Height Growth Velocity Research Articles

Nutritional Status and Growth Outcomes in Pediatric Idiopathic Growth Hormone Deficiency: A Retrospective Study in Turkey

Objective: Growth and development in children are significantly influenced by nutritional status. Nutritional deficiencies such as low hemoglobin (Hb), ferritin, vitamin B12, and vitamin D have been linked to impaired growth. This study aims to evaluate the impact of these nutritional markers on growth outcomes in children with idiopathic growth hormone deficiency (IGHD) undergoing recombinant growth hormone therapy (rhGH). Material and Methods: A cross-sectional, retrospective study was conducted on 100 children with IGHD, aged under 16, diagnosed between 2000 and 2023. Data were collected from medical records, including height, body mass index (BMI), pubertal status, bone age, and nutritional markers [Hb, ferritin, vitamin B12, 25-hydroxy-vitamin D3 (25(OH)D3]. Growth parameters were assessed at the start and end of the first year of rhGH treatment. Results: The cohort had a median age of 11.3 years; 30% were female, and 50% were prepubertal. The median height standard deviation score (SDS) was -2.8, and median BMI SDS was -0.7. Prevalence of nutritional deficiencies included 23% with low Hb, 31% with low ferritin, 44% with low 25(OH)D3, and 15% with low vitamin B12. Despite these deficiencies, no significant differences were observed in height SDS or growth velocity when grouped by nutritional markers or supplementation status. Growth velocity showed a significant positive correlation with Hb levels and mid-parental height (MPH). Conclusion: Nutritional deficiencies were common among IGHD patients; there was no significant difference in terms of growth-related metrics in the first year of the rhGH therapy in comparisons between the groups with and without common nutritional deficiencies. This finding underscores the resilience of growth in the presence of these deficiencies. In contrast, growth velocity correlated positively with Hb levels and MPH, suggesting that these factors may play a significant role in influencing growth. Further research with larger samples and extended follow-up is needed to explore the long-term impact of nutritional supplementation on growth in IGHD.

Safety and efficacy of selumetinib in pediatric and adult patients with neurofibromatosis type 1 and plexiform neurofibroma.

The MEK inhibitor, selumetinib, reduces plexiform neurofibroma (PN) in pediatric patients with neurofibromatosis type 1 (NF1). Its safety and efficacy in adults with PN and effectiveness in other NF1manifestations (e.g., neurocognitive function, growth reduction, and café-au-lait spots) are unknown. This open-label, phase 2 trial enrolled 90 pediatric or adult NF1 patients with inoperable, symptomatic, or potentially morbid, measurable PN (≥ 3cm). Selumetinib was administered at doses of 20 or 25mg/m2 or 50mg q 12 hrs for 2 years. Pharmacokinetics, PN volume, growth parameters, neurocognitive function, café-au-lait spots, and quality of life (QoL) were evaluated. Fifty-nine children and 30 adults (median age, 16 years; range, 3-47) received an average of 22±5 (4-26) cycles of selumetinib. Eighty-eight (98.9%) out of 89 per-protocol patients showed volume reduction in the target PN (median, 40.8%; 4.2%-92.2%), and 81 (91%) patients showed partial response (≥ 20% volume reduction). The response lasted until cycle 26. Scores of neurocognitive functions (verbal comprehension, perceptual reasoning, processing speed, and full-scale IQ) significantly improved in both pediatric and adult patients (P <0.05). Prepubertal patients showed increases in height score and growth velocity (P <0.05). Café-au-lait spot intensity decreased significantly (P <0.05). Improvements in QoL and pain scores were observed in both children and adults. All adverse events were CTCAE grade 1 or 2 and were successfully managed without drug discontinuation. Selumetinib decrease PN volume in the majority of pediatric and adult NF1 patients while also showing efficacy in non-malignant diverse NF1 manifestations.

