Prader-Willi syndrome (PWS) is 1 of the most common monochromosomal (15q11-13) causes of polygenic syndromic childhood obesity.

We primarily compare and correlate serum lipoprotein(a) [Lp(a)], high-sensitivity C-reactive protein (hs-CRP), and baseline clinical characteristics of genetically confirmed children with PWS at their GH treatment-naïve stage to their control groups. Secondary objectives were to correlate serum Lp(a) and hs-CRP concentration to multiplex ligation-dependent probe amplification subgroups, body composition indices, sleep apnea parameters, and hepatic shear-stress by 2-dimensional shear wave elastography in children with PWS.

A total of 32 genetically confirmed PWS children (age 5 to 18 years), 20 simple obesity children, and 20 healthy children as age-matched control groups were studied for the primary and secondary study objectives.

Lp(a) was higher in the study group as compared to the control group (P  < .0001), but we found no difference between the control groups (P = .9680).In addition, no correlation was detected in Lp(a) levels in the study population with respect to their body weight, body mass index, and waist circumference. hs-CRP levels were also higher in the study population compared to both control groups (P = .0962; P < .0001); in contrast, Lp(a) differed significantly between the control groups (P = .002). Lower fat-free mass index (FFMI) correlated with higher levels of serum Lp(a) (r = -0.5525; P = .001), whereas FFMI was not correlated with hs-CRP levels in PWS children (P = .657). Based on genomic subtypes, patients with PWS were divided into deletion and nondeletion genetic subgroups. We found significantly altered levels of Lp(a), hs-CRP, fat-free mass, and sleep apnea parameters, particularly in the deletion subgroup.

Serum Lp(a) as well as hs-CRP stand out to be the core independent risk factors along with their strong correlation with the other study parameters, which necessitates the role of future targeted therapeutics in PWS, especially in deletion pathology. Thus, genetic subtyping during diagnostic confirmation endorses further prognostic elaboration.

Obesity and metabolic syndrome (MS) accelerate arterial stiffening, increasing cardiovascular (CV) risk after transplant. BMI is limited by inability to differentiate muscle, fat mass, and fat distribution patterns. The aim of this study was to identify the best anthropometric measure to detect arterial stiffness as assessed by pulse wave velocity (PWV) in a racially diverse pediatric transplant population.

Kidney transplant recipients 6-20 years old and ≥ 6 months post-transplant were prospectively enrolled. PWV was measured oscillometrically by Mobil-O-Graph. Skeletal muscle-to-fat mass ratio (SM:FM) and percent body fat (PBF) were evaluated by dual-frequency bioelectrical impedance. BMI and waist-to-height ratio (WHR) were calculated. Associations of arterial stiffness (high PWV) with obesity and MS as defined by WHR, SM:FM, PBF, and BMI were evaluated.

Participants (n = 67) were 15 (IQR 11, 18) years old and 39 (IQR 10, 68) months post-transplant. Participants with SM:FM-obesity (OR 3.2) and WHR-obesity (OR 3.0) had increased odds of high PWV (p = 0.04) while PBF-obesity (OR 2.6, p = 0.09) and BMI-obesity (OR 2.2, p = 0.17) were not significant. Participants with WHR-MS (OR 12.5, p = 0.02), SM:FM-MS (OR 5.2, p = 0.03), and PBF-MS (OR 5.0, p = 0.02) had increased odds of arterial stiffness, while BMI-MS was not significant (OR 3.7, p = 0.08).

Obesity is associated with arterial stiffness in a racially diverse cohort of pediatric transplant recipients. Anthropometric measures that assess body fat distribution (WHR) and body composition (SM:FM) are more strongly associated with arterial stiffness than BMI. MS has a stronger association with arterial stiffness than obesity alone, particularly when WHR is used.

Left ventricular hypertrophy (LVH) secondary to hypertension is associated with cardiovascular events in adulthood. Prevalence of abnormal blood pressure and LVH in youths with congenital heart disease (CHD) is understudied despite childhood hypertension predicting adult hypertension. This study aimed to describe the prevalence of hypertension and LVH in adolescents with CHD and factors associated with LVH in this population.

This was a retrospective analysis of echocardiogram reports from patients with CHD aged 13-17 years with documented systolic blood pressure (SBP), height, weight, and left ventricular mass (LVM) indexed to body size (LVMI-ht2.7). Patients were stratified by SBP and CHD type. Hypertension and LVH prevalence were calculated; linear regression models assessed factors associated with LVH.

Of 853 patients (mean age 15.5 ± 1.5 years, 57.1 % male), 25.1 % had elevated SBP, whereas 11.6 % and 5.7 % had stage 1 and stage 2 hypertension, respectively. LVH was more prevalent with higher SBP (37.4 % elevated, 32.3 % stage 1 hypertension, and 40.7 % stage 2 hypertension) versus 19.6 % normotensive. BMI percentile and SBP were significantly associated with LVMI-ht2.7; for 10 % BMI percentile and 10 mmHg SBP increases, LVMI-ht2.7 increased by 1.2 g/m2.7 and 0.93 g/m2.7, respectively, after adjustment for age, sex, race, SBP, BMI, and CHD lesion.

Adolescents with CHD have a high prevalence of abnormal SBP and LVH. BMI percentile and SBP were associated with LVMI-ht2.7. Findings support screening for BMI and hypertension in youths with CHD as this population has increased baseline cardiovascular risk that may be compounded by obesity and chronic hypertension.

People with CF (PwCF) have low total, high, and low density lipoprotein cholesterol (TC, HDL-C and LDL-C) and historically have had low prevalence of cardiovascular disease. More recently, cases of acute myocardial infarction are reported in PwCF. The impact of elexacaftor-tezacaftor-ivacaftor (ETI) on cholesterol and triglyceride (TG) concentrations, traditional cardiometabolic risk factors, is unknown.

