Epidemiology and Health

Systematic Review

Handgrip strength thresholds associated with metabolic syndrome risk in children and adolescents: a systematic review and meta-analysis: Hye Ah Lee, Seunghee Jun, Hyesook Park; Epidemiol Health. 2024;46:e2024047. Published online April 24, 2024; DOI: https://doi.org/10.4178/epih.e2024047

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Certain studies have reported that handgrip strength (HGS) is associated with metabolic health risks in children and adolescents, and some studies have suggested HGS thresholds for identifying poor metabolic health. Therefore, we aimed to determine the HGS thresholds associated with metabolic syndrome (MetS) in children and adolescents through a systematic review.
METHODS
We searched 3 electronic databases from their inception until October 2023 to identify original papers that focused on children and adolescents and assessed their risks of MetS according to specific HGS values. Studies were selected for inclusion through a planned screening process based on specific criteria. The Quality Assessment Tool for Diagnostic Accuracy Studies version 2 (QUADAS-2) was used to evaluate quality, and a meta-analysis was performed using the diagmeta R package to suggest the optimal thresholds.
RESULTS
From the search, 8 studies were selected for this systematic review. For detecting MetS risk, the optimal threshold for HGS (defined as relative HGS by adjusting for body mass) was found to be 0.422, with a sensitivity of 76.7% (95% confidence interval [CI], 64.0 to 85.8) and a specificity of 62.9% (95% CI, 56.9 to 68.5). The stratification analysis by sex resulted in optimal thresholds of 0.416 for boys and 0.376 for girls. Additionally, when the data were stratified by age, the thresholds were 0.356 for children and 0.416 for adolescents.
CONCLUSIONS
Our results provide practical information for detecting high-risk groups and encouraging strength-related activities that may reduce the risk of MetS in children and adolescents.; Summary

Korean summary
- 본 연구는 체계적 고찰 및 메타 분석을 수행하여 아동 및 청소년의 대사 증후군(MetS) 위험을 감지하기 위한 최적의 악력 임계값을 제안했습니다. - 본 연구 결과는 아동 및 청소년의 대사 증후군(MetS) 위험을 줄이기 위해 근력 관련 활동이 필요한 고위험군을 식별하는 데 사용할 수 있으므로 1차 임상 및 공공 의료에 실용적인 정보를 제공합니다.

Key Message
- This study conducted a systematic review and meta-analysis to propose the optimal handgrip strength (HGS) threshold for detecting the risk of metabolic syndrome in children and adolescents. - The results provide practical information for primary clinical and public healthcare, as they can be used to identify high-risk groups in need of strength-related interventions to reduce the risk of metabolic syndrome in children and adolescents.

Original Articles

Aspergillus sensitization associated with current asthma in children in the United States: an analysis of data from the 2005-2006 NHANES: Hui-Ju Wen, Shu-Li Wang, Ming-Chieh Li, Yue Leon Guo; Epidemiol Health. 2022;44:e2022099. Published online October 28, 2022; DOI: https://doi.org/10.4178/epih.e2022099

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Abstract

OBJECTIVES
This study investigated the association between allergen sensitization and current asthma in children in the United States using data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES).

METHODS

Children who participated in the 2005–2006 NHANES, aged 6 years to 19 years, were included in this study. A structured questionnaire was used to assess asthma status (without asthma, asthma in remission, or current asthma). Nineteen specific immunoglobulin E (sIgE) levels were measured using the Pharmacia Diagnostics ImmunoCAP 1000 System (Kalamazoo, MI, USA). A machine-learning method was applied to select important sIgEs related to childhood asthma. Multivariate regression analysis was used to test this hypothesis.

RESULTS

In total, 2,875 children were recruited. The prevalence of ever having asthma and current asthma was 16.5% and 5.6%, respectively. Six sIgE levels were found to contribute to asthma using bootstrap forest selection. After adjusting for the child’s sex, age, and family income, children with double the sIgE levels of Dermatophagoides farinae, dogs, and Aspergillus were more likely to have current asthma than children without asthma (odds ratio [95% confident interval]: 1.11 [1.04 to 1.19], 1.30 [1.16 to 1.46], and 1.55 [1.39 to 1.72], respectively).

CONCLUSIONS

Our findings suggest that allergen sensitization, especially to Aspergillus, is associated with current asthma in children. Strategies to reduce sensitization may help prevent and manage asthma.

