Publications by authors named "Mandy Vogel"

108 Publications

Age- and weight group-specific weight gain patterns in children and adolescents during the 15 years before and during the COVID-19 pandemic.

Int J Obes (Lond) 2021 Sep 23. Epub 2021 Sep 23.

Leipzig University Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, 04103, Leipzig, Germany.

Background/objectives: There is a concern that measures aiming to limit a further spread of COVID-19, e.g., school closures and social distancing, cause an aggravation of the childhood obesity epidemic. Therefore, we compared BMI trends during the 15 years before and during the COVID-19 pandemic.

Subjects/methods: To assess the change in weight dynamics during the first months of COVID-19, we compared the trends of 3-month change in BMI-SDS (ΔBMI-SDS) and the proportions of children showing a high positive (HPC) or high negative (HNC) weight change between 2005 and 2019 and the respective changes from 2019 (pre-pandemic) to 2020 (after the onset of anti-pandemic measures) in more than 150,000 children (9689 during the pandemic period). The period of 3 months corresponds approximately to the first lockdown period in Germany.

Results: During the COVID-19 pandemic, we found a substantial weight gain across all weight and age groups, reflected by an increase in the 3-month change in BMI-SDS (β = 0.05, p < 0.001), an increase in the proportion of children showing HPC (OR = 1.4, p < 0.001), and a decrease in the proportion of children showing HNC (OR = 0.7, p < 0.001). Besides, we found the same trends since 2005 on a low but stable level with a yearly increase of ΔBMI-SDS by β = 0.001 (p < 0.001), the odds of HPC increased by OR = 1.01 (p < 0.001), and the odds of HNC decreased by OR = 0.99 (p < 0.001). These rather small effects accumulated to β = 0.02, OR = 1.14, and OR = 0.85 over the whole period 2005-2019. Alarmingly, both the long-term and the short-term effects were most pronounced in the obese subgroup.

Conclusions: There are positive dynamics in different measures of weight change, indicating a positive trend in weight gain patterns, especially within the group of children with obesity. These dynamics are likely to be escalated by COVID-19-related measures. Thus, they may lead to a significant further aggravation of the childhood obesity pandemic.
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http://dx.doi.org/10.1038/s41366-021-00968-2DOI Listing
September 2021

Associations between changes in behavioral difficulties and levels of problematic smartphone use in adolescents over a 1-year period.

Eur Child Adolesc Psychiatry 2021 Sep 21. Epub 2021 Sep 21.

LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.

Objectives: The present longitudinal study investigates associations between changes in externalizing and internalizing behavioral difficulties and changes in problematic smartphone usage within the same 1-year period in healthy adolescents.

Methods: The project is part of the LIFE Child cohort study conducted in Leipzig, Germany. Ten- to 16-year-old adolescents (n = 363) provided information on behavioral difficulties [Strengths and Difficulties Questionnaire (SDQ)], the duration of daily smartphone use, and symptoms of smartphone addiction [Smartphone Addiction Proneness Scale (SAPS)] at two consecutive study visits, t1 and t2 (1 year after t1). In the first of two analysis phases, we applied linear regression analyses to assess cross-sectional associations between externalizing and internalizing behavioral difficulties and the duration of smartphone use and symptoms of smartphone addiction (at t1 and t2). In the second, we assessed associations between the changes measured in these variables over the period of a year. All associations were adjusted for age, sex, and soci-economic status.

Results: Children who reported prolonged periods of smartphone use or more symptoms of smartphone addiction exhibited significantly higher levels of externalizing and internalizing behavioral difficulties at t1 and t2. Further, children who increased their usage or developed addiction symptoms between t1 and t2 also developed more externalizing behavioral difficulties. We found the same tendencies in regard to internalizing behavioral difficulties, although the associations did not reach statistical significance.

Conclusions: The present findings suggest that externalizing behavioral difficulties and problematic smartphone use are mutually dependent in the long term.
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http://dx.doi.org/10.1007/s00787-021-01874-8DOI Listing
September 2021

Well-being and COVID-19-related worries of German children and adolescents: A longitudinal study from pre-COVID to the end of lockdown in Spring 2020.

JCPP Adv 2021 Apr 17;1(1):e12004. Epub 2021 Mar 17.

LIFE Child Leipzig University Hospital for Children and Adolescents Leipzig University Leipzig Germany.

Background: There is concern that pandemic measures put a strain on the health and well-being of children. We investigated the effects of the COVID-19 pandemic, the lockdown, and social distancing on the well-being, media use, and emotions of children and adolescents between 9 and 18 years.

Methods: We used linear and proportional odds logistic regression correcting for age, sex, and socioeconomic status (SES) and to compare media use, peers/social support, physical, and psychological well-being between 2019 (pre-COVID baseline) and two time points shortly after the start of the lockdown (last week of March and April 2020, respectively) in 391 9-19-year-old healthy children and adolescents of the LIFE Child cohort. COVID-19-related feelings and their relationship to age, sex, and SES were assessed at two time points during lockdown.

Results: We found significantly lower scores in physical and psychological well-being during lockdown compared to baseline. The effect was significantly stronger in children with medium/low SES. Perceived social support scores were also significantly lower during the lockdown. The percentage of children who had no contact with their peers (in-person or online) increased from 3% pre-COVID to 14% and 13% in April and March 2020, respectively. About 80% of the children missed in-person contacts with friends. Most of the children worried more about the health of their families than their own. Sixty percent worried about the international situation at least moderately, whereas only 20% were afraid of COVID-19 itself. The percentage of children who believed it would never be as before COVID-19 rose from 7.4% at the beginning lockdown end of March to 16.2% a month later. In contrast, all other COVID-19-related worries, showed a (nonsignificant) decline during the same period.

Conclusion: Our study supports the notion that pandemic measures have to be balanced against adverse public health effects. Especially vulnerable groups have to be protected.
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http://dx.doi.org/10.1111/jcv2.12004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250267PMC
April 2021

Changes in diet from pregnancy to one year after birth: a longitudinal study.

BMC Pregnancy Childbirth 2021 Sep 4;21(1):600. Epub 2021 Sep 4.

LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.

