To download the Chinese version of the issue digest, please click here.

Energy expenditure and physical activity of obese children

Hong Kong Med J 2002;8:313-7

In Hong Kong, the prevalence of obesity in children and adolescents has been increasing. This is likely to reflect changes in both diet and energy expenditure of the Hong Kong children and adolescents, yet the detailed patterns of activity and energy expenditure are to be studied. In order to better understand the patterns of activity and energy expenditure, The Chinese University of Hong Kong, together with Hong Kong Sports Development Board, conducted a research on energy expenditure and physical activity of obese children in Hong Kong. The results are published in the October 2002 issue of the Hong Kong Medical Journal.

The research involved 18 obese children, and another 18 age- and sex-matched non-obese children in the local Hong Kong community. These 36 children were monitored for 3 days on their daily activities, energy expenditure (estimated using heart rate monitoring), and body composition, etc.

Research results showed that total daily energy expenditure was higher in obese children in absolute terms, and the basal metabolic rate was no different between obese and non-obese children. It is therefore suggested that an intrinsic difference of metabolic rate is not a major contributory cause of obesity. After normalisation for body weight, the total daily energy expenditure of obese children were significantly lower than that of non-obese children by 22%.

It was also found that obese children spent 12% less time in sleeping, but 51% more time in sedentary activities and 30% less time in physical activities than non-obese children did. The ratio of active-to-sedentary waking time for obese children was 0.6, while the respective ratio for non-obese children was 1.9. The potential benefit of increasing physical exercise time relative to sedentary activities to reduce the prevalence of children obesity was highlighted by researchers.

Breast conservation treatment (BCT), with its cosmetic and psychological advantages over mastectomy, has been increasingly used in the last 20 years in western countries. In Hong Kong, however, due to the relatively smaller breast size of Chinese women, BCT has long been considered unsuitable for most patients in Hong Kong. To study the clinical outcomes of breast cancer patients after BCT, a review of breast cancer patients received BCT between 1994 and 1999 has been conducted. The results of the study are published in October 2002 issue Hong Kong Medical Journal.

The clinical records of 203 female patients who were received post-lumpectomy radiotherapy for BCT at the Pamela Youde Nethersole Eastern Hospital were reviewed. These patients were treated with adjuvant radiotherapy, with or without systemic adjuvant treatment. Results of the study showed that the 5-year actuarial local control, progression-free survival, and disease-specific survival rates for patients with invasive breast cancer were all over 85% (95.5%, 85.8%, and 95.2%, respectively). Such results were comparable to respective figures in large overseas trials, which have demonstrated the equivalence of mastectomy and breast conservation treatment in terms of survival.

The study also reviewed the cosmetic scores given by patients and doctors after BCT. It was found that the average (out of 10) cosmetic scores given by patients and doctors were 8.07 and 8.04, respectively. The cosmetic results of BCT were rated as either good or excellent by 95.6% of the patients.

It was noticed by researchers that the risk of local recurrence was significantly increased in younger patients i.e. patients of age under 40 years. Another risk factor associated with local recurrence was positive final margins. Doctors recommended further excision or mastectomy to maximise local control for patients with positive final margins.

Researchers concluded that the overall outcomes of patients received BCT were comparable to those treated by mastectomy. Researchers pointed out that in addition to mastectomy, with or without breast reconstruction, breast conservation treatment should be offered as an alternative in suitable Chinese women.

Case report—

corrosive oesophageal injury following vinegar ingestion

Hong Kong Med J 2002;8:365-6

Hong Kong people enjoy eating seafood, and they like to serve fish with the bone attached. As a result, fish bone lodged in the throat is a common occurrence. There are several Chinese folk remedies such as drinking vinegar to ‘soften’ it. The Northern District Hospital has treated a patient who was diagnosed with caustic injury of the oesophagus after drinking vinegar with the intention to ‘soften’ crab shell stuck in her throat. The case report has been published to highlight the danger of such folk practice.

The patient, a 38-year-old woman, experienced a foreign body sensation and pain in her throat after eating crab at dinner. She suspected a small piece of crab shell might be lodged in her throat. She drank one tablespoon of household rice vinegar in the belief that it would dissolve the shell. The sensation of foreign body and pain persisted, however. She attended to a general out-patient clinic the next day, where she was referred to the accident and emergency department. Endoscopic finding was inflammation of the oropharynx and second-degree caustic injury of the oesophagus from 22 to 30 cm and the cardia. The patient recovered 1 week later.

The doctor pointed out that although vinegar is a weak acid, it can cause corrosive and ulcerative injury. The most common sites of injury by acid ingestion are the natural anatomic narrowings in the oesophagus and the cardia. The stomach may also be involved. Doctors warned that the use of vinegar in ‘dislodging’ a foreign body in throat should be strongly discouraged.