TC, LDL-C, HDL-C, and TG concentrations were analyzed from participants enrolled in the observational PROMISE study of clinically prescribed ETI prior to and 12-18 months after initiation. Pre-ETI and follow-up concentrations were compared, and relationships between TC, LDL-C, HDL-C and TG and clinical factors were tested using linear mixed-effect models.Fasting samples were available for 51 participants (25 M/26F, median age 17.4 y) with pancreatic exocrine insufficiency at baseline and 12-18 months after ETI initiation. TC and HDL-C were higher after 12-18 mo ETI in an unadjusted model, but with adjustment for BMI-Z, only HDL-C remained significantly higher at follow up (p < 0.05). Low HDL-C was the most common abnormality (>50 %), but prevalence of participants meeting criteria for low HDL-C did not differ between timepoints.

In a population of youth and young adults with CF, TC and HDL-C were higher after 12-18 months of ETI, but differences in TC were attenuated with adjustment for BMI-Z. Prevalence of low HDL-C was high at both timepoints.

To investigate how four different prediabetes definitions (by fasting plasma glucose (FPG), glycosylated haemoglobin (HbA1c), FPG-or-HbA1c, or FPG-and-HbA1c) affect prediabetes prevalence estimates and their association with cardiometabolic risk in Danish children and adolescents referred for tertiary obesity treatment.

This cross-sectional study included 5-18-year-olds with BMI SDS above 1.28 and blood samples taken within 30 days of obesity treatment initiation. Anthropometric measurements, blood pressure, and blood samples were analysed to determine prediabetes prevalence and calculate odds ratios for hypertension, dyslipidaemia, abdominal obesity, high alanine aminotransferase (ALT), and BMI SDS ≥99th percentile.

Among 2,849 children and adolescents, prediabetes prevalence was 12.8 %, 6.6 %, 17.2 %, and 2.2 % when applying the FPG, HbA1c, FPG-or-HbA1c, and FPG-and-HbA1c definitions, respectively. Hypertension, dyslipidaemia, abdominal obesity, high ALT, and BMI SDS ≥99th percentile phenotypes were common, with increased prevalence among individuals with prediabetes defined from FPG-or-HbA1c. The FPG-derived definition of prediabetes was associated with hypertension and abdominal obesity, while the HbA1c-derived definition of prediabetes was associated with dyslipidaemia, high ALT, and BMI SDS ≥99th percentile. The strongest association was between the FPG-derived definition and hypertension.

The FPG-derived definition identified more individuals with prediabetes than the HbA1c-derived definition. Children and adolescents with prediabetes defined from FPG-or-HbA1c exhibited a high burden of hypertension, dyslipidaemia, abdominal obesity, high ALT, and BMI SDS ≥99th percentile. No single diagnostic test proved superior, as each associated with different cardiometabolic risk factors.

To develop a standardized percentile curve of waist circumference and abdominal obesity cutoff points for children and adolescents aged 6 to 20 in Macao, the study established a reference for screening abdominal obesity in this population.

The waist circumference data of 10,095 children and adolescents from the 2015-2020 Macao People's Physical Fitness Surveys were used for modeling. The GAMLSS model with four parameters of "median, standard deviation, kurtosis and skewness" was used to construct the standardized percentile curve of waist circumference. Then, the percentile curve-joining adult method was applied to establish the critical value of high waist circumference. Finally, the curves of this study were compared with relevant domestic and international data.

(1) Standard curves of waist circumference percentile and standard deviation unit curves were obtained for children and adolescents aged 6-20 years in Macao. (2) Waist circumference of children and adolescents in Macao increased with age. After the age of 12, waist circumference growth gradually decreased. The waist circumference of males was larger than that of females. (3) Analysis of different percentile curves revealed a divergence in growth rates between P50 and P90. Specifically, from ages 6-11 in boys and 6-10 in girls, the annual increase in waist circumference at P90 exceeded that at P50. After these ages, the growth rate at P50 surpassed that at P90.

The standardized curves constructed for the percentile waist circumference of Macao's children and adolescents were smooth and tests showed good validity. We recommend using these standardized percentile curves (applicable to ages 6-20 years) and abdominal obesity thresholds (applicable to ages 6-18 years), combined with the other evaluation commonly used indicator of obesity, to identify abdominal obesity in Macao's children and adolescents and therefore, to improve the well-being of Macao's children and adolescents.

Comprehensive longitudinal data in healthy populations on cardiometabolic determinants of arterial intima-media thickness (IMT), especially aortic IMT, in adolescence are lacking. We aimed to examine in detail how cardiometabolic risk factors associate with aortic and carotid intima-media thickness (IMT) in adolescence.

Participants (n = 522) were healthy individuals from Special Turku Coronary Risk Factor Intervention Project. IMT of the abdominal aorta and common carotid artery was measured repeatedly with ultrasonography at the age of 11, 13, 15, 17 and 19 years. Data on cardiometabolic risk markers were available beginning from early childhood.

Between ages 11 and 19 years, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, serum total cholesterol, non-HDL-cholesterol, and apolipoprotein B levels, insulin and insulin resistance indicated by homeostasis model of insulin resistance (HOMA-IR), C-reactive protein, and smoking associated directly with aortic IMT. For carotid IMT, a direct association was found with BMI, waist circumference, systolic blood pressure and smoking. In multivariate analyses, BMI(β = 5.49, SE = 1.01, P < 0.0001) and HOMA-IR (β = 16.79, SE = 7.45, P = 0.02) remained as determinants of aortic IMT. Correspondingly, BMI(β = 1.78, SE = 0.42, P < 0.0001) and systolic blood pressure (β = 0.38, SE = 0.10, P = 0.0001) determined carotid IMT. Participants with longitudinal aortic or carotid IMT above/equal the 80th percentile had higher BMI measured from infancy than their peers with longitudinal IMT below the 80th percentile.