Background: Pregnancy and the first year after giving birth are marked by physiological and psychological changes. While it is well known that energy requirements change during this time, the question of how a woman's diet actually changes from pregnancy until 1 year postpartum has been left virtually unexplored. The present study employs a longitudinal design to investigate these changes.

Methods: Data were collected within the framework of the LIFE Child study (Leipzig, Germany). The diet composition and culture of eating of 110 women were assessed at 3 time points: in the 24th week of pregnancy, 3 months after giving birth (breastfeeding period), and 12 months after giving birth (after weaning). We assessed differences in nutritional health (Nutritional Health Score, NHS) and the consumption of different food items at each of these time points. We also investigated associations between nutritional health and age, socio-economic status (SES), BMI before pregnancy, and previous births at all three time points.

Results: The analyses revealed high correlations in the NHS values between the three time points (rho = .55, rho = .60). On average, nutritional health was lower in the breastfeeding period than during pregnancy. In more detail, women reported less healthy levels of treats and white bread consumption and a higher frequency of snacking in the breastfeeding period than during pregnancy. In contrast, overall nutritional health did not differ significantly between pregnancy and the time after weaning. Increased age was associated with a healthier diet during pregnancy, and a high SES was associated with healthier diet after weaning. Furthermore, the increase in nutritional health from the breastfeeding period to the time after weaning was significantly stronger in women with a higher BMI. We observed no significant associations between dietary nutritional health and previous births.

Conclusions: The present findings suggest that higher energy requirements in the breastfeeding period are met by consuming high-calorie and unhealthy food products rather than healthy and nutrient-rich food. Young mothers should be supported in taking care of their own nutritional health during the challenging time of breastfeeding and caring for a newborn child.
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http://dx.doi.org/10.1186/s12884-021-04038-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418026PMC
September 2021

Cystatin C relates to metabolism in healthy, pubertal adolescents.

Pediatr Nephrol 2021 Aug 25. Epub 2021 Aug 25.

Hospital for Children and Adolescents, University of Leipzig, Liebigstraße 27b, 04103, Leipzig, Germany.

Introduction: The cystatin C (CysC) serum level is a marker of glomerular filtration rate and depends on age, gender, and pubertal stage. We hypothesize that CysC might overall reflect energy homeostasis and be regulated by components of the endocrine system and metabolites in pubertal adolescents.

Methods: Serum CysC levels and further possible effector parameters in 5355 fasting, morning venous blood samples from 2035 healthy participants of the LIFE Child cohort study (age 8 to 18 years) were analyzed. Recruitment started in 2011, with probands followed up once a year. Linear univariate and stepwise multivariate regression analyses were performed.

Results: Annual growth rate, serum levels of thyroid hormones, parathyroid hormone, insulin-like growth factor 1, hemoglobin A1c (HbA1c), uric acid, and alkaline phosphatase show relevant and significant associations with CysC serum concentrations (p <0.001). Furthermore, male probands' CysC correlated with the body mass index and testosterone among other sexual hormones. Multivariate analyses revealed that uric acid and HbA1c are associated variables of CysC independent from gender (p <0.001). In males, alkaline phosphatase (p <0.001) is additionally significantly associated with CysC. Thyroid hormones show significant correlations only in multivariate analyses in females (p <0.001).

Conclusions: The described associations strongly suggest an impact of children's metabolism on CysC serum levels. These alterations need to be considered in kidney diagnostics using CysC in adolescents. Additionally, further studies are needed on CysC in children.
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http://dx.doi.org/10.1007/s00467-021-05209-2DOI Listing
August 2021

Dynamic alterations in linear growth and endocrine parameters in children with obesity and height reference values.

EClinicalMedicine 2021 Jul 23;37:100977. Epub 2021 Jun 23.

University of Leipzig, Medical Faculty, University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstr.19, Leipzig 04103, Germany.

Background: Obesity can affect linear growth of children but there is uncertainty regarding the dynamics and potential causes.

Methods: In the population-based LIFE Child and the obesity-enriched Leipzig Obesity Childhood cohorts (8,629 children, 37,493 measurements), recruited from 1999 to 2018 in Germany, we compared height, growth, and endocrine parameters between normal-weight and children with obesity (0-20 years). Derived from the independent German CrescNet registry (12,703 children) we generated height reference values specific for children with obesity (data collected from 1999 to 2020).

Findings: Children with obesity were significantly taller than normal-weight peers, differing at maximum by 7·6 cm (1·4 height, standard deviation scores or SDS) at age 6-8 years. Already at birth, children with obesity were slightly taller and thereafter had increased growth velocities by up to 1·2 cm/year. This growth acceleration was unrelated to parental height, but was accompanied by increased levels of insulin-like growth factor-1 (IGF-1), insulin and leptin. During puberty, children with obesity showed a catch-down in height SDS. The reduction in pubertal growth velocity by up to 25% coincided with a decrease in levels of IGF-1 (by 17%) and testosterone (by 62%) in boys and estradiol (by 37%) in girls. We confirmed these alterations in growth in the independent CrescNet cohort and furthermore provide height reference values for children with obesity for open access.

Interpretation: Dynamics of linear growth are altered distinctively in different developmental phases in children with obesity. Early emergence before other profound comorbidities implies predisposition, environmental, and/or endocrine factors affecting growth in early life. Height reference values for children with obesity may enhance the precision of clinical health surveillance.

Funding: German Research Foundation, German Diabetes Association, EU, ESF, ERDF, State of Saxony, ESPE, Hexal, Novo Nordisk, Pfizer Pharma.
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http://dx.doi.org/10.1016/j.eclinm.2021.100977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343253PMC
July 2021

Effect of physical activity and BMI SDS on bone metabolism in children and adolescents.

Bone 2021 Jul 24;153:116131. Epub 2021 Jul 24.

Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany. Electronic address:

Objective: Children with obesity are known to have reduced bone density and are at a higher risk for fractures. This may be caused by decreased physical activity or a metabolic phenomenon. In this study, we evaluated associations of physical activity with bone metabolism in children and adolescents with and without obesity.

