The association between high fructose consumption and elevated blood pressure continues to be controversial, especially in adolescence. The aim of this study was to assess the association between ...fructose consumption and elevated blood pressure in an European adolescent population.
A total of 1733 adolescents (mean ± SD age: 14.7 ± 1.2; percentage of girls: 52.8%) were analysed from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study in eight European countries. Blood pressure was measured using validated devices and methods for measuring systolic blood pressure (SBP) and diastolic blood pressure (DBP). Dietary data were recorded via repeated 24 h recalls (using specifically developed HELENA-DIAT software) and converted into pure fructose (monosaccharide form) and total fructose exposure (pure fructose + fructose from sucrose) intake using a specific fructose composition database. Food categories were separated at posteriori in natural vs. were non-natural foods. Elevated BP was defined according to the 90th percentile cut-off values and was compared according to tertiles of fructose intake using univariable and multivariable mixed logistic regression models taking into account confounding factors: centre, sex, age and z-score-BMI, MVPA (Moderate to Vigorous Physical Activity) duration, tobacco consumption, salt intake and energy intake.
Pure fructose from non-natural foods was only associated with elevated DBP (DBP above the 10th percentile in the highest consuming girls (OR = 2.27 (1.17-4.40);
= 0.015) after adjustment for cofounding factors.
Consuming high quantities of non-natural foods was associated with elevated DBP in adolescent girls, which was in part due to high fructose levels in these foods categories. The consumption of natural foods containing fructose, such as whole fruits, does not impact blood pressure and should continue to remain a healthy dietary habit.
Purpose Classrooms including children who are hard of hearing (CHH) may be modified to manage noise and reverberation and improve speech perception. Little is known about the acoustic characteristics ...of contemporary general education classrooms that include CHH compared to classrooms of typical peers. We proposed the following research questions about the acoustic environment of general education classrooms including CHH: (a) How reliable are acoustic measurements collected using an iOS device, application, and external microphone? (b) What proportion of classrooms meet the American National Standards Institute's standards for unoccupied noise levels and reverberation? Method A smartphone application was used to measure sound levels, reverberation, and clarity for 164 general education classrooms including CHH. Linear mixed models were used to examine the following: (a) reliability of acoustic measures made using an application and external microphone and (b) predictors of sound levels, reverberation, and clarity for elementary classrooms including CHH. Results Results indicate the application reliably measures classroom acoustics. Classrooms exceeded the American National Standards Institute's recommended noise levels, but met reverberation time guidelines. Grade; heating, ventilation, and air conditioning status; and room volume predicted classroom acoustics. Conclusions As a screening tool, the application was shown to be effective in reliably measuring reverberation and classroom noise levels. The high levels of noise in unoccupied classrooms indicate a need for increased use of noise abatement strategies and the use of remote-microphone systems, especially in classrooms where noise levels cannot feasibly be reduced. Using an application may be a cost-effective method for monitoring important acoustic features that impact children's ability to understand speech in the classroom.
Children with hearing loss (CHL) may exhibit spoken language delays and may also experience deficits in other cognitive domains including working memory. Consistent hearing aid use (i.e., more than ...10 hours per day) ameliorates these language delays; however, the impact of hearing aid intervention on the neural dynamics serving working memory remains unknown. The objective of this study was to examine the association between the amount of hearing aid use and neural oscillatory activity during verbal working memory processing in children with mild-to-severe hearing loss.
Twenty-three CHL between 8 and 15 years-old performed a letter-based Sternberg working memory task during magnetoencephalography (MEG). Guardians also completed a questionnaire describing the participants' daily hearing aid use. Each participant's MEG data was coregistered to their structural MRI, epoched, and transformed into the time-frequency domain using complex demodulation. Significant oscillatory responses corresponding to working memory encoding and maintenance were independently imaged using beamforming. Finally, these whole-brain source images were correlated with the total number of hours of weekly hearing aid use, controlling for degree of hearing loss.
