Twins with alveolar capillary dysplasia with misalignment of pulmonary veins: Strategies for diagnosis and management

We present a case of dichorionic-diamniotic twin females who developed hypoxemic respiratory failure. They were ultimately diagnosed by lung biopsy with alveolar capillary dysplasia with misalignment of pulmonary veins. This case highlights a practical approach to reaching a diagnosis in infants with suspected developmental lung disease.

Cell-free DNA reveals distinct pathology of multisystem inflammatory syndrome in children

Multisystem inflammatory syndrome in children (MIS-C) is a rare but life-threatening hyperinflammatory condition induced by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes pediatric COVID-19 (pCOVID-19). The relationship of the systemic tissue injury to the pathophysiology of MIS-C is poorly defined. We leveraged the high sensitivity of epigenomics analyses of plasma cell-free DNA (cfDNA) and plasma cytokine measurements to identify the spectrum of tissue injury and glean mechanistic insights. Compared with pediatric healthy controls (pHCs) and patients with pCOVID-19, patients with MIS-C had higher levels of cfDNA primarily derived from innate immune cells, megakaryocyte-erythroid precursor cells, and nonhematopoietic tissues such as hepatocytes, cardiac myocytes, and kidney cells. Nonhematopoietic tissue cfDNA levels demonstrated significant interindividual variability, consistent with the heterogenous clinical presentation of MIS-C. In contrast, adaptive immune cell-derived cfDNA levels were comparable in MIS-C and pCOVID-19 patients. Indeed, the cfDNA of innate immune cells in patients with MIS-C correlated with the levels of innate immune inflammatory cytokines and nonhematopoietic tissue-derived cfDNA, suggesting a primarily innate immunity-mediated response to account for the multisystem pathology. These data provide insight into the pathogenesis of MIS-C and support the value of cfDNA as a sensitive biomarker to map tissue injury in MIS-C and likely other multiorgan inflammatory conditions.

Changes in Food Consumption, BMI, and Body Composition in Youth in the US during the COVID-19 Pandemic

Rates of childhood overweight/obesity have risen for decades; however, data show the prevalence increased at a faster rate during the COVID-19 pandemic. Pandemic-associated increases in youth's body mass index (BMI; kg/m2) have been attributed to decreases in reported physical activity; few studies have examined changes in food intake. We therefore examined changes in total energy, nutrient consumption, BMI, BMIz, and adiposity longitudinally over 3 years, comparing healthy youth aged 8-17 years assessed twice prior to the pandemic, to youth seen once before and once during the pandemic. The total energy intake and percent macronutrient consumption were assessed using a standardized, laboratory-based, buffet-style meal. Height and weight were measured and adiposity was collected via dual energy X-ray absorptiometry. Generalized linear model univariate analyses investigated differences between groups. One-hundred-fifteen youth (15.6 + 2.8 years 47.8% female; 54.8% White) from the Washington D.C., Maryland, and Virginia greater metropolitan area participated. In this secondary analysis, neither changes in total energy intake (p = 0.52) nor changes in nutrient consumption were significantly different between the two groups (ps = 0.23-0.83). Likewise, changes in BMI, BMIz, and adiposity (ps = 0.95-0.25) did not differ by group. Further research should investigate food intake and body composition, comparing youth with and without overweight/obesity to better identify those at greatest risk of excess weight gain during the pandemic.

Case report: Pneumatosis in a neonate with thrombocytopenia absent radius syndrome

BACKGROUND

Thrombocytopenia absent radius (TAR) syndrome is a rare disease with an estimated prevalence of one in 200,000 live births. TAR is associated with cardiac and renal anomalies as well as gastrointestinal problems such as CMPA. Typically neonates with CMPA present with mild intolerance, with few reports in the literature of more severe intolerance resulting in pneumatosis. We present a case of a male infant with thrombocytopenia absent radius (TAR) syndrome who developed gastric and colonic pneumatosis intestinalis.