In adolescence, several cardiometabolic risk factors associate with aortic IMT while these links are less evident for carotid IMT. Aortic IMT may serve as a more sensitive marker than carotid IMT of early vascular remodeling.

Objective: This study analyzed the relationship between self-perceived physical fitness and anthropometric and biochemical variables in young athletes from extracurricular sports programs in northeastern Spain. Methods: A cross-sectional design was used with a sample of 673 young athletes. Data collection included self-reported physical fitness and objective anthropometric and biochemical measurements. The analysis explored associations between perceived fitness dimensions and physical/biochemical variables, with attention to sex differences. Results: Fat mass showed significant inverse associations with all perceived fitness dimensions: general fitness (OR = 0.62, 95% CI [0.41, 0.94]), cardiorespiratory fitness (OR = 0.56, 95% CI [0.37, 0.83]), muscular strength (OR = 0.61, 95% CI [0.41, 0.91]), speed/agility (OR = 0.59, 95% CI [0.39, 0.88]), and flexibility (OR = 0.57, 95% CI [0.39, 0.84]). Higher fat mass was consistently linked to lower perceived fitness. HDL levels were positively associated with general (OR = 1.40, 95% CI [1.13, 1.74]) and cardiorespiratory fitness (OR = 1.32, 95% CI [1.07, 1.62]), while LDL levels showed no significant effect (p > 0.05). Sex differences emerged for general fitness (OR = 0.52, 95% CI [0.33, 0.82]) and flexibility (OR = 0.51, 95% CI [0.33, 0.78]), favoring boys, but no differences were found for cardiorespiratory fitness, muscular strength, or speed/agility (p > 0.05). This suggests that shared athletic environments may reduce typical sex-based disparities. Conclusions: Our findings emphasize the importance of considering both anthropometric and biochemical variables when evaluating perceived fitness in youth athletes. Regular athletic engagement may buffer sex-based differences in fitness perception.

Aortic pulse wave velocity (PWV) is an indicator of vascular aging and has proven to be effective in adult cardiovascular risk assessment. To use it in young people to identify those who may be at increased cardiovascular disease risk, reference values need to be determined. The Youth Vascular Consortium is a large, international database which was established to investigate vascular aging in youth. Using data from the Youth Vascular Consortium, this study aimed to develop reference values for aortic PWV in healthy young people.

This is a retrospective, multicenter study. Data on demographics, anthropometric, biochemical, and vascular aging measures from participants aged 1 year to 40 years were harmonized. Generalized additive models were used to derive percentile curves for PWV and predicted percentiles at years of age were reported by sex, continent, and device.

Data from 19 930 participants (mean age=17 years, 51% female, 71% European), classified as healthy based on blood pressure, body mass index, serum glucose, and cholesterol levels, were included to construct the reference values. Six devices were used to assess aortic PWV (29% SphygmoCor). Device-specific percentile curves for aortic PWV were constructed, and an increasing trend was identified for both sexes with age.

This study provided reference values for aortic PWV assessed with 6 devices for healthy young people by age and sex. These percentiles may be applied clinically to identify youth with impaired vascular aging and, thus, those who may be at risk of developing overt cardiovascular disease in the future.

The global rise in pediatric hypertension (HTN) is a significant concern as it serves as a precursor to cardiovascular disease (CVD). To address this, we performed a comparative analysis of two guidelines for pediatric HTN: the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH), applying the Korean blood pressure (BP) reference specifically to the Korean pediatric population.

Data from 2,060 children and adolescents aged 10-18 years from the Korean National Health and Nutrition Examination Survey (2016-2018) were analyzed. BP was classified according to the AAP, the ESH, and the Korea Regional BP Classification (KRC). High BP was defined as BP exceeding the normotensive range.

The prevalence of high BP in Korean youth was significantly higher according to the AAP group than that in the ESH group (19.5% vs. 10.6%, P < 0.0001). Variations in prevalence were noted based on age, sex, and obesity. No significant differences were observed between the AAP and KRC groups in terms of high BP prevalence. The application of the AAP and KRC provided a more comprehensive reflection of CVD risk factors, including obesity and metabolic profiles, compared to the ESH. The KRC showed a tendency to classify more non-obese individuals as having elevated BP, although this difference was not statistically significant.

In comparing the AAP, ESH, and KRC criteria in the Korean pediatric population, the KRC demonstrated a tendency to identify individuals with CVD risk factors as having high BP. This finding suggests that using the KRC as the criterion for high BP may facilitate earlier intervention in the management of CVD risk.

Data on upadacitinib therapy in children with ulcerative colitis (UC) or unclassified inflammatory bowel disease (IBD-U) are scarce. We aimed to evaluate the effectiveness and safety of upadacitinib as an induction therapy in pediatric UC or IBD-U.

In this multicenter retrospective study, children treated with upadacitinib for induction of remission of active UC or IBD-U from 30 centers worldwide were enrolled. Demographic, clinical, and laboratory data, as well as adverse events (AEs), were recorded at Week 8 post-induction.

One hundred children were included (90 UC and 10 IBD-U, median age 15.6 [interquartile range 13.3-17.1] years). Ninety-eight were previously treated with biologic therapies, and 76 were treated with ≥2 biologics. At the end of the 8-week induction period, clinical response, clinical remission, and corticosteroid-free clinical remission (CFR) were observed in 84%, 62%, and 56% of the children, respectively. Normal C-reactive protein and fecal calprotectin (FC) <150 mcg/g were achieved in 75% and 50%, respectively. Combined CFR and FC remission was observed in 18/46 (39%) children with available data at 8 weeks. Adverse events were recorded in 37 children, including 1 serious AE of an appendiceal neuroendocrine tumor. The most frequent AEs were hyperlipidemia (n = 13), acne (n = 12), and infections (n = 10, 5 of whom with herpes viruses).

