OBJECTIVE: To identify risk factors for overweight in Hong Kong children aged 6-7 y. DESIGN: Case-control study. SETTING: Student Health Service Centres, Hong Kong. SUBJECTS: A total of 343 Hong Kong Chinese children aged 6-7 y old categorised into three groups, an overweight group (Z92nd centile for BMI), a normal middle-weight group (45th-55th centile for BMI) and a normal low-weight group (r8th centile for BMI). MEASUREMENTS: Subjects and their parents/caregivers were interviewed at home. Data on lifestyle habits, dietary habits, family structure and demographic background were collected by questionnaire. A 3-day dietary record was administrated by the parents/caregivers to assess dietary intake of the children. RESULTS: Logistic regression analyses (overweight group compared with middle-weight plus low-weight groups) showed that childhood overweight was significantly associated with parental obesity (BMI Z25 kg/m 2 , Asian reference) (paternal: OR ¼ 2.66, 95% CI ¼ 1.51-4.70; maternal: 5.07, 2.62-9.79) but not parental overweight (BMI ¼ 23-25 kg/m 2 ). After adjustment for parental obesity, the odds ratio for childhood overweight was increased by birth weight (o3.0 kg as reference, 3.0-3.5 kg: 2.13, 1.18-3.84; Z3.5 kg: 4.89, 2.49-9.60) and decreased by sleeping duration (o9 h/day as reference, 9-11 h/day: 0.54, 0.30-0.97; Z11 h/day: 0.31, 0.11-0.87). Childhood overweight was also significantly associated with higher energy consumption (2.62, 1.20-5.74) and having a father who was a current smoker (2.08, 1.25-3.46). CONCLUSIONS: Although healthy diet and regular exercise will remain the cornerstones of obesity management in children, our data support the view that education about maintaining a healthy weight could be introduced much earlier in those families with high-risk children, as indicated by high parental BMI or high birth weight. The utility and practicality of such an approach should be carefully evaluated before becoming part of any public health policy. Further study of the role of short sleeping duration and parental smoking on childhood obesity development is warranted.
Five cases of moderately severe hypernatraemic dehydration were identified within a 5-month period between two regional hospitals in Hong Kong. Unlike previous reported cases, these exclusively breast-fed infants presented with the unusual triad of fever, absence of overt signs of dehydration and within the first week of life. Three of the cases also had high serum bilirubin concentrations at presentation. The fever subsided quickly and the serum bilirubin concentration fell rapidly within a few hours of rehydration. All infants made an uneventful recovery without permanent neurological sequelae. Fever, presumably secondary to dehydration, is an useful early warning sign. These cases emphasize the importance of early and regular measurement of bodyweight in exclusively breast-fed infants so that prompt identification of affected cases may prevent potentially detrimental complications.
Discharge information for all Hong Kong government hospitals, which is routinely collected through the Clinical Management System (CMS), was used to assess the relative importance of all causes of diarrhoeal illness and to address the issue of under-diagnosis of rotavirus by linking discharge diagnostic codes with actual laboratory results for one hospital. Of all children less than 5 years of age hospitalized in Hong Kong in the 2-year period July 1997 to June 1999, 12,257 (11%) were discharged with a primary diarrhoea diagnosis (74% coded as non-specified, 10.4% as rotavirus, 11% as Salmonella and 5% as other viral or bacterial). Linked laboratory and discharge data for one hospital demonstrated that 15% (n = 1522) of all admissions had a primary diarrhoea diagnosis and that 40% of these had a specimen sent for rotavirus testing, of which 37% were positive. However, 46% (67/145) of children with a diagnosis of rotavirus infection had no virology result, and 69% (172/248) of positive rotavirus results were in children with no diagnosis indicating rotavirus infection. Modification of the CMS to routinely combine existing computerized laboratory data with the CMS discharge diagnoses and to develop mechanisms to enhance reliability of discharge diagnosis coding could produce a powerful resource for disease surveillance, auditing and for monitoring the impact of future vaccination and other prevention programmes.
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