CASE DESCRIPTION

An eight-day-old male infant born at 36 weeks gestation with a diagnosis of TAR, presented with bright red blood in his stool. At this time he was on full formula feeds. Given continued bright red blood within his stool, an abdominal radiograph was obtained which was consistent with colonic and gastric pneumatosis. A complete blood count (CBC) was notable for worsening thrombocytopenia, anemia and eosinophilia. Once enteral feeds were held there was rapid resolution of the radiographic findings and resolution of his bloody stool. He was ultimately diagnosed with a cow's milk protein allergy (CMPA).

CONCLUSION

Though there are reports of CMPA in patients with TAR, the severity of this patient's presentation with both colonic and gastric pneumatosis is unique. Without the knowledge of the association of CMPA with TAR, this case could have been misdiagnosed and led to reintroduction of cow's milk containing formula, resulting in further complications. This case highlights the importance of a timely diagnosis and severity of CMPA in this population.

114 THE EFFECTIVENESS OF A 26-WEEK CLASS AND HOME-BASED OTAGO EXERCISE PROGRAMME ON BALANCE CONFIDENCE AND PHYSICAL PERFORMANCE IN OLDER ADULTS

Background

Falls have a substantial burden on the Irish economy and on the individual. The Otago Exercise Programme (OEP) is a cost-effective falls prevention programme that can prevent 35% of falls. This study aims to evaluate the effectiveness of a 26-week modified OEP using a combined delivery approach of physiotherapists and Exercise Therapists (ET) on balance confidence and physical performance in older adults in rural Ireland.

Methods

Study-design: A prospective pre-post single arm intervention study. Older adults (≥60 years) were recruited from HSE waiting lists for the OEP which consisted of a group-class (1x/week) and a home OEP (3x/week). Participants were assessed at baseline, 6, 16 and 26 weeks. Outcome measures (OMs) were compared pre and post intervention using Paired T-Tests and Wilcoxon Signed Ranks tests. A repeated-measures ANOVA compared OMs across the time points.

Results

Improvements were detected in the CONFbal scale (diff = 2.12, 95% CI=1.353-2.803, p<0.01), 30-second sit-to-stand (diff = 3.49, CI= 2.361-4.201, p<0.01), timed-up and go (diff = 2.38, CI=8.08-12.0, p<0.01), functional reach (diff = 9.158, CI=6.758-11.294, p<0.01), 180° turn (diff = 1.04, CI=3-5, p<0.01), and the four-test balance scale (diff = 0.61, CI=1.0-3.0, p<0.01). Significant changes are noted for each measure (p<0.05) with small-moderate positive effects (ηp2=0.32-0.512). The most significant changes in the 180° turn are seen between week-0 (4.92 ±1.784) and week-6 (4.44 ±1.258) followed by a plateau in results.

Conclusion

Confidence and physical performance improved significantly pre and post intervention, suggesting the physiotherapist and ET combined delivery of the programme is effective. Static and dynamic balance improvements may plateau after 6-weeks of the OEP suggesting the participants may not have been adequately challenged. Lower limb strength and mobility continued to improve throughout suggesting the modified OEP is an effective intervention for older adults in Ireland.

64 HIGH-DOSE STEROIDS IN HAEMATOLOGICAL MALIGNANCY: A RED FLAG FOR BONE HEALTH

Background

Bone-protective treatment should always be considered when commencing glucocorticoid therapy in individuals at high risk of fracture, as outlined in recent guidelines (National Osteoporosis Guideline Group, July 2018). Despite this, many patients receive high dose glucocorticoids (>7.5mg/kg/day or equivalent for >3 months) during treatment of haematological malignancy without formal assessment of bone health.

Methods

Twenty-five patients with Non-Hodgkin’s Lymphoma (NHL) on high dose steroid chemotherapy protocols were retrospectively assessed. The inclusion criterion was defined as any patient commenced on a cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) containing protocol from 1/8/2020 to 1/8/21. Data was collected from electronic and written patient records. Information regarding patient age, diagnosis, steroid preparation and dose, presence of risk factors for osteoporosis and calcium and vitamin D prescriptions were collected. Radiological imaging was reviewed to assess for the occurrence of fragility fractures. Each patient had a FRAX® score calculated to assess fracture risk.

