Associations between early-life growth pattern and body size and follicular lymphoma risk and survival: a family-based case-control study

BackgroundThe influence of early-life growth pattern and body size on follicular lymphoma (FL) risk and survival is unclear. In this study, we aimed to investigate the association between gestational age, growth during childhood, body size, changes in body shape over time, and FL risk and survival.MethodsWe conducted a population-based family case-control study and included 706 cases and 490 controls. We ascertained gestational age, growth during childhood, body size and body shape using questionnaires and followed-up cases (median=83 months) using record linkage with national death records. We used a group-based trajectory modeling approach to identify body shape trajectories from ages 5–70. We examined associations with FL risk using unconditional logistic regression and used Cox regression to assess the association between body mass index (BMI) and all-cause and FL-specific mortality among cases.ResultsWe found no association between gestational age, childhood height and FL risk. We observed a modest increase in FL risk with being obese 5 years prior to enrolment (OR=1.43, 95 %CI=0.99–2.06; BMI ≥30 kg/m²) and per 5-kg/m² increase in BMI 5 years prior to enrolment (OR=1.14, 95 %CI=0.99–1.31). The excess risk for obesity 5 years prior to enrolment was higher for ever-smokers (OR=2.00, 95 %CI=1.08–3.69) than never-smokers (OR=1.14, 95 %CI=0.71–1.84). We found no association between FL risk and BMI at enrolment, BMI for heaviest lifetime weight, the highest categories of adult weight or height, trouser size, body shape at different ages or body shape trajectory. We also observed no association between all-cause or FL-specific mortality and excess adiposity at or prior to enrolment.ConclusionWe observed a weak association between elevated BMI and FL risk, and no association with all-cause or FL-specific mortality, consistent with previous studies. Future studies incorporating biomarkers are needed to elucidate possible mechanisms underlying the role of body composition in FL etiology.     

儿童气管支气管异物临床特征、延迟诊断因素及并发症高危因素分析

摘要 目的：探讨儿童气管支气管异物临床特征、延迟诊断因素及并发症高危因素分析。方法：以我院2014年5月到2022年7月收治的167例疑似气管支气管异物患儿作为研究对象。167例患者中男性112例,女性55例,平均年龄（25.10±21.51）月。按照患儿支气管镜检查结果将患儿分为异物组（n=140）和非异物组（n=27）。按照患儿入院时气管支气管异物的确诊时间是否在24 h内将患儿分为延迟诊断组（n=100）和早期诊断组（n=40）。并依据气管支气管异物患儿是否发生并发症将所有患儿分为并发症组（n=122）和未发生并发症组（n=18）。采用x²检验和独立样本t检验进行亚组分析。采用logistics回归模型进行回归分析。结果：异物组和无异物组患儿性别、年龄、发病后就诊时间无显著差异（P＞0.05）;异物组和无异物组患儿的物滞留部位、CRP、PCT、首诊时影像学检查、患儿居住地、异物吸入史差异显著（P<0.05）;以患儿是否发生延迟诊断作为因变量多因素logistics回归结果显示,年龄、首诊时影像学检查、患儿居住地、异物吸入史是独立危险因素（P<0.05）;以患儿是否发生并发症作为因变量,多因素logistics回归结果显示,年龄、首诊时影像学检查、患儿居住地、是否延迟诊断及异物吸入史是独立危险因素（P<0.05）。结论：儿童气管支气管异物存在较明显的年龄特征,延迟诊断和并发症受年龄、异物吸入史和影像学检查等复杂因素影响。     

Population level differences in adult body mass emerge in infancy and early childhood: Evidence from a global sample of low and lower‐income countries