Upadacitinib is an effective induction therapy for refractory pediatric UC and IBD-U. Efficacy should be weighed against the potential risks of AEs.

The increasing incidence of dyslipidemia among children and adolescents has emerged as a significant public health concern due to its associated risk of long-term cardiovascular complications. The prevalence of dyslipidemia has increased in parallel with rising obesity rates, highlighting the importance of early intervention. In this narrative review, we explore the epidemiology, screening, diagnosis, and treatment of dyslipidemia in pediatric populations, focusing on recent advancements and updates in clinical management. Key diagnostic criteria and risk assessment strategies are discussed, emphasizing the role of lipid profile screening in high-risk groups. Lifestyle and dietary interventions are key for managing dyslipidemia, while pharmacological treatments including statins, cholesterol absorption inhibitors, and emerging therapies are reviewed in cases requiring further intervention. Updated guidelines and evidence-based recommendations from Korean and other international institutions are consolidated to provide a comprehensive overview. These findings underscore the necessity of a multidisciplinary approach combining early detection, tailored treatment, and lifestyle modifications to mitigate the long-term health risks associated with dyslipidemia in younger individuals.

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) affects approximately 1 in 15 000 individuals. We leveraged the power of multicentre registry data to assess the trend and predictors of blood pressure (BP) within children and young persons with 21OHD to inform monitoring strategies.

Data from the International CAH Registry in patients younger than 20 years was compared to normative values. Values of BP were modeled to create reference curves, multiple change point analysis applied to quantify the difference with normative data. Covariate adjustment was informed by a directed acyclic graph, prior to joint outcome regression modeling to accurately assess predictors of BP.

A total of 6436 visits within 554 patients (52.5% females) showed BP-Standard deviation scores (SDS) were higher at younger ages. Patients under five years had systolic BP-SDS of 1.6 (Q1:0.6-Q3:2.7) decreasing to 1.0 (Q1:0.2-Q3:1.8) over 5 years, equating to 31.0% over the 95th centile decreasing to 15.0%. Higher doses of fludrocortisone were associated with a small increase in systolic BP equivalent to 1.2 mmHg with every 100 µg extra fludrocortisone. Renin of 100µU/mL was associated with 4.6 mmHg lower systolic BP than a renin of 1µU/mL, higher 17OH-progesterone and androstenedione also predicted lower systolic and diastolic BP (P < .05).

Higher BP in children with 21OHD is common and particularly pronounced at a younger age, but may not be attributable to excessive mineralocorticoid replacement. There is a need to improve our understanding of the determinants of this raised BP as well as its long-term effects.

Familial hypercholesterolemia (FH) is a genetic disorder that significantly increases low-density lipoprotein cholesterol (LDL-C) levels. Statins are commonly prescribed to minors to improve overall cardiovascular outcomes. Despite their well-documented efficacy in lowering lipid levels, statins can cause adverse side effects, including myopathy and, in rare cases, rhabdomyolysis.

A 17-year-old male adolescent presented with acute muscle pain in both arms. The patient had a history of FH and was undergoing treatment with rosuvastatin. Laboratory results revealed a marked elevation in creatine kinase (CK), myoglobin, cystatin C, and hepatic enzymes. Urinalysis did not show any abnormalities. Given the suspicion of statin-associated rhabdomyolysis, rosuvastatin was promptly discontinued. Further, the patient was administered intravenous fluids (3 L/m2/day) for renal protection. Nine days after admission, levels of CK, myoglobin, and creatinine returned to normal. Hepatic enzymes and cystatin C remained elevated. The patient was advised to discontinue statin therapy for a total of 6 weeks. For further treatment, the patient was referred to a pediatric lipid clinic.

While the use of statins is generally safe, rare side effects including rhabdomyolysis must be detected and therapy promptly initiated to prevent long-term health effects. Patients that experienced statin-associated rhabdomyolysis should be monitored closely and referred to a pediatric lipid clinic for further treatment.

Evaluate the differences in metabolic risk factors in preschool children with normal weight (NWG) or with some degree of excess weight (OWG).

Body mass index (BMI), umbilical waist circumference (WC), mid-upper arm circumference (MUAC) and total body fat (TBF) in children aged 1-5.9 years. The following metabolic risk factors were measured: blood pressure, fasting glycaemia, fasting serum insulin, HOMA IR Index, total cholesterol (TC), LDL cholesterol (LDL-C) HDL cholesterol (HDL-C) and triacylglycerol (TG).

In population evaluated (n=689) MUAC, WC, TBF, HOMA IR were higher in OWG compared to NWG and significantly higher in OWG girls compared to boys (two ways ANOVA). Positive associations were found between diastolic blood pressure, insulin and HOMA-IR and WC, MUAC, TBF, BMI z score in the adjusted and unadjusted model.

MUAC may emerge as an indicator with predictive power for metabolic risk and would be very useful to measure in many setting. There is a need for in-depth research into sex difference.

The prevalence of dyslipidemia in the pediatric population continues to rise, increasing the future risk of atherosclerotic cardiovascular disease (ASCVD) as these children transition to adulthood. Timely diagnosis and intervention, beginning at a young age, is important in reducing the risk of ASCVD and preventing premature mortality in this vulnerable population. Implementation of a heart-healthy lifestyle should be encouraged in all children, and, when appropriate, the role of medication discussed in those at-risk. The purpose of this review is to discuss the impact of non-lipid lowering medications which affect lipid and lipoprotein metabolism in children (< 18 years-of-age).