Results

The mean age of patients studied was 67 years and equally distributed between males and females. All patients had NHL. 32% (n=25) of patients were identified to be at high risk for fracture (FRAX® score >20% ten-year probability of major osteoporotic fracture). 16% had already established fragility fractures prior to commencing steroid treatment. 28% of patients were females over the age of 70 years. Only 12% of patients received vitamin D and calcium supplementation. No patient commenced bone protection therapy.

Conclusion

Omission of bone health assessment prior to high dose glucocorticoid treatment is prevalent in haematological malignancy and places patients at risk of significant morbidity. Patients are not routinely considered for protective measures including calcium and vitamin D supplementation and bone protection therapy. A simple risk-assessment tool and education to staff and patients prior to glucocorticoid therapy could significantly improve practice in this area. It is now planned to introduce routine risk assessment for this cohort of patients, with re-audit following implementation.

Examination of the Interaction between Parental Military-Status and Race among Non-Hispanic Black and Non-Hispanic White Adolescents with Overweight/Obesity

OBJECTIVES

Adolescent military-dependents experience distinct risk and protective factors, which may necessitate additional clinical considerations. In civilian youth, overweight/obesity is associated with eating, internalizing, and externalizing difficulties, with some studies reporting more difficulties among non-Hispanic White (vs. non-Hispanic Black) youth. It is unknown if these disparities exist among adolescent military-dependents, or between civilian and military-dependent youth.

METHODS

Non-Hispanic Black (187 civilian, 38 military-dependent) and non-Hispanic White (205 civilian, 84 military-dependent) adolescents with overweight/obesity (14.7 ± 1.6 years; 73.9% girls; body mass index adjusted for age and sex 1.9 ± 0.5) completed a disordered-eating interview; parents completed a measure assessing their child's internalizing and externalizing difficulties. Multiple linear regressions examined parental military-status as a moderator of the relationship of participant race with eating, internalizing, and externalizing difficulties.

RESULTS

White civilian youth with overweight/obesity reported significantly greater disordered-eating than their Black peers (p < .001); there were no other significant racial differences. In all regressions, parental military-status significantly moderated the association between race and each dependent variable (ps < .047). Black military-dependents (vs. civilians) reported more disordered-eating and internalizing difficulties (ps = .01). White military-dependents (vs. civilians) reported fewer externalizing difficulties (p = .01).

CONCLUSIONS

Black adolescent military-dependents with overweight/obesity may experience more eating and internalizing difficulties (vs. civilians), a pattern not observed among White participants. Future work should examine if being a military-dependent and a historically marginalized racial group member accounts for these findings. Such data may inform providers of youth with intersecting minority identities.

Effect of setmelanotide, a melanocortin-4 receptor agonist, on obesity in Bardet-Biedl syndrome

AIM

To report an analysis of ~1 year of setmelanotide treatment for obesity and hunger, as well as metabolic and cardiac outcomes, in individuals with Bardet-Biedl syndrome (BBS).

MATERIALS AND METHODS

Individuals aged 12 years and older with BBS received once-daily setmelanotide. The dose was titrated every 2 weeks to establish the individual therapeutic dose (≤3 mg); treatment continued for an additional 10 weeks. Participants who lost 5 kg or more (or ≥5% of body weight if <100 kg at baseline) continued into the 52-week extension phase. The primary outcome was mean percent change from baseline in body weight at 3 months. Hunger scores and safety were secondary outcomes.

RESULTS

From February 2017 and February 2018, 10 individuals were screened; eight completed the 3-month treatment phase and seven completed the extension phase. Mean percent change in body weight from baseline to 3 months was -5.5% (90% CI, -9.3% to -1.6%; n = 8); change from baseline was -11.3% (90% CI, -15.5% to -7.0%; n = 8) at 6 months and -16.3% (90% CI, -19.9% to -12.8%; n = 7) at 12 months. All participants reported at least one treatment-emergent adverse event (AE), most commonly injection-site reaction. No AEs led to study withdrawal or death. Most, morning, and average hunger scores were reduced across time points.

CONCLUSIONS

Setmelanotide reduced body weight and hunger in individuals with BBS and had a safety profile consistent with previous reports. Setmelanotide may be a treatment option in individuals with BBS-associated obesity and hyperphagia.

