Association and potential mediators between socioeconomic status and childhood obesity in China:findings from a national cohort study

Objective:Socioeconomic status(SES)is associated with childhood obesity,but the underlying factors remain unknown.This study aimed to identify mediators that may explain SES disparities in childhood obesity in China.Methods:Nationally representative longitudinal data from the China Education Panel Survey of 11 o019 children(13.03±0.79)collected from 2013-2014 to 2016-2017 academic years.Overweight/obesity was defined using Chinese national body mass index cut-points.Principal component analysis was used to convert the four SES indicators(maternal and paternal education,and occupation)into one comprehensive variable.Mediation analysis for SES disparities in childhood obesity was conducted using structure equation models.Results:The prevalence of overweight/obesity was 12.8%,and was higher in boys than in girls(17.8%vs.7.6%,P<0.001)at baseline.Among boys,relative risk(RR)of obesity was 1.23(95%CI:1.09 to 1.40,P<O.001)for per unit change in SES.There was no significant association between obesity and SES among girls.Mediation analyses showed that among boys,birth weight,being the only child in the family and children's selfperceived weight status mediated 70.0%of the effects of SES on obesity.No mediation effect was detected in girls.Conclusions:Chinese boys are more likely to be overweight or obese than girls.SES may impact childhood obesity through birth weight,being the only child in the family and children's self-perceived body weight status in boys,but not in girls.More attention should be made to address childhood obesity in high SES families among boys.Interventions targeting at these mediators are needed.

Noncommunicable chronic disease prevention should start from childhood

Noncommunicable chronic diseases(NCDs),such as cardiovascular disease(CVD),diabetes,cancers,and osteoporosis,are the leading causes of death and health costs.According to the 2020 Report on Chinese Resident’s Chronic Disease and Nutrition,NCDs account for 88.5%of China’s disease burden in 2019,more than all other causes combined.

一个Liddle综合征新SCNN1B基因移码突变的鉴定

Liddle综合征是一种由编码肾小管上皮细胞钠离子通道(ENa Cs)的SCNN1A、SCNN1B及SCNN1G基因突变引起的罕见单基因遗传性高血压,基于基因检测技术进行确诊并及时给予对应治疗可显著改善患者预后.由于发病率低,相关突变位点报道少,目前Liddle综合征突变位点谱仍不完善.本研究通过对野生型及突变型ENa Cs重组非洲爪蟾卵母细胞进行膜片钳检测,首次确定了SCNN1B基因中一个移码突变c.1691_1693delins G对Liddle综合征的致病性.进一步研究结果表明,突变型非洲爪蟾卵母细胞ENa Cs电流显著增加,这与已知的Liddle综合征发病机制一致.此外,本研究通过对该家系中接受阿米洛利/氢氯噻嗪复方制剂治疗的7名患者进行为期12个月的观察研究,发现所有患者血压控制理想,血清钾离子、血浆肾素及醛固酮水平正常,无心血管事件及严重药物不良反应发生.本研究有助于扩大Liddle综合征的基因诊断谱,并为该病的治疗方案提供参考.

单基因遗传性高血压:一类可“治愈”的高血压

Hypertension is a global problem that affects more than 1 billion people worldwide with the increased prevalence year by year[1,2].It contributes to major impacts on health including morbidity and all-cause mortality,as well as consumption of substantial health care expenses.Understanding the complex pathophysiology and risk factors involved in the development of elevated blood pressure can help treat the disease to better prevent life-threatening conditions and alleviate the socio-economic burden.The hereditary nature of hypertension relies on that up to 30%of blood pressure variation is due to genetics and an individual’s genetic predisposition to hypertensive disease ranges from 15%to 35%[3].

Characteristics of pediatric inpatients with primary and secondary hypertension

Importance:Extensive population-based studies have explored the prevalence of primary hypertension(HTN)in children and adolescents.However,there is little published data on the characteristics of different types of pediatric HTN and the causes of secondary HTN.Objective:To investigate the characteristics of different types of pediatric HTN and the causes of secondary HTN in a hospital setting.Methods:The study cohort comprised pediatric inpatients(<18 years of age)discharged with a diagnosis of HTN from Beijing Children's Hospital during 2015-2020.Pediatric patients with HTN were allocated to secondary and primary HTN groups on the basis of comprehensive analyses of their diagnoses,family history of HTN,and findings on physical examination,as documented in their medical records.The Mann-Whitney U test,χ^(2) and Fisher's exact test were used to assess differences in characteristics of patients with different HTN types and causes of secondary HTN.Results:Data of 1470 inpatients with HTN from 18 clinical departments were included in the analysis.Among them,458(31.2%)had primary HTN,and 1012(68.8%)had secondary HTN.Compared with patients had primary HTN,children with secondary HTN were younger and had lower body mass indexes and longer lengths of stay.Moreover,children with primary HTN had mostly been managed by the Endocrinology and Cardiology Departments,75.8%of them having obesity-related comorbidities.In contrast,most patients with secondary HTN had been managed by the Nephrology Department,renal diseases being the leading cause of their HTN(46.3%).Interpretation:Secondary HTN is more common than primary HTN in pediatric clinical settings,renal diseases being the leading cause of secondary HTN.