Nutritional interventions and BMI dynamics: A comprehensive analysis of growth outcomes in pediatric populations

Introduction: This review article emphasizes the significance of Body Mass Index (BMI) and insulin-like growth factor-1 (IGF1) in evaluating pediatric growth outcomes, particularly for those at risk of undernutrition. The review explores the long-term health consequences of early BMI trajectories, especially their association with cardiometabolic profiles in adulthood. The article also examines the correlation between BMI, insulin-like growth factor 1 (IGF-1), and growth velocity, focusing on their complex interactions in malnourished and obese pediatric populations. Methods: A comprehensive literature search was conducted using PubMed, Google Scholar, and Scopus from 1985 to 2024, focusing on BMI, height growth velocity, IGF1 levels, and the effects of nutritional interventions on pediatric growth outcomes. Studies were included if they focused on children aged 0-18 years and evaluated the impact of BMI and/or nutritional interventions on growth outcomes, with English language articles being prioritized. Review Results: A total of 15 studies involving 4737 participants were analyzed. The review highlights significant findings including the normalization of growth hormone (GH)-IGF axis post nutritional rehabilitation in malnourished children, the rapid response of IGF-1 levels to nutritional interventions, and the influence of protein-rich diets on catch-up growth. Studies also showed that early nutritional support, particularly through human milk, significantly affects IGF-1 levels and that dietary protein intake correlates with IGF-I concentrations and growth in toddlers. Long-term studies indicated that severe malnutrition can have enduring metabolic effects, necessitating sustained nutritional strategies. Discussion: The review highlights the significance of early nutritional support and its impact on IGF-1 levels, which are crucial for healthy growth trajectories. The findings advocate for careful monitoring of early growth rates to optimize long-term health outcomes and stress the importance of adequate protein intake during early childhood. Conclusions: A balanced approach to nutrition, focusing on the interplay between BMI, growth velocities, and IGF1 levels, is crucial in pediatric care. Strategic nutritional interventions, especially those rich in protein, can effectively manage growth outcomes across different BMI categories and improve health trajectories in pediatric populations. This review underscores the need for comprehensive strategies to address nutritional deficiencies and manage growth effectively from infancy through adolescence

Growth in children with nephrotic syndrome: a post hoc analysis of the NEPTUNE study.

Steroids, the mainstay of treatment for nephrotic syndrome in children, have multiple adverse effects including growth suppression. Anthropometric measurements in children < 18years enrolled in the Nephrotic Syndrome Study Network (NEPTUNE) were collected. The longitudinal association of medication exposure and nephrotic syndrome characteristics with height z-score and growth velocity was determined using adjusted Generalized Estimating Equation regression and linear regression. A total of 318 children (57.2% males) with a baseline age of 7.64 ± 5.04years were analyzed. The cumulative steroid dose was 216.4 (IQR 61.5, 652.7) mg/kg (N = 233). Overall, height z-scores were not significantly different at the last follow-up compared to baseline (- 0.13 ± 1.21 vs. - 0.23 ± 1.71, p = 0.21). In models adjusted for age, sex, and eGFR, greater cumulative steroid exposure (β - 7.5 × 10-6, CI - 1.2 × 10-5, - 3 × 10-6, p = 0.001) and incident cases of NS (vs. prevalent) (β - 1.1, CI - 2.22, - 0.11, p = 0.03) were significantly associated with lower height z-scores over time. Rituximab exposure was associated with higher height z-scores (β 0.16, CI 0.04, 0.29, p = 0.01) over time. Steroid dose was associated with lower height z-score, while rituximab use was associated with higher height z-score.

Novel signals and polygenic score for height are associated with pubertal growth traits in Southwestern American Indians.