P2498Exercise capacity and all-cause mortality in remote Indigenous and non-Indigenous populations

Background

Exercise capacity is a powerful predictor of all-cause mortality. However, its association with Indigenous populations in Central Australia, who face disproportionate health burdens, is unclear. Given the isolation from tertiary centers, exercise testing could provide useful local risk-stratification.

Purpose

To characterize the association of exercise capacity with all-cause mortality in Indigenous and non-Indigenous individuals in remote Central Australia.

Methods

Demographic, medication, and all-cause mortality data were prospectively collected from patients undergoing exercise stress tests from 2007–2017.

Results

A total of 3,414 patients (34% Indigenous) were included. At 4.8±2.9 years of follow-up, 86 (2.5%) deaths had occurred. Each 1-MET increase in exercise capacity conferred a 14% lower risk for mortality among Indigenous individuals (HR 0.86, 95% CI 0.79–0.94) and 20% lower risk for mortality among non-Indigenous individuals (HR 0.80, 95% CI 0.73–0.89) after adjusting for age, comorbidities, and medications. Mortality risk reduction for each 1-MET increase in exercise capacity was similar (p=0.32) for Indigenous and non-Indigenous individuals.

Conclusions

Exercise capacity is a significant predictor of all-cause mortality in Indigenous and non-Indigenous individuals. These findings have important clinical implications towards exercise capacity for risk-stratification and preventative importance of physical activity.

SAT-251 Acute Sleep Change, Laboratory Meal Energy Intake, and Insulin Sensitivity in Children

Background Many studies show a correlation between short sleep duration and obesity/insulin resistance. One hypothesis for this association is that shortened sleep causes increased energy intake (EI). In some studies, experimentally reduced sleep duration has been found to increase total EI. There are mixed findings about the effects of habitual and acute short sleep on the macronutrient content of consumed meals. Additionally, there are few pediatric studies with objectively measured sleep duration (e.g. using actigraphy). Therefore, we aimed to determine if an acute sleep change was associated with greater total EI, altered macronutrient intake, or altered insulin sensitivity in children. Methods Healthy weight and overweight volunteers (n=18, 44% male), aged 7-11 years wore ActiGraph activity monitors for six consecutive 24 hour periods to determine nightly sleep duration. Volunteers were given no direction regarding sleep for the week. On day six, children underwent a standardized oral glucose tolerance test (OGTT) (1.75g/kg, max 75g) after which total EI (kcal) and macronutrient composition (% of total EI) were measured during a lunchtime laboratory test meal (>10,000 kcal; ~12% protein, 32% fat, 56% CHO). Subjects were directed to eat as much as they wanted. Acute change in sleep was calculated by subtracting each participant’s average nightly total sleep time over the entire week from their total sleep time on the fifth night (i.e., night before the test meal). Linear regressions examined associations of acute change in sleep with insulin AUC during OGTT, total EI, % CHO, % fat, and ratio of %CHO to %fat intake. Results Controlling for daily predicted energy needs and physical activity level, acute change in sleep (mean of 27.5 minutes less than average) was not significantly associated with total EI (p=0.58). However, the %CHO trended toward a significant negative correlation (r=-0.47, p=0.05) and %fat was positively associated (r=0.50, p=0.036) with acute change in sleep such that the %CHO to %fat intake ratio was greater in those with greater sleep deficit (p=0.039). Additionally, controlling for BMI-z score, basal insulin, and age, greater sleep deficit was associated with increased insulin AUC during the OGTT (p=0.001). Discussion Contrary to some previous experimental data, acute sleep deficit had no significant association with total EI; however, acute sleep deficit was associated with increased relative carbohydrate intake. Acute sleep deficit was also associated with decreased relative fat intake, a known satiating macronutrient. These data also suggest an acute decrease in insulin sensitivity associated with sleep deficit. All three mechanisms could explain or exacerbate the increased prevalence of obesity and metabolic abnormalities in children with short sleep duration and therefore, provide support for sleep-associated adjunctive treatment for such children.

