Table of Content

10 June 2024, Volume 32 Issue 6

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Professional Forum

Challenge for diagnosis and treatment of attention-deficit/hyperactivity disorder comorbid with intellectual disability/developmental delay

ZHANG Yiwen

2024, 32(6):  581-585.  DOI: 10.11852/zgetbjzz2024-0567

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Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and is one of the most common childhood disorders in those with intellectual disability/developmental delay (ID/DD). Patients with this comorbidity present complex symptoms and significant functional impairments, leading to difficulties in diagnosis and suboptimal treatment outcomes. Treatment of ADHD comorbid with ID requires a comprehensive approach that includes both non-pharmacological and pharmacological interventions. Overall, multidisciplinary comprehensive assessment and treatment, combined with long-term follow-up and individualized management, can help improve the quality of life and functionality of patients with this comorbidity.

Current status and recommendations for multimodal assessment of attention-deficit/hyperactivity disorder in children

FENG Tingyong, WANG Xueke

2024, 32(6):  586-590.  DOI: 10.11852/zgetbjzz2024-0434

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Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder originating in childhood.Multimodal assessments not only provide a wealth of information to facilitate a more precise diagnosis of ADHD,but also lends critical support to the decision-making process involved in creating tailored and personalized therapeutic interventions.Therefore,this article delineates and examines the current status of ADHD assessment,multimodal assessment methods,and future development trends,with the aim of improving the understanding of multimodal assessment methods and enhancing the quality of diagnosis and treatment for children with ADHD through their application.

Original Articles

Characteristics of cognitive function in children with attention-deficit/ hyperactivity disorder with different levels of attention and control

LIU Ziqi, LIU Siqi, TAO Mengjiao, REN Yongying, LI Guannan, SUN Jing, WANG Xin, ZHANG Jianzhao, YANG Jian

2024, 32(6):  591-596.  DOI: 10.11852/zgetbjzz2023-0969

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Objective To analyze the characteristics of cognitive function in children with attention-deficit/hyperactivity disorder (ADHD) at different levels of attention and control,as well as their relationship with cognitive function. Methods A total of 104 children with ADHD who visited the Outpatient Department of Neurology and ADHD Clinic of the Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2022 to April 2023 were selected into this study to perform Wechwecht test,Integrated Visual and Auditory Continuous Performance Test (IVA-CPT),and cognitive function tests.According to the results ofIVA-CPT, children with ADHD were divided into attention deficit type (ADHD-I),hyperactive and impulsive type (ADHD-HI) and combined type (ADHD-C).SPSS 23.0 statistical software package was used to compare the cognitive function characteristics of the three subtypes of ADHD children,and the correlation of cognitive function with symptom scores,attention and control was analyzed. Results There were significant differences in intelligence quotient (IQ),mathematical cognitive ability,numerical reasoning ability,sequential relationship and short-term memory span (flashback) among the three groups(P＜0.05).In pairwise comparisons,children with ADHD-HI showed superior IQ,mathematical cognitive abilities,numerical reasoning abilities,and sequential relationships compared to children with ADHD-C and ADHD-I (P<0.05).The cognitive ability of ADHD children was positively correlated with IQ (r=0.332 - 0.399,P＜0.05).In the correlation analysis between cognitive function and IVA scores,sequential relationships and comparison performance were slightly positively correlated with IVA-CPT results in children with ADHD (r=0.300 - 0.337,P<0.05).However,no significant correlation was found between cognitive function and SNAP-Ⅳ symptom scores (r<0.3). Conclusions ADHD children with low attention level have poor cognitive functions.Attention is correlation with sequential relation and comparison size test scores.