Many studies have linked measures of adult body shape and mass in ancient and contemporary populations to ecogeographical variables such as temperature and latitude. These results tend to support Bergmann's rule, which posits that bodies will be relatively less slender for their height in colder climates and more slender in warmer climates. Less well explored is the ontogeny of these population‐level differences. Here we use data on infants and children from 46 low and lower income countries to test whether children's weight for height is associated with measures of temperature and latitude. We also test the hypothesis that children living in areas with greater pathogen prevalence will be lighter for their height because of life history trade‐offs between investment in immune function and growth. Finally, we test whether population specific adult body mass predicts infant and child body mass, and whether this is independent of ecogeographical variables. Our results show that maximum monthly temperature explains 17% of children's weight for height while adult population‐level body mass explains ～44% (Table 5 ). The measures of pathogen prevalence explain little of the variation in children's body shape (8%; P > 0.05). Our results suggest that population differences are consistent with Bergmann's rule but parental body shape explains more variance. Moreover, these population‐level differences arise early in development, suggesting that any possible environmental influences occur in utero and/or result from epigenetic or population genetic differences. Am J Phys Anthropol 154:232–238, 2014. © 2014 Wiley Periodicals, Inc.     

Early childhood undernutrition,preadolescent physical growth,and cognitive achievement in India: A population-based cohort study

BackgroundThere is a lack of nationally representative estimates for the consequences of early childhood undernutrition on preadolescent outcomes in India. Understanding this relationship is helpful to develop interventions that not only prevent child undernutrition but also mitigate its consequences.Methods and findingsIn this cohort study, we analyzed prospectively gathered data from 2 waves of the India Human Development Survey (IHDS) to investigate the association of undernutrition during early childhood (0 to 5 years) in 2004 to 2005 with physical and cognitive outcomes during preadolescent (8 to 11 years) years in 2011 to 2012. These surveys interviewed 41,554 households across all 33 states and union territories in India in 2004 to 2005 and reinterviewed 83% of the households in 2011 to 2012. Primary exposure was assessed using the Composite Index of Anthropometric Failure (CIAF) based on 2004 to 2005 survey. Primary outcomes were short stature (height-for-age z-score [HAZ] <−2), thinness (body mass index [BMI] <18.5 kg/m²), reading, and arithmetic skills during preadolescence based on the 2011 to 2012 survey. Survey-weighted generalized linear models were used, and effect modification based on child sex and sociodemographic variables were evaluated using 3-way interaction terms. Of the 7,868 children included in this analysis, 4,334 (57.3%) were undernourished. Being undernourished was associated with increased odds of short stature (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.45 to 2.06) and thinness (OR 1.52, 95% CI 1.33 to 1.73) during the preadolescent period, while it was associated with decreased odds of achieving a higher reading (cumulative odds ratio [cumOR]: 0.76, 0.66 to 0.87) and arithmetic (cumOR: 0.72, 0.63 to 0.82) outcomes. The disparity in outcomes based on CIAF increased with age, especially for female children. Increased level of female education within the household reduced the disadvantages of undernutrition among female children. Study limitations include observational and missing data, which limit our ability to draw strong causal inferences.ConclusionsIn this study, we found that early child undernutrition was associated with several adverse preadolescent physical and cognitive outcomes, especially among female children. Improved female education mitigates this association. Female education promotion should assume a central role in Indian public health policy making.

Apurv Soni and co-workers study child nutrition and developmental outcomes in India.     

Investigating the mechanical response of paediatric bone under bending and torsion using finite element analysis

