Adolescent ; Adult ; Aged ; Child ; Disease Outbreaks ; Humans ; Middle Aged ; Obesity ; epidemiology ; Singapore ; epidemiology ; Young Adult

INTRODUCTIONThe incidence of childhood obesity is rising across the globe, and obesity related co-morbidities are increasing concomitantly in the paediatric population.

MATERIALS AND METHODSPubMed search for research and review papers on complications of childhood obesity was performed.

RESULTSThe consequences of childhood obesity can be broadly classified into medical and psychosocial consequences. Medical consequences include metabolic complications such as diabetes mellitus, hypertension, dyslipidaemia and non-alcoholic fatty liver disease, and mechanical problems such as obstructive sleep apnoea syndrome and orthopaedic disorders. Psychological and social consequences are prevalent but often overlooked. Local data on these complications were also discussed.

CONCLUSIONChildhood obesity is associated with significant morbidities, which not only have immediate impact on the health of the obese children, but also significantly increase the risk of morbidities in adulthood.

Adolescent ; Body Mass Index ; Child ; Comorbidity ; Humans ; Obesity ; complications ; diagnosis ; epidemiology ; Young Adult

INTRODUCTIONObesity is a global pandemic and a major health concern. Obesity is a common but complex, multifactorial disorder with high heritability, where as much as 80% of the variance in the body mass index (BMI) is attributable to genetic factors.

MATERIALS AND METHODSLiterature on the contributing factors of the current obesity epidemic, and genetic basis of human obesity, were reviewed.

RESULTSThe current increasing prevalence of obesity is a relatively recent global event driven by our modern lifestyle and dietary habits. Common obesity is the result of subtle interaction between numerous related genetic variants and environmental factors. The role of the obesity genes in this current epidemic is passive, but its impact is highly significant, because individuals with these genes may be predisposed to severe or even morbid obesity when exposed to the modern "obesogenic" environment.

CONCLUSIONSThe human weight regulation mechanism evolved and becomes efficient in preventing weight loss, but is relatively ineffective in preventing excessive weight gain. The modern "obesogenic" environment encourages a sedentary lifestyle and provides easy access to processed food, which leads to a reduction of energy expenditure and increased caloric intake. We have inadvertently created a biology-environment mismatch, as the human weight regulation is unable to evolve fast enough to keep pace with the environmental change. This resulted in maladaptation of an otherwise sound and metabolically efficient physiological mechanism, with serious metabolic consequences.

Disease Outbreaks ; Humans ; Obesity ; epidemiology ; genetics

INTRODUCTIONCommon obesity is a multi-factorial trait, contributed by the "obesogenic" environment of caloric abundance and increasing automation, sedentary lifestyle and an underlying genetic susceptibility. There have been major advances in the past decade in our understanding of the human weight regulation mechanism and pathogenesis of obesity, abetted by discoveries of genetic defects which lead to human obesity.

MATERIALS AND METHODSReports of genetic mutations causing obesity in humans and murine models were reviewed.

RESULTSHumans with genetic defects resulting in leptin deficiency, leptin receptor deficiency, proopiomelanocortin deficiency (POMC), and melanocortin 4 receptor (MC4R) deficiency developed severe obesity as the dominant phenotypic feature, though these are rare autosomal recessive conditions, except MC4R deficiency which is inherited in an autosomal co-dominant fashion. Common and rare variants of the POMC and melanocortin 3 receptor genes may be predisposing factors in the development of common obesity. Recent reports of human obesity associated with thyrosine kinase B (TrkB) defect and brain derived neurotrophic factor (BDNF) disruption, coupled with other murine studies, supported the role of BDNF/TrkB as effectors downstream of the melanocortin receptors.

CONCLUSIONDespite exciting discoveries of single gene mutations resulting in human obesity, most cases of obesity are likely the result of subtle interactions of several related genetic variants with environmental factors which favour the net deposition of calories as fat, culminating in the obese phenotype. The mechanisms of action of these genes in the development of obesity are now being examined, with the aim of eventually discovering a therapeutic intervention for obesity.