According to National Center of Health Statistics, there has been a steady rise of pediatric obesity and cardiovascular disease (CVD) risk amongst youth over the last 2 decades, with roughly 1 out of 5 children having a BMI > 95th percentile for their age and gender. Such a rise can contribute to an increase of CVD risk factors, which play a role in the development of atherosclerosis. Evidence of atherosclerosis appears as early as childhood, progresses throughout adolescences, and accelerates after 20 years-of-age. Although some children are genetically predisposed to dyslipidemia, many have elevated lipids and lipoproteins as a result of unhealthy lifestyles - high fat, high carbohydrate diets, lack of exercise, and use of medications for other health conditions. In a 2023 survey, it was predicted that approximately 40.1% of children < 17 years-of-age have had at least one medication prescribed for a short or long-term health condition within the past 12 months. Clinicians should be aware of health conditions and medications that can adversely affect lipid levels when evaluating and treating children with lipid disorders. With the increased prevalence of lipid disorders in the pediatric population, healthcare providers are searching for both primary and secondary causes including the influence of certain medications or drug classes known to cause lipid abnormalities in adults, identifying similar findings amongst children. These include but are not limited to corticosteroids, retinoid agents, beta blockers, oral contraceptives, chemotherapy agents, antiretroviral medications, androgenic steroids and behavioral medications.

This study analyzed the relationship between obesity, metabolic syndrome (MetS) and its individual components, iron metabolism, and hepatic alterations in a pediatric group of patients. We mostly concentrated on the role of serum ferritin as a marker of inflammation. We conducted a retrospective study, in which we determined the presence of MetS and hepatic ultrasound changes in a cohort of 68 pediatric patients and examined the changes in serum iron and ferritin levels. MetS prevalence was significantly higher in obese children (64%) compared to those with average weight (11.1%). Abdominal circumference, triglycerides, and high-density lipoprotein cholesterol were the most relevant MetS criteria. Serum iron levels were significantly lower, while ferritin levels increased proportionally with MetS number of components. Liver ultrasound findings confirmed a strong association between hepatic steatosis and MetS, with advanced ultrasonographic scores correlating with increased ferritin and serum iron deficiency. These results reinforce the interplay between iron metabolism and inflammation in pediatric MetS. Given this study's unicentric design and limited ethnic diversity, further large-scale, longitudinal studies are needed to confirm these findings and improve early screening strategies for pediatric metabolic complications.

Down syndrome (DS) stands as the most frequent chromosomal abnormality leading to intellectual disability. A prevalence rate of 6.1-13.1 per 10 000 births has been estimated. Although life expectancy has been increasing from 25 years in 1983 to 60 years in 2020 in this population, their quality may be impaired by the development of diseases. However, it has also opened the possibility of carrying out a significant number of cardiovascular risk studies in DS. This includes comparisons of biochemical cardiometabolic risk factors, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), between normal-weight children with DS and age- and gender-matched children without DS.

In this cross-sectional study, with parental consent, 25 children with DS and 30 age-matched controls (8-12 years old) participated. Body mass index (BMI) was calculated from anthropometric assessments, while glucose and lipid profiles were measured from the obtained blood samples.

According to the World Health Organization BMI criteria, all individuals from both groups had normal weight. The DS group exhibited higher TC (179.4 ± 50.4 mg/dL vs. 120.7 ± 31.6 mg/dL, p < 0.000), TG (125.2 ± 42.5 mg/dL vs. 86.5 ± 54.1 mg/dL, p < 0.005) and LDL-C (108.1 ± 40.8 mg/dL vs. 120.8 ± 53.5 mg/dL, p = 0.373), while HDL-C was lower (46.3 ± 12.3 mg/dL vs. 54.7 ± 11.8 mg/dL, p = 0.008) compared with the control group.

The present study suggests that children with DS have a higher prevalence of cardiometabolic risk factors compared with the general population, regardless of weight, highlighting the importance of studying dyslipidaemias in the DS population independently of body weight.

The increasing hypertension (HTN) prevalence in children, largely driven by obesity, highlights the need to investigate its risk factors, including the role of abdominal obesity.

We analysed data from the Korea National Health and Nutrition Examination Survey (2007-2021) to assess the prevalence of overweight and obesity (OW-OB), elevated blood pressure (EBP), and HTN among 11,554 participants aged 10-18 years. EBP and HTN were defined according to the 2017 American Academy of Pediatrics guidelines, and abdominal obesity was defined as a waist-to-height ratio (WHtR) of ≥ 0.5. Secular trends in the prevalence of OW-OB and EBP-HTN were examined across five time periods, and risk factors for EBP-HTN were evaluated in OW-OB children stratified by abdominal obesity status.

The prevalence of EBP, HTN, and OW-OB was 8.22% (95% confidence interval [CI], 7.60-8.86), 10.46% (95% CI, 9.72-11.20), and 25.11% (95% CI, 24.17-26.05), respectively. Among the 3,015 participants with OW-OB, 13.53% (95% CI, 12.03-15.04) and 17.64% (95% CI, 15.98-19.31) were diagnosed with EBP and HTN, respectively. Although the prevalence of OW-OB and EBP-HTN had increasing trends from 2007 to 2009 to 2019-2021, these trends were not statistically significant. In the children with OW-OB, obesity severity, male sex, older age, and paternal HTN were associated with EBP-HTN. The HTN risk factors differed according to abdominal obesity status. In participants with abdominal obesity, male sex (OR 2.32, 95% CI 1.643-3.299; p < 0.0001), older age (OR 1.16, 95% CI 1.102-1.233; p < 0.0001), and severe obesity (OR 3.12, 95% CI 1.991-4.895; p < 0.0001) were significant risk factors; whereas, in those without abdominal obesity, paternal HTN (OR 1.66, 95% CI 1.207-2.303; p = 0.0025), hypercholesterolemia (OR 1.85, 95% CI 1.114-3.083; p = 0.0178), male sex (OR 1.83, 95% CI 1.329-2.530; p = 0.0002), and older age (OR 1.11, 95% CI 1.036-1.198; p = 0.0038) were significant risk factors.

In children with overweight or obesity, the risk factors for EBP-HTN vary depending on the presence of abdominal obesity. These findings highlight the need for differentiated surveillance and prevention strategies based on abdominal obesity status in this high-risk population.