Fractures of bone account 25% of all paediatric injuries (Cooper et al. in J Bone Miner Res 19:1976–1981, 2004.  https://doi.org/10.1359/JBMR.040902). These can be broadly categorised into accidental or inflicted injuries. The current clinical approach to distinguish between these two is based on the clinician’s judgment, which can be subjective. Furthermore, there is a lack of studies on paediatric bone to provide evidence-based information on bone strength, mainly due to the difficulties of obtaining paediatric bone samples. There is a need to investigate the behaviour of children’s bones under external loading. Such data will critically enhance our understanding of injury tolerance of paediatric bones under various loading conditions, related to injuries, such as bending and torsional loads. The aim of this study is therefore to investigate the response of paediatric femora under two types of loading conditions, bending and torsion, using a CT-based finite element approach, and to determine a relationship between bone strength and age/body mass of the child. Thirty post-mortem CT scans of children aged between 0 and 3 years old were used in this study. Two different boundary conditions were defined to represent four-point bending and pure torsional loads. The principal strain criterion was used to estimate the failure moment for both loading conditions. The results showed that failure moment of the bone increases with the age and mass of the child. The predicted failure moment for bending, external and internal torsions were 0.8–27.9, 1.0–31.4 and 1.0–30.7 Nm, respectively. To the authors’ knowledge, this is the first report on infant bone strength in relation to age/mass using models developed from modern medical images. This technology may in future help advance the design of child, car restrain system, and more accurate computer models of children.     

Quantitative Method for Biomechanical Evaluation of Bedding Comfortableness

Comfortable bedding is usually designed subjectively because of the difficulty in performing a quantitative evaluation. This paper proposes a quantitative evaluation method of comfortableness of beddings. The bedding shape determining how comfortable an individual may feel in using it depends on the body shape and normal posture of individuals. The internal physical load is expected to relate to the comfortableness of bedding. However, only a few quantitative discussions exist on the relation between the comfortableness of bedding and physical load. This study proposes a new evaluation method of physical load in a relaxed posture. The strain energy of muscles and joints was used as an indicator of physical load. To estimate physical load, a neutral body position was simulated from a natural standing posture and was used as a reference posture with the neutral condition of muscle lengths. By considering individual differences, multiple models of neutral body position were provided. We simulated individual differences of a comfortable pillow height using the proposed models. Physical load in a relaxed posture was varied according to the models. Calculated results show that physical load becomes small when a pillow is comfortable. For both subjective pillow comfortableness and smallness of physical load, there is a similar tendency that the low pillow with the small height difference between head and neck is preferable if the concave depth of back shape of head and neck is small. Moreover, the results show that muscles and joints equally affect the comfortableness of designed pillow. This implies that less total energy required for maintaining the posture contributes to pillow comfortableness.     

Are seat belt restraints as effective in school age children as in adults? A prospective crash study

ObjectiveTo study effectiveness of seat belts for protecting school age children in road vehicle crashes.DesignCrash examinations by trained investigators.SettingTen Canadian university based crash investigation centres.Subjects470 children aged 4-14 years, with 168 selected for detailed analysis, and 1301 adults.ResultsOverall, 40% (189/470) of children were unbelted. Of the 335 children in cars driven by belted adults, 73 (22%) were unbelted. The odds of sustaining fatal or moderately severe injury (injury severity score ⩾4) for children in the front passenger seat was more than nine times higher for unbelted children than for belted ones (odds ratio 9.8 (95% confidence interval 2.4 to 39.4)) and for those in the rear left seat was more than two times higher for unbelted than for belted children (2.6 (1.1 to 5.9)). The protection afforded by seat belts compared favourably with the results for adults in the same seat positions (odds ratios for unbelted v belted adults of 2.4 and 2.7 for front and rear seat passengers respectively).ConclusionsSeat belts helped to protect school age children from injury in road vehicle crashes. However, 40% of children were unbelted. Despite standard seat belts being designed for adults, school age children were at least as well protected as adults.

What is already known on this topic

Although child restraints protect young children in road vehicle crashes, it is not known whether standard seat belts used by school age children work as wellSchool age children are often unbelted in cars

What this study adds

Data from detailed crash assessments indicate that seat belts protected children at least as well as adultsAdults were more likely than children to be belted, and 22% of children travelling with belted drivers were unbelted     

Characteristics of attention-related body sensations. Temporal stability and associations with measures of body focus,affect, sustained attention,and heart rate variability

Aim: This study investigated the temporal stability and correlates of attention-related body sensations that emerge without external stimulation during rest and due to focused attention on a body part.

