Mortality in children with kidney failure is higher in girls than boys with cardiovascular complications representing the most common causes of death. Pulse wave velocity (PWV), a measure of vascular stiffness, predicts cardiovascular mortality in adults. Here, PWV in children with kidney failure undergoing kidney replacement therapy was investigated to determine sex differences and potential contributing factors. Two-hundred thirty-five children (80 girls; 34%) undergoing transplantation (150 pre-emptive, 85 with prior dialysis) having at least one PWV measurement pre- and/or post-transplantation from a prospective cohort were analyzed. Longitudinal analyses (median/maximum follow-up time of 6/9 years) were performed for PWV z-scores (PWVz) using linear mixed regression models and further stratified by the categories of time: pre-kidney replacement therapy and post-transplantation. PWVz significantly increased by 0.094 per year and was significantly higher in girls (PWVz +0.295) compared to boys, independent of the underlying kidney disease. During pre-kidney replacement therapy, an average estimated GFR decline of 4 ml/min/1.73 m² per year was associated with a PWVz increase of 0.16 in girls only. Higher diastolic blood pressure and low density lipoprotein were independently associated with higher PWVz during pre-kidney replacement therapy in both sexes. In girls post-transplantation, an estimated GFR decline of 4ml/min/1.73m² per year pre-kidney replacement therapy and a longer time (over 12 months) to transplantation were significantly associated with higher PWVz of 0.22 and of 0.57, respectively. PWVz increased further after transplantation and was positively associated with time on dialysis and diastolic blood pressure in both sexes. Thus, our findings demonstrate that girls with advanced chronic kidney disease are more susceptible to develop vascular stiffening compared to boys, this difference persist after transplantation and might contribute to higher mortality rates seen in girls with kidney failure.

Background: Poor dietary habits and low levels of physical activity (PA) have a strong tendency to track from childhood into adulthood. The Mediterranean Diet (MD) is known to be extremely healthy, associated with lower BMI and a lower risk of obesity in children and adolescents. Therefore, adherence to the MD was compared between Spanish (n = 182) and German (n = 152) children aged 10 to 13 years to examine a possible more “westernized” diet in Spain with a non-Mediterranean country, that traditionally prefers a “Western diet” and to determine the association between adherence to the MD and gender, body composition, and PA levels. Methods: In the German observational longitudinal cohort study and the Spanish cohort study, body composition and questionnaires (KIDMED, Diet Quality (IAES)) were obtained, and accelerometers (Actigraph) were applied to detect PA. Results: Girls had higher BMI-standard deviation score (SDS) than boys and Spanish girls were less active than boys. Differences were detected in MD habits, such as favorable fruit-, vegetables-, fish-intakes, and dairy products in Spanish children and unfavorable consumptions of fast food, processed bakery goods, candies, and sweet beverages in German children. Independently of country, girls, children with lower BMI-SDS and children with higher PA level were related with better diet quality. Conclusion: Spanish children showed higher adherence to MD and diet quality (IAES) compared to German children, but there was a trend toward a more “westernized” diet. Gender, body composition, and PA influenced nutrition regardless of country.

Children’s sedentary time has increased, while daily physical activity and motor performance have decreased. We evaluated an integrated school-based exercise program by assessing changes in motor skills after one year and comparing these changes to children who did not participate. We included 303 children from five schools in this longitudinal study and assigned them either to the exercise group (EG; n = 183 with daily exercise program) or the waiting group (WG; n = 120). Motor skills were assessed at baseline and after one year. Mixed modeling was used to analyze inter-group differences of change in motor skills and to determine the effect of sex, age group, and weight status. EG improved more strongly than WG for sprint, side jumps (both p = 0.017), stand and reach (p = 0.012), and ergometry (p ≤ 0.001) when compared to WG. Girls improved more strongly in the sit-ups than boys, second graders more than fifth graders in the backwards balance and the ergometry, and non-overweight children more in the standing long jump than overweight children. The exercise program is effective in increasing motor skills and physical fitness. Girls were not disadvantaged, and overweight children profited as much as their non-overweight peers in all categories but one.

Purpose Children’s sedentary time has increased in recent years, especially during school, while daily physical activity has decreased. The lack of physical activity can contribute to a deterioration in motor performance, which is key to a healthy development. We implemented a comprehensive exercise program in the school setting. Our study aimed to evaluate this program by assessing changes in motor skills after one year and to compare these changes to children who did not participate. Methods A total of 357 children from 5 schools were included in this observational longitudinal cohort study. Motor skills were assessed using the German Motor Test 6–18. Children were either assigned to the exercise group (EG) or waiting group (WG). The EG participated in the physical activity program for one year. Of those, a total of 303 children (EG n = 183; WG n = 120) completed motor tests at baseline and follow-up one year later, and comprise the study population. Linear mixed modeling was used to calculate corrected means and analyze for inter-group differences of change in motor skills after one year between the groups, and to determine the effect of sex, age group and weight category on the change in motor skills. Results After one year of additional physical activity, the EG improved significantly more strongly in 6 out of 8 motor skill tests than the WG. After the adjustment for sex, age, and BMI the improvement is still significantly stronger in the EG in 4 of 8 motor skill tests (sprint, side jumps, both p = 0.017; stand and reach, p = 0.012; ergometry, p = < 0.001), when compared to the WG. Girls improved more strongly in the sit-ups than boys, 2nd graders more than 5th graders in the backwards balance and the ergometry, non-overweight pupils more in the standing long jump than overweight children. Conclusions Participating in the exercise program for one year positively influenced motor skill development in schoolchildren. Our data suggest that girls were not disadvantaged, and even improved more than boys in the sit-ups, and that overweight pupils profited as much as their non-overweight peers in all categories but one. The exercise program, simple and easily implemented into the school routine, is effective in increasing motor skills and physical fitness.