Animals ; Body Weight ; genetics ; Disease Models, Animal ; Humans ; Leptin ; genetics ; physiology ; Melanocortins ; genetics ; physiology ; Mice ; Mutation ; Obesity ; genetics

Growth is an indicator of the health and nutritional status of infants and children. Health organisations and professionals worldwide advocate monitoring the growth of children with the primary aim of identifying and preventing malnutrition and/or obesity. Growth monitoring should be part of every health care consultation for children. However, physicians during health care consultations are often so busy addressing acute health issues, that they miss the opportunity to monitor the child's growth and provide anticipatory guidance. Appropriate growth monitoring would enable health care providers to detect abnormal growth in a timely manner, as well as to reassure parents if their concerns are unfounded. To perform this effectively, physicians need to be familiar with measurement methods, use of appropriate growth charts and interpretation of results. As weight, height and growth rates may vary among children, physicians also need to understand what constitutes normal growth. This paper aims to clarify the purpose of growth monitoring and provide recommendations for physicians to assess, monitor and manage growth in infants and children in a primary care setting.
Body Mass Index ; Child Development ; physiology ; Child, Preschool ; Growth Charts ; Humans ; Primary Health Care

Xanthogranulomatous inflammation is an uncommon form of chronic inflammatory process. Only a few isolated case reports of xanthogranulomatous appendicitis (XA) have been published. XA has nonspecific imaging findings and cannot be reliably differentiated on imaging from locally advanced malignancy. XA however follows a benign course and can potentially be treated with surgical resection.

INTRODUCTIONThere is currently a lack of representative data for local gestational age-specific size-at- birth percentile charts. Existing charts also suffer from limitations relating to the measurement of gestational age (GA) and an outdated population. We aim to construct reference values and charts for size-at-birth from 35 to 41 weeks, based on the healthy local population.

MATERIALS AND METHODSProspective observational birth cohort study which recruited pregnant mothers from the 2 major public hospitals with obstetric service in Singapore, at <14 weeks gestation and data was collected for birth weight, length and head circumference of infants born from November 2009 to May 2011. Percentile curves were created separately for male and female infants using the lambda-mu-sigma (LMS) method. The new percentile curves were then compared with other internationally published growth charts.

RESULTSSmoothened curves for birth weight, length and head circumference centiles were created from 863 infants (460 males, 403 females). Male infants consistently exceeded female infants in all 3 variables at each GA. For a male and female Singapore infant at 38 weeks gestation, the 10-50-90th centile values for weight would be 2663-3096-3597 vs. 2571-2966-3417 grams, for length 46.4-48.6-51.1 vs. 45.6-48.0-50.4 cm, and for head circumference 32.0-33.5-35.2 vs. 31.4-32.9-34.6 cm. There was no statistically significant difference between ethnic groups. On comparing our birth weight curves with data from Finland across all gestations, birth weights in our term infants (GA ≥37 weeks) were found to be lower across the 10-50-90th percentiles.

CONCLUSIONThe new centile charts in this study may be used as reference charts for size-at-birth for a subgroup of near-term and term infants. The use of foreign charts may lead to misclassification of small for gestational age (SGA) or large for gestational age (LGA) infants.

Birth Weight ; Body Size ; Cephalometry ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Prospective Studies ; Reference Values ; Singapore

INTRODUCTIONDual energy X-ray absorptiometry (DEXA) is currently the gold standard for the assessment of bone mineral density. Quantitative ultrasound (QUS), on the other hand, is a radiation-free alternative for the assessment of bone strength in the paediatric population. Establishing normative data for bone strength specific to the population would allow identification of children at risk of osteoporosis as a consequence of disease and its treatment. This cross-sectional study aims to establish the normal reference range for calcaneal broadband ultrasound attenuation (BUA) measurements in normal Singaporean children aged 6 to 12 years.

MATERIALS AND METHODSHealthy Singaporean children were randomly selected from 11 primary schools for the assessment of calcaneal BUA, using the paediatric Contact Ultrasonic Bone Analyzer (CUBA, McCue Plc, Compton, Winchester, England). The height, weight, body mass index and BUA measurements for each age group and gender were expressed as the mean ± SD. One-way ANOVA was used to compare the mean calcaneal BUA by age and gender of Singaporean children with that of children from the United Kingdom, Turkey and Taiwan.