Not applicable.

We aimed to describe the prevalence of vitamin D deficiency among American Indian adolescents and determine its association with cardiovascular disease (CVD) risk factors.

Our study population consisted of 307 adolescents (aged ≤20 years) participating in the Strong Heart Family Study with serum 25-hydroxyvitamin D (25[OH]D) measured on samples collected during baseline examinations (2001-2003). We defined baseline prevalence of vitamin D deficiency as 25(OH)D ≤20 ng/mL. We evaluated outcomes related to obesity (BMI, waist circumference, wait-to-hip ratio, and body fat percentage), diabetes, cholesterol, and metabolic syndrome. We used generalized estimating equations to determine whether the prevalence of the outcomes differed according to vitamin D deficiency status, while controlling for covariates. To determine incidence, we conducted a follow-up examination a median 5.8 years after baseline (2006-2009) and a second follow-up a median of 13.3 years after baseline (2014-2018). We calculated incidence rates (IR) per 100 person-years for the total group and stratified by vitamin D deficiency status at baseline. Finally we used shared frailty cox proportional hazards models to determine if the risk of the outcomes differed according to vitamin D deficiency status, while controlling for covariates.

The prevalence of vitamin D deficiency was 50.8% at baseline, and it was associated with the prevalence of obesity, low HDL-C, and metabolic syndrome, while controlling for covariates. By the first follow-up, the IRs per 100 person-years were the following: obesity (5.03), diabetes (1.07), any dyslipidemia (10.80), and metabolic syndrome (3.31). By the second follow-up, the IR of diabetes was significantly higher among those with (vs without) baseline vitamin D deficiency (1.32 vs 0.68 per 100 person-years; P = .02), although the association was not significant after adjusting for covariates.

Vitamin D deficiency in adolescence may be associated with the CVD risk factors obesity, low HDL-C, and metabolic syndrome and may also contribute to the development of diabetes later in life.

There are scarce data available on upadacitinib in children with Crohn's disease (CD).

To evaluate the effectiveness and safety of upadacitinib as an induction therapy in paediatric CD.

This was a multicentre retrospective study between 2022 and 2024 of children treated with upadacitinib for induction of remission of active CD conducted in 30 centres worldwide affiliated with the IBD Interest and Porto group of the ESPGHAN. We recorded demographic, clinical and laboratory data and adverse events (AEs) at week 8 post-induction. The analysis of the primary outcome was based upon the intention-to-treat (ITT) principle.

We included 100 children (median age 15.8 [interquartile range 14.3-17.2]). All were previously treated with biologic therapies including 89 with ≥ 2 biologics. At the end of the 8-week induction period, we observed clinical response, clinical remission and corticosteroid- and exclusive enteral nutrition-free clinical remission (CFR) in 75%, 56% and 52%, respectively. By the end of induction, 68% had achieved normalisation of C-reactive protein, and 58% had faecal calprotectin (FC) < 150 mcg/g. There was combined CFR and FC remission in 13/31 children with available data at 8 weeks (13% of the ITT population). AEs were recorded in 24 children; the most frequent was acne in 12. Two AEs (severe acne and hypertriglyceridemia) led to discontinuation of therapy.

Upadacitinib is an effective induction therapy for refractory paediatric CD. Efficacy should be weighed against the potential risks of AEs.

Dietary fiber is present in many food categories (fruits, cereals, vegetables, legumes), and is considered a beneficial component of adult and children's diets. It is now well-established that dietary intervention is the first line of treatment for childhood dyslipidemia, both as a curative intervention (Familial Hyperchylomicronemia Syndrome, Sitosterolemia) and as an appropriate lifestyle aimed at improving the lipid profile in dyslipidemia, which is associated with early atherosclerosis and an increased risk of cardiovascular disease in adulthood (Familial Hypercholesterolemia, overweight- and obesity-related dyslipidemia). In this paper, we reviewed the main consensus documents to determine the current indications for its use in children and adolescents, and analyzed the few specific papers on the subject in the literature to assess how fiber is currently used in the treatment of pediatric dyslipidemia, what precautions should be taken, and what the main benefits of fiber are on the lipid profile and cardiovascular risk.

Dyslipidaemia is a significant risk factor for cardiovascular diseases, which can manifest early in life. Despite its importance, the prevalence of dyslipidaemia in the paediatric population of Pakistan remains poorly understood. This study uses laboratory data to determine the prevalence of dyslipidaemia and lipid testing practices among Pakistani children and adolescents.

This retrospective cohort study analysed the laboratory data from children and adolescents, aged up to 19 years, who underwent lipid testing. The data was obtained from two centres with collection points all over Pakistan for five years (March 2019-March 2024). Logistic regression models were used to assess relationships between demographic factors (age, sex and regions/provinces) and lipid profile parameters.

Over five years, 9,787 children and adolescents with a mean age of 13.8 ± 5.1 years underwent lipid testing. Boys accounted for 59.7% of those tested compared to 40.3% of girls (p = 0.09). Most tests were conducted in Punjab (81.2%), with minimal representation from Balochistan (0.5%) and Gilgit Baltistan (0.3%). Among tested children and adolescents, 33.3% had elevated total cholesterol, 25.4% high low-density lipoprotein cholesterol, 46.6% low high-density lipoprotein cholesterol, 48.0% abnormal non- high-density lipoprotein cholesterol and 41.7% hypertriglyceridemia. Compared to boys, girls had significantly lower odds of abnormal high-density lipoprotein cholesterol (Odds Ratio 0.556, 95% CI 0.511-0.607, p < 0.001) and triglyceride levels (Odds Ratio 0.702, 95% CI 0.642-0.767, p < 0.001).