During the encoding period, hearing aid use negatively correlated with alpha-beta oscillatory activity in the bilateral occipital cortices and right precentral gyrus. In the occipital cortices, this relationship suggested that with greater hearing aid use, there was a larger suppression of occipital activity (i.e., more negative relative to baseline). In the precentral gyrus, greater hearing aid use was related to less synchronous activity (i.e., less positive relative to baseline). During the maintenance period, hearing aid use significantly correlated with alpha activity in the right prefrontal cortex, such that with greater hearing aid use, there was less right prefrontal maintenance-related activity (i.e., less positive relative to baseline).
This study is the first to investigate the impact of hearing aid use on the neural dynamics that underlie working memory function. These data show robust relationships between the amount of hearing aid use and phase-specific neural patterns during working memory encoding and maintenance after controlling for degree of hearing loss. Furthermore, our data demonstrate that wearing hearing aids for more than ~8.5 hours/day may serve to normalize these neural patterns. This study also demonstrates the potential for neuroimaging to help determine the locus of variability in outcomes in CHL.
Purpose: There is ambiguity in the clinical and research communities regarding whether children with mild bilateral hearing loss (MBHL) are at risk for delays. The goal of the current article is to ...expand the evidence base surrounding outcomes for the current generation of children with MBHL. Method: Using independent-samples "t" tests, we compared children with MBHL to same-age peers with normal hearing (NH) on measures of vocabulary, morphological awareness, listening comprehension, and reading. We completed regression analyses to explore the foundational linguistic skills that influenced reading abilities in both groups. For the children with MBHL, we examined whether hearing aid (HA) dosage was associated with individual differences in language scores. Results: Group comparisons indicated that children with NH significantly outperformed children with MBHL on tests of morphological awareness and listening comprehension. There were no differences in vocabulary size or reading achievement; however, children with MBHL displayed significant differences in the factors that accounted for variability in reading scores compared to children with NH. HA dosage was significantly associated with variation in listening comprehension scores, but not vocabulary, reading, or morphological awareness. Conclusions: The current results provide evidence that children with MBHL are at risk for persistent language deficits by 4th grade, particularly in aspects of language that involve form. Reading skills in children with MBHL appear to be commensurate with same-age hearing peers. Consistent use of well-fit HAs supports listening comprehension, although the amount of benefit from HAs may be reduced for children with higher unaided hearing levels.
Children who are hard of hearing (CHH) have restricted access to acoustic and linguistic information. Increased audibility provided by hearing aids (HAs) influences language outcomes, but the ...advantages of appropriately fit HAs can only be realized if children wear their devices on a consistent basis. The purpose of this article was to characterize long-term HA use in CHH, based on parent-report measures, and identify factors that influence longitudinal trends in HA use.
Participants were parents of 290 children with mild to severe hearing loss. At every visit, parents estimated the average amount of time the child used HAs per day during the week and on the weekends. Parent reports of daily HA use were analyzed to determine if different patterns of HA use were observed longitudinally during the study. Independent predictor variables were then related to longitudinal trends in HA use within three age groups (infant, preschool, school age).
On average across multiple visits, parents reported that their children wore their HAs for 10.63 hr per day (SD = 3.29). Data logging values were lower than parent-report measures (M = 8.44, SD = 4.06), suggesting that parents overestimated daily HA use. The majority of children in each age group wore HAs at least 8 hr per day from their first research testing interval to their last, based on parent-report measures. Maternal education level predicted longitudinal trends in HA use for infants and school-age CHH. Degree of hearing loss was related to trends in school-age children only.
These results indicated that the majority of CHH increased HA use over time, but a sizable minority demonstrated a low level of use or decreased use in the time period studied. Maternal education level influenced longitudinal trends in daily HA use. Degree of hearing loss influenced trends in school-age children only. Audiologists and early intervention service providers might aid in improving HA use by providing regular hands-on training with the HAs and individualized problem-based strategies to address the challenges families experience with attaining a high level of use. Families may also benefit from practical demonstrations of the benefits of consistent HA use, such as hearing loss simulations, examples of listening in noise with and without HAs, or listening to malfunctioning HAs.