Most genetic variants associated with adult height have been identified through large genome-wide association studies (GWASs) in European-ancestry cohorts. However, it is unclear how these variants influence linear growth during adolescence. This study uses anthropometric and genotypic data from a longitudinal study conducted in an American Indian community in Arizona between 1965-2007. Growth parameters (i.e. height, velocity, and timing of growth spurt) were derived from the Preece-Baines growth model, a parametric growth curve fitted to longitudinal height data, in 787 participants with height measurements spanning the whole period of growth. Heritability estimates suggested that genetic factors could explain 25% to 71% of the variance of pubertal growth traits. We performed a GWAS of growth parameters, testing their associations with 5 077 595 imputed or directly genotyped variants. Six variants associated with height at peak velocity (P < 5 × 10-8, adjusted for sex, birth year and principal components). Implicated genes include NUDT3, previously associated with adult height, and PACSIN1. Two novel variants associated with duration of growth spurt (P < 5 × 10-8) in LOC105375344, an uncharacterized gene with unknown function. We finally examined the association of growth parameters with a polygenic score for height derived from 9557 single nucleotide polymorphisms (SNPs) identified in the GIANT meta-analysis for which genotypic data were available for the American Indian study population. Height polygenic score was correlated with the magnitude and velocity of height growth that occurred before and at the peak of the adolescent growth spurt, indicating overlapping genetic architecture, with no influence on the timing of adolescent growth.

Magnetic resonance imaging of knees: a novel approach to predict recombinant human growth hormone therapy response in short-stature children in late puberty.

There is no appropriate tool to predict recombinant human growth hormone (rhGH) response before therapy initiation in short-stature children in late puberty. The current study aimed to explore the associations between magnetic resonance imaging (MRI) stages of the knee growth plates and rhGH response in short-stature children in late puberty. In this prospective cohort study, short-stature children in late puberty were treated with rhGH and followed up for 6 months. We proposed a novel knee MRI staging system according to the growth plate states of distal femurs or proximal tibias and divided the participants into three groups: unclosed growth plate group, marginally closed growth plate group, and nearly closed growth plate group. The primary outcomes were height gain and growth velocity (GV), which were assessed three months later. Fifty participants were enrolled, including 23 boys and 27 girls. GV and height gain after 6 months of rhGH therapy decreased successively in the three groups with an increased degree of growth plate fusion, especially when grouped by proximal tibias (GV1-3 mon from 9.38 to 6.08 to 4.56cm/year, GV4-6 mon from 6.75 to 4.92 to 3.25cm/year, and height gain from 4.03 to 2.75 to 1.95cm, all P < 0.001). Moreover, the MRI stages of growth plates independently served as a significant variable for GV and height gain after therapy, especially when grouped by proximal tibias (all P < 0.01). The MRI staging method is expected to be an effective tool for predicting rhGH response before therapy initiation in short-stature children in late puberty.

THU169 Role Of Growth Hormone (GH) Therapy In Short Children With Skeletal Dysplasias And Pathogenic Variants In The COL2A1 Gene

Abstract Disclosure: L.D. Cellin: None. K.G. Guimaraes: None. N.L. Menezes De Andrade: None. G.A. Vasques: None. E.D. Goiano: None. M. Akkari: None. C. Santili: None. A.A. Jorge: None. A.C. Malaquias: None. Introduction: COL2A1 is the primary collagen synthesized by chondrocytes and plays a critical structural role in regulating cell growth, differentiation, and migration. Mutations in the COL2A1 gene may cause heterogeneous phenotypes ranging from skeletal dysplasia to nonsyndromic short stature. Clinical characteristics in COL2A1-related disorders are abnormalities in the ocular, skeletal, oro-facial, and audiological systems. Unfortunately, data were scarce about GH treatment in short children with pathogenic variants in COL2A1.Objective: To evaluate recombinant growth hormone (GH) treatment in short children carrying mutations in the COL2A1 gene. Methods: Retrospectively, we selected 8 prepubertal patients with short stature and pathogenic variants in the COL2A1 gene who were treated with GH (mean dose of 45.8 ± 7.9 µg/kg/d at the start). The primary outcomes were changes in height SDS and growth velocity in the 1st year and at the end of treatment. Results: Five patients were male; 3 were disproportionate, and 5 showed skeletal dysplasia signs. Two had familial short stature. At the start of the treatment, the mean calendar age was 8.1 ± 3.9 yr, and bone age was 6.9 ± 4.2 yr. The mean height SDS was -4.0 ± 0.9 for the CDC reference. In the 1st year of therapy, the growth velocity (GV) increased from baseline values of 5.2 ± 1.9 cm/yr to 7.4 ± 1.4cm/yr, an increment of 2.2 ± 2.2cm (p=0.02). GV SDS increased from -1.2 ± 1.5 to 1.2 ± 1.8 in the whole cohort during the 1st year of treatment (p=0.02). Height SDS showed a modest improvement after one year of therapy (from -4.0 ± 0.9 to -3.5 ± 0.9; p=0.005). To improve adult height, we treated two patients with GnRH analogs associated with GH. After a mean duration of therapy of 5.5 ± 2.5 years, 5 patients ended the treatment with rhGH (one prematurely stopped therapy due to poor growth response). No increment was observed in height SDS at the end of treatment (from -3.8 ± 0.9 to -3.4 ± 1.3; p=0.2). Four patients achieved adult height after 6.4 ± 1.7 years of therapy (height SDS ranging from -3.4 ± 0.4 to -2.9 ± 0.8; p=0.08). The mean gain in adult height SDS was 0.5 ± 0.4 (ranging from zero to 0,97). Conclusions: Our patients with COL2A1-associated disorders showed no response to GH therapy to improve adult height as a group. However, we need more studies to determine which patient will benefit from this treatment once there is considerable phenotype heterogeneity. GnRH analogs may help to improve adult height in association with GH. Also, alternative therapies might be evaluated to treat short children with these disorders. Presentation: Thursday, June 15, 2023