Materials: To assess attention-related body sensations, participants were asked to focus on a freely chosen body area with closed eyes, and had to report whether the sensation of that area had changed. Self-report questionnaires were used to assess various aspects of body focus (body awareness, body responsiveness, somatosensory amplification, subjective somatic symptoms), and positive and negative affectivity. Previous experiences in body–mind therapies were also measured. PEBL Continuous Performance Test was used to assess sustained attention. Heart rate variability scores were based on a 3-minute long resting heart rate measurement.

Methods: Fifty-eight university students (22.3?±?3.95 years; 34 females) participated in the study. The stability of attention-related body sensations was measured 8?weeks later on a randomly chosen sub-group (n?=?28).

Results: Attention-related body sensations showed a mediocre temporal stability (r_ρ?=?0.47, p?=?0.012). People reporting attention-related body sensations showed significantly higher body awareness, somatosensory amplification, and resting heart rate; and marginally higher somatic symptoms. No relation was found with body–mind practice, body responsiveness, positive and negative affect, the vagal component of heart rate variability, and performance in the sustained attention task.

Conclusion: Attention-related sensations are relatively stable over time. They are connected to some, but not to all of the aspects of body focus. Further studies are needed to elaborate the influencing stable and situational factors.     

Geographical and morphological variation within and between colour phases in Coris julis (L. 1758), a protogynous marine fish

The possible differences between sexes in patterns of morphological variation in geographical space have been explored only in gonochorist freshwater species. We explored patterns of body shape variation in geographical space in a marine sequential hermaphrodite species, Coris julis (L. 1758), analyzing variation both within and between colour phases, through the use of geometric morphometrics and spatially‐explicit statistical analyses. We also tested for the association of body shape with two environmental variables: temperature and chlorophyll a concentration, as obtained from time‐series of satellite‐derived data. Both colour phases showed a significant morphological variation in geographical space and patterns of variation divergent between phases. Although the morphological variation was qualitatively similar, individuals in the initial colour phase showed a more marked variation than individuals in the terminal phase. Body shape showed a weak but significant correlation with environmental variables, which was more pronounced in primary specimens. © 2011 The Linnean Society of London, Biological Journal of the Linnean Society, 2011, 104 , 148–162.     

Race Differences in Accuracy of Self‐Reported Childhood Body Size Among White and Black Women

Objective: To assess the relation of self‐reported current and recalled preadolescent body size to measured BMI (kilograms per meter squared) and interviewer's assessment of body size. Research Methods and Procedures: This was a prospective cohort study of 1890 white and black women who were 9 to 10 years old at time of enrollment and were followed up 10 to 13 years later. At baseline, subjects had their weight and height measured and were asked to indicate their current body size from a series of nine pictograms. A sample of the subjects also had their body size evaluated by interviewers. At the young‐adult follow‐up visit, subjects were asked to recall their body size at 9 and 10 years old and to indicate their current weight, height, body size, and level of concern with weight. Results: Among the women with interviewer assessments, 84% of the white women and 67% of black women recalled a body size that was within one body size of the interviewer's assessment. Independent of weight status in childhood or at follow‐up, black women were 3 times more likely than white women to recall a body figure that was more than one figure leaner than the shape they reported at baseline (odds ratio = 3.5, 95% confidence interval 2.8 to 4.5) or than the interviewer's rating at baseline (odds ratio = 3.4, 95% confidence interval 2.4 to 4.9). Discussion: The results suggest that the use of body figures to recall childhood size are best suited for ranking subjects in terms of BMI. The higher rate of underestimation of size by black women suggests that body figure ratings work best for white women.     