This study highlights a high prevalence of dyslipidaemia among Pakistani children, with boys more affected than girls. The study also highlights a gender-based inequality in lipid testing where girls appear to be less frequently tested compared to boys.

Screening youth for hypercholesterolemia allows for detection of familial hypercholesterolemia that can predispose to premature heart disease, however guidelines provide conflicting recommendations regarding universal cholesterol screening. The COVID-19 pandemic and the perception of conflicting guideline recommendations (2011 National Heart, Lung, and Blood Institute guidelines and United States Preventive Services Task Force recommendations in 2016 and 2023) may have adversely affected youth cholesterol screening rates. This study examines screening rates during and after the COVID-19 pandemic and the most recent guideline update. Electronic health record data from a single academic institution was used to calculate Order Placement Rates (OPRs) for subjects aged 8 years 9 months-21 years from 3/18/2019 to 12/31/2023. Demographic data included subject sex, age, zip code, and primary provider's specialty. Zip codes were categorized as rural/urban and underserved/middle/advantaged. The study period was divided into five stages (pre-pandemic, mid-pandemic, late-pandemic, post-pandemic, and post-guideline). Relative to baseline OPR prior to 3/18/2019, study period OPRs decreased slightly in pre-pandemic (73.3%), mid-pandemic (70.9%), and late-pandemic (65.4%) stages, with sharper declines during post-pandemic (47.6%) and post-guideline stages (35.2%). OPR decreased more significantly for youth 9-11 years than 17-21 years (post-guideline OPR: 35.1% versus 46.9%). Urban underserved and urban advantaged had higher OPRs. OPRs for family medicine and pediatrics declined (p < 0.01), more significantly in pediatrics (post-guideline versus pre-pandemic OPR adjusted odds ratio [95% CI] = 0.03 [0.02-0.04] for pediatrics, 0.35 [0.30-0.40] for family medicine). Our institution showed decreases in cholesterol screening OPRs after both the COVID-19 pandemic and guideline update. OPRs dropped most significantly among youth aged 9-11 years and among pediatric providers. Urban youth were more likely to be screened than rural youth. Discrepancies persist among access to youth cholesterol screening.

Background/Objectives: Nusinersen is a disease-modifying drug for spinal muscular atrophy (SMA) that improves motor function. However, its effects on the skeletal muscles remain unclear. This study aimed to assess the intramuscular fat fraction in patients with SMA types II and III using muscle magnetic resonance imaging (MRI) and to explore the relationship between muscle tissue, lipid metabolism, and motor function during nusinersen treatment. Methods: This study included seven pediatric patients with SMA types II and III who received nusinersen treatment. Muscle MRIs were performed at three time points. Images of the central thigh were used to measure the cross-sectional area (CSA) and muscle fat area, and the intramuscular fat fraction (IMFF) was calculated. The thigh muscles were categorized into three groups: quadriceps, adductor, and hamstrings. Results: The median (range) of total IMFF for SMA type II and III at T-0, T-2, and T-4 were 18.5 (12.6-48.4), 24.4 (10.1-61.4), and 39.0 (30.0-68.6) % and increased over time. In five patients whose motor function was evaluated, a moderate negative correlation was observed between the changes in the Hammersmith Functional Motor Score Expanded (HSFME) and IMFF (r = -0.51). No significant changes in serum triglyceride or total cholesterol levels were observed during treatment. Conclusions: An increase in IMFF was associated with a decline in motor function. The baseline IMFF score was related to improvements in motor function scores, suggesting that the IMFF of the thigh muscle may serve as a novel, objective, and quantitative skeletal muscle-related biomarker for predicting the effects of nusinersen on muscle tissue.

Behavioral interventions to treat childhood obesity have had limited success. Primary prevention is desirable, but whether intervention effectiveness can be sustained is unknown.

To examine the effect of an intervention designed for the primary prevention of obesity and delivered through age 2 years on weight outcomes through age 9 years.

A longitudinal observation of a single-center randomized clinical trial comparing a responsive parenting intervention vs a home safety intervention (control) among primiparous mother-child dyads who completed the assessment at age 3 years with follow-up to age 9 years. All data were analyzed from January 21 to November 15, 2024.

Research nurses conducted 4 home visits during infancy and research center visits at ages 1 and 2 years totaling less than 10 contact hours. The responsive parenting curriculum focused on feeding, sleep, interactive play, and emotion regulation.

The primary outcome is body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) across 4 assessments from age 3 through 9 years, with the assessment of study group differences using repeated-measures analysis. A test for an interaction between sex and study group was planned. Secondary outcomes include BMI z scores and prevalence of overweight (BMI ≥85th to <95th percentile) and obesity (BMI ≥95th percentile) at 5, 6, and 9 years.

Of the 232 primiparous mother-child dyads (116 per group) (7 Asian [3%], 11 Black [5%], 1 Native Hawaiian or Other Pacific Islander [0.4%], 207 White [89%], and 6 children with other race and ethnicity [including Asian, Indian, Hispanic, Dominican, and other race; 2.5%]; 121 male children [52%]), 177 (76%) had anthropometric data at age 9 years. From ages 3 to 9 years, children in the responsive parenting group had a lower mean (SD) BMI than controls (16.64 [0.21] vs 17.07 [0.20]; absolute difference, -0.43; P = .049). Sex moderated this effect; female participants in the responsive parenting group had a lower mean (SD) BMI than female participants in the control group (16.32 [0.26] vs 17.32 [0.26]; absolute difference, -1.00; P = .007), with no group differences among male participants. Cross-sectional analyses revealed no differences in BMI z scores or prevalence of overweight or obesity at ages 5, 6, and 9 years between the responsive parenting group and the control group.

An early-life responsive parenting intervention resulted in lower BMI from age 3 to 9 years compared with a control intervention. This group difference was driven by effects on female participants, with differences appearing to dissipate over time. A life-course approach may be required to sustain the benefits of early-life responsive parenting interventions for obesity prevention.

