Lower Final Height Research Articles

Final adult height in childhood-onset inflammatory bowel disease.

Long-term growth may be compromised in patients with inflammatory bowel disease (IBD). The aims of the study were to evaluate the final height in a cohort of patients with pediatric-onset IBD with respect to genetic target and to determine factors influencing long-term growth. This is a monocentric retrospective cohort study. All patients with diagnosed prepubertal onset IBD were enrolled. Patients were classified into two groups on the basis of the achievement of target height at time of the last follow-up. Clinical parameters were also recorded. Eighty-tow patients were identified: 42 with Crohn's disease (CD) and 40 with ulcerative colitis (UC). The mean age at diagnosis was 11.0 (SD 4.0) years. Eighty-nine percent of patients achieved final target height. Mean difference between final and target height was -1.2 cm (SD: 5,4). No statistical significance was detected between CD and UC patients final height (P=0.16). Growth failure at the diagnosis and disease severity were the only factors associated with final height achievement failure (P=0.001 and P=0.01 respectively). Most part of CD and UC patients achieve the target final height. Disease severity and low height at diagnosis seem to be the two best predictive factors for low final height.

Longitudinal study of the newborn small for gestational age. Growth recovery and conditioning factors

Background: small-for-gestational-age (SGA) newborns present a higher morbidity and mortality rate when compared to infants born appropriate for gestational age (AGA), as well as insufficient growth, with height far from their target and in some cases a low final height (< -2 SDs). Objective: the aim of this study was to determine when catch-up growth (CUG) in height occurs in these children, and which factors are associated with lack of CUG. Material and methods: this is a retrospective study of SGAs born between 2011 and 2015 in a secondary hospital. Anthropometric measurements were taken consecutively until CUG was reached, and fetal, placental, parental, newborn, and postnatal variables were studied. Results: a total of 358 SGAs were included from a total of 5,585 live newborns. At 6 and 48 months of life, 93.6 % and 96.4 % of SGAs achieved CUG, respectively. By subgroups, symmetric SGAs performed worse than asymmetric SGAs with CUG in 84 % and 92 % at 6 and 48 months of life, respectively. The same occurred in the subgroup of preterm SGAs with respect to term SGAs, with worse CUGs of 88.2 % and 91.2 % at 6 and 48 months of life, respectively. Prematurity, symmetrical SGA, intrauterine growth retardation (IUGR), preeclampsia, previous child SGA, perinatal morbidity, and comorbidity during follow-up were associated with absence of CUG. Conclusions: the majority of SGAs had CUG in the first months of life. The worst outcomes were for preterm and symmetric SGAs.

Final adult height in childhood-onset Inflammatory Bowel Disease.

Long term growth may be compromised in patients with Inflammatory Bowel Disease (IBD). The aims of the study were to evaluate the final height in a cohort of patients with pediatric-onset IBD with respect to genetic target and to determine factors influencing long-term growth. This is a monocentric retrospective cohort study. All patients with diagnosed prepubertal onset IBD were enrolled. Patients were classified into two groups on the basis of the achievement of target height at time of the last follow-up. Clinical parameters were also recorded. 82 patients were identified: 42 with Crohn's Disease (CD) and 40 with Ulcerative Colitis (UC). The mean age at diagnosis was 11.0 (SD 4.0) years. Eighty-nine percent of patients achieved final target height. Mean difference between final and target height was -1.2 cm (SD: 5,4). No statistical significance was detected between CD and UC patients final height (p=0.16). Growth failure at the diagnosis and disease severity were the only factors associated with final height achievement failure (p=0.001 and p=0.01 respectively). Most part of CD and UC patients achieve the target final height. Disease severity and low height at diagnosis seem to be the two best predictive factors for low final height.