Growth Velocity and Nutritional Status in Children Exposed to Zika Virus during Pregnancy from Amazonas Cohort, Brazil.

The high incidence of Zika virus (ZIKV) infection in the period of 2015-2016 in Brazil may have affected linear height growth velocity (GV) in children exposed in utero to ZIKV. This study describes the growth velocity and nutritional status based on the World Organization (WHO) standards of children exposed to ZIKV during pregnancy and followed up in a tertiary unit, a reference for tropical and infectious diseases in the Amazon. Seventy-one children born between March 2016 and June 2018 were monitored for anthropometric indices: z-score for body mass index (BMI/A); weight (W/A); height (H/A) and head circumference (HC/A); and growth velocity. The mean age at the last assessment was 21.1 months (SD ± 8.93). Four children had congenital microcephaly and severe neurological impairment. The other 67 were non-microcephalic children (60 normocephalic and 7 macrocephalic); of these; 24.2% (16 children) had neurological alterations, and 28.8% (19 children) had altered neuropsychomotor development. Seventeen (24.2%) children had inadequate GV (low growth velocity). The frequencies of low growth among microcephalic and non-microcephalic patients are 25% (1 of 4 children) and 23.9% (16 of 67 children); respectively. Most children had normal BMI/A values during follow-up. Microcephalic patients showed low H/A and HC/A throughout the follow-up, with a significant reduction in the HC/A z-score. Non-microcephalic individuals are within the regular ranges for H/A; HC/A; and W/A, except for the H/A score for boys. This study showed low growth velocity in children with and without microcephaly, highlighting the need for continuous evaluation of all children born to mothers exposed to ZIKV during pregnancy.

Relationships for vitamin D with childhood height growth velocity and low bone mineral density risk.

To investigate how serum 25-hydroxyvitamin D (25[OH]D) affects height growth velocity and the risk of low bone mineral density (BMD) in children. A population-based prospective cohort study. A total of 10 450 participants with complete follow-up records from a cohort were included in the current study. Serum 25(OH)D concentrations were measured at baseline and 2-year follow-up, and the average of 2-time measurements was used for analysis. Low BMD was defined as calcaneus speed of sound Z-score ≤ -1. The associations of vitamin D with height growth velocity and the risks of incident low BMD were evaluated using adjusted β and risk ratio (RR). After multivariable adjustment, an inverse L-shaped association between serum 25(OH)D concentrations and height growth velocity was observed, leveling off up to 40-60 nmol/L. Overall, each 10 nmol/L higher serum 25(OH)D concentration was associated with a 0.15 cm/year higher height growth velocity (P < 0.001) and a 7% decreased risk of low BMD [RR (95%CI): 0.93 (0.87~0.98)]. Compared to those with vitamin D deficiency, participants who had sufficient vitamin D had a 22% lower risk for low BMD [RR(95%CI): 0.78 (0.62~0.98)]. However, no significant associations between vitamin D and the risk of low BMD were found in overweight and obese children. These findings highlight the importance of maintenance of sufficient 25(OH)D concentrations and healthy body weight during childhood in height growth and bone health promotion.