Summary

Key Message
This investigation studied 2,875 children from the National Health and Nutrition Examination Survey (NHANES) 2005-2006, aged less than 19 years, for the association between allergen sensitization and persistent asthma. Six specific IgE levels (i.e. Dermatophagoides farina, Dermatophagoides pteronyssinus, cat, dog, Alternaria, and Aspergillus) were found to contribute to asthma using bootstrap forest selection. Our findings suggested that allergen sensitization, especially to Aspergillus, is associated with asthma persistence in children after adjusting for potential confounders. Strategies to reduce sensitization may help prevent and manage asthma.

Citations

Citations to this article as recorded by

Aspergillus‐sensitized asthma in children
Enes Celik, Dilara Kocacik Uygun, Mehmet Akif Kaya, Merve Sibel Gungoren, Ayse Keven, Aysen Bingol
Pediatric Allergy and Immunology.2024;[Epub] CrossRef
Age-related differences in IgE between childhood and adulthood allergic asthma: Analysis of NHANES 2005–2006
Heping Fang, Juan Li, Luo Ren, Enmei Liu
World Allergy Organization Journal.2023; 16(12): 100842. CrossRef

Epidemiological data on nutritional disorders and outcomes in hospitalized Thai children: an analysis of data from the National Health Database 2015-2019: Suchaorn Saengnipanthkul, Jeeraparn Phosuwattanakul, Kaewjai Thepsuthammarat, Nalinee Chongviriyaphan; Epidemiol Health. 2022;44:e2022047. Published online May 16, 2022; DOI: https://doi.org/10.4178/epih.e2022047

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Abstract

OBJECTIVES
Malnutrition in hospitalized patients is a frequently overlooked health issue. We aimed to assess the prevalence and pattern of nutritional disorders in hospitalized Thai children from the National Health Database.

METHODS

Hospitalized children aged 1 month to 18 years diagnosed with nutritional disorders between 2015 and 2019 were retrospectively reviewed using the National Health Security Office data. Based on the International Classification of Diseases, 10th revision, Clinical Modification, nutritional disorders were classified into 3 major forms of malnutrition: undernutrition (E40-E46), overweight and obesity (E66), and micronutrient deficiencies (D50-D53, E50-E56, E58, E60-E61, and E63).

RESULTS

Out of 5,188,033 hospitalized children, malnutrition was identified in 115,254 (2.2%). Protein-energy malnutrition (PEM), overweight and obesity, and micronutrient deficiencies were prevalent in 0.21%, 0.27%, and 1.81%, respectively. Among those with micronutrient deficiencies, 95.0% had iron deficiency anemia, 2.2% had vitamin D deficiency, and 0.7% had zinc deficiency. Children aged under 5 years mostly had PEM, followed by iron deficiency anemia. Teenagers commonly had obesity and vitamin D deficiency. Patients with PEM who were admitted with common diseases had significantly longer hospital stays and higher hospital costs and mortality rates than those without PEM.

CONCLUSIONS

Hospitalized children had various nutritional disorders, particularly PEM, which was associated with higher morbidity and mortality. Nutritional screening tools should be utilized for the early detection and treatment of malnutrition. Specific International Classification of Diseases codes for nutritional care services and intervention should be available. Additionally, nutritional interventions should be reimbursed, along with nutritional education and empowerment of healthcare providers, to improve hospital care service and improve patient outcomes.

Summary

Key Message
Malnutrition is common among hospitalized Thai children, particularly protein energy malnutrition; it increases mortality, length of hospital stay, and hospital costs as well as exerts long-term effects on growth and development. Prevalence of overweight and obesity is increasing over the past 5 years, the vast majority involved patients 5 – 13 years of age.

Citations

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The Low Sensitivity and Specificity of a Nutrition Screening Tool in Real Circumstances in a Tertiary Care Hospital Setting
Nithit Semsawat, Oraporn Dumrongwongsiri, Phanphen Phoonlapdacha
Children.2023; 10(4): 747. CrossRef

Age-specific effects of ozone on pneumonia in Korean children and adolescents: a nationwide time-series study: Kyoung-Nam Kim, Youn-Hee Lim, Sanghyuk Bae, In Gyu Song, Soontae Kim, Yun-Chul Hong; Epidemiol Health. 2022;44:e2022002. Published online December 28, 2021; DOI: https://doi.org/10.4178/epih.e2022002

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Abstract

OBJECTIVES
The aim of this study was to estimate the age-specific effects of 8-hour maximum ozone levels on pneumonia in children and adolescents.