Effects of the use of growth hormone in children and adolescents with juvenile idiopathic arthritis: a systematic review

IntroductionChildren with juvenile idiopathic arthritis (JIA) often have impaired growth and short stature. There is evidence that the therapeutic use of growth hormone (GH) is useful and safe in these patients. ObjectiveTo analyze the effects of GH use in patients with JIA. MethodA systematic review of the literature over the last 18 years in Medline and Embase databases. The criteria were analyzed independently by the researchers. We used the following keywords: “growth hormone”, “arthritis, juvenile”, “arthritis, rheumatoid”, “child” and “adolescent”. ResultsAmong the 192 identified articles, 20 corresponded to the inclusion criteria. Seventeen longitudinal studies and 3 case reports were found. Most studies analyzed observed increased growth, muscle mass and bone mass using GH. Adverse effects observed were glucose intolerance, diabetes, bone deformities, osteonecrosis, reactivation of the disease and low final height. ConclusionThe majority of studies reported positive effects after the therapeutic use of GH, but some variability in response to treatment was observed. The combination of growth hormone with other drugs seems to be a good option.

Efeitos do uso do hormônio de crescimento em crianças e adolescentes com artrite idiopática juvenil: revisão sistemática

IntroductionChildren with Juvenile Idiopathic Arthritis (JIA) often have impaired growth and short stature. There is evidence that the therapeutic use of growth hormone (GH) is useful and safe in these patients. ObjectiveTo analyze the effects of GH use in patients with JIA. MethodA systematic review of the literature over the last 18 years in Medline and Embase databases. The criteria were analyzed independently by the researchers. We used the following keywords: “growth hormone”, “arthritis, juvenile”, “arthritis, rheumatoid”, “child” and “adolescent”. ResultsAmong the 192 identified articles, 20 corresponded to the inclusion criteria. Seventeen longitudinal studies and 3 case reports were found. Most studies analyzed observed increased growth, muscle mass and bone mass using GH. Adverse effects observed were glucose intolerance, diabetes, bone deformities, osteonecrosis, reactivation of the disease and low final height. ConclusionThe majority of studies reported positive effects after the therapeutic use of GH, but some variability in response to treatment was observed. The combination of growth hormone with other drugs seems to be a good option.

Final Height and Associated Factors in Perinatally HIV-infected Asian Adolescents.

We analyzed final height of 273 perinatally HIV-infected Asian adolescents older than 18 years at their last clinic visit. By the World Health Organization child growth reference, 30% were stunted, but by the Thai child growth reference, 19% were stunted. Half of those who were stunted at antiretroviral therapy initiation remained stunted over time. Being male and having a low baseline height-for-age Z score of less than -1.0 were associated with low final height Z score.

Urban Rural Comparison of Anthropometry and Menarcheal Status of Adolescent School Going Girls of Jodhpur, Rajasthan, India.

Adolescence is the formative period of life. Poor adolescent health translates into poor maternal health leading to increased maternal morbidity with inter-generational consequences. To compare anthropometric, socio-demographic, menstrual and nutritional status of rural and urban adolescent school going girls of Western Rajasthan, India. A cross-sectional comparative study was conducted in two rural schools and one urban school of Jodhpur region. Anthropometric, socio-economic (family history, menstrual history, maternal education) and dietary habit data of 327 (137 urban and 190 rural) school going adolescent girls aged 11-16 years were collected using structured questionnaires by a school based survey after consent from parents and school officials. Height and weight were taken using the standard procedure. Stunting (height for age) and thinness [Body Mass index (BMI) for age] were calculated as per the National Center for Health and Statistics (NCHS) standards. Statistical analysis was done using student t-test, fisher-exact test and Chi-square test. Mean height was significantly higher in urban girls while mean BMI of adolescents was significantly higher in rural areas as compared to their urban counterparts. Growth spurt was between 12-13 years showing maximum increase in mean height, coinciding with or immediately post-menarche. Menarche was one year earlier in urban girls as compared to rural girls (p<0.001). Thinness was more prevalent among females in urban areas and stunting was more common amongst girls residing in rural areas. Life style habits (poor dietary habits, sedentary life style) of the urban girls may contribute to an early menarche but rural girls despite having a later onset of menarche; have a lower final height which may be attributed to their poor nutritional status. Improving nutrition of rural girls and modifying the life style of urban girls and educating their mothers will reduce the disparity and lead to better health and development of adolescent girls in this region and this could be expected to improve maternal health in future.