Reference Growth Curves for Cypriot Children 6 to 17 Years of Age

Objective: The purpose of the study was to present smoothed percentiles for body weight and height, waist circumference, and body mass index (BMI) in Cypriot children and to compare their BMI 85th and 95th percentiles with those of children in other countries. Research Methods and Procedures: The study was a cross‐sectional study, including a representative sample of 2472 healthy children (49.1% boys) in Cyprus ages 6 to 17 years, who were evaluated during the 1999–2000 school year. Body weight and height and waist circumference were measured using standard procedures. BMI was calculated as weight in kilograms per height in square meters. Smoothed, sex‐specific percentiles for these variables were calculated using polynomial regression models. Crude weight, height, waist, and BMI percentile values are presented in sex‐specific tables and smoothed percentile curves are presented in charts. The 85th and 95th percentiles for BMI were compared with measurements from other countries, because of the concern of the upper limits of BMI in respect to the evaluation of obesity. Results: The 85th and 95th BMI percentile values are higher in Cypriot boys than in Swedish and Iranian boys through all ages and in girls ages 6 to 15 years, whereas after the age of 15 years, both Swedish and Iranian girls’ percentiles are equalized with their Cypriot peers. Discussion: Weight, height, waist circumference, and BMI values and charts are presented for the first time for Cypriot children and adolescents. Much concern should be addressed to the observation that for the majority of the Cypriot sample, the upper BMI limits are higher than the peers of developing and developed countries.     

Impact of the Fukushima nuclear accident on obesity of children in Japan (2008–2014)

This study used prefecture-level panel data from Japan for the period 2008–2014 to investigate the influence of the 2011 Fukushima nuclear accident on the body mass index (BMI) z-score and obesity rates of children over time. I adopted a difference-in-differences approach and found the following: (1) for the cohort aged 5–7 years in 2010, the BMI z-score and obesity rates in disaster-affected areas were higher than in other areas, although this was not observed for the other cohorts; (2) for the cohort aged 5–7 years in 2010, the influence of the accident persisted even after 3 years; and (3) the differences in the BMI z-score and obesity rate before and after the accident were greater for Fukushima Prefecture than for the other affected areas (Iwate and Miyagi prefectures). I infer that health-conscious parents, whose children had lower BMIs, may have moved from Fukushima, thereby increasing the BMI z-score of the child population living in Fukushima by around 0.05 for the cohort aged 5–7 years. The enforced reduction in physical activity increased the BMI z-score of children living in Fukushima by around 0.19 for that cohort.     

Effect of a Double Helical Spring Decompression Structure Backpack on the Lumbar Spine Biomechanics of School-Age Children: A Finite Element Study

Background: A children’s backpack is one of the important school supplies for school-age children. Long-term excessive weight can cause spinal deformity that cannot be reversed. This study compared a double helical spring decompression structure backpack (DHSB) with a traditional backpack (TB) to explore the optimization of decompression devices on upper body pressure. The finite element (FE) method was then used to explore the simulation of lumbar stress with different backpacks, in order to prove that DHSB can reduce the influence of backpack weight on lumbar vertebrae, avoid the occurrence of muscle discomfort and spinal deformity in children; Methods: 18 male children subjects (age: 12.5 ± 0.6 years; height: 145.5 ± 1.9 cm; bodyweight: 40.8 ± 3.1 kg) ran with DHSB and TB at a speed of 3.3 ± 0.2 m/s. Flexible pressure sensors were used to measure the pressure on the shoulder, back, and waist during running. The pressure data was then inputted into the FE model to simulate the effect of carrying different backpacks on the stress of the lumbar intervertebral disc (IVD); Result: There was a significant difference in shoulder and waist peak pressure between the DHSB and TB during the running posture. At a speed of 3.3 ± 0.2 m/s, the peak pressure of the shoulder and waist decreased. After finite element analysis, it was found that carrying DHSB on the back could effectively reduce the intervertebral disc pressure between L4-5 and L5-S1 by 27.9% and 34.1%, respectively; Conclusion: DHSB can effectively reduce the pressure on the shoulder and waist when children are running and can reduce the influence of backpacks on children’s posture to a certain extent. By finite element analysis, it is found that carrying DHSB can effectively reduce the stress of the lumbar intervertebral disc, and the damage to lumbar vertebrae is lower than with a TB.     