Methods: Results from 574 visits of 397 subjects, 191 girls and 206 boys aged five to 18 years (mean: 11.7 ± 2.8) representing 180 children with (mean BMI SDS 2.5 ± 0.4) and 217 without obesity (mean BMI SDS 0.2 ± 1.0) from the LIFE Child study, a population-based cohort of children/adolescents with normal weight and with obesity were analyzed for the impact of their daily physical activity (MET/day, SenseWear Accelerometer) on serum SDS levels for bone formation (alkaline phosphatase, osteocalcin, procollagen type I N propeptide [P1NP]), bone resorption (beta-crosslaps), and calcium homeostasis (parathormone, OH-25-vitamin D) by a linear regression model adjusted for gender- and age-based differences.

Results: For male subjects, BMI SDS significantly influenced the association of physical activity to PTH, vitamin D, and beta-crosslaps SDS levels. A higher physical activity was accompanied by increased PTH but decreased vitamin D SDS levels in children with normal weight. In males with obesity, all levels remained unaltered. In females, BMI SDS significantly impacted the association of physical activity to PTH, vitamin D, P1NP, beta-crosslaps, and osteocalcin SDS levels. In females with obesity, higher physical activity was related to higher SDS levels of vitamin D, P1NP, and beta-crosslaps. In contrast, in normal weight females, only PTH SDS was higher.

Conclusions: The effect of daily physical activity on bone metabolic markers and calciotropic hormones depends significantly on gender and BMI SDS. However, higher levels of physical activity were associated with increased bone turnover for female subjects with obesity only. Thus, motivating especially girls with obesity to be physically active may help improve their bone health.
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http://dx.doi.org/10.1016/j.bone.2021.116131DOI Listing
July 2021

Associations of prenatal exposure to phthalates and one phthalate substitute with anthropometric measures in early life: Results from the German LIFE Child cohort study.

Best Pract Res Clin Endocrinol Metab 2021 May 20:101532. Epub 2021 May 20.

Leipzig Research Center for Civilization Diseases (LIFE), LIFE Child, Leipzig University, Faculty of Medicine, Philipp-Rosenthal-Straße 27, D-04103, Leipzig, Germany; Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig University, Liebigstraße 20a, D-04103, Leipzig, Germany.

Exposure to phthalates is widespread and especially early life stages represent a critical window of exposure. In the present study, we investigated the effect of prenatal exposure to phthalates on birth outcomes and weight development in early life. In 130 mother-child pairs, we estimated the association of concentrations of 13 phthalates in spot-urine samples collected during pregnancy and birth outcomes and weight gain in the first two years of life using robust linear regression. High molecular weight phthalates were inversely associated with birth weight in girls but not in boys. Thus, prenatal exposure to phthalates may affect birth weight in a sex-specific manner.
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http://dx.doi.org/10.1016/j.beem.2021.101532DOI Listing
May 2021

Composition and Culture of Eating (CoCu) pregnancy: a new short questionnaire to evaluate diet composition and culture of eating during pregnancy.

Public Health Nutr 2021 Jun 28:1-9. Epub 2021 Jun 28.

Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103Leipzig, Germany.

Objective: The project aimed to validate a short questionnaire (CoCu pregnancy - Composition and Culture of Eating during pregnancy) and to investigate associations with age and socio-economic status (SES).

Design: The questionnaire was developed according to the validated CoCu for children and adolescents containing a diet composition (fourteen items) and a culture of eating part (six items). A Nutritional Health Score (NHS) was calculated based on diet composition (-120 and +120, with higher scores indicating healthier diets). The validity was assessed by comparing answers in CoCu pregnancy with a FFQ. In a subsample (n 97), we assessed the percentage of having chosen the same (or adjacent) response categories in the 24th and 36th week of pregnancy (wp).

Setting: Data were collected within the LIFE Child study in Leipzig, Germany.

Participants: We evaluated 430 questionnaires of pregnant women (24th wp).

Results: The results indicated a healthy diet in the present sample (NHS at 24th wp = 49·74 (95 % CI 47·27, 52·22)). The analyses revealed significant positive correlations between CoCu and FFQ (rho ranging from 0·32 to 0·61). For each food item, >90 % of women had chosen the same (50-60 %) or adjacent response categories in the 24th and 36th wp. The analysis revealed associations of the NHS with age (β = 0·11, P = 0·027), SES (β = 0·21, P < 0·001), snacking (β = -0·24, P < 0·001) and media use (β = -0·18, P < 0·001).

Conclusions: The questionnaire represents a useful tool for surveying the diets during pregnancy for research and clinical practice.
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http://dx.doi.org/10.1017/S1368980021002445DOI Listing
June 2021

Survival Benefits Following Liver Transplantation: A Matched-pair Analysis in Pediatric Patients With Cystic Fibrosis.

J Pediatr Gastroenterol Nutr 2021 Sep;73(3):385-390

Pediatric Gastrolenterology and Hepatology, Hannover Medical School, Hannover.

Objectives: Cystic fibrosis-related liver disease (CFLD) with consecutive cirrhosis is the third most common cause of death in CF patients. The aim of this study was to identify the potential long-term benefits of liver transplantation (LTx) in a match-control comparison.

Methods: Retrospective single-center data analysis of all pediatric LTx for CFLD between 1998 and 2014. A control group was selected from the local CF patient registry. Data were collected from case report forms and included clinical and laboratory data, lung function tests, the indication for LTx, and details of surgical procedures.

Results: At our institution, 23 patients with severe CFLD median age 13.8 years (range 8.7-17.4; 16 boys) underwent LTx between 1998 and 2014. In all patients, normalization of hepatic CF manifestations were achieved after LTx. But obviously there was no significant positive influence on nutritional status. Signs of posttransplant liver steatosis were documented by ultrasound in 17 patients. Liver biopsies after LTx were performed in 19 patients, in 42% (n = 8) of these biopsies a fatty degeneration was observed. Five patients died after LTx, none because of primary hepatic dysfunction (1 because of posttransplant proliferative disorder, 4 because of infection). Analysis of matched control pairs revealed that liver function, anthropometry, pulmonary function, and life expectancy of CFLD patients with LTx are comparable with matched CF peers without CFLD.