Changes in Predicted Adult Height over Time in Girls with Early Puberty and Related Factors

Background: One of the most important concerns parents have about their daughters’ precocious puberty is the reduction in final height. This study evaluates the changes in predicted adult height (PAH) over time in girls with early puberty. Materials and Methods: Girls with aged 7 to 9.5 years old with the beginning of puberty after seven years were evaluated. Two non-dominant hand x-ray were taken at 6 to 24 months. The predicted adult height (PAH) was estimated using bone age and the Bayley-Pinneau method. Changes in PAH were determined. The relationship between age, height and weight at birth, target height and puberty stages, and bone age and BMI with PAH changes were investigated. Results: Seventy girls with a mean age of 8.23 years (SD: 0.65) and an average time interval of 0.99 years (SD: 0.47) were studied. At the first evaluation, the average bone age was 8.6 years (p value=0.225 SD: 1.25), and the average predicted adult height was 158.95 cm (SD: 5.66). At the second evaluation, the average bone age was 10.06 years (P-value=0.15 SD: 1.36), and the average predicted adult height was 158 cm (SD: 6.75). The mean difference in predicted adult height is -0.94 ± 4.8 cm. The mean final height predicted in the first and second visits showed a significant relationship with PAH changes and in the group that increased PAH by more than 3 cm, the average growth rate was 69.7 cm per year. In other words, the group growth velocity was higher, the higher their PAH. Two factors associated with expected adult height changes were found: height growth velocity and bone age velocity. Conclusion: Girls with early puberty are not altogether at risk of reduced adult height. However, if there is concern about reducing final height, the expected adult height will still need to be re-estimated at the appropriate interval.

Estimation of Pubertal Growth-Spurt Parameters in Children and Adolescents in Colombia: Comparison between Low and Moderate Altitudes.

Context-specific information, including differences in geographical areas, such as distinct altitudes, can be important to explain variations in physical growth. We aimed to compare the estimation of maximum growth velocity and pubertal growth-spurt parameters of children and adolescents living at low and moderate altitudes in Colombia. A cross-sectional study, including a representative cohort of 30.305 (51% boys) children and adolescents aged 1–18 years from Colombia, was performed. The heights were measured with standardized techniques. The Preece–Baines growth model was used to estimate the mathematical and biological parameters of the height-growth velocities and growth spurts for both sexes. The altitudes were categorized as low (18 to 564 m above sea level) or moderate (2420 to 2640 m above sea level). There were no differences in final height (h1), peak height velocity size (hθ), age at peak height velocity (APHV), or peak height velocity PHV (cm/y) between the subjects living in both altitudes (p > 0.05). The APHV was estimated at 12.75 ± 0.75 years in the boys and at 10.05 ± 0.65 years in the girls. The girls reached the APVH 2.70 years earlier than the boys. Regarding the PHV, the boys reached higher growth velocity, which was 6.85 ± 0.55 cm/y. In conclusion, there were no significant differences in final height, peak height, APHV, or PHV between the children and adolescents living at distinct altitudes in Colombia. The PHV occurred approximately 3 years earlier in the girls than in the boys. Furthermore, the girls’ estimated PHV, APHV, and final height were lower than those of the boys. This study allows additional insight into pubertal growth-spurt parameters and also provides a valuable reference database for the assessment of Colombian children and adolescents.