Impact of anxiety traits on social impairments in children with attention-deficit/hyperactivity disorder

ZHANG Linlin, WU Zhaomin, WANG Peng, CAO Xiaolan, LIU Juan, WANG Yufeng, YANG Binrang

2024, 32(6):  597-601.  DOI: 10.11852/zgetbjzz2023-0980

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Objective To investigate the impact of anxiety traits on social impairments in children with attention-deficit/hyperactivity disorder(ADHD), in order to provide reference for the treatment of ADHD. Methods From June 2017 to December 2020, a total of 205 ADHD children and 53 healthy controls were recruited from Child Healthcare and Mental Health Center of Shenzhen Children's Hospital. According to their scores in the anxiety problem factor from the Conners Parent Rating Scales, ADHD children were divided into two subgroups: ADHD with a high level of anxiety trait(ADHD+ANX) and ADHD without high level of anxiety trait(ADHD-ANX). The WEISS functional impairment rating scale-Parent form(WEISS-P) was used to assess the multiple dimensional social functioning impairment in every participant. Mediation models were built to explore the interrelationships of anxiety level and social function impairment in ADHD children. Results Compared to the healthy controls, both ADHD groups scored higher in every sub-scale from the WEISS-P. In addition, the ADHD+ANX group displayed higher scores in the family, lift skill, social activity, and risk activity sub-scales from WEISS-P than the ADHD-ANX group. Anxiety level significantly mediated the social impairments in children with ADHD. Conclusions Some of the ADHD children display higher levels of anxiety despite no current diagnosis of any anxiety disorder. In addition, a higher level of anxiety is associated with more impaired social functioning.

Executive function in children with attention-deficit/ hyperactivity disorder comorbid learning disorder

GUO Chunyan, SONG Li, WANG Yazhe, YU Rumeng, ZHANG Dingfang, YIN Menghua

2024, 32(6):  602-607.  DOI: 10.11852/zgetbjzz2023-1133

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Objective To analyze the executive function of children with attention-deficit/hyperactivity disorder (ADHD),children with learning disorder (LD),and children with ADHD comorbid LD,so as to provide scientific basis for the diagnosis and intervention of children with ADHD comorbid LD. Methods A total of 121 children with ADHD and LD who were treated in the Third Affiliated Hospital of Zhengzhou University from July 2021 to February 2023 were selected into this study.The Number Cancelation Test,Short-Term Memory,Stroop Color Word Test (SCWT),Go/No go tests and the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-Ⅳ) were used for assessment. Results In the Number Cancelation Test,the accuracy of digital cancellation in children with ADHD comorbid LD was significantly lower than that in children with ADHD or LD (H=10.101,P=0.006).In short-term memory,the stable memory length in children with ADHD comorbid LD was significantly lower than that in children with ADHD or LD(H=5.994,P=0.050),and the most stable average reaction time were significantly longer than that in children with ADHD or LD(H=12.153,P=0.002).In SCWT,the accuracy rates of word, color, and color-word test in ADHD children comorbid with LD were significantly lower than those in children with ADHD or LD (H=13.743,7.046,11.156,P＜0.05).In the Go/No go test,the average correct time of the first round of Go in children with ADHD or LD was significantly longer than that in ADHD children (H=6.593,P=0.037). Conclusions Children with ADHD comorbid LD,ADHD,and LD have lower scores on three core aspects of executive function:working memory,cognitive flexibility,and inhibitory control,and children with ADHD comorbid LD have lower scores than children with ADHD and children with LD.Children with ADHD comorbid LD,ADHD,and LD have varying degrees of impairment in executive function,with children with ADHD comorbid LD having more extensive impairment and more severe impairment of executive function.

Association between parenting style and entertainment screen time in pre-adolescence children and adolescents

CAO Hui, CHEN Jing, SHAN Rui, XIAO Wucai, ZHANG Xiaorui, LIU Zheng

2024, 32(6):  608-612.  DOI: 10.11852/zgetbjzz2024-0005

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Objective To explore the association between parenting style and entertainment screen time in pre-adolescence children and adolescents aged 10 - 15,in order to provide reference for individualized guidance for entertainment screen time. Methods The Chinese Family Panel Studies(CFPS) database was utilized to include 1 905 children and adolescents aged 10 - 15 with complete data on their parenting styles and weekly entertainment screen time in 2020. Logistic regression analysis was conducted to assess the association between parenting style and weekly entertainment screen time. Results After adjusting for children's age, sex, region, urban/rural, parental education level, parental depressive symptoms, andfamily average monthly income, it was found that children and adolescents who received authoritative parenting had a 36.7% reduced risk of excessive weekly entertainment screen time(>14 hours per week) compared to those who received non-authoritative parenting(OR=0.633, 95%CI: 0.405 - 0.991, P=0.046). This association persisted across various subgroups, including sex, urban/rural, region, parental education level, and depressive symptoms(P_{for interaction}>0.05). Conclusions Authoritative parenting is associated with lower levels of entertainment screen time in children and adolescents aged 10 - 15. This study provides a scientific basis for future personalized guidance on children and adolescents' entertainment screen time based on parenting styles.