To determine if a stricter criterion for paediatric hearing aid fitting for proximity of fit-to-target of <3 dB root-mean-square (RMS) error produces better audibility and outcomes compared to the ...current <5 dB criterion, and to examine the relationship between aided audibility and RMS error by degree of hearing loss.
We evaluated the influence of unaided hearing level on the relationship between RMS error and aided audibility. We assessed the effect of RMS error category (<3, 3-5, >5 dB) on aided audibility, speech recognition, expressive vocabulary, and morphosyntax.
The study included 2314 hearing aid verification measurements from 307 children with hearing aids.
Children who met a <3 dB criterion had higher aided audibility than children who met no criterion (>5 dB error). Results showed no differences in speech recognition or vocabulary by error category, but children with <3 dB error demonstrated better morphosyntax than children with 3-5 and >5 dB RMS error.
Fittings that are close to prescriptive targets provide a more positive outcome for children with hearing aids. Using probe microphone measures to adjust hearing aids to within 3 dB may benefit language abilities in children.
The Ile138Met variant (rs738409) in the PNPLA3 gene has the largest effect on non-alcoholic fatty liver disease (NAFLD), increasing the risk of progression to severe forms of liver disease. It ...remains unknown if the variant plays a role in age of NAFLD onset. We aimed to determine if rs738409 impacts on the age of NAFLD diagnosis.
We applied a novel natural language processing (NLP) algorithm to a longitudinal electronic health records (EHR) dataset of >27,000 individuals with genetic data from a multi-ethnic biobank, defining NAFLD cases (n = 1,703) and confirming controls (n = 8,119). We conducted i) a survival analysis to determine if age at diagnosis differed by rs738409 genotype, ii) a receiver operating characteristics analysis to assess the utility of the rs738409 genotype in discriminating NAFLD cases from controls, and iii) a phenome-wide association study (PheWAS) between rs738409 and 10,095 EHR-derived disease diagnoses.
The PNPLA3 G risk allele was associated with: i) earlier age of NAFLD diagnosis, with the strongest effect in Hispanics (hazard ratio 1.33; 95% CI 1.15–1.53; p <0.0001) among whom a NAFLD diagnosis was 15% more likely in risk allele carriers vs. non-carriers; ii) increased NAFLD risk (odds ratio 1.61; 95% CI 1.349–1.73; p <0.0001), with the strongest effect among Hispanics (odds ratio 1.43; 95% CI 1.28–1.59; p <0.0001); iii) additional liver diseases in a PheWAS (p <4.95 × 10−6) where the risk variant also associated with earlier age of diagnosis.
Given the role of the rs738409 in NAFLD diagnosis age, our results suggest that stratifying risk within populations known to have an enhanced risk of liver disease, such as Hispanic carriers of the rs738409 variant, would be effective in earlier identification of those who would benefit most from early NAFLD prevention and treatment strategies.
Despite clear associations between the PNPLA3 rs738409 variant and elevated risk of progression from non-alcoholic fatty liver disease (NAFLD) to more severe forms of liver disease, it remains unknown if PNPLA3 rs738409 plays a role in the age of NAFLD onset. Herein, we found that this risk variant is associated with an earlier age of NAFLD and other liver disease diagnoses; an observation most pronounced in Hispanic Americans. We conclude that PNPLA3 rs738409 could be used to better understand liver disease risk within vulnerable populations and identify patients that may benefit from early prevention strategies.
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•Natural language processing increased NAFLD detection over ICD codes by 2.5 times.•rs738409 “GG” carriers were diagnosed with NAFLD 3 years earlier than non-carriers.•PNPLA3 rs738409 effects were most pronounced in Hispanics.•PheWAS showed rs738409 was associated with other NAFLD-related liver diseases.•rs738409 was associated with earlier diagnosis for PheWAS-identified diseases.