Growth Dynamics following Growth hormone treatment in group of Iraqi patients with Turner’s Syndrome

Background: Short stature is a well-known consequence of Turner’s syndrome (TS) and treatment with growth hormone can be improved the height of those patients, determination of the growth hormone velocity dynamics can help us to predict the optimum period for growth hormone treatment response. Objective: To study growth dynamics, which explained by height standard deviation, growth velocity and growth velocity standard deviation subsequent to growth hormone treatment in patients with Turner’s syndrome. Patient and Methods: During the period from January 2010 to January 2020, medical records of (30) patients with Turner’s syndrome (TS) were registered for this study, treated with growth hormone (GH). Where growth hormone (GH) dose was 0.06 IU/kg/day. Patients' height, mid-parental height (MPH), Bone age, the target height, the height standard deviation value, growth velocity and growth velocity standard deviation value were measured during Periodic follow-up of the patients every (3) months. Growth dynamics that explained by growth velocity, growth velocity Standard deviation and height standard deviation were compared before and after finishing treatment. Results: The average of height at beginning of treatment was 1.04±0.49 and the average of height at end of treatment is 1.3±0.154. While the difference in average is significant p=0.002. The difference between average of height standard deviation value at beginning of treatment and the average of height standard deviation value at end of treatment is also significant p =0.001. The first 2 years had the highest growth velocity and after that the growth velocity almost steady the same. The first year had lowest growth velocity standard deviation and the last year had the highest growth velocity standard deviation. There was no side effects observed was observed during treatment protocol. Conclusion: The growth velocity dynamics peak was more encountered during the first two years of treatment making it the optimum period of interest for compliance with growth hormone treatment.

Kt/V or Bicarbonate: What Is More Important for Growth in Pediatric Peritoneal Dialysis Patients?

Introduction: Growth retardation is a common problem in pediatric patients with chronic kidney disease. It is unknown if the growth of children on peritoneal dialysis (PD) can be augmented by more dialysis. Methods: We studied the effect of various peritoneal adequacy parameters on delta height standard deviation scores (SDSs) and growth velocity z-scores in 53 children (27 males) on PD, who underwent 2 longitudinal adequacy tests at 9-month intervals. None of the patients were on growth hormone. Intraperitoneal pressure and standard KDOQI guidelines were compared to the outcome measures delta height SDS and height velocity z-scores, using univariate and multivariate tests. Results: At the time of the second PD adequacy test, their mean age was 9.2 ± 5.3 years; mean fill volume was 961 ± 254 mL/m²; and median total infused dialysate volume was 5.26 L/m²/day (range 2.03–15.32 L). The median total weekly Kt/V was 3.79 (range 0.9–9.5), and the median total creatinine clearance was 56.6 (range 7.6–133.48) L/week, higher than previous pediatric studies. The delta height SDS was a median of −0.12 (range −2 to +3.95)/year. The mean height velocity z-score was −1.6 ± 4.0. The only relationships discovered were between the delta height SDS and age, bicarbonate, and intraperitoneal pressure, but not for Kt/V or creatinine clearance. Conclusion: Our findings highlight the importance of normalization of bicarbonate concentrations to improve height z-score.

Analysis of the Influence of High-Dose rhGH Therapy on Serum Vitamin D and IGF-1 Levels in School-Age Children with Idiopathic Short Stature.

Objective To discuss the influence of high-dose recombinant human growth hormone (rhGH) therapy on serum vitamin D and insulin-like growth factor-1 (IGF-1) levels in school-age children with idiopathic short stature (ISS). Method A total of 103 school-age children with ISS were selected from June 2016 to June 2020 in our hospital. The enrolled cases were divided into the low-dose group (n = 59) and high-dose group (n = 44) according to the treatment dose of rhGH. After the treatment, the height (Ht), height standard deviation score (Ht SDS), growth velocity (GV), and other indicators were recorded. The serum 25-hydroxy vitamin D [25-(OH)D] and IGF-1 levels of the two groups were tested, and the occurrence of adverse reactions was recorded. Results After treatment, the high-dose group outperformed the low-dose group in various growth effect indicators such as Ht, Ht SDS, and GV (P < 0.05). After treatment, the serum 25-(OH)D of children with ISS in the two groups increased significantly, but there was no significant difference between the two groups (P > 0.05). After treatment, the serum IGF-1 of children with ISS in the two groups increased significantly, but there was no significant difference between the two groups (P > 0.05). For children with ISS, adverse reactions induced by rhGH therapy were very rare. There was no significant difference in the incidence of adverse reactions induced by different doses of rhGH in the treatment of ISS (P > 0.05). Conclusion rhGH has definite efficacy in the treatment of ISS children, for it can significantly increase the annual growth rate of ISS children in a dose-dependent manner. High-dose rhGH for ISS has a better therapeutic effect. At the same time, regardless of the dose level of rhGH, serum 25-(OH)D and IGF-1 levels in children with ISS were increased, with less adverse reactions and higher safety.

