index references for Turkish children

AIM To construct the body mass index reference curves for Turkish children aged 6 to 18 y, and to determine the prevalence of overweight and obesity. SUBJECTS AND METHODS Height and weight measurements of healthy schoolchildren (1,100 boys, 1,019 girls) were obtained biannually. Body mass index was calculated from 11,648 height and weight measurements. Centile curves were constructed using the LMS method. RESULTS The smoothed percentile values and curves for body mass index in Turkish children show that there is a constant increase in body mass index values towards adulthood, especially during the pubertal years, in both sexes. The prevalence of overweight is 25% and obesity 4% in boys at age 18 y. The percentage of overweight and obesity in girls at age 14 was 15% and 1%, respectively. The sample size was too small to come to any conclusion regarding these rates at 18 y of age. CONCLUSION This study presents data and curves for body mass index values in healthy Turkish children aged 6 to 18 y. The values are in compliance with those of Western countries.

Sexual maturation in Turkish girls

Ages of attainment of successive puberty stages of the breast, public hair and axillary hair and of menarche were established in a cross-sectional study of 1468 Turkish school girls in Istanbul. The subjects were grouped into four socioeconomic classes. Onset of secondary sexual characteristics and of menarche in the highest socioeconomic class were early as compared to other population groups. Mean ages of attainment for the initial stage of breast, pubic hair and axillary hair development were 9.8, 10.4 and 10.8 years respectively in this group. Mean menarcheal age was 12.36 +/- 0.01 years. All stages of breast, pubic hair and axillary hair and also menarche consistently occurred later in the lower socioeconomic classes as compared with the higher. The time intervals from onset to completion of secondary sexual characteristics were comparable to those reported for European girls for pubic and axillary hair development, but relatively longer for the development of the breast. They differed little between the socioeconomic classes.

Sexual maturation in Turkish boys.

Ages of onset and attainment of various stages of secondary sexual characters were assessed from cross-sectional data on 1530 city schoolboys in Istanbul, Turkey. The subjects were grouped into four socio-economic classes. Ages of onset of pubic hair (11.80 years), axillary hair (13.15 years), facial hair (14.45 years) and laryngeal development (13.37 years) were relatively early in the highest socioeconomic class and agreed with recent values reported for European boys. In lower socioeconomic classes there was a relative delay of onset and attainment of the subsequent stages of secondary sexual characters. Acne was encountered in a significant proportion of the boys and increased in frequency with age. Socioeconomic level had no effect on its frequency. Gynaecomastia, unilateral in nearly half of the instances, was encountered in 7.0 per cent of the subjects. The frequency of gynaecomastia was lower in class 1 boys.

Updated growth curves for Turkish children aged 15 days to 60 months

BACKGROUND Growth reference values are useful in paediatric health care as a health indicator. Secular changes in height for age values are also known to affect the timing of puberty and brain weight. Different populations may be at different stages of this secular trend. It is, therefore, necessary to periodically update the growth reference values for each population to identify these changes. The aim of this study was to update the growth reference values for Turkish infants and young children. METHODS Background information and height/length, weight and head circumference measurements on a sample of 2391 boys and 2102 girls were obtained from Well Child Clinic Records. The LMS method was used for the analyses. The percentage of exclusive breastfeeding was 62% at 4 months and 26.6% at 6 months. The continuation rate of breastfeeding at 12 months was 62.5%. RESULTS Comparison with previous Turkish data showed an increase in height of 0.9 cm for boys and 1.1 cm for girls at age 5 years. The increase in weight was 0.220 kg in girls, while a decrease of 0.160 kg was noted in boys. Comparison with the 2000 US and Swedish values indicated that population differences may exist in pre-pubertal years. CONCLUSION This study provides an enhanced instrument to evaluate the growth of Turkish infants and young children.