Comparison of early catch-up growth among different types of small for gestational age infants and relevant influencing factors

WANG Xiuying, ZHENG Xiaoqin, ZOU Linli, DING Ling, FAN Ling, NIE Jing

2024, 32(6):  613-618.  DOI: 10.11852/zgetbjzz2023-1311

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Objective To compare the catch-up growth of different types of small for gestational age (SGA) children from birth to 2 years old,and to analyze related factors,in order to provide reference for the standardized management of SGA infants. Methods A retrospective study was performed on SGA infants who underwent health examination in the Department of Child Health Care of Sichuan Maternal and Child Health Hospital from January 2018 to July 2021 were selected as the study subjects,and were divided into three groups according to their birth weight and length:SGA-1(length at birth＜P₁₀),SGA-2(weight at birth＜P₁₀),and SGA-3(length and weight at birth＜P₁₀).The differences of catch-up growth among three different types of SGA at different months of age were statistical described and compared by the WHO anthro software and SPSS 27.0,and regression analysis was used to analyze related factors that affect the outcome of catch-up growth. Results 1) The catch-up ratios of SGA at different ages in each group were different.The height catch-up ratio of SGA-1 group was the highest at (24±1) months old (66.4%),followed by the weight catch-up ratio of SGA-2 group at (12±1) months old (78.7%).The height catch-up ratio of SGA-3 group reached the maximum at (24±1) months old (66.9%),and the weight catch-up ratio reached the maximum at (3±1) months old (77.4%).The incidence of height catch-up was significantly lower than that of weight catch-up(P＜0.05).2) There was no significant difference in the ratios of SGA height indicators reaching P₁₀,P₂₅,and P₅₀ between (18±1) months old and (24±1) months old in the same group (P>0.05),and there was no significant difference in the ratios of SGA weight indicators reaching P₁₀,P₂₅,and P₅₀ at (6±1),(12±1),(18±1),and (24±1) months old in the same group (P>0.05).The ratios of SGA-3 group reaching P₁₀ percentile of both body length and weight indicators at each month of age was significantly lower than those of SGA-1 group (P<0.05);the ratio of SGA-1 group achieving length and weight catch-up was higher than that of the other two groups,but there was no significant difference in some months of age compared with SGA-2 group (P>0.05).3) Delivery mode,systematic management,and mother's intrahepatic cholestasis during pregnancy were related factors affecting the outcome of SGA height catch-up growth (P<0.05). Conclusions Different types of SGA have different catch-up growth rates and peak periods.Weight catch-up occurs earlier than height catch-up,and its incidence rate is also higher than that of height catch-up,but height catch-up lasts longer with better catch-up effect.SGA children who are born with short height and weight below P₁₀ have relatively limited catch-up growth after birth.Natural childbirth and systematic management are positive factors affecting the early catch-up growth of SGA children,while intrahepatic cholestasis during pregnancy is a risk factor for SGA children's catch-up growth.Attention should be paid to the early growth characteristics and influencing factors of different types of SGA,which is important for the later management and intervention of SGA.

Path analysis of the relationships among parental pressure to eat, preschoolers' appetitive traits and weight status

CHEN Yujia, QU Fangge, WEI Xiaoxue, SONG Xinyi, CHEN Jinjin, TANG Xianqing, ZHU Daqiao