METHODS

We performed quasi-Poisson regression analyses for individuals of 0-4 years, 5-9 years, 10-14 years, and 15-19 years of age using nationwide time-series data from the Korea (2011-2015). We constructed distributed lag linear models employing a generalized difference-in-differences method and controlling for other air pollutants.

RESULTS

A 10.0-parts per billion increase in 8-hour maximum ozone levels was associated with a higher risk of hospital admissions due to pneumonia at 0-4 (relative risk [RR], 1.02; 95% confidence interval [CI], 1.01 to 1.03) and 5-9 years of age (RR, 1.06; 95% CI, 1.04 to 1.08), but not at 10-14 (RR, 1.01; 95% CI, 0.98 to 1.04) or 15-19 years of age (RR, 1.01; 95% CI, 0.97 to 1.06). The association between ozone and hospital admissions due to pneumonia was stronger in cool seasons (from November to April) than in warm seasons (from May to October), but was similar between boys and girls.

CONCLUSIONS

Short-term exposure to ozone was associated with a higher risk of pneumonia at 0-4 years and 5-9 years of age, but not at 10-14 years or 15-19 years of age. Our findings can help identify vulnerable periods, determine the target populations for public health interventions, and establish air pollution standards.

Summary

Korean summary
-어린이와 청소년에서 대기오염물질인 오존에 단기 노출되었을 때 폐렴으로 인한 입원 위험이 증가하는지를 건강보험공단 청구자료를 이용하여 구축한 시계열자료로 분석하였다. -0-4세, 5-9세 군에서는 오존 단기 노출 시 폐렴으로 인한 입원 위험이 증가하였으나 10-14세, 15-19세 군에서는 입원 위험 증가가 관찰되지 않았다.

Key Message
• The effects of ozone levels on hospital admissions for pneumonia were evaluated. • We used quasi-Poisson time-series models and a difference-in-differences method. • Ozone levels increased hospital admissions for pneumonia at ages 0–4 and 5–9 years. • Evidence for the effects of ozone levels on pneumonia was not found at older ages.

Citations

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Challenges of Air Pollution and Health in East Asia
Xihao Du, Renjie Chen, Haidong Kan
Current Environmental Health Reports.2024; 11(2): 89. CrossRef
Intraday exposure to ambient ozone and emergency department visits among children: a case-crossover study in southern China
Jiahong Ren, Lifeng Zhu, Yachen Li, Haiyi Li, Qian Hu, Jian Zhu, Qingyan Zhang, Yunquan Zhang
Environmental Science and Pollution Research.2023; 30(30): 74853. CrossRef

Recovery time from severe acute malnutrition and associated factors among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study: Mekonen Adimasu, Girum Sebsibie, Fikrtemariam Abebe, Getaneh Baye, Kerebih Abere; Epidemiol Health. 2020;42:e2020003. Published online February 2, 2020; DOI: https://doi.org/10.4178/epih.e2020003

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Abstract PDF

Abstract

OBJECTIVES
Recovery time from severe acute malnutrition (SAM) is often a neglected topic despite its clinical impact. Although a few studies have examined nutritional recovery time, the length of hospitalization in those studies varied greatly. Therefore, the aim of this study was to determine the recovery time from SAM and to identify predictors of length of hospitalization among under-5 children.

METHODS

A retrospective cohort study was conducted among 423 under-5 children with SAM who had been admitted to Yekatit 12 Hospital. Kaplan-Meier analysis was used to estimate time to nutritional recovery, and Cox proportional hazard regression analysis was performed to determine independent predictors.

RESULTS

The nutritional recovery rate was 81.3%, and the median recovery time was 15.00 days (95% confidence interval [CI], 13.61 to 16.39). Age, daily weight gain per kilogram of body weight, vaccination status, and the existence of at least 1 comorbidity (e.g., pneumonia, stunting, shock, and deworming) were found to be significant independent predictors of nutritional recovery time. The adjusted hazard ratio (aHR) for nutritional recovery decreased by 1.9% for every 1-month increase in child age (aHR, 0.98; 95% CI, 0.97 to 0.99).

CONCLUSIONS

The overall nutritional recovery time in this study was within the Sphere standards. However, approximately 13.0% of children stayed in the hospital for more than 28.00 days, which is an unacceptably large proportion. Daily weight gain of ≥8 g/kg, full vaccination, and deworming with albendazole or mebendazole reduced nutritional recovery time. Conversely, older age, pneumonia, stunting, and shock increased nutritional recovery time.