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

Thyroid Ultrasound in IDDM

Insulin dependent diabetes mellitus (IDMM) is often associated with autoimmune thyroiditis (AIT) and a high prevalence of thyroid antibodies (TA). Ultrasound imaging of the thyroid may contribute to the evaluation of patients with AIT. We therefore investigated ultrasound findings of the thyroid in 83 IDDM patients (44F, 39M) with an age range of 2.3-22.3 yrs (median 11.1). Thyroid volume (ml) determined by ultrasound ranged between 1.3 and 17.9 (median 5.7). Thyroid volumes of 75 healthy children (32F, 43M) with an age range of 2.0 to 11.8 yrs (median 7.6) ranged between 1.6 and 13.2 ml (median 4.8) and did not show a significant difference from the IDDM group from age 4 to 12. TA were positive in 18.8% of the IDDM group. Thyroid volume was higher in TA (+) diabetics (p = 0.05), a finding which may be attributed to a higher percentage of cases with elevated TSH in the TA (+) group. Two diabetic patients showed non-homogeneous hypoechogenicity in the ultrasound compatible with AIT which was later confirmed in one of these cases by aspiration biopsy. Ultrasound imaging of the thyroid may contribute to the evaluation of patients with AIT in IDDM.

Transient Pseudohypoaldosteronism in an infant with urinary tract anomaly

Transient pseudohypoaldosteronism (TPHA) due to renal tubular unresponsiveness to aldosterone and manifested by hyperkalemia, hyponatremia, metabolic acidosis and marked increase in plasma aldosterone concentration, has been previously identified in infants with obstructive uropathy and urinary tract infection (UTI). 1,2 TPHA can be cured by treatment for the UTI or surgery. 1 We report a case of TPHA caused by urinary tract infection associated with left vesicoureteral reflux.

Trial of Co-trimoxazole Versus Procaine Penicillin G and Benzathin Penicillin + Procaine Penicillin G in the Treatment of Childhood Pneumonia

This study, which aimed to assess the results of three different regimens in the treatment of pneumonia, was carried out at the Pediatric Outpatient Department of Capa Childrens Hospital in Istanbul on 151 patients aged between 4 months and 14 years. The first group (n = 46) received co-trimoxazole orally for 10 days and the second group (n = 63) procaine penicillin G in intramuscularly for 10 days. Benzathin penicillin G combined with procaine penicillin G was given to the third group (n = 42) as a single dose intramuscularly. While the best results were obtained with penicillin procaine G, no statistically significant difference was found between this regimen and co-trimoxazole therapy (chi 2 = 0.305023 P = 0.5). We suggest that co-trimoxazole is easy to administer and cost effective in the ambulatory treatment of pneumonia in children.

Paraprofessional women as health care facilitators in mother and child health.

The aim of the study was to compare the performance of midwives with that of lady home visitors (LHV; paraprofessionals). The project area was divided into six according to the population map. One midwife or one LHV was assigned to each visiting area. Home visits were carried out to identify and offer guidance on family planning (FP), antenatal care, well-child control, immunizations and other mother and child health related issues to those at high risk. Criteria taken for evaluation were the numbers of pregnant women identified in the last trimester; pregnant women receiving antenatal care; deliveries attended by a health care provider; modern FP users; continuation rate of the new users; pregnancy rate in new users; immunization status of children; well-child visits of the children. No significant differences were found in these health measurements between areas visited by LHV and areas visited by midwives. Response rates to the invitation was also similar in both areas. An important observation was the good performance of the LHV in communicating with the families. Women with limited school attainment from the community can be used effectively and efficiently in community health services.

Puberty and Pubertal Growth in Healthy Turkish Girls: No evidence for secular trend

Background: Assessment of pubertal stages should be related to updated and reliable referance data from the same background population. Objective: The aim of this study was to provide normative data for the onset and tempo of puberty in Turkish girls and analyze the growth parameters in puberty. Methods: The analyses are based on data that were collected and evaluated biannually on 1020 Turkish school children aged 8−18 years and a subsample of 101 girls who had reached final height (FH). The data were analyzed cross−sectionally in the total group and longitudinally in the subsample. Results: Mean age and height (Ht) at onset of puberty were 10.1 ± 1.0 years and 141.7 ± 7.6 cm, respectively. Peak height velocity (HtV) was 8.5 ± 1.0 cm/year. Total pubertal height gain was 16.0 ± 3.9 cm. The duration of puberty was 4.9 ± 1.2 years. Age at menarche was 12.2 ± 0.9 years. Height at onset of puberty was positively correlated with FH (p < 0.0001). Body size (weight and height) at onset of puberty and weight and height velocity before the year of onset of puberty correlated negatively with age at onset of puberty (p < 0.05). Conclusion: In conclusion, these results provide normative data for pubertal stages and growth parameters in girls in puberty. Height at onset of puberty is the most important determinant of FH. There is no secular trend for the onset of puberty. Weight does seem to affect the onset of puberty but not FH. Conflict of interest:None declared.