MON-161 Lipolytic Rate in Relation to Skeletal Muscle and Hepatic Insulin Resistance

Introduction: Increased circulating free fatty acid (FFA) due to impaired control of adipocyte triglyceride lipolysis contributes to the development of obesity-related insulin resistance (IR). However, it is less clear whether there are differences in the relationship between lipolysis and skeletal muscle vs hepatic IR, or how these relationships are influenced by age, race, sex, body composition, or inflammation. We investigated the associations of lipolytic rate (LR) with skeletal muscle insulin sensitivity, as evidenced by insulin sensitivity index (SI), and hepatic IR, as measured by HOMA-IR. Methods: 46 healthy, non-diabetic adults with obesity (BMI 39.8±6.9 kg/m²) and 11 lean (BMI 25.6±2.1 kg/m²) adults (40% NHB, 20% HISP, 37% NHW, 3% Asian; 65% female; age 45.8±12.6y) underwent fasting blood draws and an insulin-modified frequently sampled intravenous glucose tolerance test (FSIVGTT). LR was calculated by a mathematical minimal model that estimated basal lipolysis and insulin-mediated lipolysis stimulated by insulin modulation of FFA during the FSIVGTT; SI was derived from Bergman’s minimal model. Body composition was determined by DXA. Using ANCOVA, we examined how LR was related to SI and HOMA-IR, controlling for age, race, and sex. Secondary analyses examined if the differences seen could be accounted for by differences in total fat mass or hsCRP. Results: As expected, LR was significantly elevated in adults with obesity (Mean±SD: 0.069±0.047 vs. 0.0052±0.00084 mEq/L*min, p<.001) and was positively correlated with total fat mass (r= +.64, p<.001). LR was also correlated with fasting insulin (r=.+56, p<.001), HOMA-IR (r= +.57, p<.001), SI (r= -.39, p<.01), and hsCRP (r= +.70, p<.001). Controlling for age, race, and sex (all ps>.05), LR remained correlated with SI (B= -.24, p<.01) and with HOMA-IR (B= +.33, p<.001). However, for SI, after including total fat mass and hsCRP in the model, the effect of LR on SI was no longer observed (p>.05). By contrast, for HOMA-IR, even after including total fat mass and hsCRP in the model, the effect of LR was still observed (B= +.30, p<.05). Conclusions: Previous studies have shown that excessive lipolysis plays a significant role in the pathogenesis of IR. By minimal model analysis of an insulin-modified FSIVGTT, we confirmed the well-described association of increased LR with skeletal muscle and hepatic IR. We found that differences in total fat mass fully explained the LR effect in skeletal muscle IR. However, even after controlling for total fat mass and hsCRP, our model revealed a significant association of LR with HOMA-IR. Our data suggest that LR is likely a strong predictor of hepatic IR across age, race, and sex in human obesity. Further studies are warranted to investigate how adiposity and inflammation mediate this relationship between lipolysis and IR.

OR31-2 Effects of Colchicine on Insulin Resistance, Pancreatic Beta-Cell Function, and Aspects of the Metabolic Syndrome (MetS) in Adults with Obesity, MetS, and Inflammation: A Pilot Randomized Controlled Trial

