R J B J Gemke

Health-related-quality-of-life in obese adolescents is decreased and inversely related to BMI.

Aim: To compare health related quality of life (HRQoL) of obese adolescents with normal weight controls and to explore the relation between Body Mass Index (BMI) and HRQoL.

Monitoring health related quality of life in adolescents with diabetes: a review of measures

Particularly in chronic conditions, monitoring health related quality of life (HRQoL) of adolescents in clinical practice is increasingly advocated. We set out to identify and review the clinical utility of available generic and diabetes specific HRQoL questionnaires suitable for use in adolescents with type 1 diabetes. Four generic and five diabetes specific questionnaires were identified and evaluated. The responsiveness of most instruments warrants further research and standardisation of HRQoL measurement should be sought to facilitate comparisons across centres and countries. The PedsQL and the KINDL-R appear, at this time, to be the most suitable instruments.

Quality of life in chronic illness: perceptions of parents and paediatricians

Aims: To investigate the differences in perception of quality of life between parents of chronically ill children and paediatricians at diagnosis and follow up. Quality of life was assessed using the (HUI3). Methods: Longitudinal study (July 1999–January 2002) of 37 paediatricians and 181 parents of patients (children aged 1–17 years) with cystic fibrosis admitted for a pneumonia or patients with newly diagnosed acute lymphatic leukaemia, juvenile idiopathic arthritis, or asthma. Main outcome measure was percentage agreement on the attributes of the HUI3 between parents and paediatricians. Results: Differences in perception of health and wellbeing between paediatricians and parents of children with a chronic disease were found, not only at diagnosis but also after a period of follow up. Differences were particularly clear in the subjective attributes emotion (range of agreement 28–68%) and pain/discomfort (range of agreement 11–33%). In all patient groups, at baseline and follow up, the paediatrician assessed the patient to have less pain/discomfort in comparison to the parents. Despite a prolonged patient- paediatrician relationship, differences at follow up did not decrease compared to baseline. Conclusion: At the onset of a chronic disease, but also after a period of follow up, quality of life of paediatric patients may be misunderstood by healthcare professionals, especially in the subjective attributes. Systematic assessment of quality of life may contribute to better understanding between physicians and parents.

Quality of life in chronic illness: children, parents and paediatricians have different, but stable perceptions

Aim: Quality of life assessments can be helpful to estimate the well‐being of chronically ill children. The aim of this study was to investigate the differences in perception of health‐related quality of life (HRQoL) among children, parents and paediatricians at the time of diagnosis and after initial treatment in four chronic diseases.

Associations of infant feeding and timing of linear growth and relative weight gain during early life with childhood body composition.

Background:Growth and feeding during infancy have been associated with later life body mass index. However, the associations of infant feeding, linear growth and weight gain relative to linear growth with separate components of body composition remain unclear.Methods:Of 5551 children with collected growth and infant-feeding data in a prospective cohort study (Amsterdam Born Children and their Development), body composition measured using bioelectrical impedance analysis at the age of 5–6 years was available for 2227 children. We assessed how feeding (duration of full breastfeeding and timing of introduction of complementary feeding) and conditional variables representing linear growth and relative weight gain were associated with childhood fat-free mass (FFM) and fat mass (FM).Results:Birth weight was positively associated with both FFM and FM in childhood, and more strongly with FFM than FM. Faster linear growth and faster relative weight gain at all ages in infancy were positively associated with childhood FFM and FM. The associations with FM were stronger for relative weight gain than for linear growth (FM z score: β coefficient 0.23 (95% con 0.19 to 0.26), P<0.001 and 0.14 (0.11 to 0.17), P<0.001 per s.d. change in relative weight gain and linear growth between 1 and 3 months, respectively). Compared with full breastfeeding <1 month, full breastfeeding >6 months was associated with lower FM (FM z score: −0.17 (−0.28 to −0.05), P=0.005) and lower FFM (FFM z score: −0.13 (−0.23 to −0.03), P=0.015), as was the introduction of complementary feeding >6 months (FM z score: −0.22 (−0.38 to −0.07), P=0.004), compared with <4 months.Conclusions:Faster infant weight gain is associated with a healthier childhood body composition when it is caused by faster linear growth. Full breastfeeding >6 months and introduction of complementary feeding >6 months are associated with lower childhood FM.

The association of birth weight and infant growth with physical fitness at 8-9 years of age—the ABCD study

Background:Low birth weight and accelerated infant growth are independently associated with childhood obesity. We hypothesized that birth weight and infant growth are associated with physical fitness in childhood, and thereby could act as a link in the developmental origins of obesity. In addition, we assessed whether these associations were mediated by fat-free mass (FFM), moderate-to-vigorous physical activity (MVPA) or sedentary behavior (SB).Methods:We assessed physical fitness in 194 children of Dutch ethnicity aged 8.6 (±0.35) years from the ABCD cohort. Aerobic fitness was assessed using the 20-meter multistage shuttle run test (20-m MSRT), and neuromuscular fitness using the standing broad jump (SBJ) test and hand grip strength test. MVPA and SB were measured by accelerometry, and FFM by bioelectrical impedance analysis. Low birth weight was defined as below the 10th percentile and accelerated infant growth as an s.d. score weight gain of >0.67 between birth and 12 months.Results:Children with low birth weight and subsequent accelerated infant growth attained a lower 20-m MSRT score than the remainder of the cohort, adjusted for multiple confounders (P<0.01). Birth weight and infant growth were both independently positively associated with hand grip strength, but not after adjusting for current height and body mass index. There was no association of birth weight or infant growth with SBJ. FFM mediated >75% of the association of birth weight and infant growth with hand grip strength, but FFM, MVPA and SB did not mediate the associations with 20-m MSRT.Conclusions:Our results indicate that low birth weight and accelerated infant growth might negatively affect childhood aerobic and neuromuscular fitness. Differences in FFM largely explain the developmental origins of neuromuscular fitness. Consequently impaired fitness may constitute a link between low birth weight, accelerated infant growth and obesity. Hence, optimization of fitness in these children may affect their obesity and cardiovascular disease risk.