2024, 32(6):  619-624.  DOI: 10.11852/zgetbjzz2024-0017

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Objective To analyze the relationships among parental pressure to eat, preschoolers' appetitive traits, and child weight status. Methods From December 2022 to January 2023, a total of 1 086 preschoolers and their parents from 8 kindergartens in Shanghai were included in the investigation. The Chinese Preschooler's Caregivers' Feeding Behavior Scale and the Chinese Preschoolers' Eating Behavior Questionnaire were utilized to assess parental pressure to eat and child appetitive traits, specifically food responsiveness and satiety responsiveness. The relationship between these variables was examined using path analysis within a structural equation model. Results The results of path analysis revealed that pressure to eat positively predicted child satiety responsiveness(B=0.329, 95%CI: 0.278 - 0.380, P<0.001), satiety responsiveness negatively predicted child BMI-for-age Z score(BAZ)(B=-0.176, 95%CI:-0.258 - -0.094, P<0.001), child BAZ negatively predicted parental pressure to eat(B=-0.064, 95%CI:-0.115 - -0.013, P=0.015). However, parental pressure to eat was not statistically associated with child food responsiveness(P>0.05). Conclusions There may be a complex "triangle" relationship among parental pressure to eat, preschoolers' appetitive traits and child weight. Community child health professionals should guide parents of preschoolers to adopt reasonable feeding practices to minimize the interference with child appetitive traits and maintain a healthy weight.

Relative importance of nutritional and metabolic related indicators in blood for obesity in children aged 1 - 6 years based on random forest algorithm

LI Xuefeng, LIU Yakun, LANG Jing, WEI Shougang

2024, 32(6):  625-630.  DOI: 10.11852/zgetbjzz2023-1337

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Objective To explore the relative importance of nutritional and metabolic indicators in blood based on random forest algorithm in overweight and obesity among children aged 1 - 6 years,in order to provide reference for clinical evaluation of childhood obesity and development of nutritional plans. Methods Children aged 1-6 years who were admitted to the Children's Healthcare Department of the Daxing District Maternal and Child Health Hospital of Beijing from February 2021 to May 2022 were selected as study subjects,and were divided into normal group (n=400),overweight group (n=200),and obesity group (n=200).Blood related indicators among the three groups were compared,and multivariate Logistic regression analysis was used to explore the related factors of childhood obesity.The variable relative importance of random forest was obtained through SPSS Modeler,and the variables were sorted. Results The weight and body mass index (BMI) index of children in the obesity group were significantly higher than those in the overweight group and control group,while the weight and BMI index of children in the overweight group were significantly higher than those in the control group (P<0.05).Serum levels of vitamin D,vitamin A,high-density lipoprotein cholesterol (HDL-C) in the obesity group were significantly lower than those in the overweight group and control group (F=63.205,14.753,1.604,P<0.05),while fasting blood glucose (FBG),leptin,promelanocortin (POMC),low-density lipoprotein cholesterol (LDL-C),triglyceride (TG),serum total cholesterol (TC) levels were significantly higher than those in the overweight group and control group (F=79.923,1.637,23.177,46.202,93.157,293.033,P<0.05).Children in the overweight group had higher level of glutamic oxaloacetic transaminase (AST) than control group and obesity group (F=3.919,P=0.020).Multivariate Logistic regression analysis showed that obesity was mainly related to serum vitamin A,vitamin D,leptin,POMC,FBG,HDL-C,LDL-C,TG,cholesterol.After measuring the average Gini index of factors by 100 cycles,it was found that cholesterol,FBG,leptin,TG,LDL-C,POMC,HDL-C,serum vitamin D,and vitamin A were ranked as important factors affecting the occurrence of obesity. Conclusions The relevant factors and ranking of importance influencing childhood obesity among infants and preschool children can be used as auxiliary laboratory indicators for clinical evaluation of childhood obesity.Schools and parents should reasonably distribute micro nutrients intake and adjust the dietary structure of children to avoid an increase in the rate of childhood obesity.

Basic Experimental Articles

Expression of hepatic Connexin43 in young mouse model of nonalcoholic fatty liver disease