Introduction: Low-grade chronic inflammation, due in part to activation of the NLRP3 inflammasome, increases with increasing adiposity and plays a significant role in the development of type 2 diabetes and cardiovascular disease. However, to date, the efficacy of anti-inflammatory medications to improve aspects of the metabolic syndrome (MetS) is not well established. As colchicine has been shown to prevent assembly of the NLRP3 inflammasome and ameliorate other inflammatory conditions, we aimed to evaluate the efficacy and safety of colchicine for improving metabolic and inflammatory outcomes in adults with obesity and MetS. Materials and Methods: We conducted a randomized, double-blind, placebo-controlled pilot trial in which 40 non-diabetic adults with obesity, MetS, and elevated high-sensitivity C-reactive protein (hsCRP≥ 2.0 mg/L) were randomized to colchicine 0.6 mg or placebo twice daily for three months. Fasting labs, insulin-modified frequently sampled intravenous glucose tolerance test (FSIVGTT), and body composition by DXA were performed at baseline and 3-month follow up. The primary outcome was change in FSIVGTT insulin sensitivity (S_I) as measured by Bergman’s minimal model. Secondary outcomes included changes in other metabolic parameters and inflammatory markers. ANCOVA was used to examine differences between treatment arms, with age, sex, baseline body fat%, and Δbody fat% as covariates. Data were analyzed according to intention-to-treat and reported as mean±SD. Results: Colchicine significantly reduced inflammatory indices, including hsCRP (-2.8±2.9 vs. 0.4±2.8 mg/L, p=.002), ESR (-5.5±6.4 vs. 0.6±6.3 mm/hr, p=.007), white blood cell count (-1.09±1.23 vs. 0.29±1.16 K/µL, p=.002), and absolute neutrophil count (-1.06±1.05 vs. 0.12±0.93 K/µL, p<.001). However, change in S_I was not significantly different between colchicine and placebo arms (2.9x10^-6 ± 3.1x10^-5 vs 3.4x10^-6 ± 2.9x10^-5 min^-1·mU^-1·ml, p=.82). Changes in other metabolic parameters also did not reach significance, although changes in HOMA-IR (p=.097) and glucose effectiveness (S_G; p=.067) trended towards improvement in the colchicine group. Adverse events were similar in both groups, and no patients withdrew due to side effects. Post-hoc analyses calculated that a sample size of 166 subjects would be necessary to achieve 80% power to detect a difference in measures of metabolic health (e.g. HOMA-IR, fasting insulin, fasting glucose, S_G, and disposition index) between colchicine and placebo groups, for a two-tailed α <0.05. Conclusions: Colchicine significantly improved obesity-associated inflammatory variables and demonstrated a good safety profile among obese non-diabetic adults with MetS. Larger, adequately powered studies are needed to determine whether colchicine has beneficial effects on insulin resistance and other measures of metabolic health in at-risk individuals.

Utility of state-level influenza disease burden and severity estimates to investigate an apparent increase in reported severe cases of influenza A(H1N1) pdm09 - Arizona, 2015-2016

The Arizona Department of Health Services identified unusually high levels of influenza activity and severe complications during the 2015-2016 influenza season leading to concerns about potential increased disease severity compared with prior seasons. We estimated state-level burden and severity to compare across three seasons using multiple data sources for community-level illness, hospitalisation and death. Severity ratios were calculated as the number of hospitalisations or deaths per community case. Community influenza-like illness rates, hospitalisation rates and mortality rates in 2015-2016 were higher than the previous two seasons. However, ratios of severe disease to community illness were similar. Arizona experienced overall increased disease burden in 2015-2016, but not increased severity compared with prior seasons. Timely estimates of state-specific burden and severity are potentially feasible and may provide important information during seemingly unusual influenza seasons or pandemic situations.

Quality Improvement of Clinical Handover in a Liaison Psychiatry Department: A Three-Phase Audit

Aims To audit and improve quality of clinical handover in a Liaison Psychiatry Department. Methods An 11-item Handover Checklist was used to carry out a baseline audit and immediate and delayed post-intervention re-audits. The intervention consisted of checklist posters, an electronic database and staff training. Results There was an immediate and sustained improvement in most areas, including baseline demographics and components of SBAR communication (Situation, Background, Assessment, Recommendation). The improvement between baseline and delayed re-audit was statistically significant (P=0.007). Conclusion Poor handover practices contribute to negative outcomes in healthcare but there remains a dearth of guidelines in most specialties.This audit is important as it describes an intervention which improved clinical handover at a time of significant clinical risk. This practice could be applied effectively to other services and is relevant to all specialties. Six to twelve-monthly re-audit and longitudinal assessment of clinical outcomes are recommended to maintain the practices implemented in this audit.

Remission of loss of control eating and changes in components of the metabolic syndrome

OBJECTIVE

Pediatric loss of control (LOC) eating prospectively predicts the worsening of metabolic syndrome components. However, it is unknown if remission of LOC eating is associated with improvements in metabolic health. Therefore, we conducted a secondary analysis of a trial that enrolled adolescent girls with LOC eating, examining whether LOC remission (vs. persistence) at end-of-treatment was associated with changes in metabolic syndrome components at 6-month follow-up.