Adult Height in Patients with Advanced CKD Requiring Renal Replacement Therapy during Childhood

Growth and final height are of major concern in children with ESRD. This study sought to describe the distribution of adult height of patients who started renal replacement therapy (RRT) during childhood and to identify determinants of final height in a large cohort of RRT children. A total of 1612 patients from 20 European countries who started RRT before 19 years of age and reached final height between 1990 and 2011 were included. Linear regression analyses were performed to calculate adjusted mean final height SD score (SDS) and to investigate its potential determinants. The median final height SDS was -1.65 (median of 168 cm in boys and 155 cm in girls). Fifty-five percent of patients attained an adult height within the normal range. Adjusted for age at start of RRT and primary renal diseases, final height increased significantly over time from -2.06 SDS in children who reached adulthood in 1990-1995 to -1.33 SDS among those reaching adulthood in 2006-2011. Older age at start of RRT, more recent period of start of RRT, cumulative percentage time on a functioning graft, and greater height SDS at initiation of RRT were independently associated with a higher final height SDS. Patients with congenital anomalies of the kidney and urinary tract and metabolic disorders had a lower final height than those with other primary renal diseases. Although final height remains suboptimal in children with ESRD, it has consistently improved over time.

Alström syndrome is associated with short stature and reduced GH reserve

Alström syndrome (ALMS) is a rare autosomal recessive monogenic disease included in an emerging class of genetic disorders called 'ciliopathies' and is likely to impact the central nervous system as well as metabolic and endocrine function. Individuals with ALMS present clinical features resembling a growth hormone deficiency (GHD) condition, but thus far no study has specifically investigated this aspect in a large population. Twenty-three patients with ALMS (age, 1-52years; 11 males, 12 females) were evaluated for anthropometric parameters (growth charts and standard deviation score (SDS) of height, weight, BMI), GH secretion by growth hormone-releasing hormone + arginine test (GHRH-arg), bone age, and hypothalamic-pituitary magnetic resonance imaging (MRI). A group of 17 healthy subjects served as controls in the GH secretion study. Longitudinal retrospective and prospective data were utilized. The length-for-age measurements from birth to 36months showed normal growth with most values falling within -0·67 SDS to +1·28 SDS. A progressive decrease in stature-for-age was observed after 10years of age, with a low final height in almost all ALMS subjects (>16-20years; mean SDS, -2·22±1·16). The subset of 12 patients with ALMS tested for GHRH-arg showed a significantly shorter stature than age-matched controls (154·7±10·6cm vs 162·9±4·8cm, P=0·009) and a mild increase in BMI (Kg/m(2) ) (27·8±4·8 vs 24·1±2·5, P=0·007). Peak GH after GHRH-arg was significantly lower in patients with ALMS in comparison with controls (11·9±6·9μg/l vs 86·1±33·2μg/l, P<0·0001). Severe GHD was evident biochemically in 50% of patients with ALMS. The 10 adult ALMS patients with GHD showed a reduced height in comparison with those without GHD (149·7±6·2cm vs 161·9± 9·2cm, P=0·04). MRIs of the diencephalic and pituitary regions were normal in 11 of 12 patients. Bone age was advanced in 43% of cases. Our study shows that 50% of nonobese ALMS patients have an inadequate GH reserve to GHRH-arg and may be functionally GH deficient. The short stature reported in ALMS may be at least partially influenced by impairment of GH secretion.

Analysis of growth in female patients with pediatric-onset systemic lupus erythematosus

years, p<0.001). 90% of these patients showed period(s) of growth arrest, whereas 10% showed a gradual decline in growth only. The median height of the 36 patients with abnormal growth having reached age 16 years (presumed final height) was significantly lower compared to the height of patients diagnosed after 16 years (154.8 ±8.6 versus 161±6.1cm, p<0.001). Ethnicity, disease activity over time and cumulative medication use are currently being tested for their potential relation to growth impairment. Conclusion Growth was impaired in approximately half of female pSLE patients and may lead to abnormally low final height. Abnormal growth was characterized by periods of normal growth and growth arrest rather than gradual decline in growth, likely related to disease flares and/or treatment.