REN Xiaoxiao, LI Guohua, HUANG Xiaojin, SONG Lei, SUN Zhao, ZHAO Yongli

2024, 32(6):  631-636.  DOI: 10.11852/zgetbjzz2024-0169

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Objective To explore the change of Connexin43(Cx43) expression in the liver of young mouse model of nonalcoholic fatty liver disease (NAFLD),and to analyze its relationship with hepatocyte lipid deposition,endoplasmic reticulum stress,inflammatory infiltration and oxidative stress,in order to lay a foundation for further exploration of possible intervention targets. Methods A total of 24 4-week-old C57BL/6J mice were selected in to this study,and were randomly divided into two groups fed with normal diet and high-fat diet for 13 weeks,respectively.Then normal control and NAFLD model were established.The body weight and liver weight of mice were measured.Blood and liver samples were collected to detect blood glucose,blood lipids,cholesterol and triglycerides.The degree of liver lesion was observed by HE and oil red O staining.Immunohistochemical staining was used to detect the expression and localization of Cx43 in mouse liver tissue,and its correlation with lipid deposition related index CD36,inflammatory infiltration and oxidative stress related index CD68,F4/80 and endoplasmic reticulum stress related index GRP78,pIRE1 expression. Results Compared with the normal control group,the body weight,liver weight,triglyceride,cholesterol and blood glucose levels in NAFLD group were significantly higher (P<0.001).At the same time,it was found that compared with the control group,the expression of Cx43 in the liver of NAFLD mice was significantly up-regulated,and the expression of GRP78,IRE1,CD68,F4/80 and CD36 was also up-regulated(P<0.01).Correlation analysis showed that the expression of Cx43 was positively correlated with the expression levels of CD36 (r=0.724),CD68 (r=0.544),F4/80 (r=0.648),F4/80(r=0.575) and IRE1 (r=0.658). Conclusion Hepatic Cx43 expression is up-regulated in the young mouse model of NAFLD,which may be involved in the regulation of the pathological changes of lipid deposition,endoplasmic reticulum stress,inflammatory infiltration and oxidative stress in fatty liver.

Guideline Interpretation

Interpretation of guideline on the screening and management of congenital hypothyroidism issued by American Academy of Pediatrics in 2023

LIU Chang, ZHANG Liqin, DU Wei, LIU Tingting

2024, 32(6):  637-642.  DOI: 10.11852/zgetbjzz2023-1186

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Congenital hypothyroidism is a common thyroid disease in children. If it is not screened and treated in a timely manner, it can cause irreversible damage to intellectual and physical development. In January 2023, the American Academy of Pediatrics issued guideline on the screening and management of congenital hypothyroidism. The guideline provides detailed information on the pathophysiology of congenital hypothyroidism, neonatal screening programs and procedures, imaging and genetic diagnosis, long-term follow-up management, and evaluation. To make it more convenient for domestic pediatricians to use as a reference, this article provides an interpretation of some key contents by referring to domestic and foreign literature.

Review

Pragmatic language impairment in children with attention-deficit/hyperactivity disorder

LU Yunfeng, LI Su

2024, 32(6):  643-647.  DOI: 10.11852/zgetbjzz2023-1259

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Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder.Numerous studies indicated that pragmatic language impairment (PLI) frequently co-occurs in children with ADHD.Based on the existing literature,this paper combs the clinical manifestations of PLI in children with ADHD and its potential mechanisms of its occurrence,summarizes the possible mechanisms of PLI in ADHD children,analyzes the problems in previous studies,and proposes directions for future research.

Progress in gender differences and mechanisms of executive function in children with attention-deficit/hyperactivity disorder

HU Yiting, JIANG Kewen

2024, 32(6):  648-652.  DOI: 10.11852/zgetbjzz2024-0103

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Children with attention-deficit/hyperactivity disorder (ADHD) have significant gender differences in incidence rate, symptoms and prognosis. One of the main characteristics of ADHD children's cognitive impairment is executive function (EF) impairment. This article reviews the research on gender differences and mechanisms of ADHD children's EF in recent years, and finds that there are significant gender differences in ADHD children's EF, mainly reflected in inhibitory control, cognitive flexibility, hot EF. But the research results are different. Little is known about the mechanism of gender differences in EF, which is mainly limited to the differences in brain functional areas, such as the primary motor cortex, medial orbitofrontal cortex, basal ganglia, amygdala (positive/negative functional connection), and frontal cerebellar circuit, and there is little in-depth research.

Research progress of nutritional risk screening in hospitalized children

CHEN Qiaoling, LU Wei

2024, 32(6):  653-660.  DOI: 10.11852/zgetbjzz2023-1212

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Malnutrition is an important cause of death in children. Nutritional risk screening can initially screen children with poor clinical outcomes due to nutritional factors. However, there is no unified screening tool over the world at present, which may affect the recovery of children and increase the family burden. Malnutrition is an important cause of death in children. This review combs related researches on nutritional risk screening in children in recent years, in order to help find suitable nutritional risk screening tools for children.