Conclusions: Isolated LTx normalizes the hepatic manifestation of CF disease. LTx enables children and adolescents with severe CFLD to have a comparable prognosis in terms of growth, life expectancy, and lung function as CF patients without advanced liver involvement. Our data clarifies the long-term perspectives of affected patients.
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http://dx.doi.org/10.1097/MPG.0000000000003194DOI Listing
September 2021

The trans-ancestral genomic architecture of glycemic traits.

Nat Genet 2021 06 31;53(6):840-860. Epub 2021 May 31.

Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

Glycemic traits are used to diagnose and monitor type 2 diabetes and cardiometabolic health. To date, most genetic studies of glycemic traits have focused on individuals of European ancestry. Here we aggregated genome-wide association studies comprising up to 281,416 individuals without diabetes (30% non-European ancestry) for whom fasting glucose, 2-h glucose after an oral glucose challenge, glycated hemoglobin and fasting insulin data were available. Trans-ancestry and single-ancestry meta-analyses identified 242 loci (99 novel; P < 5 × 10), 80% of which had no significant evidence of between-ancestry heterogeneity. Analyses restricted to individuals of European ancestry with equivalent sample size would have led to 24 fewer new loci. Compared with single-ancestry analyses, equivalent-sized trans-ancestry fine-mapping reduced the number of estimated variants in 99% credible sets by a median of 37.5%. Genomic-feature, gene-expression and gene-set analyses revealed distinct biological signatures for each trait, highlighting different underlying biological pathways. Our results increase our understanding of diabetes pathophysiology by using trans-ancestry studies for improved power and resolution.
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http://dx.doi.org/10.1038/s41588-021-00852-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610958PMC
June 2021

Motor skills in relation to body-mass index, physical activity, TV-watching, and socioeconomic status in German four-to-17-year-old children.

PLoS One 2021 17;16(5):e0251738. Epub 2021 May 17.

Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Leipzig, Saxony, Germany.

Background: The present study describes motor skills in a large sample of German children and adolescents and investigates associations with age, gender, body-mass index, physical activity, television time, and socioeconomic status.

Methods: 2,106 children (1076 boys, 1030 girls) aged 4 to 17 years performed five different motor tests for strength (pushups, standing long jump), coordination (backward balancing, jumping side-to-side) and flexibility (forward bend) within the framework of the LIFE Child study (Leipzig, Germany). Anthropometric parameters were assessed through standardized measurement. Data on physical activity, television time, and socioeconomic status were collected via questionnaires. Linear regression analyses were applied to assess relations.

Results: Strength and coordination performance were higher in older than in younger children. While boys showed a higher performance in strengths tests than girls, girls performed better in flexibility and coordination during precision tasks (backward balancing). In terms of coordination under time constraint (jumping side-to-side), both genders produced similar results. Lower body-mass index, higher physical activity, and higher socioeconomic status were significantly related to better motor skills. Longer television times were significantly associated with lower performance in long jump.

Conclusions: The present findings are similar to data collected at the beginning of the century, indicating that motor skills have hardly changed in recent years. The findings furthermore suggest that children from lower social strata, children with higher body weight, and children who move little have a higher risk of developing insufficient motor skills and should therefore be given special support.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251738PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128247PMC
May 2021

And yet Again: Having Breakfast Is Positively Associated with Lower BMI and Healthier General Eating Behavior in Schoolchildren.

Nutrients 2021 Apr 18;13(4). Epub 2021 Apr 18.

LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, Ph-Rosenthal-Str. 27, 04103 Leipzig, Germany.

Given the high prevalence of childhood overweight, school-based programs aiming at nutritional behavior may be a good starting point for community-based interventions. Therefore, we investigated associations between school-related meal patterns and weight status in 1215 schoolchildren. Anthropometry was performed on-site in schools. Children reported their meal habits, and parents provided family-related information via questionnaires. Associations between nutritional behavior and weight status were estimated using hierarchical linear and logistic regression. Analyses were adjusted for age, socio-economic status, school type, migration background, and parental weight status. Having breakfast was associated with a lower BMI-SDS ( = -0.51, = 0.004) and a lower risk of being overweight (ORj = 0.30, = 0.009), while having two breakfasts resulting in stronger associations (BMI-SDS: = -0.66, < 0.001; risk of overweight: OR = 0.22, = 0.001). Likewise, children who regularly skipped breakfast on school days showed stronger associations (BMI-SDS: = 0.49, < 0.001; risk of overweight: OR = 3.29, < 0.001) than children who skipped breakfast only occasionally (BMI-SDS: = 0.43, < 0.001; risk of overweight: OR = 2.72, = 0.032). The associations persisted after controlling for parental SES and weight status. Therefore, our data confirm the school setting as a suitable starting point for community-based interventions and may underline the necessity of national programs providing free breakfast and lunch to children.
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http://dx.doi.org/10.3390/nu13041351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072724PMC
April 2021

Pediatric Reference Intervals for Thyrotropin, Free Triiodothyronine, and Free Thyroxine and the Relevance of Body Mass Index and Puberty in Measurement Interpretation.

Thyroid 2021 08 21;31(8):1192-1202. Epub 2021 Jun 21.

Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM) Leipzig University, Leipzig, Germany.

The present study aimed to establish age- and sex-specific reference intervals for serum concentrations of thyrotropin (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) in healthy children and adolescents. Additionally, we investigated the association of TSH, fT3, and fT4 with putative influencing factors, such as sex, body mass index (BMI), and puberty. A total of 9404 blood serum samples from 3140 children and adolescents without thyroid affecting diseases were included in determining TSH, fT3, and fT4 levels and age- and sex-specific reference ranges. To investigate the association of TSH, fT3, and fT4 with age, sex, weight status, and the role of puberty-based changes, the hormone levels and BMI values were converted to standard deviation scores (SDS). In general, TSH, fT3, and fT4 were found to be age- and sex-dependent. Puberty was accompanied by decreased TSH, decreased fT3 with a temporary peak in males, and a temporary nadir of fT4 in Tanner stage 3 for both sexes. BMI-SDS was positively associated with TSH-SDS ( = 0.081,  < 0.001); the effect was more pronounced in overweight subjects ( = 0.142,  < 0.01) and insignificantly negative in underweight subjects ( = -0.047,  > 0.05). BMI-SDS was positively associated with fT3-SDS ( = 0.066,  < 0.001) and negatively associated with fT4-SDS ( = -0.135,  < 0.001), with the effect insignificantly less negative in overweight children ( = -0.055,  > 0.05). Age- and sex-specific reference intervals are important for the interpretation of measurements of TSH, fT3, and fT4 in children and adolescents. Influencing factors such as BMI and puberty should be taken into consideration when using measurements of TSH and thyroid hormones in the diagnosis, treatment, and monitoring of thyroid diseases. Clinical Trial Registration number: NCT02550236.
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http://dx.doi.org/10.1089/thy.2020.0780DOI Listing
August 2021

Covid19 pandemic and pediatric endocrinology and metabolism-Are we through with it?