Paediatric hearing-aid verification relies on measures of output obtained from the ear canal or in a coupler with the child's real-ear-to-coupler difference (RECD). Measured RECD cannot always be ...completed in children, leading to fitting inaccuracies. Audiologists often have tympanometry data that characterises the child's ear-canal acoustics. The goal of this study was to determine if tympanometry can be used to improve predictions of measured RECD.
A retrospective analysis of RECD and admittance, tympanometric peak pressure, and equivalent ear-canal volume from 226 Hz tympanometry collected as part of a longitudinal study of children with hearing loss were modelled with Bayesian hierarchical regression.
Two-hundred sixty-six children with mild-to-severe hearing loss contributed data.
Age-based average RECD models were within 3 dB of measured RECD values in 54% of cases with normal middle ear status and 50.6% of cases with abnormal middle ear status. Immittance-predicted RECD were within 3 dB in 69.6% of cases with normal middle ear status and 74.4% of cases with abnormal middle ear status.
Immittance-predicted RECD was more accurate than age-based average RECD, particularly in children with abnormal middle ear status. The findings suggest that 226 Hz tympanometry could be used clinically to improve predictions of measured RECD when it cannot be measured.
Purpose: We employed a time-gated word recognition task to investigate how children who are hard of hearing (CHH) and children with normal hearing (CNH) combine cognitive-linguistic abilities and ...acoustic--phonetic cues to recognize words in sentence-final position. Method: The current study included 40 CHH and 30 CNH in 1st or 3rd grade. Participants completed vocabulary and working memory tests and a time-gated word recognition task consisting of 14 high- and 14 low-predictability sentences. A time-to-event model was used to evaluate the effect of the independent variables (age, hearing status, predictability) on word recognition. Mediation models were used to examine the associations between the independent variables (vocabulary size and working memory), aided audibility, and word recognition. Results: Gated words were identified significantly earlier for high-predictability than low-predictability sentences. First-grade CHH and CNH showed no significant difference in performance. Third-grade CHH needed more information than CNH to identify final words. Aided audibility was associated with word recognition. This association was fully mediated by vocabulary size but not working memory. Conclusions: Both CHH and CNH benefited from the addition of semantic context. Interventions that focus on consistent aided audibility and vocabulary may enhance children's ability to fill in gaps in incoming messages.
•Mild-to-severe hearing loss causes behavioral delays in language and working memory.•How hearing loss changes the neural dynamics serving working memory is unknown.•Working memory encoding and ...maintenance-related neural responses were compared.•Children with hearing loss showed increased compensatory right-hemisphere activity.•Fronto-parietal phase-specific activity was related to verbal intelligence scores.
Children with hearing loss (CHL) exhibit delays in language function relative to children with normal hearing (CNH). However, evidence on whether these delays extend into other cognitive domains such as working memory is mixed, with some studies showing decrements in CHL and others showing CHL performing at the level of CNH. Despite the growing literature investigating the impact of hearing loss on cognitive and language development, studies of the neural dynamics that underlie these cognitive processes are notably absent. This study sought to identify the oscillatory neural responses serving verbal working memory processing in CHL compared to CNH. To this end, participants with and without hearing loss performed a verbal working memory task during magnetoencephalography. Neural oscillatory responses associated with working memory encoding and maintenance were imaged separately, and these responses were statistically evaluated between CHL and CNH. While CHL performed as well on the task as CNH, CHL exhibited significantly elevated alpha–beta activity in the right frontal and precentral cortices during encoding relative to CNH. In contrast, CHL showed elevated alpha maintenance-related activity in the right precentral and parieto-occipital cortices. Crucially, right superior frontal encoding activity and right parieto-occipital maintenance activity correlated with language ability across groups. These data suggest that CHL may utilize compensatory right-hemispheric activity to achieve verbal working memory function at the level of CNH. Neural behavior in these regions may impact language function during crucial developmental ages.
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