No associations of prenatal maternal psychosocial stress with fasting glucose metabolism in offspring at 5–6 years of age

Highly prevalent maternal psychosocial complaints are accompanied by increases in glucocorticoid stress hormones, which may predispose the offspring for type 2 diabetes and cardiovascular disease later in adulthood. The aim of the current research is to study whether prenatal maternal psychosocial stress is associated with parameters of blood glucose metabolism in their children aged 5-6 years. The study design was a prospective birth cohort (the Amsterdam Born Children and their Development study, the Netherlands). Depressive symptoms, pregnancy-related anxiety, parenting daily hassles and job strain were recorded by questionnaire (gestational week 16). A cumulative score was also calculated. Possible sex differences in the associations were considered. The subjects were 1952 mother-child pairs. Outcome measures were fasting glucose (n=1952), C-peptide and insulin resistance (HOMA2-IR) (n=1478) in the children at the age of 5-6 years. The stress scales, single and cumulative, were not associated with glucose/C-peptide/insulin resistance (all P>0.05). We did not find evidence for sex differences. In conclusion, we did not find evidence for an association between psychosocial stress during early pregnancy and parameters of glucose metabolism in offspring at the age of 5-6 years. Differences emerging later in life or in response to a metabolic challenge should not be ruled out.

BMI may underestimate the socioeconomic gradient in true obesity

Body mass index (BMI) does not make a distinction between fat mass and lean mass. In children, high fat mass appears to be associated with low maternal education, as well as low lean mass because maternal education is associated with physical activity. Therefore, BMI might underestimate true obesity in children of low‐educated mothers.

Quality of Life and its Determinants in Preschool Children with Down Syndrome

Objective : Children with Down syndrome (DS) show a delay in cognitive and motor development and have various concomitant health problems. We compared Health-Related Quality of Life (HRQoL) in preschool children with DS with a reference group, and investigated child-related factors (i.e., developmental quotient, adaptive function, health problems, problem behaviour), and maternal level of education on HRQoL. Method : In a cohort of 55 children with DS, HRQoL was measured with the TNO-AZL preschool children Quality of Life Questionnaire (TAPQoL). Data from a reference group were used for comparison. Developmental Quotient (DQ) was assessed with the Bayley Scales of Infant Development II, adaptive function with the Pediatric Evaluation of Disability Inventory, health problems were derived from the medical file, and behavioural problems were measured with the Child Behaviour Checklist. Results : Children with DS (N=55; mean age 41.7 months) scored significantly lower on the TAPQoL domains lung and stomach problems, motor function and communication compared to the reference group. DQ had a significant negative correlation with the domains lung problems and liveliness. Children with DS with respiratory or gastro-intestinal problems showed significant lower scores on lung problems and communication. Problem behavior had a significant negative correlation with the domains sleeping, appetite and social function. A low level of maternal education correlated negatively with positive mood. Adaptive function and congenital heart defect (CHD) did not significantly correlate with HRQoL. Conclusion : Preschool children with DS show a lower HRQoL on particular domains of functioning compared to a normative sample. HRQoL of children with DS is correlated to DQ, respiratory and gastro-intestinal health problems, problem behaviour and maternal education, but not to CHD and adaptive function.

PO-0095 Early Programming Of Aerobic And Neuromusculair Fitness At Primary School Age. The Abcd-study

Background and aims Low birth weight and accelerated postnatal growth are associated with adult cardiovascular disease. In this perspective body composition and obesity can result from a disturbed energy balance due to early reprogramming of energy intake and expenditure. We hypothesise that low birth weight and accelerated growth may predispose (“program”) reduced physical fitness at 8–9 years of age. Methods Aerobic fitness was measured using a 20 metre multistage shuttle run test (20m-MSRT) and neuromuscular fitness using the standing broad jump (SBJ) test and handgrip strength test was measured in 194 children (104 boys) of Dutch ethnicity at mean age 8.6 years in a prospective birth cohort. Results Subjects with low birth weight and accelerated infant growth reached mean (±SD) 20m-MSRT levels of 3,9 which was significantly lower than (1) normal birth weight and normal infant growth (2) low birth weight and normal infant growth and (3) normal birth weight and accelerated infant growth groups (all p < 0.01). Low birth weight subjects had mean grip strength of 12.3 kg (±3.0), which was significantly lower than normal weight subjects with no effect of infant growth on this relationship. There was no association of birth weight or infant growth with grip strength or SBJ. Conclusions Low birth weight with accelerated infant weight gain was associated with diminished aerobic fitness. Higher birth weight was associated with increased neuromuscular fitness. These early changes may explain increased susceptibility to obesity and related risk factors in low birth weight and early growth accelerated children.