Maternal vitamin D intake and BMI during pregnancy in relation to child’s growth and weight status from birth to 8 years: a large national cohort study

ObjectivesTo examine the associations between maternal vitamin D intake and childhood growth and risk of overweight up to 8 years. We further examined the effect modification by maternal prepregnancy body...

7.1 RANDOMIZED CONTROLLED TRIAL OF MULTINUTRIENTS FOR ADHD WITH EMOTIONAL DYSREGULATION

This session aims to examine the efficacy of broad-spectrum multinutrients for ADHD and emotional dysregulation. In the Micronutrients for ADHD in Youth (MADDY) randomized controlled trial, unmedicated children (N = 135) aged 6-12 years with ADHD and emotional dysregulation (based on parent reports) at 3 sites (Oregon, Ohio, Canada) were randomized to a 36-ingredient multinutrient supplement (vitamins + minerals) or placebo (3:2 ratio) for 8 weeks. The primary outcomes were the clinician-rated Clinical Global Impression–Improvement (CGI-I; 1 or 2 = responder), and the parent-rated Child and Adolescent Symptom Inventory-5 (CASI-5) composite score comprised of ADHD, ODD, DMDD, and peer-conflict symptoms, including impairment scores for each. A teacher also completed the CASI-5. With a mean age of 9.8 years, 93% (N = 126) of the 135 randomized children comprised the intention-to-treat population. Participants’ demographic and baseline clinical characteristics were well matched between treatment groups, with no significant differences (all p > 0.05). On the CGI-I, 54% of those assigned micronutrients vs 18% of the placebo group were responders (Cramér’s V = 0.37; p < 0.001). However, parent-rated CASI-5 composite scores did not differ between groups (p = 0.70); both improved from baseline (p < 0.01). Teacher reports showed significant between-group difference favoring micronutrients on the Peer Conflict subscale, which was 0.13 points lower for micronutrients (95% CI, –0.26 to –0.01, p = 0.04; Cohen’s d = 0.16). The micronutrient group grew 6 mm more than the placebo group (p = 0.002; Cohen’s d = 1.15). Blinding was maintained. Micronutrients showed global improvement over placebo by blinded clinician rating and teacher reports of peer conflict, but not by parent report on the CASI-5 in children with ADHD and irritability. The micronutrient group showed greater height growth velocity. Micronutrients were well tolerated, and the majority of children adhered to the treatment. This randomized controlled trial replicates the efficacy reported for ADHD in 2 smaller RCTs of a similar formula, containing all vitamins and known essential minerals in therapeutic amounts between the Recommended Dietary Allowance and Tolerable Upper Intake Level.

Longitudinal assessments of child growth: A six-year follow-up of a cluster-randomized maternal education trial