Meta Analysis

Visual analysis of cognitive function of attention-deficit/hyperactivity disorder at home and abroad in recent 10 years based on Citespace

WU Yonghua, YU Jinglong, ZHOU Kangning, WANG Junhong

2024, 32(6):  661-667.  DOI: 10.11852/zgetbjzz2023-0221

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Objective To analyze the current research status, hotspots, and trends of cognitive function in attention deficit hyperactivity disorder (ADHD) in the past decade both domestically and internationally by using CiteSpace,in order to provide reference for further research of ADHD. Methods CiteSpace software was used to retrieve relevant articles on the cognitive function of ADHD in the past decade from Web of Science (WOS) and Chinese academic databases, including CNKI, Wanfang, and VIP databases.Then bibliometric method was used to analyze and visualize the results on countries, institutions and keywords. Results After screening, a total of 4 673 papers from 2013 to 2022 were included, including 4 274 articles from WOS and 399 Chinese papers after deduplication.The number of international publications was increasing, while the number of domestic publications was stable.This analysis included 78 countries/regions and 391 international institutions, with higher education institutions and medical centers in Europe and America, notably the United States, playing a significant role.Additionally, 182 domestic institutions, primarily regional specialized hospitals, were included.Keywords formed 10 tag clusters in international publications while 8 tag clusters formed in domestic publications.A total of 20 emerging words appeared in the domestic analysis, and 25 emerging words appeared in the international analysis.Both domestic and international research focused on children or adolescents as a group and highlighted the cognitive function of ADHD comorbidity.International research primarily focused on executive function and its detection methods and basic research, while domestic research mainly concentrated on observing the efficacy of drug and non-drug interventions.The research hotspot was mainly on molecular biology mechanisms and clinical research. Conclusions In the past decade, overseas research on the cognitive function of ADHD has been more comprehensive and systematic, while domestic research is currently in a stable development stage with different research hotspots.China can learn from international development experiences, increase investment in basic research such as neurophysiology, and promote the development of this field in accordance with its own national conditions.

Clinical Research

Correlation between serum irisin with endocrine and metabolic indicators in obese children

WANG Jie, XUE Yongzhen, XU Ming, CHEN Weiju, YOU Juanjuan, HU Yanyan

2024, 32(6):  668-671.  DOI: 10.11852/zgetbjzz2023-1213

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Objective To study the association of serum irisin level with endocrine and metabolic parameters in obese children,in order to provide reference for clinicd practice. Methods Data of 89 children treated in Linyi People's Hospital from May 2022 to May 2023 were retrospectively analyzed.According to body mass index (BMI), children were divided into obesity group (n=48) and normal control group (n=41).Multiple linear regression analysis was used to analyze the related factors of serum irisin and endocrine metabolism indexes. Results The levels of serum irisin, free triiodothyronine (FT3), free triiodothyronine/free thyroxine (FT3/FT4), thyroid stimulating hormone (TSH),adrenocoriticotropbic hormone(ACTH), triglyceride (TG), C-peptide, insulin, insulin resistance index (HOMA-IR)in obese children were significantly higher than those of the control group (t/Z=2.120, 2.836, 2.403, 2.325, 2.099, 5.870, 7.186, 7.120, 7.103, P<0.05), while high-density lipoproteinwas significantly lower than that in the control group (t=4.084, P<0.05).It was found that serum irisin level was positively correlated with TG (r=0.390, P=0.006) and negatively correlated with FT3 (r=-0.311, P=0.032).Multiple linear regression analysis showed that FT3 (β=-0.468) and TG (β=0.599) were the main factors influencing serum irisin levels in obese children. Conclusion Obese children have a high serum irisin level, and irisin is associated with lipid metabolism and thyroid function.