Summary

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Stabilizing time and its predictors among 1–59 months old children managed for severe acute malnutrition during the humanitarian crisis in Tigray regional state of Ethiopia, 2023: a prospective cohort study
Wagnew Tesfay, Mebrahtu Abay, Berhane Fseha Teklehaimanot, Ataklti Gebremedhin
BMC Pediatrics.2024;[Epub] CrossRef
Predictors of recovery from severe acute malnutrition among 6–59 months children admitted to a hospital
Assefa Andargie, Segenet Zewdie
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Determinants of recovery time from severe acute malnutrition among cholera-exposed and unexposed children in Ethiopia: a prospective cohort study
Alemayehu Belay Alamneh, Kalkidan Hassen Abate, Ashagre Molla Assaye, Yeshambel Worku Demlie, Moti Edosa Guma, Tefera Belachew
Frontiers in Nutrition.2024;[Epub] CrossRef
Recovery time and its predictors of severe acute malnutrition among under five children admitted at the therapeutic feeding center of Hiwot Fana comprehensive specialized hospital, eastern Ethiopia, 2024: a semi-parametric model
Fentahun Meseret, Mulualem Keneni, Ayichew Alemu, Diribsa Tizazu, Tesfaye Asfaw Alemayehu, Yalew Mossie, Tilahun Teshager, Fenta Wondimneh
Frontiers in Nutrition.2024;[Epub] CrossRef
Time to recovery from severe acute malnutrition and its predictors among under five children admitted to therapeutic feeding units of general and referral hospitals in Tigray, Ethiopia, 2020: a prospective cohort study
Gebretsadkan Fisseha Kidane, Kidane Zereabruk, Woldu Aberhe, Abrha Hailay, Guesh Mebrahtom, Gebreamlak Gebremedhn Gebremeskel, Teklehaimanot Gereziher Haile, Desalegn Massa Teklemichael
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Impact of malnutrition on the outcome and length of hospital stay in elective pediatric surgical patients: prospective cohort study at tertiary hospitals in Ethiopia
Belachew D. Wondemagegnehu, Woubedel K. Aklilu, Milliard D. Beyene, Bareng A. Sanny Nonyane
BMC Nutrition.2023;[Epub] CrossRef
Comorbidities of Child Malnutrition in Low- and Medium-Income Countries: A Systematic Review
Tshepiso Moate, Tinda Rabie, Catharina Minnie, Anne Mäenpää
Journal of Pediatric Gastroenterology & Nutrition.2022; 75(4): 400. CrossRef
Severe acute malnutrition’s recovery rate still below the minimum standard: predictors of time to recovery among 6- to 59-month-old children in the healthcare setting of Southwest Ethiopia
Seyum Ebissa Eyi, Gebiso Roba Debele, Efrem Negash, Kebebe Bidira, Debela Tarecha, Kabtamu Nigussie, Mohammedamin Hajure, Mohammedjud Hassen Ahmed, Bilisumamulifna Tefera Kefeni
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Abdullah-Al Mamun, Shuva Bhowmik, Md. Shahid Sarwar, Sharmin Akter, Tanjina Pias, MUM Abu Zakaria, Md. Monirul Islam, Hillary Egna, Ford Evans, Md Abdul Wahab, Shakuntala Haraksingh Thilsted, David C. Little
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Idzes Kundan, Rajalakshmi Nair, Shashwat Kulkarni, Aparna Deshpande, Raju Jotkar, Mrudula Phadke
BMJ Nutrition, Prevention & Health.2021; 4(1): 267. CrossRef
Risk factors for severe acute malnutrition among children aged 6–59 months: A community-based case-control study from Vellore, Southern India
SamM David, RubyA Pricilla, SherinS Paul, Kuryan George, Anuradha Bose, JasminH Prasad
Journal of Family Medicine and Primary Care.2020; 9(5): 2237. CrossRef
Time to Recovery and Its Predictors among Children 6–59 Months Admitted with Severe Acute Malnutrition to East Amhara Hospitals, Northeast Ethiopia: A Multicenter Prospective Cohort Study
Telahun Kasa Tefera, Solomon Mekonnen Abebe, Melkamu Tamir Hunegnaw, Freezer Girma Mekasha
Journal of Nutrition and Metabolism.2020; 2020: 1. CrossRef

