Obesity-related type 2 diabetes now accounts for a substantial proportion of newly recognized diabetes in the adolescent age group - and this proportion is escalating rapidly. Adverse cardiovascular risk factors are prevalent in this population. Public health measures to curtail the rise of obesity in childhood and adolescence are required urgently.
OBJECTIVES: First, to determine obesity rates in Auckland school children according to their ethnic group using two different criteria: the body mass index (BMI) and percentage body fat (PBF) derived from bioelectrical impedance analysis (BIA). Second to examine the relationship between BMI and body composition across ethnic groups to determine if BMI references from European children accurately re¯ect obesity in other ethnic groups. DESIGN: A total of 2273 Auckland school children, aged 5 ± 10.9 y had their height, weight and bioelectrical impedance measured. Using these measurements, each child's BMI, fat free mass, fat mass and PBF were derived. RESULTS: In all 14.3% of children were obese using the recommended de®nition of obesity (BMI) greater than the 95th percentile). There was no clinically signi®cant difference in the relationship between BMI and body composition in different ethnic groups. Obesity rates varied with ethnicity (P`0.0001) and were higher in Paci®c Island (24.1%) and Maori (15.8%) than in European children (8.6%). Obesity rates also varied with age (P`0.03), with the highest rates in older children. PBF levels were higher in females than males (P`0.0001). Using a de®nition of obesity based on percentage body fat (PBF b 30%), obesity rates were higher in all ethnic groups. CONCLUSIONS: Obesity rates are high in Auckland school children and there are clear differences in obesity rates in different ethnic groups. If BMI criteria are used to de®ne obesity in our population, we recommend the same standards be used for children of all ethnicities.
Although it is known that the incidence of type 1 diabetes mellitus (DM) in childhood is progressively increasing, it is less clear whether the presentation of newly diagnosed DM is changing. The aim of this study was to establish whether any biochemical or clinical presentation parameters have altered over time. A retrospective study was performed comparing newly diagnosed children with DM in two 24 month time intervals, 8 yrs apart (1988-89 and 1995-96). Fifty-seven children were diagnosed with type 1 DM in 1988-89 and 70 children in 1995-96. At presentation, children born in the later cohort had a higher pH (p < 0.001) and lower serum glucose (p < 0.05). Although the frequency of diabetic ketoacidosis (DKA) was higher in the 1988/89 cohort (63% vs. 42% in 1995/96) the absolute number of children with DKA in each time interval was similar (33 subjects in 1988-89 vs. 30 subjects in 1995/96). Islet cell antibody (ICA) levels were very different between the two cohorts; higher antibody levels were found in the 1988/89 group (p < 0.01). DKA was also associated with higher ICA titres (p < 0.05). Hospital admission stay decreased from 6.5 DS to 3.4 DS over the 8-year period (p < 0.0001). At our institution, the presentation of children with type 1 DM is changing with many more children diagnosed before developing DKA. We speculate that a new environmental factor(s) may be responsible for the absolute increase in patients presenting without DKA, while older etiologies (both genetic and environmental) are responsible for the steady, unchanging number of patients with a more severe presentation. Greater awareness of diabetes in children is not the factor contributing to earlier diagnosis before DKA develops.
The increasing use of human growth hormone (hGH) treatment has resulted in the introduction of a number of alternative delivery systems to conventional syringe and needle administration. We examined patients' evaluation of a new delivery system, the Kabipen (KabiVitrum). We also assessed the accuracy of hGH delivery by the Kabipen. Of the 77 survey respondents 13 had used only the Kabipen, 14 the syringe only, and 50 had used both systems. Altogether 46 (92%) of those who had used both systems preferred the Kabipen. Children over 10 years were more likely to self administer hGH with the Kabipen (64%) than syringe (25%
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