J Pediatr Endocrinol Metab 2021 04 28;34(5):535-537. Epub 2021 Apr 28.

Department of Women & Child Health, Center of Paediatric Research, Hospital for Children and Adolescents, Leipzig University, Leipzig, Germany.

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http://dx.doi.org/10.1515/jpem-2021-2133DOI Listing
April 2021

Atopic diseases in children and adolescents are associated with behavioural difficulties.

BMC Pediatr 2021 04 23;21(1):197. Epub 2021 Apr 23.

Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany.

Background: Atopic diseases and behavioural difficulties in children have both been on the rise in recent decades. This study seeks to assess associations between atopic diseases and behavioural difficulties, examining the differences considering child age and how behavioural difficulties were reported (via self-report or parent-report).

Methods: Data on behavioural difficulties, assessed through the Strengths and Difficulties Questionnaire (SDQ), and on atopic diseases, assessed through the participant's medical history, were available for 2701 study participants aged 3 to 18 years. Associations between atopic diseases and behavioural difficulties were evaluated using linear regression analyses. We split the study sample into two groups. I: 3-to 10-year-olds/parent-reported SDQ (n = 1764), II: 11- to 18-year-olds/parent-reported SDQ (n = 937) and self-reported SDQ (n = 915). All analyses were adjusted for age, gender, and socioeconomic status.

Results: In younger children, atopic dermatitis was strongly associated with higher total difficulties scores, more emotional problems and conduct problems, and more symptoms of hyperactivity/inattention. Parents reported higher total difficulties scores, more emotional problems, and more peer-relationship problems for adolescents with bronchial asthma and other allergies, whereas the adolescents themselves reported more peer relationship problems.

Conclusion: In younger children, atopic dermatitis is associated with internalizing and externalizing problems. In adolescents, bronchial asthma and other allergies are associated with a greater level of internalizing problems only. The findings further suggest that parents of adolescents are more likely to perceive associations between atopic diseases and behavioural difficulties than the adolescents themselves.
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http://dx.doi.org/10.1186/s12887-021-02663-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063387PMC
April 2021

COVID-19 pandemic and families' utilization of well-child clinics and pediatric practices attendance in Germany.

BMC Res Notes 2021 Apr 16;14(1):140. Epub 2021 Apr 16.

Leipzig University Hospital for Children and Adolescents, LIFE Child, Leipzig University, Ph.-Rosenthal-Str. 27, 04103, Leipzig, Germany.

Objective: The COVID-19 pandemic and the measures implemented to stop the pandemic had a broad impact on our daily lives. Besides work and social life, health care is affected on many levels. In particular, there is concern that attendance in health care programs will drop or hospital admissions will be delayed due to COVID-19-related anxieties, especially in children. Therefore, we compared the number of weekly visits to 78 German pediatric institutions between 2019 and 2020.

Results: We found no significant differences during the first 10 weeks of the year. However, and importantly, from April, the weekly number of visits was more than 35% lower in 2020 than in 2019 (p = 0.005). In conclusion, the COVID-19 pandemic seems to relate to families´ utilization of outpatient well-child clinics and pediatric practice attendance in Germany.
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http://dx.doi.org/10.1186/s13104-021-05562-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050987PMC
April 2021

Audit of sweat chloride testing reveals analytical errors.

Clin Chem Lab Med 2021 Jul 8;59(8):1376-1383. Epub 2021 Apr 8.

Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany.

Objectives: Sweat chloride testing (SCT) is the mainstay for the diagnosis of cystic fibrosis (CF) and biomarker in the evaluation of CFTR-modifying drugs. To be a reliable and valid tool, analytical variance (CVA) must be minimized. However, external quality assessments have revealed significant deviations in routine clinical practice. Our goal was to identify and quantify technical errors through proficiency testing and simulations.

Methods: Chloride concentrations of three blinded samples (each as triplicates) were measured in 9 CF centers using a chloridometer in a routine setting. Technical errors were simulated and quantified in a series of measurements. We compared imprecision and bias before and after a counseling session by evaluating coefficients of variation (CV), adherence to tolerance limits, and inter-rater variability coefficients.

Results: Pipetting errors resulting in changes in sample volume were identified as the main source of error with deviations up to 41%. After the counseling session, the overall CVA decreased from 7.6 to 5.2%, the pass rate increased from 67 to 92%, and the inter-rater variability diminished. Significant deviations continued to be observed in individual centers.

Conclusions: Prevention of technical errors in SCT decreases imprecision and bias. Quality assurance programs must be established in all CF centers, including staff training, standard operating procedures, and proficiency testing.
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http://dx.doi.org/10.1515/cclm-2020-1661DOI Listing
July 2021

Persistent organic pollutants in pregnant women potentially affect child development and thyroid hormone status.

Pediatr Res 2021 Apr 6. Epub 2021 Apr 6.

Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Germany.

Background: Potentially harmful effects of persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs) and dichlorodiphenyltrichloroethane (DDT) on prenatal development and the endocrine system have been controversially discussed.

Methods: Working with a German cohort of 324 pregnant women, we assessed POP levels and used robust linear regression models to determine potential associations between maternal POP concentrations and pre- and postnatal development in the children, as well as the thyroid hormone status of the mother and child.