Programming of hypertension: the nervous kidney

two decades after Barker and coworkers ([2][1]) described an inverse epidemiological relationship between birth weight and risk of adult cardiovascular morbidity, including hypertension, the pathophysiology of prenatally programmed hypertension remains incompletely understood. Experimental models

Final Height of Children after Stem Cell Transplantation

Background: Growth impairment is a common complication after hematopoietic stem cell transplantation (SCT). The aim of this study was to evaluate the final adult height of patients who underwent SCT in childhood and to identify the factors that influence long-term growth in these patients. Methods: A retrospective review of 15 children who underwent SCT before puberty at Chonnam National University Hospital and reached final adult height was undertaken. To assess the severity of height reduction and to monitor the height changes longitudinally, height measurements of each patient both at the time of SCT and the final height were expressed as the height standard deviation score (SDS). Results: Seven children were males and eight were females with a median age of 12.8±2.4 years (range, 6.3∼14.7) at SCT. The median follow-up period was 7.1±2.0 years (range, 4.5∼11.1) and their final height was achieved at 18.1±1.5 years (range, 17.0∼21.8). Final height SDS values were within normal for the healthy population in all except two who had short stature (below 󰠏2.0 SDS). No patient achieved height values greater than +2.0 SDS. The final height SDS value (󰠏0.5±1.2) was not decreased from the height SDS value at SCT (󰠏0.8±0.8). The younger age group at SCT (6.1∼10.0 years, n=5) showed significantly lower final height SDS and greater ΔSDS than the older age group (10.1∼15.0 years, n=10) (󰠏1.5± 0.6 vs. 󰠏0.1±1.1, P .05) and the final height SDS (P<.05). The gender, type of disease, donor type or the presence of chronic graft-versus-host disease did not influence height. Conclusion: Growth impairment may be encountered in children after SCT. A younger age at transplant and irradiation were found to be factors associated with reduced final height. However, most patients (13/15) reached a final adult height within normal limits for the general healthy population. (Korean J Hematol 2007;42:382-391.) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

4 Therapy of growth hormone deficiency

Treatment with human growth hormone in growth hormone deficient patients will improve growth rate significantly, initially demonstrating catch-up growth and later bringing forth a normal growth rate. During childhood, a dose of 0.3-0.6 units/kg body weight per week (or 14 units/m2 body surface area per week) is recommended, but during puberty the dose should be increased by 50-100%. The goal of therapy is the attainment of a normal final height, which in the past has often not been fulfilled. This was partly due to the inadequate supply of growth hormone. Since recombinant human growth hormone is now available in unlimited amounts, all patients can be treated continuously. The shorter the child is at time of presenting for therapy, the lower final height will be. It is mandatory to start therapy as early as possible. Concomitant hormonal deficiencies must be corrected by adequate therapy. Despite the fact that growth hormone is diabetogenic, supplementary therapy will not induce diabetes mellitus. Subtle changes in the immune system can be detected but no clinical correlates, such as increased susceptibility to infection, exist. Induction of leukaemia has been suspected as a possible side-effect of human growth hormone treatment but so far there is insufficient evidence to prove that growth hormone is oncogenic.

Determination of the environmental sensitivity of selection lines of Nicotiana rustica by the selection environment

Selection has been practised for high and low final height in a population of 81 highly inbred lines derived by single seed descent from a random sample of the F2 of the cross of varieties 1 and 5 of Nicotiana rustica in the poorest, best and average of 15 environments. The properties of the resulting selections show that the high selection made in the best environment has a greater environmental sensitivity than that made in the poorest environment while the low selection made in the best environment has a lower environmental sensitivity than that made in the poorest environment. The selections made in the average environment have intermediate environmental sensitivities. These selections confirm the rules laid down by Jinks and Connolly (1975) relating the environmental sensitivities of selections to the selection environment.

Joint selection for both extremes of mean performance and of sensitivity to a macro-environmental variable

Examination of the growth curves of four selections which combine high and low final height with high and low sensitivity to sowing date and planting density have confirmed earlier indications that heritable differences in the pattern of growth are major determinants of environmental sensitivity for final height in Nicotiana rustica. The two high-sensitivity selections on the one hand and the two low-sensitivity selections on the other differed in pattern of growth, as expressed by the ratio of 6-week height either to height at flowering time or to final height. The generality of this finding was confirmed by the correlation between these ratios and environmental sensitivities in 59 inbred lines derived from a single cross. No evidence could be found that the mop head, non-mop head difference in habit of growth has any effect on the environmental sensitivity.