Childhood adiposity, adult adiposity, and bone health

Importance:Childhood and adolescence are critical periods for lifelong bone mineral accrual,but few studies have determined the impact of childhood adiposity on adult bone density.Objective:To determine the long-term impact of childhood adiposity on adult areal bone mineral density(aBMD)and the effect of adult adiposity on this relationship.Methods:We conducted a longitudinal study of 1156 adults(56.3%men),for whom skinfold thickness(SFT)had been measured during childhood(6-18 years)and fat mass percentage(FMP)and aBMD were measured during adulthood(29-43 years).Adult aBMD in the lumbar spine(LS),femoral neck(FN),arms,and legs was measured using dual-energy X-ray absorptiometry.The direct effect of childhood SFT and its indirect effect through adult FMP on adult aBMD were estimated using general linear regression and a causal steps approach.Results:Significant positive associations between childhood SFT and adult aBMD were found in the LS in men(β=0.089,P=0.044)and in all the skeletal sites in women.With respect to the adult fat-bone relationship,high adult FMP was associated with low aBMD in most of the sites in men,but with high FN aBMD in women(β=0.144,P=0.002).Moreover,suppressive effects of adult FMP on the associations between childhood SFT and adult aBMD in the LS(-34.8%)and legs(-67.1%)of men,and a positive effect on the FN aBMD in women(17.0%)were identified.Interpretation:Childhood adiposity appears to have a positive long-term effect on adult aBMD,which may be reduced by adiposity in adult men but reinforced by adiposity in adult women.

Can spot urine measurement be a substitute for 24-hour urine measurement to estimate sodium intake in adolescents?

Importance:Several methods have been established in recent decades that allow use of spot urine to estimate dietary sodium intake.However,their accuracies have been controversial in children.Objective:To validate the performance of three commonly used methods-the Kawasaki,Tanaka,and International Cooperative Study on Salt,Other Factors,and Blood Pressure(INTERSALT)methods.Additionally,this study explored the accuracies of the Tanaka and INTERSALT methods by using spot urine samples taken at four separate times.Method:Forty-one adolescents aged 14 to 16 years completed two non-consecutive 24-hour urine collections and their mean values were used as reference data.The second-morning urine was used for assessment with the Kawasaki method;a casual spot urine and spot urine samples taken at four separate times(morning,afternoon,evening,and overnight)were used for assessment with the Tanaka and INTERSALT methods.Results:The mean differences were 1801 mg,542 mg,47 mg,and-31 mg for the Kawasaki,Tanaka,INTERSALT 1(with potassium),and INTERSALT2(without potassium)methods with their required spot urine,respectively.The proportions of relative difference levels within±10%were 4.9%for the Kawasaki method,19.5%for the Tanaka method,36.6%for the INTERSALT 1 method,and 36.6%for the INTERSALT2 method.Interpretation:The INTERSALT method seemed to provide minimally biased estimations of mean population sodium intake with casual spot urine.However,there is a need to be cautious regarding inconsistencies in estimation among different levels of sodium intake.The methods assessed in this study were unable to accurately estimate sodium intake at the individual level.

The impact of body weight trajectory from childhood on chronic inflammation in adulthood: The Bogalusa Heart Study

Importance:The impact of long-term burden of excessive body weight,beginning in childhood,on inflammatory status in adulthood has been poorly described.Objective:To characterize the longitudinal body mass index(BMI)trajectory from childhood and examine its relationship with inflammatory status in adulthood.Methods:We included 1285 adults who had 4-15 repeat measurements of BMI from childhood to adulthood.The area under the curve(AUC)of growth curves was calculated to characterize long-term burden(total AUC)and trends(incremental AUC)of BMI.Results:After adjusting for covariates,higher values of BMI in terms of childhood and adulthood,as well as total and incremental AUC,were strongly associated with elevated levels of adult C-reactive protein(CRP)in the four race-sex groups.There were significant differences in linear and nonlinear curve parameters between the normal and high CRP groups for all race-sex groups(P<0.01).Compared with participants who had consistently low BMI in both childhood and adulthood,participants with high BMI in adulthood had higher CRP levels(P<0.001),irrespective of their childhood BMI status;participants with high BMI in childhood but low BMI in adulthood had similar adult CRP levels.Interpretation:The impact of excessive body weight on inflammation is cumulative and exacerbated over time.The influence of childhood overweight/obesity on inflammatory status in adulthood can be alleviated by reducing adiposity in adulthood.