METHOD

One hundred three adolescent girls (age 14.5 ± 1.7 years; BMI-z 1.5 ± 0.3; 56.3% non-Hispanic White, 24.3% non-Hispanic Black) with elevated weight (75th-97th BMI %ile) and reported LOC eating were assessed for metabolic syndrome components at baseline and again six months following the interventions. The main effects of LOC status at end-of-treatment (persistence vs. remission) on metabolic syndrome components (waist circumference, lipids, glucose, and blood pressure) at 6-month follow-up were examined, adjusting for baseline age, depressive symptoms, LOC frequency, fat mass, and height, as well as race, change in height, change in fat mass, and the baseline value of each respective component.

RESULTS

Youth with LOC remission at end-of-treatment had lower glucose (83.9 ± 6.4 vs. 86.5 ± 5.8 mg/dL; p = .02), higher high-density lipoprotein cholesterol (50.3 ± 11.8 vs. 44.8 ± 11.9 mg/dL; p = .01), and lower triglycerides (84.4 ± 46.2 vs. 96.9 ± 53.7 mg/dL; p = .02) at 6-month follow-up when compared with youth with persistent LOC, despite no baseline differences in these components. No other component significantly differed by LOC eating status (ps > .05).

DISCUSSION

Reducing LOC eating in adolescent girls may have a beneficial impact on some components of the metabolic syndrome.

Relationship of pressure to be thin with gains in body weight and fat mass in adolescents

BACKGROUND

Sociocultural pressure to be thin is commonly reported by adolescents; yet, to what extent such pressure is associated with weight gain has not been evaluated longitudinally.

OBJECTIVE

Examine whether pressure to be thin was positively associated with weight and fat gain in adolescents.

METHODS

Participants were 196 healthy adolescent (age 15 ± 1 years old) girls (65%) and boys of varying weights (BMI 25 ± 7 kg/m² ) studied at baseline and 1-year follow-up. At baseline, adolescents and their mothers reported pressure to be thin by questionnaire. At baseline and follow-up, BMI was calculated, and fat mass was assessed with air displacement plethysmography. Multiple regression was used to examine associations between baseline pressure to be thin and 1-year changes in BMI and fat mass.

RESULTS

Accounting for multiple covariates, including baseline BMI or fat, adolescent-reported pressure from parents and peers and mother-reported pressure toward their teen were associated with greater gains in either adolescent BMI or fat (ps < .05). Adolescent weight status was a moderator of multiple effects (ps < .05).

CONCLUSIONS

Parental and peer pressure to be thin were associated with increases in BMI and fat mass during adolescence, particularly in heavier adolescents. Further research is necessary to clarify how this association operates reciprocally and to identify underlying explanatory mechanisms.

Impact of Age and Race on Outcomes of a Program to Prevent Excess Weight Gain and Disordered Eating in Adolescent Girls

Interpersonal psychotherapy (IPT) prevents weight gain and reduces loss-of-control (LOC)-eating in adults. However, IPT was not superior to health-education (HE) for preventing excess weight gain and reducing LOC-eating over 1-year in adolescent girls at risk for excess weight gain and eating disorders. Limited data suggest that older and non-White youth may be especially responsive to IPT. In secondary analyses, we examined if age or race moderated weight and LOC-eating outcomes. The 113 participants (12–17 years; 56.6% White) from the original trial were re-contacted 3 years later for assessment. At baseline and follow-up visits through 3 years, we assessed BMI, adiposity by dual energy X-ray absorptiometry, and LOC-eating presence. In linear mixed models, baseline age moderated 3-year BMI outcome; older girls in IPT had the lowest 3-year BMI gain compared to younger girls in IPT and all girls in HE, p = 0.04. A similar pattern was observed for adiposity. Race moderated 3-year LOC-eating; non-White girls in IPT were most likely to abstain from LOC-eating at 3 years compared to all other girls, p = 0.04. This hypothesis-generating analysis suggests future studies should determine if IPT is especially efficacious at reducing LOC-eating in older, non-White adolescents.