Results: Maternal p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) and most measured PCBs positively correlated with postnatal weight gain. We detected no correlation between newborn birth weight and head circumference, respectively, and maternal PCB and p,p'-DDE serum levels, while body length at birth was negatively associated with the maternal serum concentration of PCB 183. Maternal p,p'-DDE and nearly all PCB serum levels showed a negative correlation with maternal free triiodothyronine (FT3). p,p'-DDE and PCB 74 and 118 were negatively associated with maternal thyroid-stimulating hormone levels. In addition, we identified significant associations between maternal POP levels and thyroid hormone parameters of the child.

Conclusions: These results indicate that POP exposure likely affects different aspects of pre- and postnatal development and impacts the thyroid hormone status of both mother and child.

Impact: Pregnant women in a German cohort display a substantial accumulation of POPs. Body mass index and age influence maternal serum POP levels. Maternal POP levels show correlations with the child's length at birth and weight gain, and FT3 levels in the mother and child. Our data provide additional evidence for the potentially harmful influence of POPs. Our data indicate that POPs influence pre- and postnatal development.
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http://dx.doi.org/10.1038/s41390-021-01488-5DOI Listing
April 2021

Longitudinal analysis of axial length growth in a German cohort of healthy children and adolescents.

Ophthalmic Physiol Opt 2021 05 1;41(3):532-540. Epub 2021 Apr 1.

Leipzig Research Center for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany.

Purpose: To generate continuous growth curves for axial length (AL) in German children. We hypothesise that percentile curves of AL can be used as a predictive measure of myopia.

Methods: In this longitudinal and cross-sectional LIFE Child Study, children's non-cycloplegic refraction data was collected using the Zeiss i.Profiler plus while AL was measured using the Haag-Streit Lenstar. Reference growth curves were estimated as a continuous non-parametric function of age.

Results: Data from 4511 visits of 1965 participants (1021 boys and 944 girls) between 3 and 18 years of age were analysed. For all ages and percentiles, the estimated AL was higher in boys than girls. AL differences between boys and girls were most pronounced in the 98 percentile at 3 years of age, being 0.93 mm longer eyes in boys. This difference decreased to 0.21 mm at 18 years of age. While the lower percentiles of AL reach their final value around age 13, the 50 percentile was still increasing by 0.05 mm per year until the end of the observation period. While, in general, children with longer eyes are more likely to develop myopia, this relationship is weaker between the ages of 5 and 8.

Conclusion: The LIFE Child Study data provides European AL data. In both Germany and China, AL has comparable growth rates when the baseline ALs are compared as percentiles. Thus, percentile curves of AL can be used as a predictive measure for the likelihood of developing as well as the progression of myopia.
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http://dx.doi.org/10.1111/opo.12817DOI Listing
May 2021

Endocrine-disrupting chemicals and child health.

Best Pract Res Clin Endocrinol Metab 2021 Mar 10:101516. Epub 2021 Mar 10.

Hospital for Children and Adolescents, Center for Pediatric Research, University of Leipzig, Leipzig, Germany. Electronic address:

Endocrine-disrupting chemicals (EDCs) are chemicals which are introduced into the environment by human activities. In many cases it has been proven that EDCs can cause adverse health effects in the human. EDCs are classified by their chemical structure, putative direct or indirect effects on endocrine glands and systems, may accumulate and persist in organisms and in the environment, and/or they may exert clinically observable and measurable effects. Often, EDCs may act in concert and as mixtures. Legislation to ban EDCs and protect especially pregnant women and children at young age are needed and needs to be revised and adjusted to new developments on a regular basis. Putative associations, in spite of sometimes conflicting results, have to be analyzed in in vitro model systems be it in cell biology, in vitro settings or animal studies in more detail. This chapter depicts the mainly positive albeit detrimental epidemiological findings for EDC-caused effects in the fields of growth and metabolism, neurocognitive development and sexual development and reproduction.
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http://dx.doi.org/10.1016/j.beem.2021.101516DOI Listing
March 2021

Socioeconomic Status Is Related to Pubertal Development in a German Cohort.

Horm Res Paediatr 2020 17;93(9-10):548-557. Epub 2021 Mar 17.

LIFE - Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany,

Introduction: Current health literature suggests that there has been a decline in the age of pubertal onset and that pubertal onset/duration of puberty may, besides weight status, be influenced by socioeconomic context.

Objective: The goal of this study was to determine whether pubertal onset/duration and puberty-triggering hormones luteinizing hormone (LH) and follicle-stimulating hormone (FSH) vary according to socioeconomic status (SES). Moreover, we aimed to propose cutoff values of serum LH and FSH for predicting gonadarche in boys.

Methods: 2,657 apparently healthy children and adolescents between 5.5 and 18 years from the area of Leipzig were recruited from the LIFE Child study. Age at pubertal onset/end of puberty was given in 738/573 children, respectively. Anthropometric parameters of puberty, blood measurements of LH and FSH, and questionnaires assessing SES were evaluated.

Results: Lower SES was associated with earlier thelarche and longer duration of puberty in overweight/obese girls, whereas age of menarche was not affected. In boys with low SES, a trend versus earlier puberty onset can be seen. Lower SES was significantly associated with boys' age at mutation. No significant differences in boys' and girls' serum levels of LH and FSH during puberty according to SES were observed. Serum LH levels of 0.56 IU/L and serum FSH levels of 1.74 IU/L showed the best prediction of gonadarche in boys.

Conclusion: Puberty onset/duration and boys' age at mutation is affected by SES. The proposed cutoff levels for serum LH and FSH could provide a serological tool to determine gonadarche in boys.
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http://dx.doi.org/10.1159/000513787DOI Listing
March 2021

Loss of childcare and classroom teaching during the Covid-19-related lockdown in spring 2020: A longitudinal study on consequences on leisure behavior and schoolwork at home.

PLoS One 2021 2;16(3):e0247949. Epub 2021 Mar 2.

LIFE Child, LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Sachsen, Germany.

Aim: In spring 2020, the first Covid-19-related lockdown included the closing of kindergartens and schools. Home schooling, the lack of social contacts with peers and the care of the children at home posed an enormous challenge for many families.

