Pediatrics International

Abstract  Background : In a crowded modern world it is vital that the promotion of sport and exercise should be compatible with environmental and public health outcomes. This study aims to investigate the effects of environmental factors, lifestyle and leisure time activities on physical fitness in rural and urban children.

Methods : A cross‐sectional observational study of 98 rural and 74 urban healthy children (aged 9–11 years) was conducted in Turkey. A questionnaire was used in collecting information about the children's physical activity habits and their school's facilities. The physical fitness of children was evaluated with EUROFIT test battery.

Results : The rural children preferred to play football and volleyball while the urban children had a tendency to prefer indoor sports. The percent of urban children not involved in any sports activity was 35%, while this rate was 30.6% for rural children. It was also found that the urban children watched TV more than the rural children (13.4 ± 2.7 h/week, 10.9 ± 2.7 h/week, respectively). The results showed that body mass index and skinfolds thickness were higher in the urban children (P < 0.05). There were no significant differences in the hip–waist ratio or the hip and waist circumference between the two groups. In cardiopulmonary and motor fitness, no difference was found between the two groups. In contrast, flexibility and muscle endurance were significantly higher in the rural children.

Conclusion : The children living in the urban areas were more inactive and obese, which resulted in a decrease in their flexibility and muscle endurance fitness.

Dicarboxylic aciduria (DCA‐uria) is a relatively common finding in the screening of organic acidemias by gas chromatography/mass spectrometry (GC/MS). A considerable number of patients with DCA‐uria are involved in disturbances of mitochondrial and peroxisomal fatty acid β‐oxidation. The differential diagnosis of DCA‐uria was investigated using a combination of organic acid analysis by GC/MS, carnitine determination, acylcarnitines by fast atom bombardment/mass spectrometry (FAB/MS) and acylglycines by stable‐isotope dilution analysis. The relative distribution of urinary metabolites was examined in 46 patients with DCA‐uria of different origins, including physiological ketosis of childhood, disorders of propionic acid metabolism, glutaric aciduria type II, Zellweger syndrome and patients who were clinically diagnosed as having Reye syndrome.

Zellweger syndrome seemed to be distinguishable from other disorders by the high sebacic acid/adipic acid ratio of DCA‐uria and increased excretion of 4‐hydroxyphenyllactic acid and 2‐hydroxysebacic acid. The mild form of glutaric aciduria type II was often missed by current organic acid analysis alone, but was readily diagnosed by acylcarnitine and acylglycine determination.

The ratio of free/total carnitine was low in most of the DCA‐uria patients except for two of five cases of Zellweger syndrome and one of three cases of Reye syndrome. The acylcarnitine analysis by FAB/MS showed adipyl‐, suberyl‐, sebacyl‐ or dodecanedioylcarnitine as major peaks in most of these patients, although these were not specific. Disease‐specific peaks were detectable only in congenital organic acidemias such as glutaric aciduria type II, methylmalonic acidemia and propionic acidemia.

Abstract Background : The aim of the present study was to clarify the relationship between changing nutritional anthropometric data and serum leptin concentrations during the catch‐up growth process in children.

Methods : Thirty children with mild protein‐energy malnutrition (PEM) were followed for 6 months and their anthropometric measurements and serum leptin concentrations were recorded during follow up.

Results : Twenty‐two (73.3%) of the 30 children showed catch‐up growth. All parameters and serum leptin concentrations increased during the period of catch‐up growth. In the remaining eight children, weight for height, percentage standard body mass index, percentage standard body height and mean serum leptin concentrations did not show any significant increase at the 6 month follow‐up. Mean serum leptin concentration was higher in children with catch‐up growth than in the controls.

Conclusion : During recovery from malnutrition, leptin concentrations increase in relation to fat mass if the fat mass reaches a critical point, and leptin might trigger catch‐up growth with its regulator effects on growth. Although weight gain was noted in both groups, an increase in leptin concentration was observed only in children who showed catch‐up growth. More interestingly, the mean leptin concentration was much higher in children with PEM who had catch‐up growth compared to the control group and in children who failed to have catch‐up growth. In children with catch‐up growth, the higher serum leptin concentrations compared to healthy children and to children without catch‐up growth despite significant weight gain suggests that leptin affects nutritional status in catch‐up growth as a dynamic process, rather than merely being an index of body fat content.

Abstract Background : It is well known that acute onset brain dysfunction, which usually is diagnosed as encephalitis or encephalopathy, occurs in association with influenza. However, this may have been underestimated as a rather infrequent event. Sixty‐four infants and children developed encephalitis‐encephalopathy during the five recent influenza seasons in Hokkaido, the northernmost island of Japan.

Methods : Inquiries were sent at the end of each season, from October 1994 to March 1999, to 94 hospitals and institutes in Hokkaido which accept pediatric age patients, asking if there were any admitted cases of encephalitis or encephalopathy.

Results : The patients were 42 boys and 22 girls and 47 (73.4%) were 4 years of age or younger. None of them had received an influenza vaccine nor had an oral administration of aspirin. Most of the patients became comatose with or without convulsions within a few days of the onset of fever. Twenty‐eight (43.8%) patients died and 13 (20.3%) had neurological sequelae. Patients with clotting disorders, elevations of serum creatine kinase and/or aspartate aminotransferase and alanine aminotransferase, and brain CT abnormalities had a poor prognosis compared with patients without. Among these affected patients, the influenza genome (H3) was detected by polymerase chain reaction in nine cerebrospinal fluid samples, influenza virus A (H3N2) was isolated in 18 nasopharyngeal swab samples and a four‐fold or greater rise in serum hemagglutinin inhibition antibody titer against H3N2 was observed in seven patients.

Conclusions : It appears urgent to promote vaccination against influenza in young children to prevent these devastating disease conditions.

The newborn has an immune system, very limited in size at birth and its postnatal expansion and maturation takes time. In the meantime the transplacental IgG antibodies from the mother play an important role for the protection of the infant. However, these antibodies act in tissues and induce inflammation and are energy‐consuming. In contrast, the milk secretory IgA antibodies stop microbes already on the mucosa preventing infection, tissue engagement and energy loss. In addition, the milk contains many protective factors such as lactoferrin and oligosacharides functioning as analogues for microbial receptors preventing mucosal attachment, the initial step of most infections. As a result, breast‐feeding significantly reduces the risk of neonatal septicemia, respiratory tract infections, otitis media, diarrhea, urinary tract infections, infection‐induced wheezing and necrotizing enterocolitis. Via several mechanisms it seems that human milk can actively stimulate the immune system of the breast‐fed infant. This reduces the risk of infections like otitis media, respiratory tract infections, diarrhea and infection‐induced wheezing for several years after the termination of breast‐feeding. Furthermore, it seems that breast‐feeding decreases the risk of attracting celiac disease and allergic diseases. The latter has been much debated, but a recent critical review of published reports gives good support for long‐term protection of allergic diseases, especially in high‐risk children.