RESULTSA total of 750 healthy Singaporean children (417 males and 333 females) aged 6 to 12 years from 11 primary schools were enrolled. The calcaneal BUA values of Turkish and white British children were not statistically different from this Singaporean cohort. However, the Singaporean calcaneal BUA measurements were significantly higher compared to the Taiwanese children.

CONCLUSIONThis study provides the first normal reference data to evaluate bone strength in Singaporean children using the paediatric Contact Ultrasonic Bone Analyzer.

Absorptiometry, Photon ; Age Factors ; Analysis of Variance ; Body Mass Index ; Bone Density ; Bone and Bones ; diagnostic imaging ; Child ; Child Welfare ; Cross-Sectional Studies ; Female ; Humans ; Male ; Reference Values ; Risk Assessment ; methods ; Schools ; Sex Factors ; Singapore ; Taiwan ; Turkey ; Ultrasonography ; United Kingdom

BACKGROUND: We have no information about the safety and effectiveness when we perform overdilating a sirolimuseluting stent(SES) with high pressure. In some specific animal model, the study reported overdilatation of SES with high pressure resulted in increase of restenosis. The aim of this study was to evaluate the safety and effectiveness of overdilatation of SES with high pressure. METHODS: 97 patients underwent PCI using SES between August 2003 and July 2005 were divided into two group(high pressure group, low pressure group), stents were implanted with high pressure(>18 atm) and low pressure(<12 atm). We compared between the two group of safety of stents, major adverse cardiac events(MACE), rate of restenosis, late loss. RESULTS: In high pressure group, there are more type C lesion(51% vs 38%, p<0.01). There were no significant differences between the two groups regarding MACE(12.8% vs 17.2%, p=0.78), in-stent restenosis rate(2.6 % vs 5.2%, p=0.65). There are small increasing of late loss in high pressure group, but no statistically significant difference(0.30 vs 0.15, p=0.05). CONCLUSION: Implantation of SES overdilated with high pressure is able to be performed safely to obtain wider inner lumen of stents.
Dilatation ; Humans ; Models, Animal ; Myocardial Ischemia ; Stents

INTRODUCTIONThe Diabetes Health Profile-18 (DHP-18) measures diabetes-related psychological well-being in patients with type 2 diabetes mellitus (T2DM). It includes 3 subscales: psychological distress (PD), barriers to activity and disinhibited eating. The psychometric properties of the DHP have not been evaluated in Asia. The aim of this study was to determine the psychometric properties of the DHP in multiethnic Singapore.

MATERIALS AND METHODSPatients between the ages of 18 to 65 diagnosed with diabetes (either type 1 or type 2) for at least 1 year were recruited from a diabetes outpatient clinic in a tertiary hospital. They completed a set of self-administered questionnaires including sociodemographic information and the DHP. Validity of the DHP was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Reliability was assessed with internal consistency and sensitivity was determined by effect size, associated with detecting a statistically significant and clinically important difference between various patient subgroups.

RESULTSA total of 204 patients with mean age 45.4 (11.9) years, comprising 64% males and 50% Chinese, 27% Indian and 12% Malay were studied. In CFA, model fit was poor. Forced 3-factor EFA supported the original 3-factor structure of the DHP. Convergent and discriminant validity was demonstrated (100% scaling success). DHP was sensitive across majority of social demographic, clinical and social-functioning determinants (i.e., effect size >0.3). Cronbach's alpha exceeded 0.70 for all subscales. Ceiling effects were negligible but large floor effects were seen for the PD subscale (23%).

CONCLUSIONThe DHP is valid, reliable and sensitive for measuring well-being in Asian patients with T2DM.

Adolescent ; Adult ; Aged ; Diabetes Mellitus, Type 1 ; psychology ; Diabetes Mellitus, Type 2 ; psychology ; Emotional Adjustment ; Ethnic Groups ; psychology ; statistics & numerical data ; Factor Analysis, Statistical ; Feeding Behavior ; psychology ; Female ; Humans ; Male ; Middle Aged ; Psychological Tests ; Psychometrics ; Reproducibility of Results ; Sensitivity and Specificity ; Singapore ; Stress, Psychological ; diagnosis ; etiology ; psychology ; Surveys and Questionnaires ; Young Adult