The basal translation rate of authentic HIV-1 RNA is regulated by 5'UTR nt-pairings at junction of R and U5

The paradigm protein synthesis rate is regulated by structural complexity of the 5′untranslated region (UTR) derives from bacterial and other riboswitches. In-solution, HIV-1 5′UTR forms two interchangeable long-range nucleotide (nt) -pairings, one sequesters the gag start codon promoting dimerization while the other sequesters the dimer initiation signal preventing dimerization. While the effect of these nt-pairings on dimerization and packaging has been documented their effect on authentic HIV translation in cellulo has remained elusive until now. HIV^NL4-3 5′UTR substitutions were designed to individually stabilize the dimer-prone or monomer-prone conformations, validated in-solution, and introduced to molecular clones. The effect of 5′UTR conformation on ribosome loading to HIV unspliced RNA and rate of Gag polypeptide synthesis was quantified in cellulo. Monomer- and dimer-prone 5′UTRs displayed equivalent, basal rate of translation. Gain-of-function substitution U103, in conjunction with previously defined nt-pairings that reorient AUG to flexible nt-pairing, significantly activated the translation rate, indicating the basal translation rate is under positive selection. The observed translation up-mutation focuses attention to nt-pairings at the junction of R and U5, a poorly characterized structure upstream of the characterized HIV riboswitch and demonstrates the basal translation rate of authentic HIV RNA is regulated independently of monomer:dimer equilibrium of the 5′UTR.

Associations of sleep duration and quality with disinhibited eating behaviors in adolescent girls at-risk for type 2 diabetes

OBJECTIVES

Short sleep duration and daytime sleepiness have been associated with an increased risk for the onset of type 2 diabetes in adults. There has been far less attention to the characterization of sleep in adolescents at-risk for diabetes or to the possible behavioral mechanisms, such as disinhibited eating, through which sleep may affect metabolic functioning.

METHODS

We evaluated the associations of sleep duration and daytime sleepiness with a multi-modal assessment of disinhibited eating in 119 adolescent girls at-risk for type 2 diabetes based upon being overweight/obese and having a family history of diabetes. Girls also endorsed mild-to-moderate depressive symptoms. Adolescents reported sleep duration and daytime sleepiness with the Sleep Habits Survey and Children's Sleep Habits Questionnaire. They were administered a series of successive test meals to measure total energy intake and eating in the absence of hunger (EAH). Adolescent binge eating was assessed with the Eating Disorder Examination interview.

RESULTS

Accounting for age, race, puberty, body composition, depressive symptoms, and perceived stress, reported sleep duration was positively related to test meal total energy intake (p=0.04), but not to EAH. Adjusting for the same covariates, daytime sleepiness was associated with a greater odds of objective binge eating in the previous month (p=0.009).

CONCLUSIONS

In adolescent girls at-risk for type 2 diabetes, reported sleep characteristics are associated with disinhibited eating behaviors that have been linked to excessive weight and adverse metabolic outcomes. Future studies are called for to evaluate these links using objective measures of sleep.

Diagnostic criteria for inclusion body myositis

Inclusion body myositis (IBM) was first identified as a specific disorder about 40 years ago and is now recognized to be the most frequently presenting primary myopathy in middle age and beyond. Initial characterization was based on the observation of specific pathological features distinguishing it from polymyositis. It was soon appreciated that there were also distinguishing clinical features. The earliest diagnostic criteria were heavily biased towards pathological features, but over time revised criteria have given increasing importance to certain clinical features. Until the specific cause of IBM is determined, and the basic pathogenetic mechanisms are better understood, there can be no diagnostic gold-standard against which to compare the sensitivity and specificity of any proposed diagnostic criteria, but such criteria are essential to ensure that patients entering clinical, epidemiological, genetic, pathological or therapeutic studies represent a homogeneous population. It is likely that any currently accepted diagnostic criteria will, once a gold-standard is eventually established, be shown to have 'missed' patients with atypical features, but that has to be accepted to make certain that current studies are not contaminated by patients who do not have IBM. In other words, in everyday clinical practice there will be the occasional patient who an experienced myologist strongly suspects has IBM, but does not meet current criteria - the criteria lack sensitivity. But if the criteria are so broad as to include all such atypical cases, they would be likely to include patients who do not in fact have IBM - they would lack specificity. The sensitivity and specificity of existing criteria have been reviewed recently, in so far as it is possible to do so, and found to have high specificity but variable sensitivity.