Background & aimsChild growth impairments are rampant in sub-Saharan Africa. To combat this important health problem, long-term follow-up studies are needed to examine possible benefits and sustainability of various interventions designed to correct inadequate child growth. Our aim was to perform a follow-up study of children aged 60−72 months whose mothers participated in a two-armed cluster-randomized education intervention trial lasting 6 months in rural Uganda when their children were 6−8 months old with data collection at 20−24 and at 36 months. The education focused on nutrition, hygiene, and child stimulation.MethodsWe measured growth using anthropometry converted to z-scores according to WHO guidelines. We also included assessments of body composition using bioimpedance. We used multilevel mixed effect linear regression models with maximum likelihood method, unstructured variance-covariance structure, and the cluster as a random effect component to compare data from the intervention (receiving the education and routine health care) with the control group (receiving only routine health care).ResultsOf the 511 children included in the original trial, data from 166/263 (63%) and 141/248 (57%) of the children in the intervention and control group, respectively, were available for the current follow-up study. We found no significant differences in any anthropometrical z-score between the two study groups at child age of 60−72 months, except that children in the intervention group had lower (P = 0.006) weight-for-height z-score than the controls. There were no significant differences in the trajectories of z-scores or height growth velocity (cm/year) from baseline (start of original trial) to child age of 60−72 months. Neither did we detect any significant difference between the intervention and control group regarding body composition (fat mass, fat free mass, and total body water) at child age 60−72 months. Separate gender analyses had no significant impact on any of the growth or body composition findings.ConclusionIn this long-term study of children participating in a randomized maternal education trial, we found no significant impact of the intervention on anthropometrical z-scores, height growth velocity or body composition.Trial registrationClinical Trials (clinical trials.gov) ClinicalTrials.gov ID NCT 02098031.

Alfacalcidol improves the growth velocity in children with vitamin D deficiency/insufficiency: A single center retrospective cohort study.

ObjectivesTo investigate the growth velocity-improving effects of vitamin D replacement therapy in pediatric patients diagnosed with vitamin D deficiency and insufficiency.Study designA retrospective cohort study was conducted in 34 pediatric patients diagnosed with vitamin D deficiency/insufficiency. Based on the clinical findings, the subjects were divided into two groups: a bowed leg (BL) group and a non-bowed leg (non-BL) group. After the initiation of alfacalcidol, the standard deviation score (SDS) of their heights, weights and growth velocities in each group were monitored.ResultsThe median age at the first visit was significantly lesser in the BL group (1.58 years old [interquartile range (IQR): 1.33, 2.17]) than that in the non-BL group (3.00 years old [IQR: 2.33, 3.67]). On the contrary, the SDS for height was significantly lower in the non-BL group (-2.27 [IQR: -2.63, -1.94]) than that in the BL group (-1.37 [IQR: -1.91, -1.07]). One-year treatment with alfacalcidol showed significant improvements in both height SDSs and growth velocity SDSs not only in the BL group but also in the non-BL group.ConclusionsThe current study revealed that vitamin D replacement therapy improved the growth rate in children with vitamin D deficiency/insufficiency, regardless of the presence of BL. This study emphasizes the importance of assessing the vitamin D status in children with poor growth rates and suggests that alfacalcidol could be a valid option for the treatment of short stature.

Impact of oral nutritional supplements (ONS) on growth outcomes and IGF-1 level in underweight older children and young adolescents (5-14 years) with short stature and no systemic disease: High versus normal calories density formula.

Objectives:This controlled trial investigated the effects of energy-dense pediatric oral nutritional supplements ONS versus standard ONS in pediatric patients requiring oral nutritional support for low body mass index (BMI) or weight gain per day (WGD) below the average for age and sex.Patients and Methods:34 children and adolescents (mean age 10.2 years) with faltering growth requiring ONS were randomized to cONS (n =22) or sONS (n = 12) for a year. We recorded their weight (WT), height (HT) and calculated height growth velocity (GV), Ht-SDS, BMI, WGD, every 3 months for a year.Results:The WGD, height growth velocity (GV: cm/year), and Ht-SDS increased significantly, in both groups, during the year of ONS. The use of the cONS resulted in significantly greater mean total WGD and BMI-SDS after 6 months and 1 year, compared to the sONS group. The increase in IGF1-SDS was significantly higher in the cONS groups versus the sONS group. Moreover, the WGD was correlated significantly with the height GV during the year of ONS intake.Conclusions:ONS improved the growth of underweight old children and adolescents who had no systemic illness. There was a significantly higher WGD and BMI-SDS in the group on cONS compared to those on sONS. In both groups, long-term use of ONS significantly improved Ht-SDS. (www.actabiomedica.it)

Comparison of growth models to describe growth from birth to 6 years in a Beninese cohort of children with repeated measurements

ObjectiveTo select a growth model that best describes individual growth trajectories of children and to present some growth characteristics of this population.SettingsParticipants were selected from a prospective cohort conducted in...