ClinicalTrials.gov Identifier: NCT03555331.

Cardiovascular diseases keep being the leading cause of mortality in Spain. Efforts should be intensified to identify new risk factors that may contribute to increasing cardiovascular risk. Lipoprotein(a) (Lp(a)) has been associated with a higher risk for developing aortic valve stenosis, heart failure, ischemic stroke, ischemic heart disease and peripheral arterial disease. Hyperlipoproteinemia(a) is a common health problem. Between 10 and 30 % of the world population have Lp(a) values exceeding 50 mg/dL. The scientific evidence provided in the recent years confirms an independent association between Lp(a) and the risk for having an arteriosclerotic cardiovascular event. This finding, added to the emergence of new specific therapies for reducing Lp(a) has raised interest in the quantification of this lipoprotein. The objective of this paper was to perform a review of the evidence available to identify the patients who will benefit from undergoing Lp(a) testing and determine the recommended quantification methods, the desirable concentrations, and the role of Lp(a) determination in reclassifying the cardiovascular risk of patients.

Dyslipidemia is characterized by changes in lipid and lipoprotein levels in the blood where phospholipid transfer protein (PLTP) helps to regulate and modulate the size of high-density lipoproteins (HDL), working on the reverse transport of cholesterol. ApoA-1 is the primary protein component of HDL, and certain genetic variants like rs5072, have been associated with hypertriglyceridemia in children. This study aimed to explore the association between PLTP concentrations and the effect of the genetic variant APOA1 rs5072 on hypertriglyceridemia and atherogenic dyslipidemia (AD) in the pediatric population of Southeastern Mexico.

A cross-sectional study was carried out with a case-control design for 364 pediatric patients between 2 and 17 years old in Chiapas and Tabasco, Mexico. Serum samples were used to evaluate PLTP concentrations using ELISA kits, and DNA from peripheral blood samples was used to study genetic variation using q-PCR with TaqMan® probes. For statistical analysis, Student t-test for media comparison, Chi-square for frequency and Pearson analysis for correlation was performed. The software SNPStats was used for inheritance models.

Children with hypertriglyceridemia had higher levels of PLTP (8.3 ± 6.5 ng/ml) than the control group (6.4 ± 4.5 ng/ml). Similarly, the pediatric patients with AD had higher PLTP levels of 8.0 ± 6 ng/ml, mainly in children with high triglycerides who were between 10 and 17 years old (9.7 ± 8.0 ng/ml). Also, it was found that the genetic variant rs5072 had a protective effect against hypertriglyceridemia (OR = 0.61, p = 0.024) in the over-dominant inheritance model.

PLTP levels increase in pediatric patients aged 10 to 17 years with a diagnosis of hypertriglyceridemia and AD. The genetic variant rs5072 has a protective effect in hypertriglyceridemia.

Obesity is associated with cardiovascular disease (CVD) risk factors in both children and adults and is predictive of poor cardiovascular outcomes. Prevalence of CVD risk factors among children has become more frequent and is often influenced by the family. The purpose of this study was to both cross-sectionally and longitudinally determine the prevalence and changes in CVD risk factors among northern Colorado students. Data was collected from August 2013 to May 2023 as part of the UCHealth Healthy Hearts and Minds (HHM) program (51,882 students, 52.4 % female, 71.5 % White). Objective measures of total cholesterol (TChol), high-density lipoprotein cholesterol (HDL), blood pressure, height, and weight were collected. Self-reported familial CVD risk factors from parents/guardians including overweight/obesity were collected. CVD risk consistently rises with increasing BMI across grade levels. TChol was higher and HDL was lower as BMI increased, regardless of age or sex. Students who maintained a healthy weight in elementary and high school (66.2 % males, 67.6 % females) or moved to a healthy weight after elementary school (7.4 % males, 5.0 % females) had lower CVD risk compared to students who were overweight/obese (17.4 % males, 14.7 % females) at both timepoints. Students with a healthy weight in elementary and high school were less likely to have a family member reporting overweight/obesity (26.5 % and 28.0 %) than students who were overweight in both grade levels (50.5 % and 56.7 %). Given the increase in childhood obesity, there is a need for aggressive screening and treatment of obesity and CVD risk in children and their families.

The present study assessed low-density lipoprotein cholesterol (LDL-C) levels in school-aged children from the Ogasa District of Shizuoka Prefecture and evaluated the utility of non-invasive vascular tests, namely flow-mediated dilation (FMD) and intima-media thickness (IMT), in pediatric patients with familial hypercholesterolemia (FH).

We analyzed the lipid test results of 8,568 students screened for prevention of lifestyle-related diseases and 78 children under 15 years old with cholesterol levels exceeding 220 mg/dL who visited Chutoen General Medical Center. We examined the LDL-C distribution from school-age screenings and conducted FMD and IMT assessments on those meeting the 2022 Pediatric FH Guidelines criteria.

Among the screened students, 186 (2.2%) exhibited LDL-C levels above 140 mg/dL, including 123 fourth-graders (2.8%) and 63 first-year junior high students (1.5%). The mean LDL-C level across all students was 90.0 mg/dL (standard deviation: 21.3 mg/dL), with the 95th percentile at approximately 125.0 mg/dL. Of the 78 children who visited the hospital, 65 met the FH diagnostic criteria. In children ≥ 10 years old, no significant IMT differences were observed between the Definitive and Probable FH groups and the Possible FH group; however, a significant difference in the FMD percentage was noted between these groups (9.9% [8.1%-11.9%] vs. 14.2% [11.6%-16.3%], P=0.003).

Our findings highlight the LDL-C distribution in FH screening and suggest a potential reduction in FMD in pediatric FH patients ≥ 10 years old. These results emphasize the importance of initiating pharmacological interventions in school-aged children to maintain optimal LDL-C levels for lifelong cardiovascular health.