Consistency analysis of body composition and overweight/obesity among infants

LI Zongqin, WANG Nianrong, SHEN Liang, XIAO Xiao, WANG Li

2024, 32(6):  672-677.  DOI: 10.11852/zgetbjzz2024-0049

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Objective To investigate the prevalence of overweight and obesity among infants in Chongqing,and to analyze the consistency of body composition with overweight /obesity,so as to provide a basis for child nutrition assessment and the prevention and control of childhood obesity. Methods A total of 4 546 infants aged 0 to 12 months who visited the outpatient clinic of the Department of Child Health of Chongqing Maternal and Child Health Hospital were selected into this study from September 2021 to September 2023,and physical measurements were routinely performed.At the same time,a three-dimensional modeling body composition analyzer was used to determine their body composition,and the detection indicators included length,weight,body mass index (BMI),protein,inorganic salt,body water,muscle mass,lean body mass,etc.The relationship of gender,month age and nutritional status with body composition,and the consistency of body fat percentage and weight-for-length Z-score (WLZ) diagnosing overweight/obesity were analyzed. Results The body length,weight,BMI,basal metabolism,total water content,body fat percentage,body fat weight,fat-free body weight,muscle weight,protein and inorganic salt of male infants were significantly higher than those in female infants (t=10.427,14.183,10.586,10.413,10.291,20.712,22.222,10.601,10.139,9.559,17.447,P<0.001).The detection rates of overweight and obesity reached the peak at 5 and 6 months old (P<0.05).In the total composition,the proportion of body fat weight gradually increased among weight loss(13.72%),normal(17.81%),overweight (20.79%) and obesity(23.34%) groups (P<0.05).The detection rates of overweight and obesity was higher male infants than in female infants (χ²=37.808,17.655,P<0.001).The detection rate of infant obesity diagnosed by WLZ was 10.60% for male infants and 7.04% for female infants,while the detection rate of infant obesity diagnosed by body composition test was 19.67% for male infants and 12.95% for female infants.The consistency of percentage of body fat and WLZ screening for infant obesity was high,with a Kappa index of 0.614 and 0.649 for male and female infants,respectively(P<0.001). Conclusions The current situation of overweight and obesity among infants in Chongqing is not optimistic,and the combination of body composition testing can reduce the rate of missed diagnosis and misdiagnosis,as well as the development of individualized interventions.It is of great practical significance to adjust the infant nutrition structure and reduce the health risk.

Expression and significance of serum cortisol, insulin growth factor-binding protein-3, 25-hydroxyvitamin D in children with idiopathic short stature

HE Li, LYU Jiali, LI Jun, DU Chunhua

2024, 32(6):  678-681.  DOI: 10.11852/zgetbjzz2023-0716

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Objective To explore the expression and significance of serum cortisol, insulin growth factor binding protein-3(IGFBP-3), and 25-hydroxyvitamin D [25-(OH)D] in children with idiopathic short stature(ISS). Methods A total of 86 patients with ISS diagnosed and treated in Longquanyi District Maternal and Child Health Hospital of Chengdu from April 2020 to June 2022 were selected as the study subjects. Meabwhile, 43 children who took physical examination were enrolled into control group. Baseline data, serum cortisol, IGFBP-3, 25-(OH)D levels were compared. Pearson analysis was used to test the associations of cortisol, IGFBP-3, and 25-(OH)D with height, weight and body mass index(BMI). Logistic regression model was used to construct a combination model of cortisol, IGFBP-3 and 25-(OH)D for diagnosing ISS. The AUC value, sensitivity, and specificity of cortisol, IGFBP-3, 25-(OH)D and three combined indicators for diagnozing ISS were analyzed using the ROC curve model. Results Height, weight and BMI of the observation group were significantly lower than those of the control group(t=6.472, 15.193, 5.208, P<0.05). Serum level of cortisol in the observation group was significantly higher than that in the control group, while IGFBP-3 and 25-(OH)D levles were significantly lower than those in the control group(t=4.505, 5.341, 4.857, P<0.05). Pearson correlation analysis showed that serumcortisol level was negatively correlated with height, body weight and BMI(r＝-0.231,-0.716,-0.720, P<0.05), while serum IGFBP-3 and 25-(OH)D levels were positively correlated with height, body weight and BMI(r=0.200, 0.612, 0.636, 0.365, 0.716, 0.715, P<0.05). ROC curve analysis showed that the AUC values of cortisol, IGFBP-3, 25-(OH)D and three combined diagnosis of ISS were 0.750, 0.736, 0.728, 0.941(P<0.05), and the sensitivities were 54.70%, 93.00%, 90.70% and 93.00%, respectively, while the specificity was 88.40%, 53.50%, 51.20% and 79.10%, respectively. Conclusions Serum cortisol, IGFBP-3, 25-(OH) D levels show an abnormal expression trend in children with ISS. Monitoring the changes in their levels is beneficial to provide guidance for the early detection of ISS.