Methods: The present study investigated the leisure behavior of 285 one- to 10-year-old German children at two time points (t1 and t2) during the Covid-19-related lockdown in spring 2020. In the subsample of primary school children (n = 102), we also explored children's attitudes towards schoolwork at home. Analyses focused on the change of behavior from t1 to t2, on differences in these changes depending on socio-economic status (SES), and on associations of behavior with SES, the number of children at home, and the frequency of receiving learning materials from school.

Results: While the frequency of playing outside increased significantly from t1 to t2, the frequency of handicrafts, playing board games, indoor sports, and motivation to do schoolwork decreased. The observed changes between t1 and t2 did not differ depending on SES. However, a lower SES was associated with higher media use, less outdoor activity, and (though only marginally significant) a reduced time doing schoolwork and a reduced ability to concentrate on schoolwork at t1. In households with more children, children played outside more often, but were read to less frequently and (though only marginally significant) watched movies and series less frequently. Children receiving learning materials from school on a regular basis spent significantly more time doing schoolwork at home than children receiving materials only irregularly.

Conclusions: A continuing loss of childcare in day-care facilities and schools entails the danger of declining education in the form of (inter)active indoor activities and schoolwork.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247949PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924794PMC
March 2021

Prenatal exposure to phthalate esters and its impact on child development.

Best Pract Res Clin Endocrinol Metab 2020 Dec 17:101478. Epub 2020 Dec 17.

Leipzig Research Center for Civilization Diseases (LIFE), LIFE Child, University of Leipzig, Faculty of Medicine, Philipp-Rosenthal-Straße 27, D-04103, Leipzig, Germany; Hospital for Children and Adolescents, Center for Paediatric Research, Liebigstraße 20a, D-04103, Leipzig, Germany. Electronic address:

Endocrine disruptive chemicals (EDCs) cause adverse health effects through interaction with endocrine systems. They are classified by chemical structure, effects on specific endocrine systems, their bioaccumulation and/or persistence in the environment, and/or clinically observable effects. In industrial nations, people are exposed to complex mixtures of many different substances all of which may have multiple and deleterious effects upon the individual. The clinical importance of epigenetic changes caused by the action of EDCs during vulnerable phases of development is currently unclear but of particular relevance. Epidemiological studies are criticized because reproducibility is not always guaranteed. Nevertheless, they remain the method of choice for the development and analysis of suitable model systems. Positive associations, despite of sometimes conflicting results, are the key in the selection of factors that can then be analyzed in model systems in an unbiased way. This article reports EDC-caused effects in the fields of growth and metabolism, neurocognitive development and sexual development and reproduction focusing mainly on phthalates and their metabolites. However, research will have to focus on the interactions of different EDCs and their consequences of prenatal and early life exposure.
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http://dx.doi.org/10.1016/j.beem.2020.101478DOI Listing
December 2020

Folate and Cobalamin Serum Levels in Healthy Children and Adolescents and Their Association with Age, Sex, BMI and Socioeconomic Status.

Nutrients 2021 Feb 7;13(2). Epub 2021 Feb 7.

LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103 Leipzig, Germany.

This study proposes age- and sex-specific percentiles for serum cobalamin and folate, and analyzes the effects of sex, age, body mass index (BMI), and socioeconomic status (SES) on cobalamin and folate concentrations in healthy children and adolescents. In total, 4478 serum samples provided by healthy participants (2 months-18.0 years) in the LIFE (Leipzig Research Centre for Civilization Diseases) Child population-based cohort study between 2011 and 2015 were analyzed by electrochemiluminescence immunoassay (ECLIA). Continuous age-and sex-related percentiles (2.5th, 10th, 50th, 90th, 97.5th) were estimated, applying Cole's LMS method. In both sexes, folate concentrations decreased continuously with age, whereas cobalamin concentration peaked between three and seven years of age and declined thereafter. Female sex was associated with higher concentrations of both vitamins in 13- to 18-year-olds and with higher folate levels in one- to five-year-olds. BMI was inversely correlated with concentrations of both vitamins, whilst SES positively affected folate but not cobalamin concentrations. To conclude, in the assessment of cobalamin and folate status, the age- and sex-dependent dynamic of the respective serum concentrations must be considered. While BMI is a determinant of both vitamin concentrations, SES is only associated with folate concentrations.
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http://dx.doi.org/10.3390/nu13020546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915137PMC
February 2021

Establishing Normative Data on Singing Voice Parameters of Children and Adolescents with Average Singing Activity Using the Voice Range Profile.

Folia Phoniatr Logop 2021 Feb 1:1-12. Epub 2021 Feb 1.

Section of Phoniatrics and Audiology, Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany.

Purpose: The purpose of this study was to establish and characterize age- and gender-specific normative data of the singing voice using the voice range profile for clinical diagnostics. Furthermore, associations between the singing voice and the socioeconomic status were examined.

Methods: Singing voice profiles of 1,578 mostly untrained children aged between 7.0 and 16.11 years were analyzed. Participants had to reproduce sung tones at defined pitches, resulting in maximum and minimum fundamental frequency and sound pressure level (SPL). In addition, maximum phonation time (MPT) was measured. Percentile curves of frequency, SPL and MPT were estimated. To examine the associations of socioeconomic status, multivariate analyses adjusted for age and sex were performed.

Results: In boys, the mean of the highest frequency was 750.9 Hz and lowered to 397.1 Hz with increasing age. Similarly, the minimum frequency was 194.4 Hz and lowered to 91.9 Hz. In girls, the mean maximum frequency decreased from 754.9 to 725.3 Hz. The mean minimum frequency lowered from 202.4 to 175.0 Hz. For both sexes, the mean frequency range ∆f showed a constant range of roughly 24 semitones. The MPT increased with age, for boys and girls. There was neither an effect of age nor sex on SPLmin or SPLmax, ranging between 52.6 and 54.1 dBA and between 86.5 and 82.8 dBA, respectively. Socioeconomic status was not associated with the above-mentioned variables.