Body shape variation in the Characid Psalidodon rivularis from São Francisco river,Southeast Brazil (Characiformes: Stethaprioninae)

Psalidodon rivularis is a species of tetra endemic to the São Francisco River basin and, based on cytogenetic and molecular studies, represents a complex of species. The objective of the present work was to identify morphological differences in the body shape of seven populations of P. rivularis from the Upper and Middle São Francisco River basin through geometric morphometry. In all, we photographed 174 individuals on the right side of the body and 17 landmarks were digitized on each image. To study the effects of allometry on the shape, we performed regression analysis and, to study shape modulation at different collection points and sub-basins, the canonical variation analyses. We found differences in shape between collection points and sub-basins associated with relative body height and sub-orbital plate recoil, in addition to a significant influence of size on specimen shape (allometry) associated with the ventral skull, orbits and sub-orbital plate. We do not envision differences in body shape between males and females. Several works with fish relate body height with water velocity, while the sub-orbital plate recoil shows a taxonomic or ecological potential, marking the main difference between the populations of the Upper and Middle São Francisco River.     

Stunting at 2 Years in Relation to Body Composition at 9 Years in African Urban Children**

Objective: To determine whether African urban children who were stunted at 2 years of age demonstrated an altered body composition by the end of childhood, before entering puberty, at 9 years of age. Research Methods and Procedures: This was a mixed‐longitudinal study of 330 prepubertal African children (182 boys) from Soweto‐Johannesburg, South Africa. Anthropometric data at 2 years of age were compared with anthropometric, DXA‐determined body composition and fat patterning in late childhood (7 to 9 years). Results: Children who had been stunted at 2 years were significantly shorter and lighter than non‐stunted children at 7 to 9 years, but there were no differences in their BMI or centralization of body fat. Previously stunted status significantly predicted reduced weight and height at 7 to 9 years but did not predict BMI, body composition, or fat patterning after controlling for potential confounding factors. The odds ratio for stunting at 2 years as a predictor of overweight at 7 to 9 years was not significant at 1.09 (95% confidence limits: 0.30, 3.98). Discussion: Greater BMI in stunted infants does not demonstrate a tendency toward overweight or obesity but is a reflection of the greater reduction in height rather than weight in stunted children. Stunted children may be programmed to accumulate greater body fat at central sites during adolescence, but we have been unable to show that these changes are evident before the initiation of pubertal development.     

Parental age and the risk of childhood acute myeloid leukemia: results from the Childhood Leukemia International Consortium

BackgroundParental age has been associated with several childhood cancers, albeit the evidence is still inconsistent.AimTo examine the associations of parental age at birth with acute myeloid leukemia (AML) among children aged 0–14 years using individual-level data from the Childhood Leukemia International Consortium (CLIC) and non-CLIC studies.Material/methodsWe analyzed data of 3182 incident AML cases and 8377 controls from 17 studies [seven registry-based case-control (RCC) studies and ten questionnaire-based case-control (QCC) studies]. AML risk in association with parental age was calculated using multiple logistic regression, meta-analyses, and pooled-effect estimates. Models were stratified by age at diagnosis (infants <1 year-old vs. children 1–14 years-old) and by study design, using five-year parental age increments and controlling for sex, ethnicity, birthweight, prematurity, multiple gestation, birth order, maternal smoking and education, age at diagnosis (cases aged 1–14 years), and recruitment time period.ResultsAdjusted odds ratios (ORs) and 95% confidence intervals (CIs) derived from RCC, but not from the QCC, studies showed a higher AML risk for infants of mothers ≥40-year-old (OR = 6.87; 95% CI: 2.12–22.25). There were no associations observed between any other maternal or paternal age group and AML risk for children older than one year.ConclusionsAn increased risk of infant AML with advanced maternal age was found using data from RCC, but not from QCC studies; no parental age-AML associations were observed for older children.     

Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000–2019

BackgroundArmed conflicts have major indirect health impacts in addition to the direct harms from violence. They create enduring political instability, destabilise health systems, and foster negative socioeconomic and environmental conditions—all of which constrain efforts to reduce maternal and child mortality. The detrimental impacts of conflict on global maternal and child health are not robustly quantified. This study assesses the association between conflict and maternal and child health globally.Methods and findingsData for 181 countries (2000–2019) from the Uppsala Conflict Data Program and World Bank were analysed using panel regression models. Primary outcomes were maternal, under-5, infant, and neonatal mortality rates. Secondary outcomes were delivery by a skilled birth attendant and diphtheria, pertussis, and tetanus (DPT) and measles vaccination coverage. Models were adjusted for 10 confounders, country and year fixed effects, and conflict lagged by 1 year. Further lagged associations up to 10 years post-conflict were tested. The number of excess deaths due to conflict was estimated. Out of 3,718 country–year observations, 522 (14.0%) had minor conflicts and 148 (4.0%) had wars. In adjusted models, conflicts classified as wars were associated with an increase in maternal mortality of 36.9 maternal deaths per 100,000 live births (95% CI 1.9–72.0; 0.3 million excess deaths [95% CI 0.2 million–0.4 million] over the study period), an increase in infant mortality of 2.8 per 1,000 live births (95% CI 0.1–5.5; 2.0 million excess deaths [95% CI 1.6 million–2.5 million]), a decrease in DPT vaccination coverage of 4.9% (95% CI 1.5%–8.3%), and a decrease in measles vaccination coverage of 7.3% (95% CI 2.7%–11.8%). The long-term impacts of war were demonstrated by associated increases in maternal mortality observed for up to 7 years, in under-5 mortality for 3–5 years, in infant mortality for up to 8 years, in DPT vaccination coverage for up to 3 years, and in measles vaccination coverage for up to 2 years. No evidence of association between armed conflict and neonatal mortality or delivery by a skilled birth attendant was found. Study limitations include the ecological study design, which may mask sub-national variation in conflict intensity, and the quality of the underlying data.ConclusionsOur analysis indicates that armed conflict is associated with substantial and persistent excess maternal and child deaths globally, and with reductions in key measures that indicate reduced availability of organised healthcare. These findings highlight the importance of protecting women and children from the indirect harms of conflict, including those relating to health system deterioration and worsening socioeconomic conditions.

Mohammed Jawad and co-workers report on a global analysis of maternal and child health outcomes in situations of armed conflict.     

Rate of Fat Gain Is Faster in Girls Undergoing Early Adiposity Rebound

Objective: To determine the changes in body composition (fat and lean mass) occurring in children during adiposity rebound (AR). Research Methods and Procedures: Thirty‐nine girls, 3 to 6 years of age at baseline, underwent yearly DXA scans for 2 years. An additional DXA scan was obtained 4 to 5 years after baseline. Age at AR was determined by modeling, and the velocity of change in height, weight, fat mass, and lean mass was estimated for each child using random coefficient models. Girls with an AR <5 years of age were classified as having an early AR, and those having an AR ≥5 years were classified as late AR. Results: Although body composition was similar at age 5, by age 9, girls with an early AR were significantly taller (3.5% more) and heavier (14.4%), with greater fat mass (50%) and percentage body fat (27%) than girls with a later AR. In addition, more girls were overweight according to BMI (18% vs. 6%) or percentage body fat (29% vs. 11%) at this time, despite no differences at baseline. Annual velocity of fat mass gain was over 2‐fold higher in early compared with late rebounders (17.1% vs. 6.5%, p < 0.0001), with no difference in lean mass velocity (13.1% vs. 12.5%, p = 0.116). Discussion: Differences in BMI during AR were caused specifically by alterations in body fat and not by alterations in lean mass or height. Children undergoing early AR gained fat at a faster rate than children who rebounded at a later age.