Case-control study of family and behavioral factors for precocious puberty in girls

LI Weiqin, DU Yuexin, SONG Panpan, WANG Leishen, ZHANG Shuang, LI Wei, LENG Junhong

2024, 32(6):  682-686.  DOI: 10.11852/zgetbjzz2023-0706

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Objective To analyze the influencing factors of precocious puberty in girls, in order to provide evidence for children's healthcare. Methods A total of 177 precocious puberty girls treated in Tianjin Women and Children's Health Center between October 2019 and August 2022 were recruited as the case group, and 354 healthy girls matched 1∶2 by age were selected as the control group based on routine physical examination. Information of age, behavior factors were collected, height and body weight were recorded and body mass index(BMI) was calculated. The comparison between the two groups was performed using the t test or the χ² test. Logistic regression model was used to determine the potential influencing factors of precocious puberty. Results The average age of girls in case and control groups were (7.72±1.02) and (7.60±1.05) years old, respectively,and the difference was not significant (P>0.05). Multivariate Logistic regression analysis showed that larger waist circumference(OR=1.11, 95%CI: 1.07 - 1.15), screen time ＞1h/d(OR=4.35, 95%CI: 2.62 - 7.22), moderate-to-vigorous physical activity ≤1h/d(OR=3.14, 95%CI: 1.71 - 5.75), and higher ratio of plastic bottled water(OR=1.02, 95%CI:1.01 - 1.03) were risk factors, and mother's older age at menarche(OR=0.59, 95%CI:0.45 - 0.76), father's older age of first spermatorrhea(OR=0.67, 95%CI: 0.53 - 0.85), and longer nap time(OR=0.97, 95%CI: 0.96 - 0.98) were protective factors for precocious puberty in girls(P＜0.05). Conclusion Health education should be strengthened to help children establish good behavior habits to reduce the risk of precocious puberty in girls.

Health Education

Quality of life in adolescents and its relationships with healthy knowledge and healthy behavior

BAO Chengzhen, GAO Lili, HAN Lili

2024, 32(6):  687-691.  DOI: 10.11852/zgetbjzz2024-0048

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Objective To investigate the status of quality of life among adolescents in Beijing, and to analyze its correlation with healthy knowledge and healthy behavior, in order to provide reference for improving their quality of life. Methods Adolescents aged 10 - 19 in Beijing participated in the survey from April to May, 2020 after multistage cluster sampling. Based on field survey, data on basic information, quality of life, healthy knowledge and healthy behavior were collected. Influencing factors for quality of life in adolescents were determined through multiple linear regression analysis. Results In 6 098 valid questionnaires, the mean score of quality of life was 88.15±13.26, and those of four dimensions named physical functioning, emotional functioning, social functioning and school functioning were 89.46±13.93, 84.49±20.45, 91.60±14.87, 86.26±15.27, respectively. All of the mean scores of four dimensions in female were significantly lower than those in male, and which in general high school students were also significantly lower than those in primary, middle and vocational high school students (P＜0.05). Based on multivariate analysis, it was found that wrong knowledge about healthy food (β=-0.06) and drink (β=-0.05), and risk assessment (β=-0.05) and emergency treatment (β=-0.03) for injuries, as well as the inappropriate eating habits (β=-0.03), hygiene practice (β=-0.11), and inadequate sleeping duration (β=-0.09) had negative effect on quality of life among adolescents in Beijing, while non-experience of smoking (β=0.07) had positive effect on quality of life(P＜0.05). Conclusions Adolescents in Beijing have higher quality of life than the others, which might be influenced by healthy knowledge and healthy behavior. An effective model for intervention should be found to improve the quality of life of adolescents.

Case Report

Clinical and rare cranial magnetic resonance image findings of a child with atypical RETT syndrome and literature review

SHI Zhen, CHEN Wenxiong

2024, 32(6):  692-696.  DOI: 10.11852/zgetbjzz2023-0426

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