Conclusion: To our knowledge, this study is the first to present large normative data on the singing voice in childhood and adolescence based on a high number of measurements. In addition, we provide percentile curves for practical application in clinic and vocal pedagogy which may be applied to distinguish between normal and pathological singing voice.
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http://dx.doi.org/10.1159/000513521DOI Listing
February 2021

[Detection of relevant changes in the speaking voice of women measured by the speaking voice profile].

Laryngorhinootologie 2020 Dec 16. Epub 2020 Dec 16.

Medizinische Fakultät, LIFE Forschungszentrum, Universität Leipzig.

Background:  A healthy voice serves us as a basis for communication and an indispensable tool in a modern society with a growing number of vocal-intensive professions. There are indications that the average frequency of the speaking voice of women has decreased in recent years and is approaching that of men in the sense of sociophony. An epidemiological prospective cohort study will investigate the influences of age, personality traits and socio-demographic factors on the speaking voice of women.

Material And Methods:  Within the framework of a standardized examination procedure, the speaking voice of 2478 voice-healthy female participants between 5 and83 years of age was registered in 4 different intensity levels (softest voice, conversational voice, classroom voice and shouting voice). Subsequently, the collected values for frequency and loudness of the different intensity levels were examined for correlation with age and results from questionnaires on personality (FFFK and BFI-10), on (mental) health (Patient-Health-Questionnaire - PHQ) and on socio-economic status (SES).

Results:  Significant age-related influences on the speaking voice could be demonstrated for all voice intensities. For the personality traits investigated, significant positive correlations between the volume of the calling and speaking voice and extraversion were found. For the frequency of the softest voice and speaking voice, significant correlations were found for the personality traits of extraversion and tolerance. While no significant associations were found between the voice parameters of the speaking voice and the PHQ, it was found that the SES has a significant influence on both frequency and intensity.

Conclusion:  In addition to age-related changes, relevant influences of personality traits and the SES on speaking voice parameters in women were confirmed, which should be considered in clinical care of dysphonia.
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http://dx.doi.org/10.1055/a-1327-4275DOI Listing
December 2020

Age-Related Association of Calcitonin with Parameters of Anthropometry, Bone and Calcium Metabolism during Childhood.

Horm Res Paediatr 2020 11;93(6):361-370. Epub 2020 Dec 11.

Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University Hospital Leipzig, Leipzig, Germany,

Introduction: The thyroid parafollicular hormone calcitonin (CT) shows particularly high blood levels in early childhood, a period of high bone turnover, which decrease with increasing age. Data about the physiological role of CT during infancy, childhood, and adolescence are contradictory or lacking.

Objective: We hypothesize that CT demonstrates age-related correlations with parameters of bone growth and turnover as well as with parameters of calcium homeostasis.

Methods: 5,410 measurements of anthropometric data and venous blood samples were collected from 2,636 participants of the LIFE Child study, aged 2 months-18 years. Univariate correlations and multiple regression analysis were performed between serum CT and anthropometric indicators (height standard deviation scores [SDS] and BMI-SDS), markers of calcium (Ca) homeostasis (Ca, parathyroid hormone, 25-OH vitamin D, and phosphate [P]), bone formation (procollagen type 1 N-terminal propeptide [P1NP], osteocalcin), and bone resorption (β-CrossLaps).

Results: CT was significantly associated with Ca (β = 0.26, p < 0.05) and P1NP/100 (β = 0.005, p < 0.05) in children aged 2 months-1.1 years. These relations were independent of age and sex and could not be confirmed in children aged 1.1-8 years. Independent of age, sex, puberty, P, and height SDS CT showed a significant positive relation to Ca (β = 0.26; p < 0.001) in children aged 8-18 years.

Conclusions: Our findings suggest a unique association between CT and Ca in periods of rapid bone growth and point to a possible involvement of CT in promoting bone formation during the first year of life.
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http://dx.doi.org/10.1159/000512107DOI Listing
December 2020

[The LIFE Child study: A cohort study investigating child development in changing environmental conditions].

Z Psychosom Med Psychother 2020 Dec;66(4):390-401

LIFE - Leipziger Forschungszentrum für Zivilisationserkrankungen Universität Leipzig Deutschland https://www.life.uni-leipzig.de/.

The LIFE Child study investigates healthy child development from pregnancy to young adulthood and the development of lifestyle diseases. Since study initiation in 2011, 1068 pregnant women and 4658 children have been included in the study. Children are recruited until the age of 16 years. Follow-up visits take place once per year. Assessments include physical examinations, interviews, questionnaires, standardized tests, and biological samples including genetic analysis. We found significant associations between socio-economic status and health behaviour, between the weight of mothers and their children and between excessive media use and psychological complaints. Further projects dealt with the creation of references curves and the evaluation of new research methods. The study provides important insights into the interplay between the living environment, behaviour and child health.
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http://dx.doi.org/10.13109/zptm.2020.66.4.390DOI Listing
December 2020

Seasonal variation of blood pressure in children.

Pediatr Nephrol 2021 Aug 19;36(8):2257-2263. Epub 2020 Nov 19.

Hospital for Children and Adolescents, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany.

Seasonal blood pressure (BP) variation is mostly found between the summer and winter months. Guidelines for diagnosis and treatment of hypertension in children have not considered this variation until recently. This review aims to present an overview of seasonal BP variation in childhood along with potential underlying pathophysiological mechanisms and long-term implications as well as conclusions for future studies. In pediatric cohorts, seven studies investigated seasonal changes in BP. These changes amount to 3.4-5.9 mmHg (or 0.5-1.5 mmHg per - 1 °C difference in environmental temperature) in systolic BP with a peak in fall or winter. Potential mechanisms and mediators of seasonal BP variation include sympathetic activation of the nervous system with an increase of urinary and plasma norepinephrine levels in the winter season. Additionally, the physical activity among children and adolescents was inversely correlated with BP levels. Temperature sensitivity of BP and pediatric BP levels predict future systolic BP and target-organ damage. Therefore, cardiovascular events may even be long-term complications of seasonal BP variation in pediatric hypertensive patients. Overall, these data strongly suggest an important effect of ambient temperature on BP in children. Additional studies in pediatric cohorts are needed to define how best to incorporate such variation into clinical practice.
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http://dx.doi.org/10.1007/s00467-020-04823-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260525PMC
August 2021
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