Incidence and predictors of tuberculosis among HIV-positive children at Adama Referral Hospital and Medical College, Oromia, Ethiopia: a retrospective follow-up study: Masino Tessu Beshir, Aklil Hailu Beyene, Kenean Getaneh Tlaye, Tefera Mulugeta Demelew; Epidemiol Health. 2019;41:e2019028. Published online June 22, 2019; DOI: https://doi.org/10.4178/epih.e2019028

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Abstract

OBJECTIVES
Tuberculosis (TB) is common in children with human immunodeficiency virus (HIV), but its effect on the survival of HIV-infected children is not well understood. Therefore, the aim of this study was to assess the incidence and predictors of active TB among HIV-positive children at Adama Referral Hospital and Medical College, Oromia, Ethiopia.

METHODS

A retrospective study was conducted over 5 years using a checklist to gather data from 428 randomly selected pediatric patient charts. The checklist was adapted from the standardized antiretroviral therapy (ART) follow-up form currently used by the institution’s ART clinic. Data were analyzed by bivariate and multivariable analysis using Cox regression proportional hazards models, as appropriate. Survival was calculated and compared using the Kaplan-Meier and log-rank tests.

RESULTS

Of the 466 charts reviewed, 428 patient records were included in the analysis. A total of 67 new TB cases were observed during the follow-up period. Hence, the incidence rate in this cohort was found to be 6.03 per 100 child-years of observation. A baseline hemoglobin level <10 g/dL (adjusted hazard ratio [aHR], 7.04; 95% confidence interval [CI], 1.03 to 48.15), moderate wasting (aHR, 2.86; 95% CI, 1.02 to 7.99), and not receiving isoniazid preventive therapy (aHR, 8.23; 95% CI, 2.11 to 32.06) were among the independent predictors of TB occurrence.

CONCLUSIONS

The incidence of TB was high, particularly in pre-ART patients receiving chronic care for HIV. Close followup of HIV-positive children is crucial to protect them against the development of TB. Initiating isoniazid preventive therapy, averting malnutrition, and managing anemia are also of significant importance.

Summary

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Fassikaw Kebede Bizuneh, Dejen Tsegaye, Belete Negese Gemeda, Tsehay Kebede Bizuneh, Sanghyuk S. Shin
PLOS Global Public Health.2024; 4(8): e0003528. CrossRef
Incidence and predictors of opportunistic infections among HIV-infected children on antiretroviral therapy at public health facilities of Southwest Ethiopia People Regional State, 2023: a multicenter retrospective follow-up study
Nigatu Admasu, Mohammed Jihad, Abeje Kebede, Masrie Getnet
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Socioeconomic disparities and difficulties to access to healthcare services among Canadian children with neurodevelopmental disorders and disabilities: Sana Raouafi, Sofiane Achiche, Maxime Raison; Epidemiol Health. 2018;40:e2018010. Published online March 29, 2018; DOI: https://doi.org/10.4178/epih.e2018010

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Abstract PDF Supplementary Material

Abstract

OBJECTIVES
The aims of this study were to identify the associations of levels of severity of neurodevelopmental disorders and disabilities (NDD/D) in children with their household socioeconomic status (SES) and their frequency of visits to a healthcare provider, and to examine how the severity of disability varied with these determinants among NDD/D subgroups, in order to inform possible social policy changes and to improve access to the healthcare system.

METHODS

Data from the 2006 Participation and Activity Limitation Survey on children aged 5-14 years, collected by Statistics Canada, were analyzed (n=7,072 and weighted n=340,340). Children with NDD/D constituted those with impairments in motor, speech, neurosensory, and psychological functioning, as well as those who had issues with learning/cognition and social interactions. The weighted sample size for this group was n=111,630 (total sample size for children with limitations: n=174,810). We used logistic regression to assess the associations of household SES and frequency of visits to a healthcare provider with disability level. We included NDD/D subgroups as interaction terms in the model. Multiple correspondence analysis (MCA) was conducted to develop a profile of disability level.

RESULTS

After-tax low income, family assistance, out-of-pocket expenses, needing but not receiving health services from a social worker, condition of the dwelling, and residential location were associated with the severity of NDD/D. Using MCA, 2 disability profiles could be identified based on access to healthcare, household income status, and condition of the dwelling.

CONCLUSIONS

More social interventions are needed to reduce difficulties in accessing healthcare and to diminish the socially determined health inequalities faced by children with NDD/D.

Summary

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